Abstract 165: Hospital Variation in Time to Administration of Epinephrine After Cardiac Arrest With Initial Non-shockable Rhythm

Background: For patients with in-hospital cardiac arrests due to non-shockable rhythms, delays in epinephrine administration beyond 5 minutes is associated with worse survival. However, the extent of hospital variation in delayed epinephrine administration and its impact on hospital-level outcomes is unknown. Methods: Within Get with the Guidelines-Resuscitation, we identified 103,932 adult patients (>18 years) at 548 hospitals with an in-hospital cardiac arrest due to a non-shockable rhythm who received at least 1 dose of epinephrine between 2000 to 2014. We constructed two-level hierarchical regression models to quantify hospital variation in rates of delayed epinephrine administration (>5 minutes) and its association with hospital rates of survival to discharge. Results: Among the 548 hospitals, there was substantial variation in rates of delayed epinephrine administration (median 13.5%, range: 0%- 53.8%). The odds of delay in epinephrine administration were 61% higher at one randomly selected hospital compared to a similar patient at another randomly selected hospitals (median odds ratio [OR] 1.61; 95% C.I. 1.54 - 1.67). After adjusting for patient characteristics, the median risk-standardized survival rate for non-shockable in-hospital cardiac arrests was 12.1% and varied significantly across hospitals (range: 5.2% to 30.9%). There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized survival rate for cardiac arrests due to non-shockable rhythm (ρ= -0.23, P<0.0001). Compared to hospitals in the best quartile, risk-standardized survival was 17.4% lower at hospitals in the worst quartile of delayed epinephrine administration (13.8% vs. 11.4%, P<0.0001, Figure). Conclusions: Although delays in epinephrine administration following in-hospital cardiac arrest are common, there is substantial hospital variation in rates of delayed epinephrine administration. Hospitals with high rates of delayed epinephrine administration were found to have lower rates of risk-adjusted survival. Further studies are needed to determine if improving hospital performance on time to epinephrine administration, especially at hospitals with poor performance on this metric will lead to improvement in outcomes.

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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.

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Abstract 44: Time to Epinephrine Impacts Mortality Following Pediatric In-Hospital Nonshockable Cardiac Arrest

Circulation ◽

10.1161/circ.130.suppl_2.44 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Lars W Andersen ◽

Katherine Berg ◽

Brian Z Saindon ◽

Joseph M Massaro ◽

Tia T Raymond ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Neurological Outcome ◽

Spontaneous Circulation ◽

National Registry ◽

Epinephrine Administration ◽

Negatively Associated ◽

Logistic Regression Models ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Background: Delay in administration of the first epinephrine dose has been shown to be associated with a lower chance of good outcome in adult, in-hospital, non-shockable cardiac arrest. Whether this association is true in pediatric in-hospital non-shockable cardiac arrest remains unknown. Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify pediatric patients (age < 18 years) with an in-hospital cardiac arrest between 2000 and 2010. We included patients with an initial non-shockable rhythm who received at least one dose of epinephrine. To assess the association between time to epinephrine administration and survival to discharge we used multivariate logistic regression models with adjustment for multiple predetermined variables including age, gender, illness category, pre-existing mechanical ventilation, monitored, witnessed, location, time of the day/week, year of arrest, insertion of an airway, initial rhythm, time to initiation of cardiopulmonary resuscitation, hospital type and hospital teaching status. Secondary outcomes included return of spontaneous circulation (ROSC) and neurological outcome. Results: 1,131 patients were included. Median age was 9 months (quartiles: 21 days - 6 years) and 46% were female. Overall survival to hospital discharge was 29%. Longer time to epinephrine was negatively associated with survival to discharge in multivariate analysis (OR: 0.94 [95%CI: 0.90 - 0.98], per minute delay). Longer time to epinephrine was negatively associated with ROSC (OR: 0.93 [95%CI: 0.90 - 0.97], per minute delay) but was not statistically significantly associated with survival with good neurological outcome (OR: 0.95 [95%CI: 0.89 - 1.03], per minute delay). Conclusions: Delay in administration of epinephrine during pediatric in-hospital cardiac arrest with a non-shockable rhythm is associated with a lower chance of ROSC and lower survival to hospital discharge.

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Abstract 309: Prediction Chart for Neurological Outcomes of Elderly Patients with Out-of-hospital Cardiac Arrest and the Corresponding Time to Termination of Resuscitation: Evidence from a Japanese Nationwide Population-based Cohort Study

Circulation ◽

10.1161/circ.142.suppl_4.309 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Akira Funada ◽

Yoshikazu Goto ◽

Masayuki Takamura

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Elderly Patients ◽

Service Providers ◽

Patient Characteristics ◽

Case Scenario ◽

Worst Case ◽

Neurological Outcomes ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Introduction: Neurological outcomes and the appropriate duration from call receipt to termination of resuscitation (TOR) in patients with out-of-hospital cardiac arrest (OHCA) could differ according to patient characteristics. Hypothesis: We hypothesized that a prediction chart comprising prehospital variables, including age, could be useful for predicting neurological outcomes and determining the time to TOR in the field or at the emergency department. Methods: We evaluated 19,829 elderly patients with OHCA (age ≥65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC). Data were obtained from the prospectively recorded All-Japan Utstein Registry between 2011 and 2016. Patients with OHCA witnessed by emergency medical service providers were excluded. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1-2. Patients with OHCA were divided into 12 groups according to shockable rhythm (YES/NO), witness status (YES/NO), and age (65-74, 75-89, or ≥90 years). The time from call receipt to ROSC was calculated and categorized by 5-min intervals. The time from call receipt to ROSC at which the probability of 1-month CPC 1-2 decreased to <1% was defined as the call to TOR duration. Results: The overall 1-month CPC 1-2 rate was 18.9% (n = 3,756). When stratified by patient characteristics, the 1-month CPC 1-2 rates ranged from 52.3% in patients aged 65-74 years with shockable rhythm and witnessed OHCA (best-case scenario) to 1.6% in patients aged ≥90 years with non-shockable rhythm and un-witnessed OHCA (worst-case scenario). The corresponding call to TOR duration ranged from 35 to 10 min (Table). Conclusions: Neurological outcomes and the appropriate call to TOR duration differed according to patient characteristics, including age. Our prediction chart for elderly patients with OHCA could be useful for determining TOR in the field or at the emergency department.

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P1703Impact of prehospital epinephrine administration and quality of cardiopulmonary resuscitation on neurologically intact survival in out-of-hospital cardiac arrest patients with non-shockable rhythm

European Heart Journal ◽

10.1093/eurheartj/ehz748.0458 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Funada ◽

Y Goto ◽

H Okada ◽

T Maeda ◽

M Takamura

Keyword(s):

Cardiac Arrest ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

High Quality ◽

Epinephrine Administration ◽

Hospital Arrival ◽

Shockable Rhythm ◽

Neurologically Intact ◽

Hospital Cardiac Arrest

Abstract Background The effects of prehospital epinephrine administration in combination with the quality of cardiopulmonary resuscitation (CPR) on neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythm remains unclear. Purpose This study aimed to elucidate the effects of prehospital epinephrine administration in combination with the quality of CPR on neurologically intact survival in OHCA patients with non-shockable rhythm. Methods We analysed 118,732 adult OHCA patients with non-shockable rhythm from the All-Japan OHCA registry between 2011 and 2016 (29,989 emergency medical service [EMS]-witnessed arrests with EMS-initiated CPR [high-quality CPR] and 88,743 bystander-witnessed arrests with bystander-initiated CPR continued by EMS providers [low-quality CPR]). Patients who achieved prehospital return of spontaneous circulation without prehospital epinephrine administration were excluded. The primary outcome measure was 1-month neurologically intact survival (cerebral performance category 1 or 2; CPC 1–2). Time from collapse to prehospital epinephrine administration for patients with prehospital epinephrine administration, or to hospital arrival for patients without prehospital epinephrine administration was calculated and adjusted collectively in multivariate logistic regression analysis for 1-month CPC 1–2. Results Multivariate logistic regression analysis revealed that the time from collapse to prehospital epinephrine administration or to hospital arrival was negatively associated with 1-month CPC 1–2 (adjusted odds ratio [OR] 0.95 per 1-minute increment, 95% confidence interval [CI] 0.94–0.96). Compared with bystander-witnessed arrests without prehospital epinephrine administration, EMS-witnessed arrests with or without prehospital epinephrine administration were significantly associated with increased chances of 1-month CPC 1–2 (adjusted OR 2.04, 95% CI 1.50–2.75 and adjusted OR 1.97, 95% CI 1.57–2.48, respectively). Prehospital epinephrine administration was significantly associated with an increased chance of 1-month CPC 1–2 among bystander-witnessed arrests (adjusted OR 1.57, 95% CI 1.24–1.98), but not among EMS-witnessed arrests. EMS-witnessed arrests without prehospital epinephrine administration were significantly associated with an increased chance of 1-month CPC 1–2 compared with bystander-witnessed arrests with prehospital epinephrine administration (adjusted OR 1.26, 95% CI 1.01–1.56). Conclusions High-quality CPR is crucial for increasing neurologically intact survival in OHCA patients with non-shockable rhythm. The additional beneficial effects of prehospital epinephrine administration were observed only among OHCA patients with low-quality CPR.

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Survival rate of incoming patients with cardiac arrest at the cardiology infirmary of the emergency department of a public hospital in Greece

Health & Research Journal ◽

10.12681/healthresj.20871 ◽

2019 ◽

Vol 5 (2) ◽

pp. 53

Author(s):

Styliani Papadopoulou ◽

Olympia Konstantakopoulou ◽

Antonia Kalogianni ◽

Martha Kelesi-Stavropoulou ◽

Theodore Kapadohos

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Survival Rate ◽

Emergency Room ◽

Survival Rates ◽

Public Health Problem ◽

Spontaneous Circulation ◽

Shockable Rhythm ◽

Discharged Patients ◽

Hospital Cardiac Arrest

Introduction: Cardiac arrest is an urgent situation that, despite the improved resuscitation capabilities, the survival rate of out-of-hospital cardiac arrest victims remains low.Aim: Τo investigate the survival rate of the incoming patients with cardiac arrest in the cardiology infirmary of the emergency department of a public hospital.Material-Method: The study included 210 patients who were transferred pulseless and breathless at the cardiology infirmary of the emergency department of “Tzaneio” Hospital, Piraeus, during the period April 2017 - November 2018. Data was collected from the National Center of Emergency Dispatch's printed forms, as well as from the patients’ admission book of the emergency department.Results: More than 10% (11.9%) of patients with cardiac arrest returned to spontaneous circulation in the emergency department, of which 16% was discharged. Patients with known cardiac history, (p=0.002), with a shockable rhythm (p<0.001), and especially ventricular fibrillation (p<0.001) upon arrival at the emergency room, and patients who were defibrillated at the ambulance during admission and at the emergency room, were more likely to survive (p<0.001). No statistically significant correlation was found between the factors studied and survival after cardiac arrest, in the group of patients that were discharged.Conclusions: The survival rate of the incoming patients with cardiac arrest at the emergency department of “Tzaneio” Hospital, Piraeus, was low. As for most health systems, this issue constitutes a fairly complex public health problem. Cardiopulmonary resuscitation and corresponding guidelines require further improvement in order for the survival rates of out-of-hospital cardiac arrest patients to increase.

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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 146: Neurological Prognostication by Gender in Patients with Out-of-Hospital Cardiac Arrest Receiving Hypothermia Treatment

Circulation ◽

10.1161/circ.130.suppl_2.146 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Min Jung Kim ◽

Sang Do Shin ◽

William McClellan ◽

Bryan McNally

Keyword(s):

Cardiac Arrest ◽

Cardiac Rhythm ◽

Age Groups ◽

Patient Characteristics ◽

Neurologic Outcome ◽

Neurologic Recovery ◽

Hypothermia Treatment ◽

Shockable Rhythm ◽

Gender And Age ◽

Hospital Cardiac Arrest

Objectives: This study aimed to to examine whether neurologic recovery of out-of-hospital cardiac arrest patients receiving hypothermia treatment is enhanced for women of childbearing age. Methods: A cross-sectional analysis was conducted using a nationwide surveillance database in Korea of out-of-hospital cardiac arrest (OHCA) that occurred between 2008 and 2012. The exposure and outcomes studied were hypothermia treatment and neurologic outcome at discharge. Patient characteristics between hypothermia-treated and non-treated groups were compared. Multivariate logistic regression was used to account for the patient characteristics. The association was examined for each stratum of gender, age (<45, 45-65, and >65 years old), and initial cardiac rhythm. Cardiac rhythms were considered in two different categorizations: 1) shockable/non-shockable rhythm, and 2) VF.VT/PEA/asystole. Results: Crude analysis showed that women of childbearing ages treated with hypothermia had enhanced neurologic recovery than older aged women and all men. After adjusted, men had stronger association between hypothermia and good neurologic recovery than women. The highest association was found in men who are under 45 years of age and have shockable cardiac rhythm (OR=2.00 (1.26, 3.19)). The association between hypothermia and neurologic recovery was not statistically significant in all women. The magnitude of association decreased with age. Shockable rhythm was associated with better neurologic recovery than non-shockable rhythms in all gender and age groups. Using VF.VT/PEA/asystole categorization of cardiac rhythms, men consistently showed higher ORs than women. In all gender and age groups, having PEA rhythm was associated with better neurologic outcome than shockable rhythms (VF/VT) or asystole. Conclusion: The unadjusted association between hypothermia and neurologic recovery was the strongest in women of childbearing ages. After adjustment, men had a better neurologic outcome than women across all ages. Shockable rhythms were associated with enhanced neurologic recovery. Our results suggest that among OHCA patients, the effect of hypothermia treatment on neurologic recovery is greater for men, young ages, and having shockable cardiac rhythm.

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Abstract 120: Outcomes of Out-of-Hospital Cardiac Arrest in Children

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.120 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Natalie Jayaram ◽

Bryan McNally ◽

Fengming Tang ◽

Paul S Chan

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Temporal Trends ◽

Pulseless Electrical Activity ◽

Patient Characteristics ◽

National Registry ◽

Older Children ◽

Shockable Rhythm ◽

Study Population ◽

Hospital Cardiac Arrest

Background: As pediatric out-of-hospital cardiac arrest (OHCA) occurs infrequently, little is known about survival outcomes in children. We examined whether OHCA survival in children differed by patients’ age, sex, and race, as well as recent survival trends. Methods: Within the Cardiac Arrest Registry to Enhance Survival (CARES), a prospective U.S. OHCA registry encompassing 64 million residents, we identified patients less than 18 years of age with an OHCA from October, 2005 to December, 2012. We examined whether survival differed by patients’ age (≤1 year, 1-8 years, >8 years), sex, race, and initial cardiac arrest rhythm, using modified Poisson regression, adjusted for patient characteristics. Similarly, we examined trends in survival, with years 2005-7 as the reference. Results: A total of 1,412 patients with an OHCA were identified, of which 67 (4.7%) were infants, 918 (65.0%) were younger children, and 427 (30.2%) older children. Sixty percent of the study population was male and 33.4% were black. The vast majority of arrests involved a non-shockable rhythm, with only 9.2% of patients having a first documented rhythm of ventricular tachycardia (VT) or ventricular fibrillation (VF). Overall, 103 (7.3%) patients survived to hospital discharge. Of those with non-shockable rhythms (asystole, pulseless electrical activity, and unknown, non-shockable rhythms), 4.4% survived to discharge compared with a survival of 36.2% in those with VT or VF (P<0.001). After adjustment for patient characteristics, children 1-8 years of age were less likely to survive to hospital discharge compared with children >8 years of age (rate ratio [RR]: 0.52; 95% confidence interval [CI]: 0.34, 0.82). In addition, OHCAs due to VT or VF were associated with improved survival (RR 6.67; 95% CI 4.35, 10.23). In contrast, there were no differences in survival by sex or race. Additionally, no temporal trends in survival were observed (p=0.47). Conclusion: In a large, national registry of pediatric OHCA, we found no disparities in survival by patients’ sex, race, or year of arrest, although survival was lower in young children and those with non-shockable cardiac arrest rhythms.

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Abstract 188: Racial Disparities in Survival Outcomes Following Pediatric In-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.188 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Sarah E Haskell ◽

Saket Girotra ◽

Yunshu Zhou ◽

Marina Del Rios ◽

Raina M Merchant ◽

...

Keyword(s):

Cardiac Arrest ◽

Racial Differences ◽

Heart Association ◽

Spontaneous Circulation ◽

Epinephrine Administration ◽

Black Race ◽

Shockable Rhythm ◽

Black Patients ◽

Hospital Cardiac Arrest ◽

White Patients

Introduction: Among adults with in-hospital cardiac arrest (IHCA), overall survival is lower in black patients compared to white patients. Data regarding racial differences in survival for pediatric IHCA remain unknown. Methods: Using data from the American Heart Association Get With the Guidelines-Resuscitation registry, we identified children >24 hours and < 18 years of age with IHCA due to an initial pulseless rhythm. We used generalized estimation equation to examine the association of black race with survival to hospital discharge and return of spontaneous circulation (ROSC). Results: Overall, 2940 pediatric patients (898 black, 2042 white) with IHCA were included. The mean age was 6 years, 57% were male and 16% had an initial shockable rhythm. Baseline demographics, cardiac arrest characteristics including initial rhythm did not differ significantly by race. Although black race was associated with lower rates of ROSC compared to white patients (69.5% in blacks vs. 74.6% in whites; adjusted OR 0.8012, 95% CI 0.6749 - 0.9512, P= 0.0113), it was not associated with survival to discharge (34.7% in blacks vs. 37.8% in whites; adjusted OR 0.9705, 95% CI 0.8086 – 1.1648, P=0.7476). A lower rate of ROSC in black patients was not explained by longer delays in epinephrine administration for patients with a non-shockable rhythm, or defibrillation in patients with a shockable rhythm. Conclusion: In contrast to adults, no statistically significant racial differences in survival were present in pediatric IHCA.

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Trend in survival after out-of-hospital cardiac arrest and its relationship with bystander cardiopulmonary resuscitation: a six-year prospective observational study in Beijing

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02446-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuling Chen ◽

Peng Yue ◽

Ying Wu ◽

Jia Li ◽

Yanni Lei ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Cardiopulmonary Resuscitation ◽

Observational Study ◽

Indirect Effect ◽

Prospective Observational Study ◽

Shockable Rhythm ◽

Bystander Cardiopulmonary Resuscitation ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA), a global health problem with a survival rate ranging from 2 to 22% across different countries, has been a leading cause of premature death for decades. The aim of this study was to evaluate the trends of survival after OHCA over time and its relationship with bystander cardiopulmonary resuscitation (CPR), initial shockable rhythm, return of spontaneous circulation (ROSC), and survived event. Methods In this prospective observational study, data of OHCA patients were collected following the “Utstein style” by the Beijing, China, Emergency Medical Service (EMS) from January 2011 (data from February to June in 2011 was not collected) to October 2016. Patients who had a cardiac arrest and for whom an ambulance was dispatched were included in this study. All cases were followed up to determine hospital discharge or death. The trend of OHCA survival was analyzed using the Chi-square test. The relationship among bystander CPR, initial shockable rhythm, ROSC, survived event, and OHCA survival rate was analyzed using multivariate path analyses with maximum standard likelihood estimation. Results A total of 25,421 cases were transferred by the Beijing EMS; among them, 5042 (19.8%) were OHCA (median age: 78 years, interquartile range: 63–85, 60.1% male), and 484 (9.6%) received bystander CPR. The survival rate was 0.6%, which did not improve from 2012 to 2015 (P = 0.569). Overall, bystander CPR was indirectly associated with an 8.0% (β = 0.080, 95% confidence interval [CI] = 0.064–0.095, P = 0.002) increase in survival rate. The indirect effect of bystander CPR on survival rate through survived event was 6.6% (β = 0.066, 95% CI = 0.051–0.081, P = 0.002), which accounted for 82.5% (0.066 of 0.080) of the total indirect effect. With every 1 increase in survived event, the possibility of survival rate will directly increase by 53.5% (β = 0.535, 95% CI = 0.512–0.554, P = 0.003). Conclusions The survival rate after OHCA was low in Beijing which has not improved between 2012 and 2015. The effect of bystander CPR on survival rate was mainly mediated by survived event. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-12002149 (2 May, 2012, retrospectively registered). http://www.chictr.org.cn/showproj.aspx?proj=7400

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