***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the association between favourable neurological outcome and hospital characteristics such as hospital volume and number of critical care centres ( CCMCs ) after  out-of-hospital cardiac arrest ( OHCA ) . METHODS This retrospective , population -based observational study conducted in Osaka Prefecture , Japan included adult patients with OHCA , aged ≥18 years who were transported to acute care hospitals between January 2005 and December 2012 . We divided acute care hospitals into CCMCs or non-CCMCs , the latter of which were divided into the following three groups according to the annual average number of transported OHCA cases : low-volume ( ≤10 cases ) , middle-volume ( 11 - 39 cases ) , and high-volume ( ≥40 cases ) groups . R and om effects logistic regression models , with hospital treated as a r and om effect , were used to assess factors potentially associated with a favourable neurological outcome . RESULTS A total of 44,474 patients were eligible .  The proportions of favourable neurological outcome from OHCA were 0.9 % ( 31/3559 ) in the low-volume group , 1.2 % ( 106/9171 ) in the middle-volume group , 1.6 % ( 222/14,007 ) in the high-volume group , and 4.3 % ( 766/17,737 ) in the CCMC group ( P<0.001 ) . In the multivariable analysis , transport to CCMCs was significantly associated with favourable neurological outcome , compared with transport to non-CCMCs ( adjusted odds ratio 1.63 ; 95 % confidence interval , 1.60 - 1.66 ) . Among the non-CCMC group , there was no significant relationship between hospital volume and favourable neurological outcome . CONCLUSIONS In this population , transport of OHCA patients to CCMCs led to significantly higher one-month survival rates with favourable neurological outcome from OHCA , whereas no significant association was noted among the hospitals with different volumes BACKGROUND Wide variation exists in inter-hospital survival from out-of-hospital cardiac arrest ( OHCA ) . Regionalisation of care into cardiac arrest centres ( CAC ) may improve this . We report a pilot r and omised trial of expedited transfer to a CAC following OHCA without ST-elevation . The objective was to assess the feasibility of performing a large-scale r and omised controlled trial . METHODS Adult witnessed ventricular fibrillation OHCA of presumed cardiac cause were r and omised 1:1 to either : ( 1 ) treatment : comprising expedited transfer to a CAC for goal -directed therapy including access to immediate reperfusion , or ( 2 ) control : comprising current st and ard of care involving delivery to the geographically closest hospital . The feasibility of r and omisation , protocol adherence and data collection of the primary ( 30-day all-cause mortality ) and secondary ( cerebral performance category ( CPC ) ) and in-hospital major cardiovascular and cerebrovascular events ( MACCE ) clinical outcome measures were assessed . RESULTS Between November 2014 and April 2016 , 118 cases were screened , of which 63 patients ( 53 % ) met eligibility criteria and 40 of the 63 patients ( 63 % ) were r and omised . There were no protocol deviations in the treatment arm . Data collection of primary and secondary outcomes was achieved in 83 % . There was no difference in baseline characteristics between the groups : 30-day mortality ( Intervention 9/18 , 50 % vs. Control 6/15 , 40 % ; P=0.73 ) , CPC 1/2 ( Intervention : 9/18 , 50 % vs. Control 7/14 , 50 % ; P>0.99 ) or MACCE ( Intervention : 9/18 , 50 % vs. Control 6/15 , 40 % ; P=0.73 ) . CONCLUSIONS These findings support the feasibility and acceptability of conducting a large-scale r and omised controlled trial of expedited transfer to CAC following OHCA to address a remaining uncertainty in post-arrest care AIM Survival after out-of-hospital cardiac arrest ( OOHCA ) varies between regions , but the contribution of different factors to this variability is unknown . This study examined whether survival to hospital discharge was related to receiving hospital characteristics , including bed number , capability of performing cardiac catheterization and hospital volume of OOHCA cases . MATERIAL AND METHODS Prospect i ve observational data base of non-traumatic OOHCA assessed by emergency medical services was created in 8 US and 2 Canadian sites from December 1 , 2005 to July 1 , 2007 . Subjects received hospital care after OOHCA , defined as either ( 1 ) arriving at hospital with pulses , or ( 2 ) arriving at hospital without pulses , but discharged or died > or = 1 day later . RESULTS A total of 4087 OOHCA subjects were treated at 254 hospitals , and 32 % survived to hospital discharge . A majority of subjects ( 68 % ) were treated at 116 ( 46 % ) hospitals capable of cardiac catheterization . Unadjusted survival to discharge was greater in hospitals performing cardiac catheterization ( 34 % vs. 27 % , p=0.001 ) , and in hospitals that received > or = 40 patients /year compared to those that received < 40 ( 37 % vs. 30 % , p=0.01 ) . Survival was not associated with hospital bed number , teaching status or trauma center design ation . Length of stay ( LOS ) for surviving subjects was shorter at hospitals performing cardiac catheterization ( p<0.01 ) . After adjusting for all variables , there were no independent associations between survival or LOS and hospital characteristics . CONCLUSIONS Some subsets of hospitals displayed higher survival and shorter LOS for OOHCA subjects but there was no independent association between hospital characteristics and outcome INTRODUCTION The aim of the EuReCa ONE study was to determine the incidence , process , and outcome for out of hospital cardiac arrest ( OHCA ) throughout Europe . METHODS This was an international , prospect i ve , multi-centre one-month study . Patients who suffered an OHCA during October 2014 who were attended and /or treated by an Emergency Medical Service ( EMS ) were eligible for inclusion in the study . Data were extracted from national , regional or local registries . RESULTS Data on 10,682 confirmed OHCAs from 248 regions in 27 countries , covering an estimated population of 174 million . In 7146 ( 66 % ) cases , CPR was started by a byst and er or by the EMS . The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year . 1735 had ROSC on arrival at hospital ( 25.2 % ) , Overall , 662/6414 ( 10.3 % ) in all cases with CPR attempted survived for at least 30 days or to hospital discharge . CONCLUSION The results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe . EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe . Using these data and analyses , different countries , regions , systems , and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events PURPOSE As post-cardiac arrest care may influence patients ' outcome , characteristics of receiving hospitals should be integrated in the evaluation of survival . We aim ed at assessing the influence of care level center on patients ' survival at hospital discharge using a regional registry of out-of-hospital cardiac arrest patients ( OHCA ) . METHODS We retrospectively analysed a Utstein and in-hospital data prospect ively collected for all non-traumatic OHCA patients , in whom a successful return of spontaneous circulation ( ROSC ) had been obtained , from a large metropolitan area ( Great Paris ) . Receiving hospitals were categorized in 3 groups as follows : A centers ( High-case volume with cath-lab 24/7 ) , B centers ( Intermediate-case volume with cath-lab partly available ) and C centers ( Low-case volume and no cath-lab ) We compared patients ' characteristics and outcome in the 3 groups and performed a multivariate logistic regression using survival to discharge as primary endpoint . RESULTS Between May 2011 and December 2013 , 1476 patients were admitted in 48 hospitals ( group A : n=917 ; group B : n=428 ; group C : n=91 ) .  Overall survival rate at discharge was 433/1436 ( 30 % ) . Patients ' baseline characteristics significantly differed , as hospitals from group A received younger patients with a higher rate of shockable cardiac rhythms ( p<0.001 ) . Unadjusted survival rate differed significantly among the 3 groups of hospitals ( respectively 34 % , 25 % and 15.4 % for A-C , p<0.01 ) . In multivariate analysis , the category of receiving hospital was no longer associated with survival , even in the subgroup of witnessed arrest and shockable patients . CONCLUSION In this population -based study , characteristics of receiving hospitals are not associated with survival rate at discharge . This might be partially explained by the prehospital triage organization used in France Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies CONTEXT The health and policy implication s of regional variation in incidence and outcome of out-of-hospital cardiac arrest remain to be determined . OBJECTIVE To evaluate whether cardiac arrest incidence and outcome differ across geographic regions . DESIGN , SETTING , AND PATIENTS Prospect i ve observational study ( the Resuscitation Outcomes Consortium ) of all out-of-hospital cardiac arrests in 10 North American sites ( 8 US and 2 Canadian ) from May 1 , 2006 , to April 30 , 2007 , followed up to hospital discharge , and including data available as of June 28 , 2008 . Cases ( aged 0 - 108 years ) were assessed by organized emergency medical services ( EMS ) personnel , did not have traumatic injury , and received attempts at external defibrillation or chest compressions or resuscitation was not attempted . Census data were used to determine rates adjusted for age and sex . MAIN OUTCOME MEASURES Incidence rate , mortality rate , case-fatality rate , and survival to discharge for patients assessed or treated by EMS personnel or with an initial rhythm of ventricular fibrillation . RESULTS Among the 10 sites , the total catchment population was 21.4 million , and there were 20,520 cardiac arrests . A total of 11,898 ( 58.0 % ) had resuscitation attempted ; 2729 ( 22.9 % of treated ) had initial rhythm of ventricular fibrillation or ventricular tachycardia or rhythms that were shockable by an automated external defibrillator ; and 954 ( 4.6 % of total ) were discharged alive . The median incidence of EMS-treated cardiac arrest across sites was 52.1 ( interquartile range [ IQR ] , 48.0 - 70.1 ) per 100,000 population ; survival ranged from 3.0 % to 16.3 % , with a median of 8.4 % ( IQR , 5.4%-10.4 % ) . Median ventricular fibrillation incidence was 12.6 ( IQR , 10.6 - 5.2 ) per 100,000 population ; survival ranged from 7.7 % to 39.9 % , with a median of 22.0 % ( IQR , 15.0%-24.4 % ) , with significant differences across sites for incidence and survival ( P<.001 ) . CONCLUSION In this study involving 10 geographic regions in North America , there were significant and important regional differences in out-of-hospital cardiac arrest incidence and outcome Objective : To investigate the relationship between trauma center volume and outcome . Background : The Resuscitation Outcomes Consortium is a network of 11 centers and 60 hospitals conducting emergency care research . For many procedures , high-volume centers demonstrate superior outcomes versus low-volume centers . This remains controversial for trauma center outcomes . Methods : This study was a secondary analysis of prospect ively collected data from the Resuscitation Outcomes Consortium multicenter out-of-hospital Hypertonic Saline Trial in patients with Glasgow Coma Scale score of 8 or less ( traumatic brain injury ) or systolic blood pressure of 90 or less and pulse of 110 or more ( shock ) . Regression analyses evaluated associations between trauma volume and the following outcomes : 24-hour mortality , 28-day mortality , ventilator-free days , Multiple Organ Dysfunction Scale incidence , worst Multiple Organ Dysfunction Scale score , and poor 6-month Glasgow Outcome Scale 
    Output:
    
Very low certainty of evidence suggests that post-cardiac arrest care at CACs is associated with improved outcomes at hospital discharge .