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

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.

Download Full-text

Outcomes of out-of-hospital cardiac arrest in Beijing: a 5-year cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-041917 ◽

2021 ◽

Vol 11 (4) ◽

pp. e041917

Author(s):

Fei Shao ◽

Haibin Li ◽

Shengkui Ma ◽

Dou Li ◽

Chunsheng Li

Keyword(s):

Cardiac Arrest ◽

Urban Areas ◽

Patient Characteristics ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Term Survival ◽

Shockable Rhythm ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

ObjectiveThe purpose of this study was to assess the trends in outcomes of out-of-hospital cardiac arrest (OHCA) in Beijing over 5 years.DesignCross-sectional study.MethodsAdult patients with OHCA of all aetiologies who were treated by the Beijing emergency medical service (EMS) between January 2013 and December 2017 were analysed. Data were collected using the Utstein Style. Cases were followed up for 1 year. Descriptive statistics were used to characterise the sample and logistic regression was performed.ResultsOverall, 5016 patients with OHCA underwent attempted resuscitation by the EMS in urban areas of Beijing during the study period. Survival to hospital discharge was 1.2% in 2013 and 1.6% in 2017 (adjusted rate ratio=1.0, p for trend=0.60). Survival to admission and neurological outcome at discharge did not significantly improve from 2013 to 2017. Patient characteristics and the aetiology and location of cardiac arrest were consistent, but there was a decrease in the initial shockable rhythm (from 6.5% to 5.6%) over the 5 years. The rate of bystander cardiopulmonary resuscitation (CPR) increased steadily over the years (from 10.4% to 19.4%).ConclusionSurvival after OHCA in urban areas of Beijing did not improve significantly over 5 years, with long-term survival being unchanged, although the rate of bystander CPR increased steadily, which enhanced the outcomes of patients who underwent bystander CPR.

Download Full-text

Factors Affecting a Successful Out-Of-Hospital Cardiopulmonary Resuscitation / Pirmsslimnīcas Etapa Kardiopulmonālo Reanimāciju Rezultātus Ietekmējošie Faktori

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.2478/prolas-2014-0028 ◽

2014 ◽

Vol 68 (5-6) ◽

pp. 228-231

Author(s):

Kaspars Setlers ◽

Indulis Vanags ◽

Anita Kalēja

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hospital Admission ◽

Heart Rhythm ◽

Patient Characteristics ◽

Spontaneous Circulation ◽

Factors Affecting ◽

Bystander Cpr ◽

And Gender ◽

Hospital Cardiac Arrest

Abstract A retrospective patient record analysis of the Emergency Medial Service’s Rîga City Regional Centre was provided from January 2012 through December 2013. 1359 adult patients were CPR treated for out-of-hospital cardiac arrest according to ERC Guidelines 2010. A total of 490 patients were excluded from the study. The main outcome measure was survival to hospital admission. Of 869 CPR-treated patients, 60% (n = 521) were men. The mean age of patients was 66.68 ± 15.28 years. The survival rate to hospital admission was 12.9% (n = 112). 54 of survived patients were women. Mean patient age of successful CPR was 63.22 ± 16.21 and unsuccessful CPR 67.20 ± 15.09. At least one related illness was recorded with 63.4% (n = 551) patients. There were 61 survivors in bystander witnessed OHCA and nine survivors in unwitnessed OHCA. The rate of bystander CPR when CA (cardiac arrest) was witnessed was 24.8%. Ventricular fibrillation (VF) as initial heart rhythm was significantly associated with survival to hospital admission in 54 cases (p < 0.0001). Age and gender affected return of spontaneous circulation. Survival to hospital admission had rhythm-specific outcome. Presence of OHCA witnesses improved outcome compared to bystander CPR. The objective of this study was to report patient characteristics, the role of witnesses in out-of-hospital cardiac arrest (OHCA) and outcome of adult cardiopulmonary resuscitation

Download Full-text

Abstract 10: Regional Variation in Out-Of-Hospital Cardiac Arrest Survival in the United States

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.10 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Saket Girotra ◽

Sean van Diepen ◽

Brahmajee K Nallamothu ◽

Margaret Carrel ◽

Monique L Anderson ◽

...

Keyword(s):

Cardiac Arrest ◽

Regional Variation ◽

The United States ◽

Hierarchical Regression ◽

County Level ◽

Hypothermia Treatment ◽

Shockable Rhythm ◽

Bystander Cpr ◽

Cardiac Arrest Survival ◽

Hospital Cardiac Arrest

Background: Although previous studies have shown marked variation in out-of-hospital cardiac arrest survival across U.S. regions, factors underlying this variation in survival remain unknown. Methods & Results: Using 2005-2013 data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 88,305 adult patients (age >18 years) in 107 U.S. counties with out-of-hospital cardiac arrest at home or in a public location, and geo-coded them to a U.S. county using the address where cardiac arrest occurred We constructed a two-level hierarchical regression model (patient & county) and used median odds ratios (MOR) to quantify regional variation in out-of-hospital cardiac arrest survival. Moreover, we examined the proportion of variation in survival that was explained by 1) patient demographics 2) cardiac arrest characteristics 3) county-level rates of bystander cardiopulmonary resuscitation (CPR) and hypothermia treatment and 4) county-level socio-demographic factors. The mean rate of survival to discharge was 10.0%, and varied markedly across counties (range: 1.4%-18.4%, MOR: 1.33; 95% CI: 1.24-1.38, Figure 1). Compared to counties in the lowest quartile of survival, patients in the highest quartile counties were younger (62.5 vs 61.6 years), more likely to be men (60.8% vs 64.4%), have a shockable rhythm (21.1% vs 26.9%), witnessed arrest (50.3% vs 53.0%), receive bystander CPR (23.4% vs 32.6%), and hypothermia (44.4% vs 62.3%, P for trend < 0.01 for all). County-level rates of survival were positively correlated with rates of bystander CPR (ρ = 0.45, P < 0.0001) and hypothermia treatment (ρ = 0.24, P < 0.0001). Sequential adjustment of demographic and cardiac arrest characteristics explained only 4.3% and 12.4% of the county-level variation in survival, respectively. Inclusion of county-level rates of bystander CPR and hypothermia explained a total of 28.5% of the survival variation, and this proportion increased to 36% after adjustment of other county-level factors. Conclusion: There is substantial variation in out-of-hospital cardiac arrest survival across U.S. counties. Although a large proportion of survival variation was unexplained, most of the variation that could be accounted for was due to county-level differences in rates of bystander CPR and hypothermia treatment.

Download Full-text

Dispatcher-assisted cardiopulmonary resuscitation for traumatic patients with out-of-hospital cardiac arrest

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-019-0679-2 ◽

2019 ◽

Vol 27 (1) ◽

Cited By ~ 2

Author(s):

Chien-Hsin Lu ◽

Pin-Hui Fang ◽

Chih-Hao Lin

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Statistical Significance ◽

Spontaneous Circulation ◽

Stepwise Logistic Regression ◽

Population Database ◽

Stepwise Logistic Regression Analysis ◽

Emergency Calls ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Abstract Background Resuscitation efforts for traumatic patients with out-of-hospital cardiac arrest (OHCA) are not always futile. Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) during emergency calls could increase the rate of bystander cardiopulmonary resuscitation (CPR) and thus may enhance survival and neurologic outcomes of non-traumatic OHCA. This study aimed to examine the effectiveness of DA-CPR for traumatic OHCA. Methods A retrospective cohort study was conducted using an Utstein-style population database with data from January 1, 2014, to December 31, 2016, in Tainan City, Taiwan. Voice recordings of emergency calls were retrospectively retrieved and reviewed. The primary outcome was an achievement of sustained (≥2 h) return of spontaneous circulation (ROSC); the secondary outcomes were prehospital ROSC, ever ROSC, survival at discharge and favourable neurologic status at discharge. Statistical significance was set at a p-value of less than 0.05. Results A total of 4526 OHCA cases were enrolled. Traumatic OHCA cases (n = 560, 12.4%), compared to medical OHCA cases (n = 3966, 87.6%), were less likely to have bystander CPR (10.7% vs. 31.7%, p < 0.001) and initially shockable rhythms (7.1% vs. 12.5%, p < 0.001). Regarding DA-CPR performance, traumatic OHCA cases were less likely to have dispatcher recognition of cardiac arrest (6.3% vs. 42.0%, p < 0.001), dispatcher initiation of bystander CPR (5.4% vs. 37.6%, p < 0.001), or any dispatcher delivery of CPR instructions (2.7% vs. 20.3%, p < 0.001). Stepwise logistic regression analysis showed that witnessed cardiac arrests (aOR 1.70, 95% CI 1.10–2.62; p = 0.017) and transportation to level 1 centers (aOR 1.99, 95% CI 1.27–3.13; p = 0.003) were significantly associated with achievement of sustained ROSC in traumatic OHCA cases, while DA-CPR-related variables were not (All p > 0.05). Conclusions DA-CPR was not associated with better outcomes for traumatic OHCA in achieving a sustained ROSC. The DA-CPR program for traumatic OHCAs needs further studies to validate its effectiveness and practicability, especially in the communities where rules for the termination of resuscitation in prehospital settings do not exist.

Download Full-text

Abstract 118: The Epidemiology of Airway Management Following Pediatric Out-of-Hospital Cardiac Arrest in the United States

Circulation ◽

10.1161/circ.138.suppl_2.118 ◽

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 ◽

Airway Management ◽

Multivariable Analysis ◽

Cerebral Performance Category ◽

The United States ◽

Supraglottic Airway ◽

Shockable Rhythm ◽

Advanced Airway ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: Bag mask ventilation (BMV) has been associated with improved survival following out of hospital cardiac arrest (OHCA), however advanced airway placement remains part of pre-hospital protocols for many emergency medical services (EMS) agencies. Hypothesis: To characterize airway management for pediatric OHCA and assess whether BMV alone vs. BMV plus advanced airway (supraglottic airway or tracheal intubation) is associated with neurologically favorable survival. 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 EMS. To adjust for covariate imbalance, propensity score matching and entropy balancing were utilized; variables included age category, sex, bystander CPR, and shockable rhythm. The primary outcome was favorable neurologically favorable survival defined as a cerebral performance category scale of 1 or 2. Results: Of 5241 cardiac arrests, 2588 (49.3%) had BVM and 2653 (50.6%) had advanced airway placement. The majority 5118 (97.7%) were resuscitated by agencies using both BMV and advanced airways. Advanced airway placement was more common in older children compared to infants, arrests with bystander CPR, in white and Hispanic children, witnessed arrests, arrests with a shockable rhythm, and AED use (Table). Neurologically favorable survival was significantly higher with BMV compared to advanced airways in bivariate analysis (11.4% vs. 5.7%, p<0.001). In multivariable analysis, advanced airway placement was associated with lower neurologically favorable survival (adjusted proportion 4.9% vs. 13.5% BVM, OR 0.21, 95% CI 0.17, 0.28). These results were robust on propensity analysis 3.0% advanced airway vs.11.9% BMV (OR 0.18, 95% CI 0.14, 0.25), and entropy balance 5.9% advanced airway, 15.0% for BMV (OR 0.28, 95% CI 0.22). Conclusion: In pediatric OHCA, advanced airways are placed in half of cardiac arrests where resuscitation is attempted. Advanced airway, compared to BMV alone management, is associated with lower neurologically favorable survival.

Download Full-text

Abstract 184: AED Application in Non-Shockable Out-of-Hospital Cardiac Arrest Does Not Reduce Survival

Circulation ◽

10.1161/circ.138.suppl_2.184 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Ross A Pollack ◽

Siobhan P Brown ◽

Thomas Rea ◽

Peter J Kudenchuk ◽

Myron L Weisfeldt

Keyword(s):

Cardiac Arrest ◽

Primary Outcome ◽

Patient Characteristics ◽

Neurological Status ◽

Relative Safety ◽

Initial Rhythm ◽

Bystander Cpr ◽

Rhythm Analysis ◽

In Transit ◽

Hospital Cardiac Arrest

Introduction: It is well established that AEDs improve outcome in shockable out-of-hospital cardiac arrest (OHCA). An increasing proportion (now the majority) of OHCAs present with non-shockable rhythms. Survival from non-shockable OHCA depends on high-quality CPR in transit to definitive care. Studies of AED use in non-shockable in-hospital arrest (as opposed to OHCA) have shown reduced survival with AED application possibly due to CPR interruptions to apply pads and perform rhythm analysis. We sought to determine whether AED application in non-shockable public, witnessed OHCA has a significant association with survival to discharge. Methods: This is a retrospective analysis of OHCA from 2010-2015 at 10 Resuscitation Outcomes Consortium centers. All adult, public, witnessed non-shockable OHCAs were included. Non-shockable arrest was defined as no shock delivered by the AED or by review of defibrillator tracings (10%). The initial rhythm on EMS arrival was used to confirm the rhythm. The primary outcome was survival to hospital discharge with favorable neurological status (modified rankin score <3). The OR was adjusted for the Utstein variables. Results: During the study period there were 1,597 non-shockable public, witnessed OHCA, 9.8% of which had an AED applied. The initial rhythm on EMS arrival was PEA or asystole in 86% of cases. Significantly more OHCA in the AED applied group had CPR performed. 6.5% of those without an AED applied survived with favorable neurologic status compared to 9% with an AED. After adjustment for the Utstein variables including bystander CPR, the aOR for survival with favorable neurologic outcome was 1.38 (95% CI:0.72-2.65). Conclusion: After adjusting for patient characteristics and bystander CPR, the application of an AED in non-shockable public witnessed OHCA had no significant association with survival or neurological outcome supporting the relative safety and potential benefit of AED application in non-shockable OHCA.

Download Full-text

Abstract 170: Challenges in Implementing an ECPR Program for Out of Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.170 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Meshe Chonde ◽

Jeremiah Escajeda ◽

Jonathan Elmer ◽

Frank X Guyette ◽

Arthur Boujoukos ◽

...

Keyword(s):

Cardiac Arrest ◽

Inclusion Criteria ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Implementation Challenges ◽

Shockable Rhythm ◽

Bystander Cpr ◽

Stay And Play ◽

Load And Go ◽

Mechanical Cpr ◽

Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapy. Many institutions are interested in developing their own ECPR program. However, there are challenges in logistics and implementation. Hypothesis: Development of an ECPR team and identification of UPMC Presbyterian as a receiving center will increase recognition of potential ECPR candidates. Methods: We developed an infrastructure of Emergency Medical Services (EMS), Medic Command, and an in-hospital ECPR team. We identified inclusion criteria for patients with an out of hospital cardiac arrest (OHCA) likely to have a reversible arrest etiology and developed them into a simple checklist. These criteria were: witnessed arrest with bystander CPR, shockable rhythm, and ages 18 to 60. We trained local EMS crews to screen patients and review the checklist with a Command Physician prior to transport to our hospital. Results: From October 2015 to March 31 st 2018, there were 1165 dispatches for OHCA, of which 664 (57%) were treated and transported to the hospital and 120 to our institution. Of these, five patients underwent ECPR. Of the remaining cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. Prehospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) underwent mechanical CPR with LUCAS device. Time from arrest to arrive on scene was 5 [IQR 4-6] min and time call MD command was 13 [IQR 7-21] min. Time to transport was 20 [IQR 19-21] min. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min. Conclusions: ECPR is a relatively infrequent occurrence. Implementation challenges include prompt identification of patients with reversible OHCA causes, preferential transport to an ECPR capable facility and changing the focus of EMS in these select patients from a “stay and play” to a “load and go” mentality.

Download Full-text

Abstract P80: Short-term Outcomes of Vasopressin Administerd with Epinephrine versus Epinephrine Alone in ED for Out-of-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.118.suppl_18.s_1462-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Tae Yun Kim ◽

Sun Woo Lee ◽

Kyuseok Kim ◽

Joong Eui Rhee ◽

Sung Koo Jung

Keyword(s):

Cardiac Arrest ◽

Spontaneous Circulation ◽

National Registry ◽

Controlled Clinical Trial ◽

Emergency Medical Service System ◽

Short Term ◽

Combined Administration ◽

Before And After ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OOHCA) victims are increasing, but emergency medical service system (EMSS) is not ready for them in Korea. A previous randomized, controlled clinical trial has suggested that vasopressin followed epinephrine was superior to epinephrine in patients with asystole. According to the Korean national registry of OOHCA, patients with asystole were more than two thirds of them. In Korean EMSS, no drugs are permitted to administer in the prehospital phase by law. Thereafter epinephrine or vasopressin cannot be administered until patients are transported to emergency departments (EDs). This study was to evaluate whether the combined administration of vasopressin and epinephrine in ED for OOHCA patients would increase the return of spontaneous circulation (ROSC) and survival discharge. Methods: From October 2007 to May 2008, we changed the CPR protocol in adult, nontraumatic OOHCA that 40 U of vasopressin was administered as soon as possible after the first dose of epinephrine (the after group). Cardiac arrest data were collected using the Utstein template. Data from January to September 2007, when vasopressin has not been used, were also collected for comparative analysis (the before group). These two groups were compared in terms of ROSC, and survival discharge Results: There were 45 and 50 patients in the before and after groups, respectively. There was no significant differences in the initial ECG rhythm of asystole (67% vs 78%), witnessed arrest (73% vs 72%), bystander CPR (16% vs 10%), time from collapse to BLS time (6 min vs 8.5 min), and time from collapse to study drugs (23 min vs 26.5 min). The rate of sustained ROSC was similar between the before and after groups (53% vs 48%, P=0.604) as was the survival discharge (27% vs 14%, P=0.123). Conclusions: Vasopressin with administerd with epinephrine does not increase the rate of ROSC nor the survival discharge.

Download Full-text

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.

Download Full-text

Abstract 236: Regional Incidence and Outcome of Out-of-Hospital Cardiac Arrest Associated with Overdose

Circulation ◽

10.1161/circ.130.suppl_2.236 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

David D Salcido ◽

Allison C Koller ◽

Cesar D Torres ◽

Aaron M Orkin ◽

Rob H Schmicker ◽

...

Keyword(s):

Cardiac Arrest ◽

North America ◽

Prescription Drugs ◽

Regional Variation ◽

Spontaneous Circulation ◽

Research Network ◽

Shockable Rhythm ◽

Statistics Canada ◽

Population Counts ◽

Hospital Cardiac Arrest

Introduction: The frequency of lethal overdose due to prescription and non-prescription drugs is increasing in North America. The contribution of drug overdose (OD) to regional variation in the incidence and outcome out-of-hospital cardiac arrest (OHCA) is unclear. Objective: To estimate overall and regional variation in incidence and outcomes of emergency medical services (EMS)-treated OD-OHCA cases across North America. Methods: The Resuscitation Outcomes Consortium (ROC) is a clinical research network with 10 regional clinical centers in United States (US) and Canada that uses uniform methods for surveillance of all EMS-treated OHCA in participating regions. Cases of OHCA from 2006 to 2010 were reviewed for evidence of association with or without OD. Incidence of OD-OHCA was calculated as the number of OD-OHCA in a region per 100,000 cumulative person-years, using 2000 US Census and 2006 Statistics Canada population counts. Patient and EMS characteristics as well as outcome were described. Multiple logistic regression was used to describe the association between OD status on return of spontaneous circulation (ROSC) and survival to hospital discharge, while adjusting for case characteristics and consortium center. Results: Included were 56,272 cases of OHCA. Regional incidence of OD-OHCA varied between 0.5 and 2.7 per 100,000 person years (p<0.001), and proportion of OD-OHCA among all EMS-treated OHCA ranged from 0.9% to 3.8%. Table 1 shows outcomes and characteristics stratified by OD status; OD-OHCA were younger, less likely to be witnessed, and less likely to present with a shockable rhythm. Compared to non-OD, OD-OHCA was associated with ROSC (OR: 1.55; 95%CI: 1.35-1.78) and survival (OR: 2.14; 95%CI: 1.72-2.65). Conclusions: OD-OHCA are a small proportion of all OHCA, although incidence varied up to 5-fold across regions. OD-OHCA were more likely to survive than non-OD-OHCA.

Download Full-text