Predicting Survival After Out-of-Hospital Cardiac Arrest: Role of the Utstein Data Elements

Rea, Thomas D.; Cook, Andrea J.; Stiell, Ian G.; Powell, Judy; Bigham, Blair L.; Callaway, Clifton W.; Chugh, Sumeet S.; Aufderheide, Tom P.; Morrison, Laurie J.; Terndrup, Thomas E.; Beaudoin, Tammy; Wittwer, Lynn; Davis, Daniel G.; Idris, Ahamed H.; Nichol, Graham

doi:10.1016/j.annemergmed.2009.09.018

Cited by 196 publications

(112 citation statements)

References 33 publications

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“…In 2010, Rea and colleagues observed that the core Utstein data elements, a set of internationally recognized OHCA process of care variables believed to be associated with survival and explain geographic differences in outcome, collectively accounted for only 43.7% of the between-community survival difference among EMS-treated cardiac arrest. 4,5 One way that community response to OHCA differs is in the number of emergency medical services (EMS) personnel dispatched to provide on-scene treatment. 6 This generally depends on EMS organizational structure.…”

Section: Introductionmentioning

confidence: 99%

Volume versus outcome: More emergency medical services personnel on-scene and increased survival after out-of-hospital cardiac arrest

et al. 2015

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a b s t r a c tBackground and aim: : The large regional variation in survival after treatment of out-of-hospital cardiac arrest (OHCA) is incompletely explained. Communities respond to OHCA with differing number of emergency medical services (EMS) personnel who respond to the scene. The effect of different numbers of EMS personnel on-scene upon outcomes is unclear. We sought to evaluate the association between number of EMS personnel on-scene and survival after OHCA. Methods: We performed a retrospective review of prospectively collected data on 16,122 EMS-treated OHCA events from December 1, 2005 to May 31, 2007 from a combined population over 21 million people residing in an area of over 33,000 square miles in Canada and the United States. Number of EMS personnel on-scene was defined as the number of EMS personnel who responded to the scene of OHCA within 15 min after 9-1-1 call receipt and prior to patient death or transport away from the scene. Associations with survival to hospital discharge were assessed by using generalized estimating equations to construct multivariable logistic regression models. Results: Compared to a reference number of EMS personnel on-scene of 5 or 6, 7 or 8 EMS personnel onscene was associated with a higher rate of survival to hospital discharge, adjusted odds ratio [OR], 1.35 (95% CI: 1.05, 1.73). There was no significant difference in survival between 5 or 6 personnel on-scene versus fewer. Conclusion: More EMS personnel on-scene within 15 min of 9-1-1 call was associated with improved survival of out-of-hospital cardiac arrest. It is unlikely that this finding was mediated solely by earlier CPR or earlier defibrillation.

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Section: Introductionmentioning

confidence: 99%

Volume versus outcome: More emergency medical services personnel on-scene and increased survival after out-of-hospital cardiac arrest

et al. 2015

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“…Complete information about, for example, the quality of CPR or the timing of care was not routinely available and would likely help explain relationships; however, the goals of the project favored broad participation, and detailed comprehensive data collection was not feasible for many stakeholders because many systems were new to case capture and reporting. Classification of etiology can be difficult to determine in some cases, and variable approaches to classification could produce bias, although investigations of etiology suggest that cardiac etiology accounts for the large majority of arrests in North America, and etiology is not associated with outcome 34. We acknowledge the variability in published OHCA incidence estimates; however, our case ascertainment rates were based on estimates developed through a systematic review of published literature 16, 35.…”

Section: Discussionmentioning

confidence: 99%

Multistate 5‐Year Initiative to Improve Care for Out‐of‐Hospital Cardiac Arrest: Primary Results From the HeartRescue Project

Diepen

Girotra

Abella

et al. 2017

JAHA

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BackgroundThe HeartRescue Project is a multistate public health initiative focused on establishing statewide out‐of‐hospital cardiac arrest (OHCA) systems of care to improve case capture and OHCA care in the community, by emergency medical services (EMS), and at hospital level.Methods and ResultsFrom 2011 to 2015 in the 5 original HeartRescue states, all adults with EMS–treated OHCA due to a presumed cardiac cause were included. In an adult population of 32.8 million, a total of 64 988 OHCAs—including 10 046 patients with a bystander‐witnessed OHCA with a shockable rhythm—were treated by 330 EMS agencies. From 2011 to 2015, the case‐capture rate for all‐rhythm OHCA increased from an estimated 39.0% (n=6762) to 89.2% (n=16 103; P<0.001 for trend). Overall survival to hospital discharge was 11.4% for all rhythms and 34.0% in the subgroup with bystander‐witnessed OHCA with a shockable rhythm. We observed modest temporal increases in bystander cardiopulmonary resuscitation (41.8–43.5%, P<0.001 for trend) and bystander automated external defibrillator application (3.2–5.6%, P<0.001 for trend) in the all‐rhythm group, although there were no temporal changes in survival. There were marked all‐rhythm survival differences across the 5 states (8.0–16.1%, P<0.001) and across participating EMS agencies (2.7–26.5%, P<0.001).ConclusionsIn the initial 5 years, the HeartRescue Project developed a population‐based OHCA registry and improved statewide case‐capture rates and some processes of care, although there were no early temporal changes in survival. The observed survival variation across states and EMS systems presents a future challenge to elucidate the characteristics of high‐performing systems with the goal of improving OHCA care and survival.

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“…7 But despite the vast amount of evidence implicating the Utstein variables as the main predictors of survival, few studies to date have investigated non-Utstein variables as predictors of survival and their influence on outcome variability. 3,7 In OHCA, socioeconomic status (SES) [8][9][10][11][12][13][14] and race/ ethnicity [14][15][16][17][18][19][20][21][22][23][24] have been studied in relation to survivalto-hospital discharge and bystander CPR. These results are often contradictory and inconclusive, and these studies were limited in scope, only including one or two non-Utstein variables.…”

Section: Introductionmentioning

confidence: 99%

Does location matter? A proposed methodology to evaluate neighbourhood effects on cardiac arrest survival and bystander CPR

Buick

Allan

Ray

et al. 2015

CJEM

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Background: Traditional variables used to explain survival following out-of-hospital cardiac arrest (OHCA) account for only 72% of survival, suggesting that other unknown factors may influence outcomes. Research on other diseases suggests that neighbourhood factors may partly determine health outcomes. Yet, this approach has rarely been used for OHCA. This work outlines a methodology to investigate multiple neighbourhood factors as determinants of OHCA outcomes. Methods: A retrospective, observational cohort study design will be used. All adult non-emergency medical service witnessed OHCAs of cardiac etiology within the city of Toronto between 2006 and 2010 will be included. Event details will be extracted from the Toronto site of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest, an existing population-based dataset of consecutive OHCA patients. Geographic information systems technology will be used to assign patients to census tracts. Neighbourhood variables to be explored include the Ontario Marginalization Index (deprivation, dependency, ethnicity, and instability), crime rate, and density of family physicians. Hierarchical logistic regression analysis will be used to explore the association between neighbourhood characteristics and 1) survival-to-hospital discharge, 2) return-of-spontaneous circulation at hospital arrival, and 3) provision of bystander cardiopulmonary resuscitation (CPR). Receiver operating characteristics curves will evaluate each model's ability to discriminate between those with and without each outcome. Discussion: This study will determine the role of neighbourhood characteristics in OHCA and their association with clinical outcomes. The results can be used as the basis to focus on specific neighbourhoods for facilitating educational interventions, CPR awareness programs, and higher utilization of automatic defibrillation devices.

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Predicting Survival After Out-of-Hospital Cardiac Arrest: Role of the Utstein Data Elements

Cited by 196 publications

References 33 publications

Volume versus outcome: More emergency medical services personnel on-scene and increased survival after out-of-hospital cardiac arrest

Volume versus outcome: More emergency medical services personnel on-scene and increased survival after out-of-hospital cardiac arrest

Multistate 5‐Year Initiative to Improve Care for Out‐of‐Hospital Cardiac Arrest: Primary Results From the HeartRescue Project

Does location matter? A proposed methodology to evaluate neighbourhood effects on cardiac arrest survival and bystander CPR

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