Paramedic Out-of-hospital Cardiac Arrest Case Volume Is a Predictor of Return of Spontaneous Circulation

Abstract

IntroductionMany factors contribute to the survival of out-of-hospital cardiac arrest (OHCA). One such factor is the quality of resuscitation efforts, which in turn may be a function of OHCA case volume. However, few studies have investigated the OHCA case volume-survival relationship. Consequently, we sought to develop a model describing the likelihood of return of spontaneous circulation (ROSC) as a function of paramedic cumulative OHCA experience.MethodsWe conducted a statewide retrospective study of cardiac arrest using the North Carolina Prehospital Care Reporting System. Adult patients suffering a witnessed, non-traumatic cardiac arrest between January 2012 and June 2014 were included. Using logistic regression, we calculated an adjusted odds ratio (OR) for the influence of the preceding five-year paramedic OHCA case volume on ROSC while controlling for the potentially confounding variables identified a priori as patient age, gender, and non-Caucasian race; shockable presenting rhythm; layperson/first responder cardiopulmonary resuscitation (CPR); and emergency medical services (EMS) response time.ResultsOf the 6,405 patients meeting inclusion criteria, 3,155 (49.3%) experienced ROSC. ROSC was more likely among patients treated by paramedics with ≥ 15 OHCA experiences during the preceding five years (OR [1.21], p<0.01). ROSC was also more likely among patients with shockable initial rhythms (OR [2.35], p<0.01) and who received layperson/first responder CPR (OR [1.77], p<0.01). Increasing patient age (OR [0.996], p=0.02), male gender (OR [0.742], p<0.01), and increasing EMS response time (OR [0.954], p<0.01) were associated with a decreased likelihood of ROSC. Non-Caucasian race was not an independent predictor of ROSC.ConclusionWe found that a paramedic five-year OHCA case volume of ≥ 15 is significantly associated with ROSC. Further study is needed to determine the specific actions of these more experienced paramedics who are responsible for the increased likelihood of ROSC, as well as the influence of case volume on the longer-term outcome measures of hospital discharge and neurological function.

Predictive model of return of spontaneous circulation among patients with out‐of‐hospital cardiac arrest in Thailand: The WATCH‐CPR Score

“…OHCA is a public health problem in Thailand and an emergency condition that requires early recognition and early management to save lives 1 . Our study found a 36.3% incidence of sustained ROSC among OHCA patients, which is similar to that found in a previous study in the Netherlands that reported a 39.0% incidence of sustained ROSC among OHCA patients 24 .…”

“…Previous reports have shown that bystander CPR can improve the chance of survival, that is, the ROSC and survival to hospital discharge 1,12,29 . Therefore, it is suggested that developing the general population's basic life support skills is important for obtaining early proper chest compression and early use of the automated external defibrillator (AED) prior to the arrival of EMS.…”

“…Out‐of‐hospital cardiac arrest (OHCA) is an emergency condition that requires immediate management to save patients 1 . Worldwide, millions of people develop OHCA each year, and it is a major cause of death 2 .…”

“…In Thailand, the Pan Asian Resuscitation Outcomes Study (PAROS) showed a 4.0% survival to discharge rate 4 . These figures indicate that the incidence and outcomes of the resuscitation of patients with OHCA vary among countries because of differences in the study design, sample size, baseline characteristics, and in particular hospital facilities which include prehospital care, emergency medical services (EMS) and in‐hospital care 1,3,4 . These hospital facilities involve in the occurrence of sustained return of spontaneous circulation (ROSC) among patients with OHCA ranging from 9.0%‐50.0% 5 .…”

“…These hospital facilities involve in the occurrence of sustained return of spontaneous circulation (ROSC) among patients with OHCA ranging from 9.0%‐50.0% 5 . Previous studies have shown that predictive factors for the sustained ROSC include age, male sex, witnessed arrest, location of arrest, bystander cardiopulmonary resuscitation (CPR), time to first chest compression, suspected cardiac cause, EMS response time, initial shockable rhythm and total CPR duration 1,6‐11 …”