Comparison of out-of-hospital cardiac arrest occurring before and after paramedic arrival: Epidemiology,survival to hospital discharge and 12-month functional recovery |
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| Institution: | 1. Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia;2. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia;3. Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia;4. Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia;1. Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Sweden;2. Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden;3. The Northern Sweden MONICA Myocardial Registry, Department of Research, Norrbotten County Council, Luleå and Department of Health Science, Division of Nursing, Luleå University of Technology, Sweden;1. Department of Epidemiology and Preventive Medicine, Monash University, Level 5, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia;2. Ambulance Victoria, 375 Manningham Road, Doncaster, Victoria 3108, Australia;3. Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia;4. Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia;5. Department of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia;1. Singapore Clinical Research Institute, Singapore, Singapore;2. Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore;3. Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore;4. Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore, Singapore;5. Home Team, Ministry of Home Affairs, Singapore, Singapore;6. Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore;7. Emergency Medicine, Ng Teng Fong General Hospital, Singapore, Singapore;8. Emergency Medicine Department, National University Hospital, Singapore, Singapore;9. Accident & Emergency, Changi General Hospital, Singapore, Singapore;10. Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore;11. Children’s Emergency, KK Women’s and Children’s Hospital, Singapore, Singapore;12. Health Services Research Unit, Singapore General Hospital, Singapore, Singapore;1. Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA;2. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA;3. Department of Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore;4. Department of Surgery, Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA;5. Duke Global Health Institute, Duke University, Durham, NC, USA;1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;2. Operations Department, Ambulance Victoria, Victoria, Australia;3. Research and Evaluation Department, Ambulance Victoria, Melbourne, Australia;4. Discipline of Emergency Medicine, University of Western Australia, Perth, Australia;5. Intensive Care Unit, Alfred Hospital, Melbourne, Australia;6. Medical Advisor, Ambulance Victoria, Victoria, Australia;7. Faculty of Health Sciences, Curtin University, Perth, Australia;1. Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia;2. Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia;3. Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia;4. Alfred Hospital, Prahran, Victoria, Australia;5. Discipline of Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia |
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| Abstract: | BackgroundDespite immediate resuscitation, survival rates following out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical service (EMS) are reportedly low. We sought to compare survival and 12-month functional recovery outcomes for OHCA occurring before and after EMS arrival.MethodsBetween 1st July 2008 and 30th June 2013, we included 8648 adult OHCA cases receiving an EMS attempted resuscitation from the Victorian Ambulance Cardiac Arrest Registry, and categorised them into five groups: bystander witnessed cases ± bystander CPR, unwitnessed cases ± bystander CPR, and EMS witnessed cases. The main outcomes were survival to hospital and survival to hospital discharge. Twelve-month survival with good functional recovery was measured in a sub-group of patients using the Extended Glasgow Outcome Scale (GOSE).ResultsBaseline and arrest characteristics differed significantly across groups. Unadjusted survival outcomes were highest among bystander witnessed cases receiving bystander CPR and EMS witnessed cases, however outcomes differed significantly between these groups: survival to hospital (46.0% vs. 53.4% respectively, p < 0.001); survival to hospital discharge (21.1% vs. 34.9% respectively, p < 0.001). When compared to bystander witnessed cases receiving bystander CPR, EMS witnessed cases were associated with a significant improvement in the risk adjusted odds of survival to hospital (OR 2.02, 95% CI: 1.75–2.35), survival to hospital discharge (OR 6.16, 95% CI: 5.04–7.52) and survival to 12 months with good functional recovery (OR 5.56, 95% CI: 4.18–7.40).ConclusionWhen compared to OHCA occurring prior to EMS arrival, EMS witnessed arrests were associated with significantly higher survival to hospital discharge rates and favourable neurological recovery at 12-month post-arrest. |
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| Keywords: | Cardiac arrest Cardiopulmonary resuscitation Emergency medical services Paramedic witnessed Prognosis |
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