Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.

中文翻译：

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院内心脏骤停护理的中心间差异：一项前瞻性队列研究

院内心脏骤停后的生存率很差，但目前的文献显示报告的生存率存在很大的异质性。本研究旨在通过评估医院间结果的异质性来评估对荷兰院内心脏骤停 (IHCA) 患者的护理，并解释这种异质性源于病例组合的差异或护理质量的差异。进行了一项由 14 个中心组成的前瞻性多中心研究。所有 IHCA 患者均包括在内。护理质量和结果（院内死亡率和脑功能类别[CPC]量表）的结构和过程指标的调整变化通过以中心为随机截距的混合效应回归进行评估。使用中位比值比（MOR）对变异进行量化，代表两个随机挑选的中心之间不良结果的预期比值比。排除少于 10 个纳入的中心（2 个中心）后，共纳入 701 名患者，其中 218 名（32%）存活至出院。未调整和病例组合调整后的死亡率 MOR 分别为 1.19 和 1.05。CPC 分数的未调整和调整 MOR 分别为 1.24 和 1.19。在工作人员每年接受两次心肺复苏 (CPR) 培训的医院中，分别有 183 名 (64.7%) 和 290 名 (71.4%) 患者死亡或处于植物人状态，59 名 (20.8%) 和 68 名 (16.7%) 患者表现出完全恢复状态。恢复（p < 0.001）。在荷兰，IHCA 后的生存率相对较高，并且中心之间的结果差异很小。现有的生存差异主要归因于病例组合的差异。神经系统结果的变化较少归因于病例组合。