Measure and achievable of quality indicators in an out-of-hospital cardiac arrest real population

Post-resuscitation care after out-of-hospital cardiac arrest (OHCA) is essential to improve mortality rates and reduce side effects associated with it. The lack of structured protocol implementation has led to the formulation of a joint statement with quality indicators (QIs) in OHCA that should be met in order to accomplish quality of care.

This retrospective study has analyzed 212 patients who survived OHCA and were admitted to a Cardiac ICU at a tertiary hospital between 2014 and 2024. Clinical variables, mortality, and neurological prognosis were evaluated. Additionally, the QIs proposed in the ACVC/EUSEM/ERC/ESICM consensus document were assessed based on their measurability and achievability in our population using electronic patient records. A cut-off point of 90% was established for adequate compliance with the indicators

A total of 212 patients were analyzed, where the mean age was 63.9 years (SD ±15.5), 149 were male (70.3%), 61 presented previous CAD (28.8%). The OHCA was witnessed in 189 cases (89.2%) and bystander CPR was performed in 106 (52.7%) of the victims. Mean lactate at arrival was 5.81 (SD ±3.9) and the mean hospital length of stay was 16 days (CI 14.45-19.46). Neurological outcomes with CPC ≥3 were observed in 113 (53.8%) of patients and mortality at 6 months was 40.1% (n=85). Additional clinical and epidemiological characteristics are detailed in Figure 1.

Quality indicators proposed by the ACVC are shown in Figure 2. Indicators were measurable in 93,1%. The most difficult identification domains were BGA (Domain 3) (n= 176 83.4%), EEG (domain 5) (56.1%, n=119), follow-up (87%, n=94) and good neurological outcomes at 6 months (86%, n=98).

In patients where indicators were measurable, our global achievability was 83,9 %. Sorted by domain, we reach achievability over 90% for echocardiography (91.2%, n=187), mechanical ventilation (VMI) 99.5% (n=197), blood gas test at 2h 99.4% (n=175), mechanical circulatory support (MCS) 92.3% (n=60), vasopressors 95.8% (n=137) and functional assessments before discharge 93.4% (n=113). Nevertheless, we did not obtain it in time to angiography (80%), temperature control (89,4%), organ-donation (80,0%) CT scan within first 72 hours (58%), EEG within first 72 hours (68,1%), follow-up (88,3%) and outcomes at 6 months (88,55).

Some limitations in our population are changes in guidelines over the years as well as the subjectivity in the correct application of indicators.