Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry

  • Teresa L. MayEmail author
  • Christine W. Lary
  • Richard R. Riker
  • Hans Friberg
  • Nainesh Patel
  • Eldar Søreide
  • John A. McPherson
  • Johan Undén
  • Robert Hand
  • Kjetil Sunde
  • Pascal Stammet
  • Stein Rubertsson
  • Jan Belohlvaek
  • Allison Dupont
  • Karen G. Hirsch
  • Felix Valsson
  • Karl Kern
  • Farid Sadaka
  • Johan Israelsson
  • Josef Dankiewicz
  • Niklas Nielsen
  • David B. Seder
  • Sachin Agarwal



Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers.


Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average.


A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11–63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37–0.58) to 0.20 (0.12–0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 °C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers.


Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.


Cardiac arrest Center variability Out of hospital arrest 



The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), Grant Number KL2TR001063. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interests.

Ethical approval

All participating centers had institutional review board approval at their center.

Supplementary material

134_2019_5580_MOESM1_ESM.docx (147 kb)
Supplementary material 1 (DOCX 146 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Teresa L. May
    • 1
    • 2
    Email author
  • Christine W. Lary
    • 3
  • Richard R. Riker
    • 1
  • Hans Friberg
    • 4
  • Nainesh Patel
    • 5
  • Eldar Søreide
    • 6
    • 7
  • John A. McPherson
    • 8
  • Johan Undén
    • 9
    • 10
  • Robert Hand
    • 11
  • Kjetil Sunde
    • 12
    • 13
  • Pascal Stammet
    • 14
  • Stein Rubertsson
    • 15
  • Jan Belohlvaek
    • 16
  • Allison Dupont
    • 17
  • Karen G. Hirsch
    • 18
  • Felix Valsson
    • 19
  • Karl Kern
    • 20
  • Farid Sadaka
    • 21
  • Johan Israelsson
    • 22
  • Josef Dankiewicz
    • 8
    • 23
  • Niklas Nielsen
    • 24
  • David B. Seder
    • 1
  • Sachin Agarwal
    • 25
  1. 1.Department of Critical Care ServicesMaine Medical CenterPortlandUSA
  2. 2.Clinical and Translational Science InstituteTufts UniversityBostonUSA
  3. 3.Center for Outcomes ResearchMaine Medical CenterPortlandUSA
  4. 4.Department of Anesthesia and Intensive Care, Skåne University HospitalLund UniversityLundSweden
  5. 5.Division of Cardiovascular MedicineLehigh Valley Hospital and Health NetworkAllentownUSA
  6. 6.Critical Care and Anesthesiology Research GroupStavanger University HospitalStavangerNorway
  7. 7.Department Clinical MedicineUniversity of BergenBergenNorway
  8. 8.Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleUSA
  9. 9.Department of Clinical SciencesLund UniversityLundSweden
  10. 10.Department of Intensive and Perioperative CareSkåne University HospitalMalmöSweden
  11. 11.Department of Critical CareEastern Maine Medical CenterBangorUSA
  12. 12.Department of Anaesthesiology, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
  13. 13.Institute of Clinical MedicineUniversity of OsloOsloNorway
  14. 14.Medical Department National Rescue Services, LuxembourgLuxembourgLuxembourg
  15. 15.Department of Surgical Sciences/Anesthesiology and Intensive CareUppsala UniversityUppsalaSweden
  16. 16.Department of Internal Medicine II, Cardiovascular Medicine, General Teaching Hospital and 1st Medical SchoolCharles University in PraguePragueCzech Republic
  17. 17.Department of CardiologyNortheast Georgia Medical CenterGainesvilleUSA
  18. 18.Stanford Neurocritical Care Program, Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordUSA
  19. 19.Department of Anesthesia and Intensive CareLandspitali University HospitalReykyavikIceland
  20. 20.Division of Cardiology, Sarver Heart CenterUniversity of ArizonaTucsonUSA
  21. 21.Mercy Hospital St LouisSt Louis UniversitySt. LouisUSA
  22. 22.Department of Internal Medicine, Division of CardiologyKalmar County HospitalKalmarSweden
  23. 23.Department of Intensive and Perioperative CareSkåne University HospitalLundSweden
  24. 24.Department of Clinical Sciences, Anesthesia and Intensive CareLund University, Helsingborg HospitalHelsingborgSweden
  25. 25.Department of NeurologyColumbia-Presbyterian Medical CenterNew YorkUSA

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