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Inter-hospital variations in resuscitation processes and outcomes of out-of-hospital cardiac arrests in Singapore

	author = {Timothy Xin Zhong Tan and Ying Hao and Andrew Fu Wah Ho and Nur Shahidah and Susan Yap and Yih Yng Ng and Nausheen Doctor and Benjamin Sieu-Hon Leong and Han Nee Gan and Desmond Renhao Mao and Michael Yih Chong Chia and Si Oon Cheah and Marcus Eng Hock Ong},
	title = {Inter-hospital variations in resuscitation processes and outcomes of out-of-hospital cardiac arrests in Singapore},
	journal = {Journal of Emergency and Critical Care Medicine},
	volume = {3},
	number = {0},
	year = {2019},
	keywords = {},
	abstract = {Background: Variability in post-resuscitation care of out-of-hospital cardiac arrests (OHCA) contributes to differences in survival outcomes. Interventions of significance include targeted temperature management (TTM) and percutaneous coronary intervention (PCI). In this study, we sought to determine the magnitude and factors involved.
Methods: From April 2010 to December 2014, all consecutive OHCAs presenting to hospitals across Singapore were considered for analysis. Primary outcome was survival to discharge or 30 days. Secondary outcomes included survival to admission, and neurological outcome (Glasgow-Pittsburgh Cognitive Performance Categories ≤2). The effects of hospital-based resuscitative interventions and admitting hospital on outcome were compared using Chi-squared tests and multivariate logistic regression models.
Results: A total of 7,609 OHCA cases were included from six hospitals in Singapore. TTM and PCI usage varied significantly (P<0.001). Hospitals B, C, D had a lower survival to discharge or 30 days post-arrest [adjusted odds ratio (AOR) 0.392, 95% CI: 0.229–0.671, P=0.0006; AOR 0.499, 95% CI: 0.298–0.837, P=0.008; AOR 0.495, 95% CI: 0.304–0.805, P=0.005, respectively]. Hospitals B, D had lower survival to discharge with good neurological function (AOR 0.390, 95% CI: 0.206–0.738, P=0.004; AOR 0.443, 95% CI: 0.249–0.791, P=0.006 respectively). Hospitals B, C, D, E had lower survival to ED admission (AOR 0.582, 95% CI: 0.462–0.733, P<0.0001; AOR 0.600, 95% CI: 0.474–0.759, P<0.001; AOR 0.678, 95% CI: 0.542–0.847, P=0.0007; AOR 0.620, 95% CI: 0.494–0.777, P<0.0001 respectively). Both teaching status and bed number (≥1,000 beds) are associated with improved survival to discharge or 30 days (OR 1.488, P=0.007; OR 1.536, P=0.005).
Conclusions: TTM and PCI usage, and OHCA outcomes vary between hospitals. This is associated with teaching status, bed number, and post-resuscitation care.},
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