Between-hospital variability in outcomes after cardiac arrest in a large clinical trial network

Authors

• Jonathan Elmer, Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: elmerjp@upmc.edu.
• Akash Roy, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
• Robert Silbergleit, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.
• Romergryko G. Geocadin, Departments of Neurology, Anesthesiology-Critical Care, Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.
• Karen G. Hirsch, Department of Neurology, Stanford University, Palo Alto, CA, USA.
• Teresa L. May, Department of Critical Care, Maine Medical Center, Portland, ME, USA.

Document Type

Article

Publication Date

4-12-2026

Institution/Department

Critical Care Medicine

Journal Title

Resuscitation

MeSH Headings

Humans; Out-of-Hospital Cardiac Arrest (therapy, mortality); Male; Female; Cardiopulmonary Resuscitation (methods, mortality, statistics & numerical data); Middle Aged; Aged; Hypothermia, Induced (methods); Hospitals (statistics & numerical data)

Abstract

INTRODUCTION: Previous cohorts found significant variability in outcomes of out-of-hospital cardiac arrest (OHCA) between hospitals. We analyzed screening logs of a recent multicenter trial to quantify between-hospital variability in risk-adjusted OHCA survival. METHODS: Among 69 hospitals participating in the Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (ICECAP) trial, we extracted data pertaining to both screen failures and enrollments between April 2020 and March 2024. We included all patients screened for ICECAP after resuscitation from OHCA, regardless of whether they were subsequently enrolled, excluding those who died prior to admission, those aged < 18 years, those awake on presentation, and those with severe preexisting functional impairment or terminal illness. We summarized population characteristics and hospital-level outcomes, then quantified between-hospital variability in survival to discharge overall and after adjustment for patient factors using Bayesian hierarchical regressions. In secondary analyses, we explored relationships between site volume, and temperature management practices and risk-adjusted survival. Overall, 8603 patients were included of whom 2192 (25%) survived to discharge. Median survival to discharge by site was 28% [IQR 24-32%], equating to a median odds ratio (MOR) of 1.80 (95% credible interval [CI] 1.72-1.91) across sites. After adjusting for measured patient characteristics, between-site variability increased slightly (MOR 1.90 [95% CI 1.80-2.03]). There was no relationship between site volume or temperature management practices and risk-adjusted outcomes. CONCLUSION: This prospective, multicenter study suggests that the marked between-hospital variability in OHCA outcomes consistently observed in previous cohorts persists today. Improving outcomes at lower performance hospitals could have a substantial impact on survival and functional recovery after resuscitation from cardiac arrest.

First Page

111090

Recommended Citation

Elmer, Jonathan; Roy, Akash; Silbergleit, Robert; Geocadin, Romergryko G.; Hirsch, Karen G.; and May, Teresa L., "Between-hospital variability in outcomes after cardiac arrest in a large clinical trial network" (2026). MaineHealth Maine Medical Center. 4522.
https://knowledgeconnection.mainehealth.org/mmc/4522