Hospital Variation in the Utilization and Implementation of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest

Rohan Khera, Andrew Humbert, Brian Leroux, Graham Nichol, Peter Kudenchuk, Damon Scales, Andrew Baker, Mike Austin, Craig Newgard, Ryan Radecki, Gary M. Vilke, Kelly N. Sawyer, George Sopko, Ahamed H. Idris, Henry Wang, Paul S. Chan, Michael C. Kurz

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Targeted temperature management (TTM) for out-of-hospital cardiac arrest is associated with improved functional survival and is a class I recommendation in resuscitation guidelines. However, patterns of utilization of TTM and adherence to recommended TTM guidelines in contemporary practice are unknown. Methods and Results In a multicenter, prospective cohort of consecutive adults with non-traumatic out-of-hospital cardiac arrest in the Resuscitation Outcomes Consortium in 2012 to 2015, we identified all adults (≥18 years) who were potential candidates for TTM. Of 37 898 out-of-hospital cardiac arrest patients at 186 hospitals across 10 Resuscitation Outcomes Consortium sites, 8313 survived for ≥4 hours after hospital arrival, of which, 2878 (34.6%) received TTM. Mean age was 61.5 years and 36.3% were women. Median hospital rate of TTM use was 27% (interquartile range [IQR]: 14%, 45%), with an over 2-fold difference across sites after accounting for differences in presentation characteristics (median odds ratio, 2.10 [1.83-2.26]). Notably, TTM utilization decreased during the study period (57.5% [2012] to 26.5% [2015], P<0.001) including among shockable out-of-hospital cardiac arrest (73.4% to 46.3%, P<0.001). When administered, the median rate of deviation from one or more recommended practices was 60% (IQR: 40%, 78%). The median rate for delayed onset of TTM was 13% (IQR: 0%, 25%), varying by 70% for identical patients across 2 randomly chosen hospitals (median odds ratio 1.70 [1.39-1.97]). Similarly, the median rate for TTM <24 hours was 20% (IQR: 0%, 34%) and for achieved temperature <32°C was 18% (IQR: 0%, 39%), with marked variation across sites (median odds ratios of 1.44 [1.18-1.64] and 1.98 [1.62-2.31], respectively). Conclusions There has been a substantial decline in the utilization of TTM with significant variation in its real-world implementation. Further standardization of contemporary post-resuscitation practices, like TTM, is critical to ensure that their potential survival benefit is realized.

Original languageEnglish (US)
Pages (from-to)e004829
JournalCirculation. Cardiovascular quality and outcomes
Volume11
Issue number11
DOIs
StatePublished - Nov 1 2018

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Out-of-Hospital Cardiac Arrest
Temperature
Resuscitation
Odds Ratio
Guidelines
Survival

Keywords

  • hospitals
  • odds ratio
  • out-of-hospital cardiac arrest
  • resuscitation
  • temperature

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Hospital Variation in the Utilization and Implementation of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest. / Khera, Rohan; Humbert, Andrew; Leroux, Brian; Nichol, Graham; Kudenchuk, Peter; Scales, Damon; Baker, Andrew; Austin, Mike; Newgard, Craig; Radecki, Ryan; Vilke, Gary M.; Sawyer, Kelly N.; Sopko, George; Idris, Ahamed H.; Wang, Henry; Chan, Paul S.; Kurz, Michael C.

In: Circulation. Cardiovascular quality and outcomes, Vol. 11, No. 11, 01.11.2018, p. e004829.

Research output: Contribution to journalArticle

Khera, R, Humbert, A, Leroux, B, Nichol, G, Kudenchuk, P, Scales, D, Baker, A, Austin, M, Newgard, C, Radecki, R, Vilke, GM, Sawyer, KN, Sopko, G, Idris, AH, Wang, H, Chan, PS & Kurz, MC 2018, 'Hospital Variation in the Utilization and Implementation of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest', Circulation. Cardiovascular quality and outcomes, vol. 11, no. 11, pp. e004829. https://doi.org/10.1161/CIRCOUTCOMES.118.004829
Khera, Rohan ; Humbert, Andrew ; Leroux, Brian ; Nichol, Graham ; Kudenchuk, Peter ; Scales, Damon ; Baker, Andrew ; Austin, Mike ; Newgard, Craig ; Radecki, Ryan ; Vilke, Gary M. ; Sawyer, Kelly N. ; Sopko, George ; Idris, Ahamed H. ; Wang, Henry ; Chan, Paul S. ; Kurz, Michael C. / Hospital Variation in the Utilization and Implementation of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest. In: Circulation. Cardiovascular quality and outcomes. 2018 ; Vol. 11, No. 11. pp. e004829.
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abstract = "Background Targeted temperature management (TTM) for out-of-hospital cardiac arrest is associated with improved functional survival and is a class I recommendation in resuscitation guidelines. However, patterns of utilization of TTM and adherence to recommended TTM guidelines in contemporary practice are unknown. Methods and Results In a multicenter, prospective cohort of consecutive adults with non-traumatic out-of-hospital cardiac arrest in the Resuscitation Outcomes Consortium in 2012 to 2015, we identified all adults (≥18 years) who were potential candidates for TTM. Of 37 898 out-of-hospital cardiac arrest patients at 186 hospitals across 10 Resuscitation Outcomes Consortium sites, 8313 survived for ≥4 hours after hospital arrival, of which, 2878 (34.6{\%}) received TTM. Mean age was 61.5 years and 36.3{\%} were women. Median hospital rate of TTM use was 27{\%} (interquartile range [IQR]: 14{\%}, 45{\%}), with an over 2-fold difference across sites after accounting for differences in presentation characteristics (median odds ratio, 2.10 [1.83-2.26]). Notably, TTM utilization decreased during the study period (57.5{\%} [2012] to 26.5{\%} [2015], P<0.001) including among shockable out-of-hospital cardiac arrest (73.4{\%} to 46.3{\%}, P<0.001). When administered, the median rate of deviation from one or more recommended practices was 60{\%} (IQR: 40{\%}, 78{\%}). The median rate for delayed onset of TTM was 13{\%} (IQR: 0{\%}, 25{\%}), varying by 70{\%} for identical patients across 2 randomly chosen hospitals (median odds ratio 1.70 [1.39-1.97]). Similarly, the median rate for TTM <24 hours was 20{\%} (IQR: 0{\%}, 34{\%}) and for achieved temperature <32°C was 18{\%} (IQR: 0{\%}, 39{\%}), with marked variation across sites (median odds ratios of 1.44 [1.18-1.64] and 1.98 [1.62-2.31], respectively). Conclusions There has been a substantial decline in the utilization of TTM with significant variation in its real-world implementation. Further standardization of contemporary post-resuscitation practices, like TTM, is critical to ensure that their potential survival benefit is realized.",
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AU - Khera, Rohan

AU - Humbert, Andrew

AU - Leroux, Brian

AU - Nichol, Graham

AU - Kudenchuk, Peter

AU - Scales, Damon

AU - Baker, Andrew

AU - Austin, Mike

AU - Newgard, Craig

AU - Radecki, Ryan

AU - Vilke, Gary M.

AU - Sawyer, Kelly N.

AU - Sopko, George

AU - Idris, Ahamed H.

AU - Wang, Henry

AU - Chan, Paul S.

AU - Kurz, Michael C.

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N2 - Background Targeted temperature management (TTM) for out-of-hospital cardiac arrest is associated with improved functional survival and is a class I recommendation in resuscitation guidelines. However, patterns of utilization of TTM and adherence to recommended TTM guidelines in contemporary practice are unknown. Methods and Results In a multicenter, prospective cohort of consecutive adults with non-traumatic out-of-hospital cardiac arrest in the Resuscitation Outcomes Consortium in 2012 to 2015, we identified all adults (≥18 years) who were potential candidates for TTM. Of 37 898 out-of-hospital cardiac arrest patients at 186 hospitals across 10 Resuscitation Outcomes Consortium sites, 8313 survived for ≥4 hours after hospital arrival, of which, 2878 (34.6%) received TTM. Mean age was 61.5 years and 36.3% were women. Median hospital rate of TTM use was 27% (interquartile range [IQR]: 14%, 45%), with an over 2-fold difference across sites after accounting for differences in presentation characteristics (median odds ratio, 2.10 [1.83-2.26]). Notably, TTM utilization decreased during the study period (57.5% [2012] to 26.5% [2015], P<0.001) including among shockable out-of-hospital cardiac arrest (73.4% to 46.3%, P<0.001). When administered, the median rate of deviation from one or more recommended practices was 60% (IQR: 40%, 78%). The median rate for delayed onset of TTM was 13% (IQR: 0%, 25%), varying by 70% for identical patients across 2 randomly chosen hospitals (median odds ratio 1.70 [1.39-1.97]). Similarly, the median rate for TTM <24 hours was 20% (IQR: 0%, 34%) and for achieved temperature <32°C was 18% (IQR: 0%, 39%), with marked variation across sites (median odds ratios of 1.44 [1.18-1.64] and 1.98 [1.62-2.31], respectively). Conclusions There has been a substantial decline in the utilization of TTM with significant variation in its real-world implementation. Further standardization of contemporary post-resuscitation practices, like TTM, is critical to ensure that their potential survival benefit is realized.

AB - Background Targeted temperature management (TTM) for out-of-hospital cardiac arrest is associated with improved functional survival and is a class I recommendation in resuscitation guidelines. However, patterns of utilization of TTM and adherence to recommended TTM guidelines in contemporary practice are unknown. Methods and Results In a multicenter, prospective cohort of consecutive adults with non-traumatic out-of-hospital cardiac arrest in the Resuscitation Outcomes Consortium in 2012 to 2015, we identified all adults (≥18 years) who were potential candidates for TTM. Of 37 898 out-of-hospital cardiac arrest patients at 186 hospitals across 10 Resuscitation Outcomes Consortium sites, 8313 survived for ≥4 hours after hospital arrival, of which, 2878 (34.6%) received TTM. Mean age was 61.5 years and 36.3% were women. Median hospital rate of TTM use was 27% (interquartile range [IQR]: 14%, 45%), with an over 2-fold difference across sites after accounting for differences in presentation characteristics (median odds ratio, 2.10 [1.83-2.26]). Notably, TTM utilization decreased during the study period (57.5% [2012] to 26.5% [2015], P<0.001) including among shockable out-of-hospital cardiac arrest (73.4% to 46.3%, P<0.001). When administered, the median rate of deviation from one or more recommended practices was 60% (IQR: 40%, 78%). The median rate for delayed onset of TTM was 13% (IQR: 0%, 25%), varying by 70% for identical patients across 2 randomly chosen hospitals (median odds ratio 1.70 [1.39-1.97]). Similarly, the median rate for TTM <24 hours was 20% (IQR: 0%, 34%) and for achieved temperature <32°C was 18% (IQR: 0%, 39%), with marked variation across sites (median odds ratios of 1.44 [1.18-1.64] and 1.98 [1.62-2.31], respectively). Conclusions There has been a substantial decline in the utilization of TTM with significant variation in its real-world implementation. Further standardization of contemporary post-resuscitation practices, like TTM, is critical to ensure that their potential survival benefit is realized.

KW - hospitals

KW - odds ratio

KW - out-of-hospital cardiac arrest

KW - resuscitation

KW - temperature

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