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Hohnhaus, Marc (2012): Auswirkung struktureller Unterschiede in den Krankenhäusern auf das Überleben von Patienten mit außerklinischem Herzkreislaufstillstand im Rettungsdienstbereich München zwischen 2007-2009. Dissertation, LMU München: Faculty of Medicine



Aims: Survival to out-of-hospital (OHCA) cardiac arrest is due to many prehospital and inhospital variables. While many studies have identified positive prehospital variables, there is still great variability regarding postresuscitation care in hospitals. We examined basic hospital variables in order to detect differences among hospitals. Methods: Between 2007 and 2009, 30-day survival in 949 admitted ROSC-patients after OHCA was retrospectively identified. 18 hospitals were included in our analysis. We created two groups regarding hospital volume and level of medical structure. Results: A total of 298 (31,4%) out of 949 ROSC-patients survived. Survival of each hospital ranged from 14,3% to 60,5%. Hospital volume in terms of the number of treated ROSC-patients per year, had no positive effect on survival whereas the level of medical structure mattered significantly (p<0,0001). Hospitals specialised in cardiology and cardiothoracic surgery achieved better survival of 49,3%, leaving hospitals of maximum care (31,6%) and hospitals of standard care (18,5%) behind. Furthermore, differences in patient variables such as age and initial rhythm were observed, indicating that young age and ventricular fibrillation may contribute to positive outcome. Conclusions: We observed in our setting that hospital volume has no significant positive effect on survival. On the contrary, small volume hospitals that specially focus on cardiology and cardiothorarcic surgery had significantly better survival rates. Further, we were able to show that postresuscitation care depends on the level of medical structure as well as routine and expertise.