Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC) |
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| Affiliation: | 1. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States;2. University of Washington Clinical Trial Center, Seattle, WA, United States;3. University of Washington, Seattle, WA, United States;4. University of Toronto, Toronto, ON, Canada;5. Queens University, Kingston, ON, Canada;6. University of British Columbia, Vancouver, BC, Canada;7. Wilfrid Laurier University, Waterloo, ON, Canada;8. University of Pittsburgh, Pittsburgh, PA, United States;9. University of California at San Diego, San Diego, CA, United States;10. University of Texas Southwestern, Dallas, TX, United States;11. University of Alabama at Birmingham, Birmingham, AL, United States;1. European Resuscitation Council (ERC), Niel, Belgium;2. Consultant in Anaesthesia and Intensive Care, Ospedale Maggiore, Bologna, Italy;1. European Resuscitation Council (ERC), Niel, Belgium;2. Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany;1. European Resuscitation Council (ERC), Niel, Belgium;2. Institute of Anesthesia and Intensive Care, Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy;1. European Resuscitation Council (ERC), Niel, Belgium;2. IRCCS-Istituto di ricerche farmacologiche “Mario Negri”—IRCCS, Milano, Italy;1. European Resuscitation Council (ERC), Niel, Belgium;2. Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany;1. University of Washington, Harborview Center for Prehospital Emergency Care, Department of Medicine, University of Washington, Seattle, WA, United States;2. University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States;3. Kyoto University Health Service, Kyoto, Japan;4. Academic Medical Center, Amsterdam, The Netherlands;5. Helsinki Emergency Medical Service, Helsinki University Central Hospital, Helsinki, Finland;6. St John Ambulance, Perth, WA, Australia;7. University of Western Australia, Perth, WA, Australia;8. Monash University, Melbourne, Vic., Australia;9. Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna, Austria;10. Ambulance Victoria, Vic., Australia;11. Rescu, Li Ka Shing Knowledge Institute, St. Michael''s Hospital and Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont., Canada;12. Oslo University Hospital, Oslo, Norway;13. Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States;14. Seoul National University, College of Medicine, Seoul, Republic of Korea;15. Department of Anesthesiology and Intensive Medicine, University-Medical Center Hospital, Schleswig-Campus Kiel, Kiel, Germany;p. Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States;q. Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan;r. University of Borås, Sahlgrenska University Hospital, Göteborg, Sweden;s. School of Health and Social Sciences, University of Dalarna, Falun, Sweden;t. Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States;u. Discipline of General Practice, National University of Ireland, Galway, Ireland and Department of Public Health Medicine, Health Service Executive, Donegal, Ireland;v. Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States;w. Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada;x. Department of Emergency Medicine, University of Ottawa, Ottawa, Ont., Canada;y. Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States;1. Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;2. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;3. Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;1. Department of Emergency Medicine, University of Pittsburgh, 3600 Forbes Avenue, Suite 400A Iroquois Building, Pittsburgh, PA, USA;2. Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic College of Medicine and Sciences, 200 First Street SW, Rochester, MN, USA;3. Department of Emergency Medicine, Mayo Clinic College of Medicine and Sciences, 200 First Street SW, Rochester, MN, USA;4. Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine and Sciences, 200 First Street SW, Rochester, MN, USA;1. Centre for Research and Evaluation, Ambulance Victoria, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia;2. University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States;3. Centre for Research and Evaluation, Ambulance Victoria, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia; University of Western Australia, Perth, WA, Australia;4. Academic Medical Center, Amsterdam, The Netherlands;5. Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland;6. School of Nursing, Midwifery and Paramedicine, Curtin University, WA, Australia; University of Western Australia, WA, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia;7. Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna, Austria;8. Rescu, Li Ka Shing Knowledge Institute, St. Michael''s Hospital and Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada;9. Oslo University Hospital, Oslo, Norway;10. Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States;11. Seoul National University, College of Medicine, Seoul, Republic of Korea;12. Department of Anesthesiology and Intensive Medicine, University-Medical Center Hospital, Schleswig-Campus Kiel, Kiel, Germany;13. Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States;14. Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan;15. Prehospen-Centre of Prehospital Research; Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Sweden;p. School of Health and Social Sciences, University of Dalarna, Falun, Sweden;q. Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States;r. On behalf of the National Out-of-Hospital Cardiac Arrest Register (OHCAR). Discipline of General Practice, National University of Ireland, Galway, Ireland and National Ambulance Service, Health Service Executive, Dublin, Ireland;s. Department of Emergency Medicine, University of Texas Health Science Center, Houston, TX, United States;t. Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada;u. Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada;v. Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States;w. Department of Emergency Medicine, University of Texas Southwester, Dallas, TX, United States;x. Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan;y. Kyoto University Health Service, Kyoto, Japan;z. University of Washington – Harborview Center for Prehospital Emergency Care, Departments of Emergency Medicine and Medicine, University of Washington, Seattle, WA, United States |
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| Abstract: | BackgroundOut-of-hospital cardiac arrest (OHCA) remains a leading cause of death and a 2010 meta-analysis concluded that outcomes have not improved over several decades. However, guidelines have changed to emphasize CPR quality, minimization of interruptions, and standardized post-resuscitation care. We sought to evaluate whether OHCA outcomes have improved over time among agencies participating in the Resuscitation Outcomes Consortium (ROC) cardiac arrest registry (Epistry) and randomized clinical trials (RCTs).MethodsObservational cohort study of 47,148 EMS-treated OHCA cases in Epistry from 139 EMS agencies at 10 ROC sites that participated in at least one RCT between 1/1/2006 and 12/31/2010. We reviewed patient, scene, event characteristics, and outcomes of EMS-treated OHCA over time, including subgroups with initial rhythm of pulseless ventricular tachycardia or ventricular fibrillation (VT/VF).ResultsMean response interval, median age and male proportion remained similar over time. Unadjusted survival to discharge increased between 2006 and 2010 for treated OHCA (from 8.2% to 10.4%), as well as for subgroups of VT/VF (21.4% to 29.3%) and bystander witnessed VT/VF (23.5% to 30.3%). Compared with 2006, adjusted survival to discharge was significantly higher in 2010 for treated cases (OR = 1.72; 95% CI 1.53, 1.94), VT/VF cases (OR = 1.69; 95% CI 1.45, 1.98) and bystander witnessed VT/VF cases (OR = 1.65; 95% CI 1.36, 2.00). Tests for trend in each subgroup were significant (p < 0.001).ConclusionsROC-wide survival increased significantly between 2006 and 2010. Additional research efforts are warranted to identify specific factors associated with this improvement. |
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| Keywords: | Emergency Medical Services (EMS) Out-of-hospital cardiac arrest (OHCA) Resucitation |
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