Abstract
Purpose
This study aimed to determine the effect of case volume on targeted temperature management
(TTM) performance, incidence of adverse events, and neurologic outcome in comatose
out-of-hospital cardiac arrest (OHCA) survivors treated with TTM.
Methods
We used a Web-based, multicenter registry (Korean Hypothermia Network registry), to
which 24 hospitals throughout the Republic of Korea participated to study adult (≥18 years) comatose out-of-hospital cardiac arrest patients treated with TTM between
2007 and 2012. The primary outcome was neurologic outcome at hospital discharge. The
secondary outcomes were inhospital mortality, TTM performance, and adverse events.
We extracted propensity-matched cohorts to control for bias. Multivariate logistic
regression analysis was performed to assess independent risk factors for neurologic
outcome.
Results
A total of 901 patients were included in this study; 544 (60.4%) survived to hospital
discharge, and 248 (27.5%) were discharged with good neurologic outcome. The high-volume
hospitals initiated TTM significantly earlier and had lower rates of hyperglycemia,
bleeding, hypotension, and rebound hyperthermia. However, neurologic outcome and inhospital
mortality were comparable between high-volume (27.7% and 44.6%, respectively) and
low-volume hospitals (21.1% and 40.5%) in the propensity-matched cohorts. The adjusted
odds ratio for the high-volume hospitals compared with low-volume hospitals was 1.506
(95% confidence interval, 0.875-2.592) for poor neurologic outcome.
Conclusions
Higher TTM case volume was significantly associated with early initiation of TTM and
lower incidence of adverse events. However, case volume had no association with neurologic
outcome and inhospital mortality.
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Article Info
Publication History
Published online: October 10, 2014
Accepted:
October 2,
2014
Received in revised form:
October 1,
2014
Received:
July 5,
2014
Footnotes
☆Funding sources/disclosures: The authors have no relevant financial information or potential conflicts of interest to disclose.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
