Increasing hospital volume is not associated with improved survival in out of hospital cardiac arrest of cardiac etiology

Michael T. Cudnik, Comilla Sasson, Thomas D. Rea, Michael R. Sayre, Jianying Zhang, Bentley J. Bobrow, Daniel W. Spaite, Bryan McNally, Kurt Denninghoff, Uwe Stolz, Mike Levy, Joseph Barger, James V. Dunford, Karl Sporer, Angelo Salvucci, David Ross, Christopher Colwell, Dorothy Turnbull, Rob Rosenbaum, Kathleen SchrankMark Waterman, Richard Dukes, Melissa Lewis, Raymond Fowler, John Lloyd, Art Yancey, Earl Grubbs, John Lloyd, Johnathan Morris, Stephen Boyle, Troy Johnson, Christopher Wizner, Melissa White, Sabina Braithwaite, Sophia Dyer, Gary Setnik, Bob Hassett, John Santor, Bob Swor, Todd Chassee, Charlie Lick, Mike Parrish, Darel Radde, Brian Mahoney, Darell Todd, Joseph Salomone, Eric Ossman, Brent Myers, Lee Garvey, James Camerson, David Slattery, Joseph Ryan, Jason McMullan, David Keseg, James Leaming, B. K. Sherwood, Jeff Luther, Corey Slovis, Paul Hinchey, Michael Harrington, John Griswell, Jeff Beeson, David Persse, Mark Gamber, Joe Ornato

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


Background: Resuscitation centers may improve patient outcomes by achieving sufficient experience in post-resuscitation care. We analyzed the relationship between survival and hospital volume among patients suffering out-of-hospital cardiac arrest (OHCA). Methods: This prospective cohort investigation collected data from the Cardiac Arrest Registry to Enhance Survival database from 10/1/05 to 12/31/09. Primary outcome was survival to discharge. Hospital characteristics were obtained via 2005 American Hospital Association Survey. A hospital's use of hypothermia was obtained via direct survey. To adjust for hospital- and patient-level variation, multilevel, hierarchical logistic regression was performed. Hospital volume was modeled as a categorical (OHCA/year. ≤. 10, 11-39, ≥40) variable. A stratified analysis evaluating those with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) was also performed. Results: The cohort included 4125 patients transported by EMS to 155 hospitals in 16 states. Overall survival to hospital discharge was 35% among those admitted to the hospital. Individual hospital rates of survival varied widely (0-100%). Unadjusted survival did not differ between the 3 hospital groups (36% for ≤10 OHCA/year, 35% for 11-39, and 36% for ≥40; p=0.75). After multilevel adjustment, differences in survival across the groups were not statistically significant. Compared to patients at hospitals with ≤10 OHCA/year, adjusted OR for survival was 1.04 (CI95 0.83-1.28) among 11-39 annual volume and 0.97 (CI95 0.73-1.30) among the ≥40 volume hospitals. Among patients presenting with VF/VT, no difference in survival was identified between the hospital groups. Conclusion: Survival varied substantially across hospitals. However, hospital OHCA volume was not associated with likelihood of survival. Additional efforts are required to determine what hospital characteristics might account for the variability observed in OHCA hospital outcomes.

Original languageEnglish (US)
Pages (from-to)862-868
Number of pages7
Issue number7
StatePublished - Jul 2012


  • Health outcomes
  • Out of hospital cardiac arrest
  • Resuscitation

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


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