Abstract 136: Disparities in Out of Hospital Cardiac Arrest Care and Outcomes in Texas

Background: Minorities and impoverished persons experience disparities in access to healthcare. Large inequalities in out-of-hospital cardiac arrest (OHCA) care have been described. We sought to characterize racial and socioeconomic disparities in OHCA care and outcomes in Texas. Hypothesis: There are census tract level disparities in OHCA care and outcomes in Texas. Methods: We analyzed Texas-Cardiac Arrest Registry to Enhance Survival (CARES) data from 13 EMS agencies providing care in 15 counties to roughly 30% of the state population. We included all adult (>=18 year) OHCA from 1/1/14 through 12/31/18 with complete data. Using census tract data, we stratified census tracts into racial/ethnic categories: >50% non-Hispanic/Latino white, >50% black, and >50% Hispanic/Latino. We also stratified census tracts into neighborhoods above and below the median for socioeconomic characteristics: household income, employment rate, and high school graduation. We defined outcomes as bystander CPR rates, public bystander AED use, and survival to hospital discharge. Using mixed models, we analyzed the associations between outcomes and neighborhood (1) racial/ethnic categories and (2) socioeconomic categories. Results: We included data on 18,487 OHCAs from 1,727 census tracts. Relative to white neighborhoods, black neighborhoods had a significantly lower rate of bystander AED use (OR 0.3, CI 0.1-0.9), and Latino neighborhoods had a lower rate of bystander CPR (OR 0.7, CI 0.6-0.8), bystander AED use (OR 0.4, CI 0.3-0.6) and survival to hospital discharge (OR 0.9, CI 0.8-0.98). Lower income was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.8), bystander AED use (OR 0.5, 0.4-0.8), and survival to hospital discharge (OR 0.6, CI 0.5-0.9). Lower high school graduation was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.9) and bystander AED use (OR 0.6, CI 0.4-0.9). High unemployment was associated with lower rates of bystander CPR (OR 0.9, CI 0.8-0.94) and bystander AED use (OR 0.7, CI 0.5-0.99). Conclusion: Minority and poor neighborhoods in Texas experience large and unacceptable disparities in OHCA bystander response and outcomes. These data present an important opportunity for targeted resuscitation training and quality improvement.

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156 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.6 ◽

2020 ◽

Vol 37 (12) ◽

pp. 825.1-825

Author(s):

Ed Barnard ◽

Daniel Sandbach ◽

Tracy Nicholls ◽

Alastair Wilson ◽

Ari Ercole

Keyword(s):

Overall Survival ◽

Cardiac Arrest ◽

Hospital Admission ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Discharge Data ◽

Successful Resuscitation ◽

Bystander Cpr ◽

Number Percentage ◽

Hospital Cardiac Arrest

Aims/Objectives/BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Aim: to compare differential determinants of survival to hospital admission and survival to hospital discharge for traumatic (TCA) and non-traumatic cardiac arrest (NCTA).Methods/DesignAn analysis of 9109 OHCA in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for NTCA and TCA. Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. Data reported as number (percentage), number (percentage (95% CI)) and median (IQR) as appropriate. Continuous data have been analysed with a Mann-Whitney U test, and categorical data have been analysed with a χ2 test. Analyses were performed using the R statistical programming language.Results/ConclusionsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95%CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander-CPR was dependent on geographical socioeconomic status.NTCA and TCA are clinically distinct entities with different predictors for outcome and should be reported separately. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

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Abstract 19427: Epidemiology and Outcomes of Out-of-hospital Cardiac Arrest in Qatar

Circulation ◽

10.1161/circ.132.suppl_3.19427 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Furqan B Irfan ◽

Zain A Bhutta ◽

Tooba Tariq ◽

Loua A Shaikh ◽

Pregalathan Govender ◽

...

Keyword(s):

Cardiac Arrest ◽

Incidence Rate ◽

Hospital Discharge ◽

Middle Eastern ◽

Cerebral Performance Category ◽

Pulseless Electrical Activity ◽

Final Analysis ◽

National Registry ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Aim: There is a scarcity of population based studies on out-of-hospital cardiac arrest (OHCA) in the Middle East and the wider Asian region. This study describes the Epidemiology and outcomes of OHCA in Qatar, a Middle Eastern country. Methods: Data was extracted retrospectively from a national registry on all adult cardiac origin OHCA patients attended by Emergency Medical Services (EMS) in Qatar, from June 2012 - May 2013. Results: The annual crude incidence rate of cardiac origin OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence rate was 87.83 per 100,000 population. The annual sex-standardized incidence rate for males and females was 91.5 and 84.25 per 100,000 population respectively. Of 447 adult, cardiac origin OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities of OHCA cases were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Common initial cardiac arrest rhythms were asystole (n=301, 67.3%), ventricular fibrillation (n=82, 18.3%) and pulseless electrical activity (n=49, 11%). OHCA was unwitnessed (n=220, 49%) in nearly half of the cases while bystanders witnessed it in 170 (38%) patients. Bystander CPR was carried out in 92 (20.6%) of the cases. Of 187 (41.8%) patients who were given shocks, bystander defibrillation was delivered to 12 (2.7%) patients. Prehospital outcomes; 332 (74.3%) patients did not achieve return of spontaneous circulation (ROSC), 40 (8.9%) patients achieved unsustainable ROSC, 58 (13%) achieved ROSC till Emergency department (ED) handover and 5 patients achieved ROSC but rearrested again before reaching ED. Survival to hospital discharge occurred in 38 (8.5%) patients. Neurological outcomes were assessed utilizing Cerebral Performance Category [CPC] scores with a favorable CPC score of 1-2 at discharge in 27 (6%) patients, while 11 (2.5%) patients had a poor CPC score of 3-4. Of those with CPC score 1-2 at hospital discharge, 59% and 26% had CPC score 1-2, at 1 and 3 years follow-up respectively. Overall survival was 9.7%. Conclusion: Standardized rates are comparable to western countries, there are significant opportunities to improve outcomes, including better bystander CPR.

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Abstract 13209: Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.13209 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Luke A Wohlford ◽

Bruce J Barnhart ◽

Daniel W Spaite ◽

Joshua B Gaither ◽

Amber D Rice ◽

...

Keyword(s):

Cardiac Arrest ◽

Law Enforcement ◽

Cardiopulmonary Resuscitation ◽

Patient Care ◽

Hospital Discharge ◽

System Response ◽

Healthcare Facilities ◽

Bystander Cpr ◽

Provision Of Care ◽

Hospital Cardiac Arrest

Background: Little is known about the provision of care by law enforcement (LE) personnel within modern EMS systems. We evaluated LE performance of bystander CPR (BCPR) and associated outcomes in OHCA across Arizona. Methods: A total of 5,654 OHCA cases (1/1/2019-12/31/2019) were evaluated using the Save Hearts in Arizona Registry and Education (SHARE) cardiac arrest registry. Data were abstracted from all EMS patient care records (PCRs). If two parties provided BCPR, the first to give compressions was considered the provider for this analysis. Cases identified as “Stranger” or “Unknown” BCPR were manually evaluated for narrative data to identify BCPR provider when possible. Results: BCPR was provided in 2285 cases [48.8%; (95% CIs 47.4%, 50.3%)] after excluding 850 cases that occurred in healthcare facilities where personnel are duty-bound to provide CPR. LE provided BCPR in 444 patients [19.4% (17.8%, 21.1%)], second only to family/spouse [1143 pts; 50.0% (48.0%, 52.1%)]. Overall, 279 patients survived to hospital discharge [12.2%, (10.9%, 13.6%)]. The Table shows the rates of BCPR in each provider category and the associated rates of survival. Of note is that the rate of bystander AED use was more than four times higher in LE BCPR [6.3% (4.23%, 8.99%)] than family-provided BCPR [1.5% (0.87%, 2.37%; p < 0.0001)], but was still very low. Conclusions: In this statewide study that included more than 130 EMS agencies from frontier to urban settings, LE personnel were frequently involved in the care of OHCA patients within the 911 system response. To our knowledge, this magnitude of provision of BCPR by LE (nearly one in five BCPR cases) has not been reported previously. Furthermore, the consequential rate of LE response to OHCA provides the opportunity to significantly increase AED use. Our findings support the widespread and intentional training of LE in CPR and AED use and has the potential to improve survival in diverse settings.

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Abstract 22: When Laws Save Lives: Impact of Legislation Requiring Cardiopulmonary Resuscitation Education in High Schools on Survival After Sudden Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.22 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Victoria L Vetter ◽

Katherine F Dalldorf ◽

Joseph Rossano ◽

Maryam Y Naim ◽

Andrew C Glatz ◽

...

Keyword(s):

High School ◽

Cardiac Arrest ◽

High School Students ◽

Cardiopulmonary Resuscitation ◽

Hospital Discharge ◽

Cerebral Performance Category ◽

School Education ◽

High School Education ◽

School Students ◽

Bystander Cpr

Introduction: Thirty eight states have laws requiring education of high school students on cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AED). No study has measured the association of these laws and outcomes. Hypothesis: Out of hospital cardiac arrests (OHCAs) occurring in states with CPR high school education laws will have higher bystander CPR, survival, and favorable neurological survival than states without such laws. Methods: We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database and included all nontraumatic OHCAs with at least 50% population catchment from 1/2013-12/2017 in all ages. We excluded OHCAs witnessed by 911 responders, in healthcare facilities, or nursing homes. Outcomes were bystander CPR, survival to hospital discharge and neurologically favorable survival (Cerebral Performance Category score of 1 or 2 at hospital discharge). Chi-square tests were used to assess associations. Results: The 110,902 subjects with OHCA included Male, 64.0%; <18 yrs., 3.2%; <35 yrs., 10.7%; <50 yrs., 23.9%; White, 49.3%; Black, 19.1%; Hispanic, 2.3%; Other, 2.9%; Unknown, 26.5%. Most OHCAs occurred at home, 81.4%. 44.4% were witnessed by bystanders. 75.5% occurred in states with CPR high school education laws. A higher percent of OHCAs received bystander CPR prior to emergency medical services (EMS) arrival in states with CPR high school education laws (40.1%) compared to states without laws (37.0%) (p<0.001). Bystander CPR was less common in males (40.3% vs. 37.7% for females), those >50 yrs. (38.9% vs. 40.7% for ≤50 yrs.), Black and Hispanic subjects (25.7% and 34.9%, respectively, vs. 42.4% for Whites) (p<0.001 for all). Overall survival to hospital discharge was 10.4%; 8.8% had a favorable neurological outcome. A higher percent survived to hospital discharge in states with CPR high school education laws (11.0%) compared to states without laws (8.7%) (p<0.001). Neurologically favorable survival was more likely in states with CPR high school education laws, (9.3%) compared to states without laws (7.5%) (p<0.001). Conclusions: Bystander CPR, survival to hospital discharge, and neurologically favorable survival was higher in states that had CPR high school education laws.

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Abstract 14172: Impact of Sex on Survival With Preserved Neurologic Function Following Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.142.suppl_3.14172 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Fatima Lakhani ◽

Brendan Caprio ◽

Elena Deych ◽

David L Brown

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Menopausal Status ◽

Favorable Outcome ◽

Categorical Variables ◽

Female Sex ◽

Shockable Rhythm ◽

Bystander Cpr ◽

Neurologic Function ◽

Hospital Cardiac Arrest

Introduction: Females experience worse survival than males following out-of-hospital cardiac arrest (OHCA). Proposed explanations include previous observations that females less often have an initial shockable rhythm or a witnessed arrest and less often receive bystander CPR. Methods: We utilized a prospective, population-based registry of patients experiencing OHCA responded to by EMS from 2011-2015. We included patients 18 years or older who were admitted to the hospital. Univariate comparisons were performed with chi-squared test for categorical variables and t-test for age. Additional analysis compared outcomes stratified by age > 50 years as a surrogate for menopausal status. A multivariate logistic regression model was constructed to evaluate the independent association of sex with outcomes. The primary outcome was survival to hospital discharge with Modified Rankin Score (MRS) ≤3. Results: Of 13,651 patients, 4894 were female and 8757 were male. The average age was 65 years for females and 64.2 years for males (P=0.005). Females were less likely than males to arrest in a public location (13% vs 27%; P <0.001), have bystander witnessed arrest (48% vs 57%; P <0.001), receive bystander CPR (44% vs 49%; P <0.001), have an initial shockable rhythm (29% vs 48%; P <0.001), have achieved ROSC upon ED arrival (76% vs 78%; P=0.014), have an ED arrival time less than 30 minutes from dispatch call (10% vs 12% P=0.008). Among males, 27% had a favorable outcome compared to 16% of females (P <0.0001). Among individuals of age ≤ 50 years, 31% of males and 26% of females had a favorable outcome (P= 0.004). Among those of age > 50 years, 26% of males and 14% of females had a favorable outcome (P <0.0001). After adjustment for differences in age and presentation, female sex was found to be independently associated with lower rates of survival with intact neurologic function (OR 0.79, 95% CI 0.71-0.89, P =0.0001). Conclusions: Compared to males, females have less favorable OHCA presentations and worse survival to hospital discharge with preserved neurologic function. However, even after adjustment for the differences in presentation, female sex remains a significant predictor of worse survival with preserved neurologic function.

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Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

CJEM ◽

10.1017/cem.2016.8 ◽

2016 ◽

Vol 18 (6) ◽

pp. 453-460 ◽

Cited By ~ 19

Author(s):

Brian Grunau ◽

Frank Xavier Scheuermeyer ◽

Dion Stub ◽

Robert H. Boone ◽

Joseph Finkler ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Secondary Analysis ◽

Secondary Outcome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

High Performing ◽

Canadian Health ◽

Bystander Cpr ◽

Hospital Cardiac Arrest ◽

Refractory Cardiac Arrest

AbstractObjectiveExtracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation.MethodsWe performed a secondary analysis from a 52-month prospective registry of consecutive adult non-traumatic OHCA cases from a single urban Canadian health region serving one million patients. We developed a hypothetical ECPR-eligible cohort including adult patients <60 years of age with a witnessed OHCA, and either bystander CPR or EMS arrival within five minutes. The primary outcome was the proportion of ECPR-eligible patients who had refractory cardiac arrest, defined as termination of resuscitation pre-hospital or in the ED. The secondary outcome was the proportion of EPCR-eligible patients who survived to hospital discharge.ResultsOf 1,644 EMS-treated OHCA, 168 (10.2%) fulfilled our ECPR criteria. Overall, 54/1644 (3.3%; 95% CI 2.4%-4.1%) who were ECPR-eligible had refractory cardiac arrest. Of ECPR-eligible patients, 114/168 (68%, 95% CI 61%-75%) survived to hospital admission, and 70/168 (42%; 95% CI 34-49%) survived to hospital discharge.ConclusionIn our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes.

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Response Time Threshold for Predicting Outcomes of Patients with Out-of-Hospital Cardiac Arrest

Emergency Medicine International ◽

10.1155/2021/5564885 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Ling Hsuan Huang ◽

Yu-Ni Ho ◽

Ming-Ta Tsai ◽

Wei-Ting Wu ◽

Fu-Jen Cheng

Keyword(s):

Cardiac Arrest ◽

Response Time ◽

Hospital Discharge ◽

Youden Index ◽

Roc Curve Analysis ◽

Optimal Response ◽

Time Threshold ◽

Bystander Cpr ◽

The Impact ◽

Hospital Cardiac Arrest

Ambulance response time is a prognostic factor for out-of-hospital cardiac arrest (OHCA), but the impact of ambulance response time under different situations remains unclear. We evaluated the threshold of ambulance response time for predicting survival to hospital discharge for patients with OHCA. A retrospective observational analysis was conducted using the emergency medical service (EMS) database (January 2015 to December 2019). Prehospital factors, underlying diseases, and OHCA outcomes were assessed. Receiver operating characteristic (ROC) curve analysis with Youden Index was performed to calculate optimal cut-off values for ambulance response time that predicted survival to hospital discharge. In all, 6742 cases of adult OHCA were analyzed. After adjustment for confounding factors, age (odds ratio [OR] = 0.983, 95% confidence interval [CI]: 0.975–0.992, p < 0.001 ), witness (OR = 3.022, 95% CI: 2.014–4.534, p < 0.001 ), public location (OR = 2.797, 95% CI: 2.062–3.793, p < 0.001 ), bystander cardiopulmonary resuscitation (CPR, OR = 1.363, 95% CI: 1.009–1.841, p = 0.044 ), EMT-paramedic response (EMT-P, OR = 1.713, 95% CI: 1.282–2.290, p < 0.001 ), and prehospital defibrillation using an automated external defibrillator ([AED] OR = 3.984, 95% CI: 2.920–5.435, p < 0.001 ) were statistically and significantly associated with survival to hospital discharge. The cut-off value was 6.2 min. If the location of OHCA was a public place or bystander CPR was provided, the threshold was prolonged to 7.2 min and 6.3 min, respectively. In the absence of a witness, EMT-P, or AED, the threshold was reduced to 4.2, 5, and 5 min, respectively. The adjusted OR of EMS response time for survival to hospital discharge was 1.217 (per minute shorter, CI: 1.140–1299, p < 0.001 ) and 1.992 (<6.2 min, 95% CI: 1.496–2.653, p < 0.001 ). The optimal response time threshold for survival to hospital discharge was 6.2 min. In the case of OHCA in public areas or with bystander CPR, the threshold was prolonged, and without witness, the optimal response time threshold was shortened.

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Abstract 164: Comparison of Tracheal Intubation vs. Supraglottic Airway Following Pediatric Out of Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.164 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Maryam Y Naim ◽

Heather Griffis ◽

Robert A Berg ◽

Richard N Bradley ◽

Matthew L Hansen ◽

...

Keyword(s):

Cardiac Arrest ◽

Tracheal Intubation ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Cerebral Performance Category ◽

Supraglottic Airway ◽

Secondary Outcome ◽

Initial Rhythm ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: There are few data comparing Tracheal Intubation (TI) and SupraGlottic Airway (SGA) following pediatric out of hospital cardiac arrest (OHCA). Hypothesis: TI is associated with improved outcomes compared to SGA following pediatric OHCA. Methods: Analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years, non-traumatic OHCA from 2013 through 2017, resuscitated by Emergency Medical Services (EMS). To adjust for covariate imbalance, propensity score matching and entropy balancing were utilized; variables included age category, sex, bystander CPR, and initial rhythm. Primary outcome was neurologically favorable survival defined as a cerebral performance category scale of 1 or 2. Secondary outcome was survival to hospital discharge. Results: Of 2653 cardiac arrests evaluated, 2178 (82.1%) had TI and 475 (17.9%) had SGA placed during OHCA. 835 (31.2%) arrests were resuscitated by agencies used bag valve mask (BVM) and TI and 1818 (68.0%) arrests had agencies that used all 3 airway types (BVM/TI/SGA). Overall, unadjusted favorable neurological survival was 5.7% for TI and 5.3% for SGA, p=0.67 and survival to hospital discharge was 7.9% for TI and 7.5% for SGA, p=0.73. In multivariable analysis (adjusting for age, sex, race/ethnicity, bystander witness, bystander CPR, initial rhythm, AED use, year of arrest, and agency category), SGA was associated with lower neurologically favorable survival compared to TI (adjusted proportion 3.7% vs. 6.3%, OR 0.49, p=0.01), and lower survival to hospital discharge (5.5% vs. 8.5%, OR 0.57, 95% CI 0.36, 0.89). These results were robust on tests for unmeasured confounding and covariate balance; propensity analysis neurologically favorable survival 4.4% vs.7.6% (OR 0.54, 95% CI 0.30, 0.96), survival to hospital discharge 6.6% vs.10.5% (OR 0.58, 95% CI 0.35, 0.95); and entropy balance neurologically favorable survival 5.0 % vs. 9.7% for ETI (OR 0.44, 95% CI 0.27, 0.72), survival to hospital discharge 7.3% vs.12.5% (OR 0.51, 95% CI 0.34, 0.78). Conclusion: In pediatric OHCA, TI, compared with SGA advanced airway management is associated with improved neurologically favorable survival and survival to hospital discharge.

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Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

Emergency Medicine Journal ◽

10.1136/emermed-2018-208165 ◽

2019 ◽

Vol 36 (6) ◽

pp. 333-339 ◽

Cited By ~ 15

Author(s):

Ed B G Barnard ◽

Daniel D Sandbach ◽

Tracy L Nicholls ◽

Alastair W Wilson ◽

Ari Ercole

Keyword(s):

Overall Survival ◽

Cardiac Arrest ◽

Hospital Admission ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Neurological Injury ◽

Successful Resuscitation ◽

Traumatic Cardiac Arrest ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement.MethodsAn analysis of 9109 OHCA attended in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for non-traumatic cardiac arrest (NTCA) and traumatic cardiac arrest (TCA). Two Utstein outcome variables were used: survival to hospital admission and hospital discharge.ResultsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95% CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95% CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander CPR was dependent on geographical socioeconomic status. An air ambulance was associated with increased survival to both hospital admission and discharge in NTCA, but only with survival to admission in TCA.ConclusionNTCA and TCA are clinically distinct entities with different predictors for outcome—future OHCA reports should aim to separate arrest aetiologies. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

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Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups

BMC Emergency Medicine ◽

10.1186/s12873-020-00400-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jyun-Bin Huang ◽

Kuo-Hsin Lee ◽

Yu-Ni Ho ◽

Ming-Ta Tsai ◽

Wei-Ting Wu ◽

...

Keyword(s):

Cardiac Arrest ◽

Prognostic Factors ◽

Response Time ◽

Hospital Discharge ◽

Age Groups ◽

Age Group ◽

Bystander Cpr ◽

Group 2 ◽

The Impact ◽

Hospital Cardiac Arrest

Abstract Background The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor. While several prehospital factors are known to be associated with improved survival, the impact of prehospital factors on different age groups is unclear. The objective of the study was to access the impact of prehospital factors and pre-existing comorbidities on OHCA outcomes in different age groups. Methods A retrospective observational analysis was conducted using the emergency medical service (EMS) database from January 2015 to December 2019. We collected information on prehospital factors, underlying diseases, and outcome of OHCAs in different age groups. Kaplan-Meier type survival curves and multivariable logistic regression were used to analyze the association between modifiable pre-hospital factors and outcomes. Results A total of 4188 witnessed adult OHCAs were analyzed. For the age group 1 (age ≦75 years old), after adjustment for confounding factors, EMS response time (odds ratio [OR] = 0.860, 95% confidence interval [CI]: 0.811–0.909, p < 0.001), public location (OR = 1.843, 95% CI: 1.179–1.761, p < 0.001), bystander CPR (OR = 1.329, 95% CI: 1.007–1.750, p = 0.045), attendance by an EMT-Paramedic (OR = 1.666, 95% CI: 1.277–2.168, p < 0.001), and prehospital defibrillation by automated external defibrillator (AED)(OR = 1.666, 95% CI: 1.277–2.168, p < 0.001) were prognostic factors for survival to hospital discharge in OHCA patients. For the age group 2 (age > 75 years old), age (OR = 0.924, CI:0.880–0.966, p = 0.001), EMS response time (OR = 0.833, 95% CI: 0.742–0.928, p = 0.001), public location (OR = 4.290, 95% CI: 2.450–7.343, p < 0.001), and attendance by an EMT-Paramedic (OR = 2.702, 95% CI: 1.704–4.279, p < 0.001) were independent prognostic factors for survival to hospital discharge in OHCA patients. Conclusions There were variations between younger and older OHCA patients. We found that bystander CPR and prehospital defibrillation by AED were independent prognostic factors for younger OHCA patients but not for the older group.

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