Abstract 11759: Survival Among Medicare Beneficiaries After Out-of-Hospital Cardiac Arrest Undergoing Interhospital Transfer

Intro: Among individuals treated for out-of-hospital cardiac arrest (OHCA), there is hospital-level variability in mortality, but the relationship between interhospital transfer (IHT) OHCA volume and survival remain unclear. We sought to examine the association of OHCA volume and survival for individuals undergoing IHT. Methods: Utilizing age-eligible Medicare fee-for-service claims, we identified an emergency department treated OHCA cohort using ICD-9/10 diagnosis codes. Hospital OHCA volume was defined as the total number of index (first-treated) OHCA claims during the study period and were binned into quartiles. Each claim was assigned the OHCA volume quartile of the index hospital and the index volume of the receiving hospital. Multiple logistic regression was conducted to assess the association between initial and receiving hospital volume categories and survival to 30 days among IHT patients while controlling for patient-level characteristics (age, sex, race), comorbidity index, urbanicity of index hospital and days to transfer. Results: We identified a cohort of 222,018 claims at 4,461 hospitals between 1/2013-12/2015. Median age was 78 years (IQR 71-85); 44% were female; 11% of the cohort was alive at 30 days. IHT occurred in 12,245 cases (5.5%) and 59% of transfers occurred on the day of admission or day 1. Transfers originated from 3411 index hospitals and 1566 receiving hospitals. Median OHCA hospital index volume was 25 [IQR 9, 67]. Adjusted odds of survival at 30 days was significantly lower at index hospitals with lower OHCA volumes compared to the highest volume category (aOR [95%CI] Q2: 0.71 [0.6, 0.83] p<0.001). Additionally, odds of survival at 30 days was significantly lower at low volume receiving hospitals (aOR [95%CI] Q1: 0.73 [0.55, 0.99] p<0.001), and increased for higher OHCA volume receiving hospitals, but these groups did not achieve statistical significance. Conclusion: For Medicare beneficiaries who suffer an OHCA and undergo IHT, lower index and receiving hospital OHCA volume was significantly associated with decreased adjusted odds of 30-day survival. Further exploration of hospital characteristics, timing, and transfer patterns is needed to understand differences in benefit for OHCA patients undergoing IHT.

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Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults

SLEEP ◽

10.1093/sleep/zsab076 ◽

2021 ◽

Author(s):

G L Dunietz ◽

R D Chervin ◽

J F Burke ◽

A S Conceicao ◽

T J Braley

Keyword(s):

Older Adults ◽

Statistical Significance ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Lower Odds ◽

Logistic Regression Models ◽

Not Otherwise Specified ◽

Dementia Risk ◽

Obstructive Sleep ◽

Study Participants

Abstract Study Objectives To examine associations between PAP therapy, adherence and incident diagnoses of Alzheimer’s disease (AD), mild cognitive impairment (MCI), and dementia not-otherwise-specified (DNOS) in older adults. Methods This retrospective study utilized Medicare 5% fee-for-service claims data of 53,321 beneficiaries, aged 65+, with an OSA diagnosis prior to 2011. Study participants were evaluated using ICD-9 codes for neurocognitive syndromes [AD(n=1,057), DNOS(n=378), and MCI(n=443)] that were newly-identified between 2011-2013. PAP treatment was defined as presence of ≥1 durable medical equipment (HCPCS) code for PAP supplies. PAP adherence was defined as ≥2 HCPCS codes for PAP equipment, separated by≥1 month. Logistic regression models, adjusted for demographic and health characteristics, were used to estimate associations between PAP treatment or adherence and new AD, DNOS, and MCI diagnoses. Results In this sample of Medicare beneficiaries with OSA, 59% were men, 90% were non-Hispanic whites and 62% were younger than 75y. The majority (78%) of beneficiaries with OSA were prescribed PAP (treated), and 74% showed evidence of adherent PAP use. In adjusted models, PAP treatment was associated with lower odds of incident diagnoses of AD and DNOS (OR=0.78, 95% CI:0.69-0.89; and OR=0.69, 95% CI:0.55-0.85). Lower odds of MCI, approaching statistical significance, were also observed among PAP users (OR=0.82, 95% CI:0.66-1.02). PAP adherence was associated with lower odds of incident diagnoses of AD (OR=0.65, 95% CI:0.56-0.76). Conclusions PAP treatment and adherence are independently associated with lower odds of incident AD diagnoses in older adults. Results suggest that treatment of OSA may reduce risk of subsequent dementia.

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Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽

10.1161/circ.130.suppl_2.13131 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shuichi Hagiwara ◽

Kiyohiro Oshima ◽

Masato Murata ◽

Makoto Aoki ◽

Kei Hayashida ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Statistical Significance ◽

Coronary Arteriography ◽

Spontaneous Circulation ◽

P Value ◽

Return Of Spontaneous Circulation ◽

Overall Performance ◽

The Mean ◽

Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

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Abstract 19225: Impact of Change in Resuscitation Guidelines on National Out-of-hospital Cardiac Arrest Outcomes: Fulfilled Expectations?

Circulation ◽

10.1161/circ.132.suppl_3.19225 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Shaker M Eid ◽

Aiham Albaeni ◽

Rebeca Rios ◽

May Baydoun ◽

Bolanle Akinyele ◽

...

Keyword(s):

Time Series ◽

Cardiac Arrest ◽

Time Series Data ◽

Statistical Significance ◽

Interrupted Time Series ◽

The United States ◽

Series Data ◽

National Database ◽

Resuscitation Guidelines ◽

Hospital Cardiac Arrest

Background: The intent of the 5-yearly Resuscitation Guidelines is to improve outcomes. Previous studies have yielded conflicting reports of a beneficial impact of the 2005 guidelines on out-of-hospital cardiac arrest (OHCA) survival. Using a national database, we examined survival before and after the introduction of both the 2005 and 2010 guidelines. Methods: We used the 2000 through 2012 National Inpatient Sample database to select patients ≥18 years admitted to hospitals in the United States with non-traumatic OHCA (ICD-9 CM codes 427.5 & 427.41). A quasi-experimental (interrupted time series) design was used to compare monthly survival trends. Outcomes for OHCA were compared pre- and post- 2005 and 2010 resuscitation guidelines release as follows: 01/2000-09/2005 vs. 10/2005-9/2010 and 10/2005-9/2010 vs. 10/2010-12/2012. Segmented regression analyses of interrupted time series data were performed to examine changes in survival to hospital discharge. Results: For the pre- and post- guidelines periods, 81600, 69139 and 36556 patients respectively survived to hospital admission following OHCA. Subsequent to the release of the 2005 guidelines, there was a statistically significant worsening in survival trends (β= -0.089, 95% CI -0.163 – -0.016, p =0.018) until the release of the 2010 guidelines when a sharp increase in survival was noted which persisted for the period of study (β= 0.054, 95% CI -0.143 – 0.251, p =0.588) but did not achieve statistical significance (Figure). Conclusion: National clinical guidelines developed to impact outcomes must include mechanisms to assess whether benefit actually occurs. The worsening in OHCA survival following the 2005 guidelines is thought provoking but the improvement following the release of the 2010 guidelines is reassuring and worthy of perpetuation.

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Abstract 14171: Prehospital Outcomes and Patient Characteristics Associated With PulsePoint Dispatches for Out-of-Hospital Cardiac Arrest in Pittsburgh, Pennsylvania

Circulation ◽

10.1161/circ.144.suppl_2.14171 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

David Salcido ◽

Christian Martin-Gill ◽

LEONARD WEISS ◽

David D Salcido

Keyword(s):

Cardiac Arrest ◽

Response Time ◽

Statistical Significance ◽

Patient Characteristics ◽

The United States ◽

Spontaneous Circulation ◽

Shockable Rhythm ◽

Bystander Cpr ◽

Case Characteristics ◽

Hospital Cardiac Arrest

Background: Mobile phone-based dispatch of volunteers to out-of-hospital cardiac arrest (OHCA) has been shown to increase the likelihood of early chest compressions and AED application. In the United States, limited characterization of patients encountered as a result of such systems exists, including PulsePoint Respond, a smartphone-based volunteer dispatch system. Objective: Examine prehospital case characteristics and outcomes from a multi-year deployment of PulsePoint in Pittsburgh, Pennsylvania. Methods: Case data, including PulsePoint determinant triggers and timing, prehospital electronic health records (EHRs), and computer aided dispatch records were obtained for suspected EMS-treated OHCA cases that did and did not generate PulsePoint alerts within the service area of Pittsburgh EMS for the period July 2016 to October 2020. EHRs were reviewed to determine true OHCA status, and OHCA case characteristics were extracted according to the Utstein template. Key characteristics and the outcome of prehospital return of spontaneous circulation (ROSC) were summarized and compared between cases with and without PulsePoint dispatches. Chi-squared tests were used to determine statistical significance of relationships. Results: There were 1229 OHCA cases overall in the capture period, with an estimated 29.6% occurring in public. Of 840 total PulsePoint dispatches, 68 (8.1%) were for true OHCA. Forty-five (66.2%) of these were witnessed, 43 (63.2%) received bystander CPR, and 17 (25%) had an AED applied prior to first responder arrival. Twenty-seven (39.7%) had an initial shockable rhythm, and 34 (50%) achieved ROSC in the field. Compared to non-PulsePoint dispatch generating OHCA, PulsePoint alert-associated patients were significantly more likely to be male (p=0.024), have bystander CPR/AED application performed (p<0.001), have an initial shockable rhythm (p<0.001), and achieve ROSC (p<0.001). EMS response time, age, ALS response time, and witnessed status were not significantly different. Conclusions: A minority of PulsePoint dispatches in Pittsburgh were triggered by true OHCA. Among cases that did generate a PulsePoint dispatch, case characteristics were prognostically favorable.

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Abstract 14264: National Comparison of Hospital Market Share for Out-of-Hospital Cardiac Arrest and Elective Cardiac Surgery

Circulation ◽

10.1161/circ.144.suppl_2.14264 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

David G Buckler ◽

Ethan Abbott ◽

Benjamin Abella ◽

Brendan G Carr ◽

Douglas Wiebe ◽

...

Keyword(s):

Cardiac Arrest ◽

Market Share ◽

Cost Savings ◽

Cardiac Surgical Procedures ◽

Fee For Service ◽

Hospital Market ◽

Elective Cardiac Surgery ◽

Replacement Surgery ◽

Market Shares ◽

Hospital Cardiac Arrest

Introduction: Competition in the healthcare market is a theoretical driver of innovation, cost-savings, and improved quality. When patients are treated for certain emergent conditions, such as out-of-hospital cardiac arrest (OHCA), individuals have less choice in their treating hospital. For patients undergoing elective cardiac valve replacement surgery (EVRS), hospital choice may reflect distinct referral patterns and preferences. Our objective was to compare hospital market share for different cardiac services, thus allowing for better understanding of the care landscape and target interventions to improve outcomes. Methods: Using age-eligible Medicare fee-for-service institutional claims, an emergency department (ED) treated OHCA cohort was identified via ICD-9/10 diagnosis codes and ED charges. EVRS, an inpatient referral procedure, were identified from in-patient summary claims using procedure codes. Market shares were built for each hospital by sequential addition of ZIP-code areas and calculating the hospital’s cumulative market share. Geographic market share areas were defined for each hospital at 90%, 25% and 10% cut-offs if present. Correlation between corresponding market shares and patient counts were assessed using Pearson’s r. Results: Between 1/2013 and 12/2015, we identified 206,162 EVRS claims and 222,018 OHCA claims. Median age was similar (77 vs 78 yrs), as was percent of female patient (43% vs 44%). Very few beneficiaries (0.38%) appeared in both cohorts. Many more hospitals cared for OHCA than EVRS (4482 vs 1170). More OHCA treating hospitals achieved a 25% market share (68% vs 57%) however, EVRS hospital with a 25% market share covered more population (420,294 vs 66,394) and had a greater client radius (21 vs 15 miles). Among the hospitals providing care to both cohorts, the cumulative market share and patient counts were positively correlated (r = 0.49 and 0.46 respectively, p<0.001 for both). Conclusion: Despite many more hospitals providing care for OHCA, the market share for EVRS and OHCA trend together. This market trend, combined with the association of better outcomes with higher OHCA volume suggests that OHCA should be regionalized within markets to facilities that provide elective cardiac surgical procedures.

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Abstract 17852: Epinephrine Does Not Impact Survival and May Worsen Neurological Outcomes in Out-of-hospital Cardiac Arrest: Meta-analysis of Randomized Control Trials

Circulation ◽

10.1161/circ.132.suppl_3.17852 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Sayf Altabaqchali ◽

Shashi Kumar ◽

Emad Aziz ◽

Eyal Herzog ◽

Cody William ◽

...

Keyword(s):

Cardiac Arrest ◽

Randomized Controlled Trials ◽

Life Support ◽

Meta Analysis ◽

Statistical Significance ◽

Outcome Data ◽

Controlled Trials ◽

Neurological Outcomes ◽

Randomized Controlled ◽

Hospital Cardiac Arrest

Background: Advanced cardiac life support is a corner stone in the management of cardiac arrest and epinephrine is an important part of its armamentarium. Randomized controlled trials and observational studies have demonstrated inconsistent results regarding the benefits of epinephrine in out-of-hospital cardiac arrest. We conducted a meta-analysis to evaluate mortality and neurological outcomes. Methods: All randomized controlled trials regarding out of hospital cardiac resuscitation were sought using PubMed and Scopus databases from 1963 until June 2015. We calculated the chances of patients surviving to hospital admission and through discharge as well as having a good neurological outcome. Data was analyzed with RevMan 5.2 software. Results: Epinephrine was found to be associated with a higher rate of hospital arrival but not survival to discharge. Epinephrine also had numerically less favorable neurologic outcomes neurological but despite that this was seen in all trials this did not reach statistical significance (OR 0.71, CI95% 0.45-1.12, p 0.14). Conclusion: There is no data to support the use of epinephrine in out-of-hospital cardiac arrest patients. Increased unjustified financial and perhaps social costs seem to be present. Larger randomized controlled trials are needed.

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Abstract 13027: Investigating the Airway Opening Index During Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.144.suppl_2.13027 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Shiv Bhandari ◽

Jason Coult ◽

Natalie Bulger ◽

Catherine Counts ◽

Heemun Kwok ◽

...

Keyword(s):

Cardiac Arrest ◽

Retrospective Study ◽

Cardiopulmonary Resuscitation ◽

Statistical Significance ◽

Chest Compressions ◽

Airway Patency ◽

Significant Difference ◽

Airway Opening ◽

Automated Methods ◽

Hospital Cardiac Arrest

Introduction: In 40-70% of out-of-hospital cardiac arrest (OHCA) cases, chest compressions (CCs) during CPR induce measurable oscillations in capnography (E T CO 2 ). Recent studies suggest the magnitude and frequency of oscillations are due to intrathoracic airflow dependent on airway patency. These oscillations can be quantified by the Airway Opening Index (AOI), ranging from 0-100%. We sought to develop, automate, and evaluate multiple methods of computing AOI throughout CPR. Methods: We conducted a retrospective study of all OHCA cases in Seattle, WA during 2019. E T CO 2 and impedance waveforms from LifePak 15 defibrillators were annotated for the presence of intubation and CPR, and imported into MATLAB for analysis. Four proposed methods for computing AOI were developed (Fig. 1) using peak E T CO 2 in conjunction with ΔE T CO 2 (oscillations in E T CO 2 from CCs). We examined the feasibility of automating ΔE T CO 2 and AOI calculation during CCs throughout OHCA resuscitation and evaluated differences in mean AOI using each method. Statistical significance was assessed with ANOVA (alpha = 0.05). Results: AOI was measurable in 312 of 465 cases. Mean [95% confidence interval] AOI across all cases was 34.3% [32.0-36.5%] for method 1, 27.6% [25.5-29.7%] for method 2, 22.7% [21.1-24.3%] for method 3, and 28.8% [26.6-31.0%] for method 4. Mean AOI was significantly different across the four methods (p<0.001), with the greatest difference between method 1 and 3 (11.6%, p<0.001), but no significant difference between methods 2 and 4 (p=0.44). Mean ΔE T CO 2 was 7.76 [7.08-8.44] mmHg. Conclusion: We implemented four proposed methods of automatically calculating AOI during OHCA. Each method produced a different average AOI. Consistent, automated methods to measure AOI provide the foundation to evaluate if, and how, AOI may change with treatment or predict outcomes. These four approaches require additional investigation to understand which may be best suited to improve OHCA care.

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P2829Arrhythmia burden during long-term follow-up in a large cohort of patients surviving out-of-hospital cardiac arrest

European Heart Journal ◽

10.1093/eurheartj/ehz748.1139 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Caro Codon ◽

L Rodriguez Sotelo ◽

J R Rey Blas ◽

O Gonzalez Fernandez ◽

S O Rosillo Rodriguez ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Admission ◽

Hospital Discharge ◽

Atrial Arrhythmias ◽

Coronary Syndrome ◽

Long Term Follow Up ◽

Index Hospital ◽

Hospital Cardiac Arrest

Abstract Background Data regarding incidence of ventricular (VA) and atrial arrhythmias (AA) in survivors after out-of-hospital cardiac arrest (OHCA) are scarce. Purpose To assess incidence of VA and AA in OHCA patients during long-term follow-up and to identify relevant predictive factors during the index hospital admission. Methods All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA from August 2007 to January 2019 and surviving until hospital discharge were included. Cox proportional hazard models and logistic regression analysis were used to investigate clinical variables related to the incidence of VA and AA. Results The final analysis included 201 patients. Mean age was 57.6±14.2 years and 168 (83.6%) were male. The majority of patients experienced witnessed arrests related to shockable rhythms (176, 87.6%). Thirty-six patients (17.9%) died after a median follow-up of 40.3 months (18.9–69.1), but only 4 presented another cardiac arrest. Eighteen patients (9.0%) suffered new VA and 37 (18.4%) developed atrial fibrillation/atrial flutter. History of coronary heart disease [HR 3.59 (1.37–9.42), p=0.010] and non-acute coronary syndrome-related arrhythmia [HR 5.17 (1.18–22.60), p=0.029] were independent predictors of VA during follow-up. The optimal predictive model for atrial arrhythmias included age at the time of OHCA, LVEF at hospital discharge and non-acute coronary syndrome-related arrhythmias (p<0.001). Table 1 Variable Without VA With VA p value Age, mean ± DS, years 57.4±14.2 60.8±14.7 0.336 Male sex, n (%) 150 (83.3) 15 (83.3) 1.000 Coronary heart disease, n (%) 36 (20.0) 11 (61.1) <0.001 Cardiomyopathy, n (%) 27 (15.0) 8 (44.4) 0.006 Shockable rhythm, n (%) 157 (87.2) 16 (88.9) 1.000 ACS-related arrhythmia (Primary VF), n (%) 83 (46.1) 2 (11.1) 0.004 LVEF at hospital discharge (%) 47.5±13.9 38.3±16.5 0.010 Death during follow-up 32 (17.8) 3 (16.7) 0.603 Cardiac arrest during follow-up 2 (1.1) 2 (11.1) 0.042 CV hospital admission during follow-up 39 (21.7) 14 (77.8) <0.001 Atrial arrhythmias during follow-up 28 (15.6) 9 (50.0) <0.001 Figure 1 Conclusions Despite low incidence of recurrent cardiac arrest, OHCA survivors face a high incidence of VA and AA. Several clinical characteristics during index hospital admission may be useful to identify patients at high risk.

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Abstract 271: Care Patterns for Out Of Hospital Cardiac Arrest Differ From Other Emergency Care Sensitive Conditions

Circulation ◽

10.1161/circ.142.suppl_4.271 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

David G Buckler ◽

Douglas Wiebe ◽

Sarah Sims ◽

Ronan Doorley ◽

Alexis Zebrowski ◽

...

Keyword(s):

Cardiac Arrest ◽

Emergency Care ◽

Systems Of Care ◽

Heart Association ◽

Care Utilization ◽

Fee For Service ◽

Care Patterns ◽

Utilization Patterns ◽

Hospital Cardiac Arrest ◽

Sensitive Conditions

Background: Understanding utilization patterns for out of hospital cardiac arrest (OHCA) is critical to organizing regional systems of care as recommended by the American Heart Association. We examined the agreement between regional utilization patterns for out-of-hospital cardiac arrest (OHCA) and other emergency care sensitive conditions (ECSCs). Methods: We used Medicare fee-for-service outpatient and inpatient claims from 2013-2014 to describe geographic utilization patterns for 5 emergency care conditions as has been done previously. We compared these regional clusters developed for OHCA to similarly created clusters for other emergency cardiovascular (ECV) conditions (by adding STEMI and stroke). Regional ZIP code attributions were compared using a modified Jaccard index, measuring the agreement between region membership. We also calculated patient-level risk-adjusted survival probabilities (controlling for patient age, sex, race and presenting condition) and summarized for each region as an observed-to-expected (O:E) ratio. O:E ratios higher than 1 indicate better than expected survival. Each region was ranked based on its O:E ratio and ranks between the two sets of conditions were compared. Results: The analysis included 3,279,013 ECSC claims containing 246,342 OHCA and 1,037,472 ECV claims grouped into 234 OHCA regions and 343 ECV regions. When comparing OHCA only to all ECV utilization (clusters), agreement was 64%. O:E survival to hospital discharge for OHCA regions showed greater variability compared to ECV regions (OHCA: 0.53-2.2 vs. ECV: 0.90 - 1.10). In comparing ranked O:E outcomes between OHCA and ECV regions, we found 72% discordance in quartile rankings (κ = 0.28). Conclusion: Care utilization pattern and risk-adjusted survival for OHCA in older adults vary greatly when compared to other emergency cardiovascular conditions and should be benchmarked separately. Further research is needed to understand the role strong regionalization of care policies could play in improving outcomes and streamlining care processes.

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Comorbidity and bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Heart ◽

10.1136/heartjnl-2019-315954 ◽

2020 ◽

Vol 106 (14) ◽

pp. 1087-1093

Author(s):

Geir Hirlekar ◽

Martin Jonsson ◽

Thomas Karlsson ◽

Maria Bäck ◽

Araz Rawshani ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Multiple Logistic Regression ◽

Multivariable Model ◽

National Patient Registry ◽

National Patient ◽

Bystander Cardiopulmonary Resuscitation ◽

Bystander Cpr ◽

Comorbidity Index ◽

Hospital Cardiac Arrest

ObjectiveCardiopulmonary resuscitation (CPR) performed before the arrival of emergency medical services (EMS) is associated with increased survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to determine whether patients who receive bystander CPR have a different comorbidity compared with patients who do not, and to determine the association between bystander CPR and 30-day survival when adjusting for such a possible difference.MethodsPatients with witnessed OHCA in the Swedish Registry for Cardiopulmonary Resuscitation between 2011 and 2015 were included, and merged with the National Patient Registry. The Charlson Comorbidity Index (CCI) was used to measure comorbidity. Multiple logistic regression was used to examine the effect of CCI on the association between bystander CPR and outcome.ResultsIn total, 11 955 patients with OHCA were included, 71% of whom received bystander CPR. Patients who received bystander CPR had somewhat lower comorbidity (CCI) than those who did not (mean±SD: 2.2±2.3 vs 2.5±2.4; p<0.0001). However, this difference in comorbidity had no influence on the association between bystander CPR and 30-day survival in a multivariable model including other possible confounders (OR 2.34 (95% CI 2.01 to 2.74) without adjustment for CCI and OR 2.32 (95% CI 1.98 to 2.71) with adjustment for CCI).ConclusionPatients who undergo CPR before the arrival of EMS have a somewhat lower degree of comorbidity than those who do not. Taking this difference into account, bystander CPR is still associated with a marked increase in 30-day survival after OHCA.

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