A Pilot Study Examining the Severity and Outcome of the Post–Cardiac Arrest Syndrome A Comparative Analysis of Two Geographically Distinct Hospitals

Cardiac arrest occurs in >400 000 patients in the United States per year,1 a figure that will likely increase with the aging population. Overall morbidity and mortality remain high, but outcomes from cardiac arrest vary markedly across the country. Factors including geography,2,3 hospital size, intensive care unit volume,4,5 and day of the week or time of day6 potentially influence outcomes from after cardiac arrest. The wide outcome variability has been labeled an “unacceptable disparity”7 and has led to calls for reform. In a recent position statement by the American Heart Association, authors hypothesized that postarrest outcome is driven mainly by hospital-based care quality, so much so that individual patient characteristics become irrelevant: “Large interhospital variations exist in survival to hospital discharge after admission after successful resuscitation from out-of-hospital cardiac arrest. Such differences do not appear to be explained by differences in patient characteristics, which implies that variation in hospital-based care contributes to differences in outcomes across regions.”8 If this hypothesis is true, then hospitals could be graded on the quality care provided to patients after out-of-hospital cardiac arrest (OHCA) by using unadjusted in-hospital mortality rates. Evaluating and testing this hypothesis is highly important particularly given the recent movement toward grading healthcare quality based on unadjusted mortality (or perhaps adjusted without literature-based validation of technique). In addition, recent calls for OHCA to be considered a reportable event further accentuates the need to evaluate this hypothesis, because future quality comparisons nationwide could potentially shift from process measures to outcome measures. To test the hypothesis that outcome variation results from hospital-based care with little contribution from patient characteristics (ie, prearrest and intra-arrest conditions), we set up a pilot comparison between 2 geographically distinct cities in the United States. Through the stepwise analysis of variables that can only be determined by pre- and intra-arrest conditions, we are able to adequately test the hypothesis that patient outcome for OHCA depends mostly (or only) on postarrest care provided in the in-hospital setting.