Abstract 10611: Variation in Out-of-Hospital Cardiac Arrest Survival Across EMS Agencies

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
R Garcia ◽  
Bryan McNally ◽  
Saket Girotra ◽  
Paul S Chan ◽  
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Hospital Admission ◽  
Geographic Region ◽  
Hierarchical Logistic Regression ◽  
Initial Rhythm ◽  
The Mean ◽  
Adjusted Rate ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Background: Although some studies have reported variation in out-of-hospital cardiac arrest (OHCA) survival by neighborhood and geographic region, little is known about variation in OHCA survival at the level of EMS agencies—which, unlike neighborhoods and regions, may have modifiable resuscitation practices. Methods: Within the national Cardiac Arrest Registry to Enhance Survival, we identified 258,320 non-traumatic OHCAs from 764 EMS agencies with ≥10 OHCAs annually between 2015-2019. Using multivariable hierarchical logistic regression, we computed risk-adjusted rates of survival to hospital admission for each EMS agency. We quantified the extent of variation in survival with the median odds ratios (MOR) and assessed the extent to which variation in survival was explained by two EMS agency resuscitation practices: time from 911 call to EMS arrival and the proportion of OHCAs at each EMS agency with termination of resuscitation (TOR) without meeting TOR futility criteria. Results: Of 258,320 persons with OHCA, mean age was 62.2 ± 17.0 years and 36.1% were female. Overall, 85.0% were of presumed cardiac etiology, 82.3% occurred at home, 44.0% were witnessed by a bystander, and ~75% were due to a non-shockable initial rhythm. Across the 764 EMS agencies, the median risk-adjusted rate of survival to hospital admission was 27.4% (IQR, 24.5% - 30.2%). The adjusted MOR was 1.35 (95% CI: 1.32, 1.39), suggesting that the odds of survival to hospital admission after an OHCA varied by 35% in two identical patients in one randomly selected EMS agency vs. another. EMS agencies in the lowest quartile of risk-adjusted survival had a mean EMS response time of 12.0 ± 3.4 minutes, whereas those in the highest quartile had a mean EMS response time of 9.0 ± 2.6 minutes ( P <0.001). The mean proportion of OHCA cases where CPR was terminated in the field without meeting TOR futility criteria was 27.9% ±16.1% in quartile 1 and 18.9% ±11.4% in quartile 4 ( P <0.001). Adjustment for the EMS-level variation in both resuscitation practices attenuated the MOR to 1.30 (95% CI: 1.27, 1.33). Conclusions: Rates of survival to hospital admission for OHCA vary significantly by EMS agency, and some of this variation in survival is explained by differences in EMS arrival time and TOR practice patterns.

Abstract 249: The Effect of Response Time on Out-Of-Hospital Cardiac Arrest Survival Varies by Patient Subpopulation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Clara Stoesser ◽  
Justin Boutilier ◽  
Christopher L Sun ◽  
Katie N Dainty ◽  
Steve Lin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Regression Analysis ◽  
Response Time ◽  
Time Interval ◽  
Probability Of Survival ◽  
Subgroup Analyses ◽  
Impact On Survival ◽  
The Impact ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Itroduction: Previous research has quantified the impact of EMS response time on the probability of survival from OHCA, but the impact on different subpopulations is currently unknown. Aim: To investigate how response time affects OHCA survival for different patient subpopulations. Methods: We conducted a logistic regression analysis on non-EMS witnessed OHCAs of presumed cardiac etiology from the Toronto Regional RescuNet between January 1, 2007 and December 31, 2016. We predicted survival using age, sex, public location, presenting rhythm, bystander witnessed, bystander resuscitation, and response time, defined as the time interval from 911 call to EMS arrival at the patient. We conducted subgroup analyses to quantify the effect of response time on survival for eight different subpopulations: public, private, bystander resuscitation, no bystander resuscitation, patients ≥65, patients <65, witnessed, and unwitnessed OHCA. We also quantified the effect of response time on survival for pairwise intersections of the subpopulations. We compared our results to Valenzuela et al. (1997), which suggests survival odds decrease by 10% for each minute delay in response time. Results: We identified 22,988 OHCAs. Overall, a one-minute delay in EMS response time was associated with a 13.2% reduction in the odds of survival. The reduction varied by subpopulation, ranging from a 7.2% reduction in survival odds for unwitnessed arrests to a 16.4% reduction in survival odds for arrests with bystander resuscitation. Response time had the largest impact on survival for the subpopulation of OHCAs that were both witnessed and received bystander resuscitation (17.4% reduction in survival odds). Conclusion: The effect of a one-minute delay in EMS response on the odds of survival from OHCA can be as low as a 7.2% reduction and as high as a 17.4% reduction. This variability contrasts with the currently accepted 10% rule that is assumed across the entire population.

scholarly journals Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001805
Author(s):  
Laura Helena van Dongen ◽  
Marieke T Blom ◽  
Sandra C M de Haas ◽  
Henk C P M van Weert ◽  
Petra Elders ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Heart Disease ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Lower Proportion ◽  
Initial Rhythm ◽  
Multivariable Regression ◽  
Medical Histories ◽  
Underlying Mechanisms ◽  
Hospital Cardiac Arrest

AimThis study aimed to determine whether patients suffering from out-of-hospital cardiac arrest (OHCA) with a pre-OHCA diagnosis of heart disease have higher survival chances than patients without such a diagnosis and to explore possible underlying mechanisms.MethodsA retrospective cohort study in 3760 OHCA patients from the Netherlands (2010–2016) was performed. Information from emergency medical services, treating hospitals, general practitioner, resuscitation ECGs and civil registry was used to assess medical histories and the presence of pre-OHCA diagnosis of heart disease. We used multivariable regression analysis to calculate associations with survival to hospital admission or discharge, immediate causes of OHCA (acute myocardial infarction (AMI) vs non-AMI) and initial recorded rhythm.ResultsOverall, 48.1% of OHCA patients had pre-OHCA heart disease. These patients had higher odds to survive to hospital admission than patients without pre-OHCA heart disease (OR 1.25 (95%CI 1.05 to 1.47)), despite being older and more often having cardiovascular risk factors and some non-cardiac comorbidities. These patients also had higher odds of shockable initial rhythm (SIR) (OR 1.60 (1. 36 to 1.89)) and a lower odds of AMI as immediate cause of OHCA (OR 0.33 (0.25 to 0.42)). Their chances of survival to hospital discharge were not significantly larger (OR 1.16 (0.95 to 1.42)).ConclusionHaving pre-OHCA diagnosed heart disease is associated with better odds to survive to hospital admission, but not to hospital discharge. This is associated with higher odds of a SIR and in a subgroup with available diagnosis a lower proportion of AMI as immediate cause of OHCA.

scholarly journals Shortening Ambulance Response Time Increases Survival in Out‐of‐Hospital Cardiac Arrest

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Johan Holmén ◽  
Johan Herlitz ◽  
Sven‐Erik Ricksten ◽  
Anneli Strömsöe ◽  
Eva Hagberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Response Time ◽  
Primary Outcome ◽  
Response Times ◽  
The Past ◽  
Confounding Variables ◽  
Initial Rhythm ◽  
Correct Understanding ◽  
Hospital Cardiac Arrest

Background The ambulance response time in out‐of‐hospital cardiac arrest (OHCA) has doubled over the past 30 years in Sweden. At the same time, the chances of surviving an OHCA have increased substantially. A correct understanding of the effect of ambulance response time on the outcome after OHCA is fundamental for further advancement in cardiac arrest care. Methods and Results We used data from the SRCR (Swedish Registry of Cardiopulmonary Resuscitation) to determine the effect of ambulance response time on 30‐day survival after OHCA. We included 20 420 cases of OHCA occurring in Sweden between 2008 and 2017. Survival to 30 days was our primary outcome. Stratification and multiple logistic regression were used to control for confounding variables. In a model adjusted for age, sex, calendar year, and place of collapse, survival to 30 days is presented for 4 different groups of emergency medical services (EMS)‐crew response time: 0 to 6 minutes, 7 to 9 minutes, 10 to 15 minutes, and >15 minutes. Survival to 30 days after a witnessed OHCA decreased as ambulance response time increased. For EMS response times of >10 minutes, the overall survival among those receiving cardiopulmonary resuscitation before EMS arrival was slightly higher than survival for the sub‐group of patients treated with compressions‐only cardiopulmonary resuscitation. Conclusions Survival to 30 days after a witnessed OHCA decreases as ambulance response times increase. This correlation was seen independently of initial rhythm and whether cardiopulmonary resuscitation was performed before EMS‐crew arrival. Shortening EMS response times is likely to be a fast and effective way of increasing survival in OHCA.

Abstract 264: Timing of In-Hospital Cardiac Arrest and Association with Survival to Discharge and Subsequent Length of Stay

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Abdul H Qazi ◽  
Kevin Kennedy ◽  
Paul Chan
Keyword(s):  
Cardiac Arrest ◽  
Length Of Stay ◽  
Regression Models ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Logistic Regression Models ◽  
Hierarchical Logistic Regression ◽  
The Mean ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: In-hospital cardiac arrest (IHCA) is common and often fatal. To date, the time from admission to IHCA has not been described, and the association between timing of cardiac arrest and likelihood of survival to discharge and subsequent hospital length of stay (LOS) is unknown. Methods: Within the national Get with the Guidelines Resuscitation registry, we identified 175,904 patients admitted between 2000 and 2013 with an IHCA. For each patient, the time from admission to IHCA was determined and categorized as early (7 days). Multivariable hierarchical logistic regression models examined the association between timing of IHCA and both survival to discharge and, among survivors, subsequent LOS from date of IHCA. Results: Overall, the mean and median times from admission to IHCA were 5.3 ± 6.3 days and 3 days (IQR: 1-8), respectively. Nearly half (83,811 [47.6%]) of patients had their IHCA 7 days from admission, respectively. After adjustment for patient and and cardiac arrest factors, cardiac arrests occurring later during the hospitalization were associated with modestly lower survival (reference: 7 days: adjusted OR 0.89 [0.86-0.92]; P<.01). However, this association pertained only to patients with a shockable IHCA (P for interaction between shockable and non-shockable rhythms: <0.001). Lastly, among those surviving to discharge, later timing of IHCA was associated with much longer subsequent LOS (reference: 7 days: 6.8 additional days [6.3-7.3]; P<0.001). Conclusion: Most IHCA occur after the first 72 hours of admission. Patients with IHCA >3 days from admission had significantly lower hospital survival and longer hospitalizations from the time of cardiac arrest.

Abstract 18923: Trends in Long-term Survival After In-hospital Cardiac Arrest: Insights From Get With the Guidelines-Resuscitation®

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Lauren E Thompson ◽  
Paul S Chan ◽  
Fengmeng Tang ◽  
Brahmajee K Nallamothu ◽  
Saket Girotra ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Temporal Trends ◽  
Pulseless Electrical Activity ◽  
Term Survival ◽  
Initial Rhythm ◽  
Adjusted Rate ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: Although survival to hospital discharge after in-hospital cardiac arrest (IHCA) has improved over the last decade, it is unknown if these survival gains are sustained after hospital discharge. Accordingly, we evaluated temporal trends in 1-year survival after IHCA. Methods: We linked data from Get With The Guidelines-Resuscitation (a national IHCA registry) with Medicare files and evaluated temporal trends in 1-year survival after IHCA between 2000 and 2011, using multivariable Poisson regression models to account for patient factors, clinical factors, cardiac arrest characteristics (e.g. initial rhythm, location of arrest), and hospital site. We examined 1-year survival trends overall, and separately for shockable (ventricular fibrillation [VF] and pulseless ventricular tachycardia [VT]) and non-shockable rhythms (asystole and pulseless electrical activity [PEA]). Results: Of 45,567 patients with IHCA, the majority had a presenting rhythm of PEA (43.5%) or asystole (42.2%), and half (53.6%) occurred in an ICU. Overall 1-year survival was 9.4%, with higher survival each successive year (FIGURE). Risk-adjusted 1-year survival increased over time for all IHCA (adjusted rate ratio [RR] per year, 1.05; 95% confidence interval [CI], 1.04 to 1.06; P<0.001 for trend) and separately for VT/VF and PEA/asystole arrests (all p for trend <0.001). Compared with 2000-01, 1-year survival after IHCA in 2011 increased by 62% (adjusted RR, 1.62 [95% CI: 1.44-1.81]) (TABLE). Conclusions: Over the past decade, 1-year survival after IHCA has significantly improved each year.

Abstract 25: Effect of Thrombolytics on the Immediate Prognosis for Out-of-Hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Aurelien Renard ◽  
Daniel Jost ◽  
Catherine Verret ◽  
Frederique Briche ◽  
David Fontaine ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Response Time ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Response Times ◽  
Randomized Study ◽  
Bystander Cpr ◽  
The Impact ◽  
Hospital Cardiac Arrest

Immediate care of out-of-hospital cardiac arrest (CA) is standardized by the established ILCOR ACLS Guidelines. Studies concerning the impact of thrombolysis, generally for CA of cardiac etiology have not shown a benefit. We sought to evaluate the rate of hospital admission for all CA patients treated with pre-hospital thrombolytics. Methods: Non-randomized retrospective study was conducted from 09/1/2005 to 02/15/2007 of non-traumatic CA patients treated with (T+) or without (T-) thrombolysis. The protocol for administration of thrombolytics was at the discretion of the field physician, aiming for within 20 minutes of collapse in almost all cases, and prior to return of spontaneous circulation. The primary endpoint was admission alive to the hospital. We performed multivariate analysis by logistic regression to identify risk factors independently associated with outcome: age, gender, response time, defibrillation, witnessed arrest, bystander CPR. Results: We reviewed 1331 consecutive patient records, of which 116 (8.7%) received thrombolytics. Both T+ and T- groups had comparable response times, witnessed arrest, and bystander CPR. Patients in T+ were significantly younger (59±14 vs 67±19 years old), predominantly males (81% vs 61%), and received more defibrillation shocks (61% vs 26 %). Significantly more patients T+ arrived alive to hospital for admission (45% vs 24%). Risk factors independently associated with hospital admissions were thrombolysis, age, response time, witnessed arrest, and bystander CPR. The impact of thrombolysis was different whether or not the patient was defibrillated (odds ratio with shocks 1.1 [95%CI: 0.2–5.0] vs without shocks 3.6 [95%CI: 1.9 – 6.9]), despite a greater overall rate of hospital admission for shocked patients. Conclusion: Thrombolysis appears to improve the rate of admission alive to the hospital in patients that were not defibrillated with adjustment for age, gender, response time, witnessed arrest, and bystander CPR. These preliminary results should be confirmed by a prospective randomized study. This analysis can help determine appropriate inclusion criteria for a future study.

scholarly journals Clinical outcomes in COVID-19 patients with in-hospital cardiac arrest – an insight from multi-centre data

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Mughal ◽  
I Kaur ◽  
S Waxman ◽  
H Gandhi ◽  
M Kakadia ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
End Of Life ◽  
Clinical Outcomes ◽  
End Of Life Care ◽  
Pulseless Electrical Activity ◽  
High Rate ◽  
Life Care ◽  
Initial Rhythm ◽  
The Mean ◽  
Hospital Cardiac Arrest

Abstract Background In general, rates of in-hospital cardiac arrest are reportedly 9 to 10 arrests per 1000 admissions, with survival rates of approximately 20–25%. Data regarding clinical characteristics and outcomes in patients with COVID-19 who received in-hospital CPR (cardiopulmonary resuscitation) are limited. This information can help guide end-of-life care conversations between families and health care workers based on real-world experience. Purpose To observe the outcomes (survival to discharged alive from the hospital) in critically sick COVID-19 patients who experienced in-hospital cardiac arrest. Methods This is a multi-centre institutional review board (IRB) approved retrospective study. The RT-PCR confirmed adult COVID-19 patients consecutively admitted from March 1st to April 30, 2020, were included. Data were extracted manually using the hospital's electronic medical record. The final date of follow-up to monitor clinical outcomes was January 2021. Results A total of 721 patients were admitted to the hospital. Of these, only 64 (8.87%) patients had “no CPR” orders.Cardiac arrest occurred in 141 (19.5%) patients. The mean duration of beginning of resuscitation was less than a minute and the mean duration of CPR was 19 minutes. The median age was 65 years; 62.4% were male. The most common co-morbidities were hypertension (66%) and diabetes mellitus (56%). The initial rhythm was non-shockable in 93.7% of patients [asystole in 48.4% and Pulseless Electrical Activity (PEA) in 45.3% of patients]. Only six (4.2%) patients had pulseless ventricular tachycardia and three (2.1%) patients had ventricular fibrillation. A total of eight patients (5.6%) survived and were discharged from the hospital; six (4.25%) had non-shockable and two (0.82%) had shockable initial rhythms. The median age of those who survived was 60 years (Figure 1). Conclusions Our study showed that critically sick patients with COVID-19 have a high rate of cardiac arrest and poor outcomes in those who received CPR. A non-shockable initial rhythm indicates that non-cardiac reasons might be playing a major role. These include acute respiratory insufficiency, severe sepsis, or multiorgan failure. These data should inform end-of-life care discussions between providers and patients' families. FUNDunding Acknowledgement Type of funding sources: None.

Analysis of initial rhythm, witnessed status and delay to treatment among survivors of out-of-hospital cardiac arrest in Sweden

Heart ◽  
2010 ◽  
Vol 96 (22) ◽  
pp. 1826-1830 ◽  
Author(s):  
C. Holmgren ◽  
L. Bergfeldt ◽  
N. Edvardsson ◽  
T. Karlsson ◽  
J. Lindqvist ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

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

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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