Variation in Survival After Cardiopulmonary Arrest in Cardiac Catheterization Laboratories in the United States

Area of Science:

• Cardiology
• Critical Care Medicine
• Health Services Research

Background:

• In-hospital cardiac arrest during cardiac catheterization is a recognized clinical challenge.
• Significant variation exists in survival rates following cardiac arrest within the cardiac catheterization laboratory (CCL).
• Underlying factors contributing to survival disparities after CCL cardiac arrest are not well understood.

Purpose of the Study:

• To identify factors associated with improved survival rates after an index cardiac arrest in the CCL.
• To quantify hospital-level variation in risk-adjusted survival rates (RASRs) for cardiac arrest in the CCL.

Main Methods:

• Utilized the Get With The Guidelines-Resuscitation registry (2003-2017) for patients aged ≥18 years with in-hospital cardiac arrest in the CCL.
• Employed hierarchical models to adjust for demographics, comorbidities, and arrest characteristics, calculating RASRs to discharge.
• Quantified hospital-level variation using the median odds ratio (OR) for RASR.

Main Results:

• The study analyzed 4,787 patients from 231 hospitals, with a median RASR of 36%.
• Significant variation in RASR was observed, ranging from 20% to 52% across hospitals.
• A median OR of 1.71 indicated a 71% greater odds of survival for similar patients between different hospitals; higher annual case volume correlated with higher RASR.

Conclusions:

• Substantial hospital-level variation in survival after in-hospital cardiac arrest persists, even in controlled settings like the CCL.
• These findings highlight a critical opportunity to enhance resuscitation outcomes in procedural areas.
• Standardizing care and sharing best practices may help reduce survival disparities in CCL cardiac arrest.