Background: More than 350,000 people in the United States suffer from an out-of-hospital cardiac arrest (OHCA) annually. Targeted temperature management (TTM) and percutaneous coronary angiography (PCI) are class one recommendations in resuscitation guidelines for hospital-level OHCA interventions. We sought to characterize TTM and PCI utilization and association with survival across Chicago hospitals.
Methods: This was a retrospective analysis of OHCA in Chicago from the Cardiac Arrest Registry to Enhance Survival (CARES) database from September 2013 to December 2017. We excluded cases that did not survive hospital admission; involved patients younger than 18 years old; or were missing destination hospital, survival to hospital discharge (SHD), or age. Hierarchical logistic regression models controlled for individual and hospital-level characteristics including age, year, female gender, public location, witnessed arrest, bystander CPR, and shockable rhythm were used to analyze the effects of TTM and PCI on SHD and functional neurological outcome (defined as a cerebral performance category of 1 or 2 [CPC 1-2]). TTM and PCI were measured as individual outcomes to determine their incidence at the hospital level.
Results: Out of 10,153 OHCA, 2,526 cases were included. 953 (37.73%) received only TTM, 206 (8.16%) received only PCI, and 219 (8.67%) received both TTM and PCI. There was great variability from the estimated average percent of TTM (37.9%, range 28.5%-48.3%) and PCI (14.6%, range 11.5%-18.4%) among Chicago hospitals that was not explained by hospital volume nor resuscitation characteristics (95% prediction limit). SHD was more likely if patients received only PCI (OR 4.55; 95%CI 3.10-6.67) or both TTM and PCI (OR 1.75; 95%CI 1.21-2.52), but it was not significantly affected with only TTM (OR 0.90, 95%CI 0.71-1.14) when compared to patients who did not receive TTM or PCI. CPC 1-2 was more likely with only PCI (OR 5.76; 95%CI 3.86-8.60), but it was not significantly affected with both TTM and PCI (OR 1.48; 95%CI 0.98-2.23) and decreased with only TTM (OR 0.49; 95%CI 0.35-0.66).
Conclusion: Interhospital variability in OHCA treatment and survival indicates inconsistencies in the implementation of and adherence to hospital-level interventions in Chicago. PCI confers survival benefits in the treatment of OHCA in Chicago, while the role of TTM remains uncertain.