CSU-ALS Certified Centers Are Associated with Improved Failure to Rescue after Cardiac Arrest: A Propensity Score Match Analysis

Objective The impact of Cardiac Surgical Unit - Advanced Life Support (CSU-ALS) training on failure to rescue after cardiac arrest (FTR-CA) is unknown. We hypothesized that institutional CSU-ALS certification would be associated with lower FTR-CA. Methods Patients undergoing Society of Thoracic Surgeons (STS) index operations from 2020-2023 from a regional collaborative were analyzed. Each institution was surveyed regarding its status as a CSU-ALS certified center. Patients stratified by CSU-ALS certification were 1:1 propensity score matched with subsequent multivariable model reviewing associations with failure to rescue after cardiac arrest. Results A total of 12209 patients were included in the study period across 15 institutions. Eight centers reported CSU-ALS certification. After propensity score matching, two patient cohorts were formed (n = 3557). Patients at CSU-ALS centers had higher rates of ICU readmission (3.9% vs 2.3%, p<0.01) and total OR time (340 min vs 323 min, p<0.01). Hospital readmission was less likely in the CSU-ALS centers (9.0% vs 10.1%, p <0.01). There was no difference in the rate of post-operative cardiac arrest (1.8% vs 2.2 %, p = 0.24) or operative mortality (2.5% vs 2.9%, p = 0.30). After risk-adjustment, CSU-ALS centers (OR 0.30 [CI 0.12 – 0.72], p <0.01) and higher-volume centers (OR 0.15 [CI 0.03 – 0.74], p = 0.02) had reduced odds of FTR after cardiac arrest. Conclusions Centers with CSU-ALS certification are associated with a lower risk-adjusted likelihood of FTR after cardiac arrest. This highlights the importance of well-trained staff and treatment algorithms in the care of post-operative cardiac surgery patients.