Regional variation in temperature control after out-of-hospital cardiac arrest

被引：0

作者：

Meitlis, Iana ^{[1
]}

Hall, Jane ^{[2
]}

Gunaje, Navya ^{[2
]}

Parayil, Megin ^{[3
]}

Yang, Betty Y. ^{[4
]}

Danielson, Kyle ^{[5
]}

Counts, Catherine R. ^{[2
,6
]}

Drucker, Christopher ^{[3
]}

Maynard, Charles ^{[5
]}

Rea, Thomas D. ^{[3
,7
]}

Kudenchuk, Peter J. ^{[3
,8
]}

Sayre, Michael R. ^{[2
,6
]}

Johnson, Nicholas J. ^{[2
,7
]}

机构：

[1] Univ Washington, Sch Med, Seattle, WA USA

[2] Univ Washington, Dept Emergency Med, Seattle, WA USA

[3] Publ Hlth Seattle & King Cty, Div Emergency Med Serv, Seattle, WA USA

[4] Univ Texas Southwestern Med Ctr, Dept Emergency Med, Dallas, TX USA

[5] Univ Washington, Dept Hlth Syst & Populat Hlth, Seattle, WA USA

[6] Seattle Fire Dept, Seattle, WA USA

[7] Univ Washington, Dept Med, Seattle, WA USA

[8] Univ Washington, Dept Med, Div Cardiol, Seattle, WA USA

来源：

RESUSCITATION PLUS | 2024年 / 20卷

基金：

美国国家卫生研究院;

关键词：

OHCA; Cardiac arrest; Temperature management; Targeted temperature management; TTM; Temperature control; Induced hypothermia; Cardiopulmonary resuscitation; Post-arrest care; Out-of-hospital cardiac arrest; CEREBRAL PERFORMANCE CATEGORY; NON-SHOCKABLE RHYTHM; LONG-TERM SURVIVAL; MANAGEMENT; OUTCOMES; DISCHARGE; PROGNOSIS;

D O I：

10.1016/j.resplu.2024.100794

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Introduction: We evaluated hospitals for variation in temperature control (TC) use after out-of-hospital cardiac arrest (OHCA) in a regional emergency medical services system and assessed association of hospital-level TC utilization with survival. Methods: A retrospective cohort study of adults with non-traumatic OHCA who survived to hospital admission from 2016 to 2018 in King County, Washington. Hospitals with < 80 OHCA cases were excluded. Primary exposure was hospital-level proportion of TC. Measured outcomes were survival to hospital discharge and neurologically favorable survival (defined as Cerebral Performance Category 1 or 2). Logistic regression modeling clustered patients by treating hospital and evaluated associations between TC and outcomes with covariate adjustment. Results: Of 1,035 eligible patients admitted to eight hospitals, 69% were male, 38% had an initial shockable rhythm, and 61% had presumed cardiac etiology for OHCA. TC was initiated in 787 patients (74%) and ranged from 57 to 87% across hospitals. Overall, 34% of patients survived neurologically intact, 74% of whom received TC. In the adjusted model, public OHCA location (OR: 1.7 [95% CI 1.3-2.3]), witnessed arrest (OR: 1.6 [1.2-2.2]), and shockable rhythm (OR: 5.5 [3.9-7.8]) were more strongly associated with survival than TC utilization (OR: 0.6 [0.4-0.8]). Similar results were seen for neurologically favorable survival and did not vary significantly by hospital. Conclusions: Hospital-level TC utilization was not associated with improved survival or neurologically favorable survival after OHCA. Future studies should examine which aspects of the post-cardiac arrest care bundle most strongly influence outcomes.

引用

页数：7