Effect of Cardiac Arrest Center Protocol Implementation on Survival After Nontraumatic Out‐of‐Hospital Cardiac Arrest

Background Evidence on the effect of treatment at a cardiac arrest center (CAC) on clinical outcomes is incomplete and conflicting. The aim was to evaluate the effect of treatment at a CAC on survival after out‐of‐hospital cardiac arrest. Methods For this retrospective cohort study, data from all 790 consecutive patients admitted to our center from January 2018 to May 2023 after nontraumatic out‐of hospital cardiac arrest were analyzed. All CAC protocols were completely introduced in October 2020. The primary end point was death or unfavorable neurological outcome (cerebral performance category 3–5) at 90 days. Patients were stratified by Cardiac Arrest Survival Score. Results We compared 432 patients (54.7%) managed before to 358 patients (45.3%) after full CAC implementation. Their median age was 68 (interquartile range, 56–78) years before and 67 (interquartile range, 55–78) thereafter. Cardiac Arrest Survival Score was significantly higher before CAC introduction (median, 28.9% [interquartile range, 8.78–59.9]) than after (6.9% [interquartile range, 1.1–23.3]; P<0.01). The incidence of the primary end point did not differ significantly between the 2 periods in multivariable analysis (82.9% versus 84.3%; hazard ratio [HR], 0.95 [95% CI, 0.74–1.23]; P=0.7). However, there was significant statistical interaction between CAC implementation and Cardiac Arrest Survival Score (P<0.048). The risk of death or unfavorable neurological outcome at 90 days was significantly lower after than before CAC implementation (HR, 0.73 [95% CI, 0.54–0.98]; P=0.04) in patients with Cardiac Arrest Survival Score above the overall median of 15.5%. Conclusions Coordinated and specialized treatment in a certified CAC may not impact outcomes in patients with low survival probability after nontraumatic out‐of‐hospital cardiac arrest, but appears to improve survival in patients with intermediate and high survival probability