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

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.