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Critical Care

, 18:R84

First Online: 29 April 2014Received: 26 November 2013Accepted: 03 April 2014

Abstract

IntroductionThe study aimed to determine the impact of treatment frequency, hospital size, and capability on mortality of patients admitted after cardiac arrest for postresuscitation care to different intensive care units.

MethodsProspectively recorded data from 242,588 adults consecutively admitted to 87 Austrian intensive care units over a period of 13 years 1998 to 2010 were analyzed retrospectively. Multivariate analysis was used to assess the effect of the frequency of postresuscitation care on mortality, correcting for baseline parameters, severity of illness, hospital size, and capability to perform coronary angiography and intervention.

ResultsIn total, 5,857 patients had had cardiac arrest and were admitted to an intensive care unit. Observed hospital mortality was 56% in the cardiac-arrest cohort 3,302 nonsurvivors. Patients treated in intensive care units with a high frequency of postresuscitation care generally had high severity of illness median Simplified Acute Physiology Score SAPS II, 65. Intensive care units with a higher frequency of care showed improved risk-adjusted mortality. The SAPS II adjusted, observed-to-expected mortality ratios O-E-Ratios in the three strata <18; 18 to 26; >26 resuscitations per ICU per year were 0.869 95% confidence interval, 0.844 to 894, 0.876 0.850 to 0.902, and 0.808 0.784 to 0.833.

ConclusionsIn this database analysis, a high frequency of post-cardiac arrest care at an intensive care unit seemed to be associated with improved outcome of cardiac-arrest patients. We were able to identify patients who seemed to profit more from high frequency of care, namely, those with an intermediate severity of illness. Considering these findings, cardiac-arrest care centers might be a reasonable step to improve outcome in this specific population of cardiac-arrest patients.

AbbreviationsANOVAAnalysis of variance

ASDIAustrian Centre for Documentation and Quality Assurance in Intensive Care Medicine

CIconfidence interval

GCSGlascow coma scale

ICUintensive care unit

IQRinterquartile range

NYHANew York Heart Association functional classification

O-EObserved-to-expected ratio

ORodds ratio

SAPS IISimplified Acute Physiologic Score

TISSTherapeutic Intervention Scoring System.

Electronic supplementary materialThe online version of this article doi:10.1186-cc13847 contains supplementary material, which is available to authorized users.

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Autor: Andreas Schober - Michael Holzer - Helene Hochrieser - Martin Posch - Rene Schmutz - Philipp Metnitz

Fuente: https://link.springer.com/







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