Efforts to Improve Survival Outcomes of Out-of-Hospital Cardiac Arrest in China: BASIC-OHCA

Abstract

Background: Establishing registries to collect demographic characteristics, processes of care, and outcomes of patients with out-of-hospital cardiac arrest (OHCA) can better understand epidemiological trends, measure care quality, and identify opportunities for improvement. This study aimed to describe the design, implementation, and scientific significance of a nationwide registry―the BASIC-OHCA (Baseline Investigation of Out-of-Hospital Cardiac Arrest)―in China. Methods: BASIC-OHCA was designed as a prospective, multicenter, observational, population-based study. The BASIC-OHCA registry was developed based on Utstein templates. BASIC-OHCA includes all OHCA patients confirmed by emergency medical services (EMS) personnel regardless of age, sex, or cause. Patients declared dead at the scene by EMS personnel for any reasons are also included. To fully characterize an OHCA event, BASIC-OHCA collects data from 3 sources—EMS, the receiving hospital, and patient follow-up—and links them to form a single record. Once data entry is completed and quality is checked, individual identifiers are stripped from the record. Results: Currently, 32 EMS agencies in 7 geographic regions contribute data to BASIC-OHCA. They are distributed in the urban and rural areas, covering ≈9% of the population of mainland China. Data collection started on August 1, 2019. By July 31, 2020, a total of 92 913 EMS-assessed OHCA patients were enrolled. Among 28969 (31.18%) EMS-treated OHCAs‚ the mean age was 65.79±17.36 years, and 68.35% were males. The majority of OHCAs (76.85%) occurred at home or residence. A shockable initial rhythm was reported in 5.43% of patients. Any return of spontaneous circulation, survival to hospital discharge, and favorable neurological outcome at hospital discharge were 5.98%, 1.15%, and 0.83%, respectively. Conclusions: BASIC-OHCA is the first nationwide registry on OHCA in China. It can be used as a public health surveillance system and as a platform to produce evidence-based practices to help identify opportunities for improvement. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03926325.

Data Equity: The Foundation of Out-of-Hospital Cardiac Arrest Quality Improvement

“…The Baseline Investigation of Out-of-Hospital Cardiac Arrest (BASIC-OHCA registry) was first established in August of 2019 and is the first, systematic OHCA registry in China. 4 Previous reports from China included only data from individual hospitals or cities. One study reported a survival rate for OHCA of 1.3% in Beijing, but little is known about OHCA incidence and survival in other regions of China, a country of 1.4 billion people.…”

“…BASIC-OHCA is funded largely by government and university funding. 4 Meanwhile, ARREST has a diversity of funding sources including public, philanthropy, and industry funding. 13 Some may argue that China is an increasingly wealthy and well-resourced country that is allowing for investments in data around OHCA.…”

“…3 This month's issue of Circulation: Cardiovascular Quality and Outcomes features 2 articles that reaffirm the power of data access and the importance of cardiac arrest registries. One article by Xie and colleagues 4 describes the design, implementation, and significance of the first nationwide registry of OHCA in China. The second article by van Nieuwenhuizen and colleagues 5 describes how linkage of a robust cardiac arrest registry with other health care datasets can be used to prevent OHCA.…”

Remimazolam Improves the Markers of Postresuscitation Cerebral Injury in a Swine Model of Cardiac Arrest

“…Cardiac arrest (CA) is one main life-threatening event caused by multiple etiologies in the world. Recent data have manifested that the annual incidence of out-of-hospital CA was 88.8 individuals per 100,000 population in United States, 67 to 170 individuals per 100,000 population in Europe, and 73.5 individuals per 100,000 population in China; however, their survival to hospital discharge were only 9.0%, 8.0%, and 1.15%, respectively (1)(2)(3). After obtaining return of spontaneous circulation (ROSC) from the efforts of cardiopulmonary resuscitation (CPR) performance, the ensuing global ischemia reperfusion injury would result in multiple organ dysfunction and even death (2,4,5).…”

Sulforaphane Alleviates Postresuscitation Lung Pyroptosis Possibly via Activating the Nrf2/Ho-1 Pathway

“…Cardiac arrest (CA) is always a major health problem with high incidence and poor outcome in the world (1)(2)(3). It is estimated that approximately 1,050,000 individuals annually experience out-of-hospital CA events in China, and their survival to hospital discharge is only 1.15% (3). After restoring spontaneous circulation from the cardiopulmonary resuscitation (CPR) efforts, the ensuing dysfunction of vital organs including the heart, brain, and lung would result in high proportion of deaths during hospital stay (4,5).…”