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Variation in Post-Cardiac Arrest Care Within a Regional EMS System.

Nichole Bosson1, Juliana Tolles1, David Shavelle1

  • 1Received June 6, 2021 from Los Angeles County Emergency Medical Service Agency, Santa Fe Springs, CA, USA (NB, MGH); Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, CA, USA (NB, JT, JTN, MGH); David Geffen School of Medicine at UCLA, Los Angeles, CA, USA (NB, JT, JTN, JLT, WJF, MGH); Department of Cardiology, Long Beach Medical Center, Long Beach, CA, USA (DS); Division of Cardiology, UCLA Medical Center, Torrance, CA, USA (JLT; WJF). Revision received July 27, 2021; accepted for publication August 3, 2021.

Prehospital Emergency Care
|August 9, 2021
PubMed
Summary

Significant variations in post-cardiac arrest care, including coronary angiography (CAG) and targeted temperature management (TTM), exist across hospitals. Hospital size influenced CAG likelihood, highlighting the need to address care disparities in emergency medical systems.

Keywords:
emergency medical servicesheart arresthypothermiainducedpercutaneous coronary intervention

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Health Services Research

Background:

  • Standardization of care within Emergency Medical Systems (EMS) is crucial but challenging.
  • Variations in post-cardiac arrest care can impact patient outcomes.
  • Identifying hospital-level factors is key to improving care consistency.

Purpose of the Study:

  • To evaluate variations in post-cardiac arrest care within a large EMS system.
  • To explore the contribution of hospital-level factors to these variations.
  • To analyze the utilization of coronary angiography (CAG) and targeted temperature management (TTM).

Main Methods:

  • Retrospective analysis of out-of-hospital cardiac arrest (OHCA) patients from a regional cardiac system (2016-2018).
  • Inclusion criteria: adult patients with OHCA and return of spontaneous circulation (ROSC), excluding DNR orders and ED deaths.
  • Generalized estimating equations used to assess patient- and hospital-level factors influencing CAG and TTM receipt and neurologic recovery.

Main Results:

  • Significant variation observed in CAG (median 23%, range 12-49%) and TTM (median 58%, range 17-92%) administration post-OHCA.
  • Larger hospital size was associated with increased likelihood of receiving CAG (aOR 1.71, p=0.03).
  • Academic status showed a trend towards association with TTM (aOR 1.69, p=0.06).
  • Overall good neurologic outcome (CPC 1-2) was 28%, with hospital-level variation from 17% to 43%.

Conclusions:

  • Substantial variation in CAG and TTM use exists within this regional cardiac system.
  • Patient-level factors do not fully explain these observed care variations.
  • Hospital size is a significant factor associated with the utilization of coronary angiography after OHCA.