Intensive Care Medicine

, Volume 35, Issue 3, pp 505–511 | Cite as

A national analysis of the relationship between hospital factors and post-cardiac arrest mortality

  • Brendan G. Carr
  • Munish Goyal
  • Roger A. Band
  • David F. Gaieski
  • Benjamin S. Abella
  • Raina M. Merchant
  • Charles C. Branas
  • Lance B. Becker
  • Robert W. Neumar



We sought to generate national estimates for post-cardiac arrest mortality, to assess trends, and to identify hospital factors associated with survival.


We used a national sample of US hospitals to identify patients resuscitated after cardiac arrest from 2000 to 2004 to describe the association between hospital factors (teaching status, location, size) and mortality, length of stay, and hospital charges. Analyses were performed using logistic regression.


A total of 109,739 patients were identified. In-hospital mortality was 70.6%. A 2% decrease in unadjusted mortality from 71.6% in 2000 to 69.6% in 2004 (OR 0.96, P < 0.001) was observed. Mortality was lower at teaching hospitals (OR 0.58, P = 0.001), urban hospitals (OR 0.63, P = 0.004), and large hospitals (OR 0.55, P < 0.001).


Mortality after in-hospital cardiac arrest decreased over 5 years. Mortality was lower at urban, teaching, and large hospitals. There are implications for dissemination of best practices or regionalization of post-cardiac arrest care.


  1. 1.
    Eisenberg MS, Mengert TJ (2001) Cardiac resuscitation. N Engl J Med 344:1304–1313PubMedCrossRefGoogle Scholar
  2. 2.
    Nichol G, Stiell IG, Hebert P, Wells GA, Vandemheen K, Laupacis A (1999) What is the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med 6:95–102PubMedCrossRefGoogle Scholar
  3. 3.
    Herlitz J, Bang A, Gunnarsson J, Engdahl J, Karlson BW, Lindqvist J, Waagstein L (2003) Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest: change in outcome over 20 years in the community of Goteborg, Sweden. Heart 89:25–30PubMedCrossRefGoogle Scholar
  4. 4.
    Niskanen M, Reinikainen M, Kurola J (2007) Outcome from intensive care after cardiac arrest: comparison between two patient samples treated in 1986–1987 and 1999–2001 in Finnish ICUs. Acta Anaesthesiol Scand 51:151–157PubMedCrossRefGoogle Scholar
  5. 5.
    Langhelle A, Tyvold SS, Lexow K, Hapnes SA, Sunde K, Steen PA (2003) In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway. Resuscitation 56:247–263PubMedCrossRefGoogle Scholar
  6. 6.
    Vukmir RB (2006) Survival from prehospital cardiac arrest is critically dependent upon response time. Resuscitation 69:229–234PubMedCrossRefGoogle Scholar
  7. 7.
    Iwami T, Hiraide A, Nakanishi N, Hayashi Y, Nishiuchi T, Uejima T, Morita H, Shigemoto T, Ikeuchi H, Matsusaka M, Shinya H, Yukioka H, Sugimoto H (2006) Outcome and characteristics of out-of-hospital cardiac arrest according to location of arrest: a report from a large-scale, population-based study in Osaka, Japan. Resuscitation 69:221–228PubMedCrossRefGoogle Scholar
  8. 8.
    Eisenburger P, Sterz F, Haugk M, Scheinecker W, Holzer M, Koreny M, Kaff A, Laggner A, Herkner H (2006) Cardiac arrest in public locations—an independent predictor for better outcome? Resuscitation 70:395–403PubMedCrossRefGoogle Scholar
  9. 9.
    Eisenberg MS, Copass MK, Hallstrom AP, Blake B, Bergner L, Short FA, Cobb LA (1980) Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med 302:1379–1383PubMedGoogle Scholar
  10. 10.
    Grubb NR, Elton RA, Fox KA (1995) In-hospital mortality after out-of-hospital cardiac arrest. Lancet 346:417–421PubMedCrossRefGoogle Scholar
  11. 11.
    Sandroni C, Nolan J, Cavallaro F, Antonelli M (2007) In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 33:237–245PubMedCrossRefGoogle Scholar
  12. 12.
    Cummins RO, Ornato JP, Thies WH, Pepe PE (1991) Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 83:1832–1847PubMedGoogle Scholar
  13. 13.
    Peberdy MA, Ornato JP (2005) Post-resuscitation care: is it the missing link in the chain of survival? Resuscitation 64:135–137PubMedCrossRefGoogle Scholar
  14. 14.
    Engdahl J, Abrahamsson P, Bang A, Lindqvist J, Karlsson T, Herlitz J (2000) Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same emergency medical service and admitted to one of two hospitals over a 16-year period in the municipality of Goteborg. Resuscitation 43:201–211PubMedCrossRefGoogle Scholar
  15. 15.
    Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563PubMedCrossRefGoogle Scholar
  16. 16.
    Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556CrossRefGoogle Scholar
  17. 17.
    Polderman KH (2004) Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: indications and evidence. Intensive Care Med 30:556–575PubMedCrossRefGoogle Scholar
  18. 18.
    Polderman KH (2004) Application of therapeutic hypothermia in the intensive care unit. Opportunities and pitfalls of a promising treatment modality—Part 2: practical aspects and side effects. Intensive Care Med 30:757–769PubMedCrossRefGoogle Scholar
  19. 19.
    Sunde K, Pytte M, Jacobsen D, Mangschau A, Jensen LP, Smedsrud C, Draegni T, Steen PA (2007) Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 73:29–39PubMedCrossRefGoogle Scholar
  20. 20.
    Oddo M, Schaller MD, Feihl F, Ribordy V, Liaudet L (2006) From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med 34:1865–1873PubMedGoogle Scholar
  21. 21.
    AHA (1988) Coding Clinic for ICD-9-CM. In: Book coding clinic for ICD-9-CM. American Hospital Association, Chicago, IL, p 8Google Scholar
  22. 22.
    Nolan JP, Morley PT, Hoek TL, Hickey RW (2003) Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation. Resuscitation 57:231–235PubMedCrossRefGoogle Scholar
  23. 23.
    McCaig LF, Nawar EW (2006) National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. Adv Data 372:1–29PubMedGoogle Scholar
  24. 24.
    Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME, Nichol G, Lane-Truitt T, Potts J, Ornato JP, Berg RA (2006) First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. Jama 295:50–57PubMedCrossRefGoogle Scholar
  25. 25.
    Nolan JP, Laver SR, Welch CA, Harrison DA, Gupta V, Rowan K (2007) Outcome following admission to UK intensive care units after cardiac arrest: a secondary analysis of the ICNARC case mix programme database. Anaesthesia 62:1207–1216PubMedCrossRefGoogle Scholar
  26. 26.
    Keenan SP, Dodek P, Martin C, Priestap F, Norena M, Wong H (2007) Variation in length of intensive care unit stay after cardiac arrest: where you are is as important as who you are. Crit Care Med 35:836–841PubMedCrossRefGoogle Scholar
  27. 27.
    Werling M, Thoren AB, Axelsson C, Herlitz J (2007) Treatment and outcome in post-resuscitation care after out-of-hospital cardiac arrest when a modern therapeutic approach was introduced. Resuscitation 73:40–45PubMedCrossRefGoogle Scholar
  28. 28.
    Merchant RM, Soar J, Skrifvars MB, Silfvast T, Edelson DP, Ahmad F, Huang KN, Khan M, Vanden Hoek TL, Becker LB, Abella BS (2006) Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med 34:1935–1940PubMedCrossRefGoogle Scholar
  29. 29.
    Safar P (1985) Effects of the postresuscitation syndrome on cerebral recovery from cardiac arrest. Crit Care Med 13:932–935PubMedGoogle Scholar
  30. 30.
    Langhelle A, Nolan J, Herlitz J, Castren M, Wenzel V, Soreide E, Engdahl J, Steen PA (2005) Recommended guidelines for reviewing, reporting, and conducting research on post-resuscitation care: the Utstein style. Resuscitation 66:271–283PubMedCrossRefGoogle Scholar
  31. 31.
    American Heart Association (2005) Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care; postresuscitation support. Circulation 112(Suppl 1):IV84–IV88Google Scholar
  32. 32.
    Negovsky VA (1988) Postresuscitation disease. Crit Care Med 16:942–946PubMedCrossRefGoogle Scholar
  33. 33.
    Adrie C, Laurent I, Monchi M, Cariou A, Dhainaut JF, Spaulding C (2004) Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care 10:208–212PubMedCrossRefGoogle Scholar
  34. 34.
    Herlitz J, Castren M, Friberg H, Nolan J, Skrifvars M, Sunde K, Steen PA (2006) Post resuscitation care: what are the therapeutic alternatives and what do we know? Resuscitation 69:15–22PubMedCrossRefGoogle Scholar
  35. 35.
    Kern KB (2002) Postresuscitation myocardial dysfunction. Cardiol Clin 20:89–101PubMedCrossRefGoogle Scholar
  36. 36.
    Wright WL, Geocadin RG (2006) Postresuscitative intensive care: neuroprotective strategies after cardiac arrest. Semin Neurol 26:396–402PubMedCrossRefGoogle Scholar
  37. 37.
    Lurie KG, Idris A, Holcomb JB (2005) Level 1 cardiac arrest centers: learning from the trauma surgeons. Acad Emerg Med 12:79–80PubMedCrossRefGoogle Scholar
  38. 38.
    Gatrell CB (2005) Level 1 cardiac arrest centers: a lesson it is not time to learn. Acad Emerg Med 12:1014PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Brendan G. Carr
    • 1
    • 2
    • 4
    • 5
  • Munish Goyal
    • 2
    • 3
  • Roger A. Band
    • 2
  • David F. Gaieski
    • 2
    • 3
  • Benjamin S. Abella
    • 2
    • 3
  • Raina M. Merchant
    • 1
    • 2
    • 3
    • 4
  • Charles C. Branas
    • 5
  • Lance B. Becker
    • 2
    • 3
  • Robert W. Neumar
    • 2
    • 3
  1. 1.The Robert Wood Johnson Clinical Scholars ProgramUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  2. 2.Department of Emergency MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.Center for Resuscitation ScienceUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  4. 4.The Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Center for Clinical Epidemiology and BiostatisticsUniversity of Pennsylvania School of MedicinePhiladelphiaUSA

Personalised recommendations