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

作者：Iana Meitlis, Jane Hall, Navya Gunaje, Megin Parayil, Betty Yang, Kyle Danielson, Catherine R. Counts, Christopher Drucker, Charles Maynard, Thomas D. Rea, Peter J. Kudenchuk, Michael R. Sayre, Nicholas J. Johnson · 发表于：Resuscitation Plus · 年份：2024 · DOI：10.1016/j.resplu.2024.100794 · 被引用次数：4 · 研究领域：Cardiac Arrest and Resuscitation、Healthcare Technology and Patient Monitoring、Sepsis Diagnosis and Treatment

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 util...