Although the prognosis of patients treated at specialized facilities has improved, the relationship between the number of patients treated at hospitals and prognosis is controversial and lacks constancy in those with out-of-hospital cardiac arrest (OHCA). This study aimed to clarify the effect of annual hospital admissions on the prognosis of adult patients with OHCA by analyzing a large cohort. The effect of annual hospital admissions on patient prognosis was analyzed retrospectively using data from the Japanese Association for Acute Medicine OHCA registry, a nationwide multihospital prospective database. This study analyzed 3632 of 35,754 patients hospitalized for OHCA of cardiac origin at 86 hospitals. The hospitals were divided into tertiles based on the volume of annual admissions. The effect of hospital volume on prognosis was analyzed using logistic regression analysis with multiple imputation. Furthermore, three subgroup analyses were performed for patients with return of spontaneous circulation (ROSC) before arrival at the emergency department, patients admitted to critical care medical centers, and patients admitted to extracorporeal membrane oxygenation-capable hospitals. Favorable neurological outcomes 30 days after OHCA for patients overall showed no advantage for medium- and high-volume centers over low-volume centers; Odds ratio (OR) 0.989, (95% Confidence interval [CI] 0.562-1.741), OR 1.504 (95% CI 0.919-2.463), respectively. However, the frequency of favorable neurological outcomes in OHCA patients with ROSC before arrival at the emergency department at high-volume centers was higher than those at low-volume centers (OR 1.955, 95% CI 1.033-3.851). Hospital volume did not significantly affect the prognosis of adult patients with OHCA. However, transport to a high-volume hospital may improve the neurological prognosis in OHCA patients with ROSC before arrival at the emergency department.

中文翻译：

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院外心脏骤停患者每年住院对心脏骤停后预后的影响

尽管在专门机构接受治疗的患者的预后有所改善，但在院外心脏骤停 (OHCA) 患者中，在医院接受治疗的患者数量与预后之间的关系存在争议且缺乏稳定性。本研究旨在通过分析大型队列来阐明每年入院对成人 OHCA 患者预后的影响。使用来自日本急性医学协会 OHCA 登记处（一个全国性多医院前瞻性数据库）的数据，回顾性分析每年入院对患者预后的影响。本研究分析了 86 家医院 35,754 名因心源性 OHCA 住院的患者中的 3632 名。根据每年的入院量将医院分为三等分。使用多重插补的逻辑回归分析分析医院容量对预后的影响。此外，对到达急诊室前恢复自主循环 (ROSC) 的患者、入住重症监护医疗中心的患者和入住具有体外膜肺氧合能力的医院的患者进行了三个亚组分析。总体而言，OHCA 后 30 天患者的良好神经学结果表明，中等和高容量中心与低容量中心相比没有优势；比值比 (OR) 分别为 0.989、（95% 置信区间 [CI] 0.562-1.741）或 1.504（95% CI 0.919-2.463）。然而，到达急诊室前在高容量中心进行 ROSC 的 OHCA 患者的良好神经学结果频率高于低容量中心 (OR 1.955, 95% CI 1.033-3.851)。住院量对成年 OHCA 患者的预后没有显着影响。然而，在到达急诊室之前，将 ROSC 的 OHCA 患者运送到大容量医院可能会改善其神经学预后。