Bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest in the Hispanic vs the non-Hispanic populations

Study Objective

The aim of this study is to compare rates of bystander cardiopulmonary resuscitation (CPR) for Hispanic and non-Hispanic out-of-hospital cardiac arrest (OOHCA) victims in Arizona.

Methods

This is a secondary analysis of consecutive OOHCA victims prospectively enrolled into our statewide OOHCA quality improvement database between November 2004 and November 2006. Continuous data are presented as means ± SDs and analyzed using t tests; categorical data are presented as frequency of occurrence and analyzed using χ². The primary outcome was whether bystander CPR rates were different for Hispanic vs non-Hispanic OOHCA victims. Secondary comparisons were initial cardiac rhythms and survival to hospital discharge.

Results

There were 2411 OOHCA victims during the period of analysis. A total of 952 arrests were excluded because ethnicity was not documented; 80 arrests were excluded because they were traumatic. A total of 1379 arrests were included for analysis, of which 273 (19.8%) were Hispanic. Hispanics were less likely to receive bystander CPR than non-Hispanics (32.2% vs 41.5%; P < .0001). Hispanics and non-Hispanics were dissimilar with respect to age (53.2 ± 25 vs 64.5 ± 19.3 years; P = .0001), paramedic response time (5.1 vs 5.5 minutes; P = .0006), initial rhythm asystole (53.8% vs 44.5%; P = .005), and initial rhythm ventricular fibrillation (20.5% vs 26.7%; P = .036). Survival to hospital discharge (8.1% vs 7.1%) was not statistically different.

Conclusion

In the state of Arizona, significantly fewer Hispanic OOHCA victims receive bystander CPR than non-Hispanics.     

Evaluation of the Impact of Implementing the Emergency Medical Services Traumatic Brain Injury Guidelines in Arizona: The Excellence in Prehospital Injury Care (EPIC) Study Methodology

Traumatic brain injury (TBI) exacts a great toll on society. Fortunately, there is growing evidence that the management of TBI in the early minutes after injury may significantly reduce morbidity and mortality. In response, evidence‐based prehospital and in‐hospital TBI treatment guidelines have been established by authoritative bodies. However, no large studies have yet evaluated the effectiveness of implementing these guidelines in the prehospital setting. This article describes the background, design, implementation, emergency medical services (EMS) treatment protocols, and statistical analysis of a prospective, controlled (before/after), statewide study designed to evaluate the effect of implementing the EMS TBI guidelines—the Excellence in Prehospital Injury Care (EPIC) study (NIH/NINDS R01NS071049, “EPIC”; and 3R01NS071049‐S1, “EPIC4Kids”). The specific aim of the study is to test the hypothesis that statewide implementation of the international adult and pediatric EMS TBI guidelines will significantly reduce mortality and improve nonmortality outcomes in patients with moderate or severe TBI. Furthermore, it will specifically evaluate the effect of guideline implementation on outcomes in the subgroup of patients who are intubated in the field. Over the course of the entire study (~9 years), it is estimated that approximately 25,000 patients will be enrolled.     

Body Temperature after EMS Transport: Association with Traumatic Brain Injury Outcomes

Introduction: Low body temperatures following prehospital transport are associated with poor outcomes in patients with traumatic brain injury (TBI). However, a minimal amount is known about potential associations across a range of temperatures obtained immediately after prehospital transport. Furthermore, a minimal amount is known about the influence of body temperature on non-mortality outcomes. The purpose of this study was to assess the correlation between temperatures obtained immediately following prehospital transport and TBI outcomes across the entire range of temperatures. Methods: This retrospective observational study included all moderate/severe TBI cases (CDC Barell Matrix Type 1) in the pre-implementation cohort of the Excellence in Prehospital Injury Care (EPIC) TBI Study (NIH/NINDS: 1R01NS071049). Cases were compared across four cohorts of initial trauma center temperature (ITCT): <35.0°C [Very Low Temperature (VLT)]; 35.0–35.9°C [Low Temperature (LT)]; 36.0–37.9°C [Normal Temperature (NT)]; and ≥38.0°C [Elevated Temperature (ET)]. Multivariable analysis was performed adjusting for injury severity score, age, sex, race, ethnicity, blunt/penetrating trauma, and payment source. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) for mortality were calculated. To evaluate non-mortality outcomes, deaths were excluded and the adjusted median increase in hospital length of stay (LOS), ICU LOS and total hospital charges were calculated for each ITCT group and compared to the NT group. Results: 22,925 cases were identified and cases with interfacility transfer (7361, 32%), no EMS transport (1213, 5%), missing ITCT (2083, 9%), or missing demographic data (391, 2%) were excluded. Within this study cohort the aORs for death (compared to the NT group) were 2.41 (CI: 1.83–3.17) for VLT, 1.62 (CI: 1.37–1.93) for LT, and 1.86 (CI: 1.52–3.00) for ET. Similarly, trauma center (TC) LOS, ICU LOS, and total TC charges increased in all temperature groups when compared to NT. Conclusion: In this large, statewide study of major TBI, both ETs and LTs immediately following prehospital transport were independently associated with higher mortality and with increased TC LOS, ICU LOS, and total TC charges. Further study is needed to identify the causes of abnormal body temperature during the prehospital interval and if in-field measures to prevent temperature variations might improve outcomes.