Trends in Short- and Long-Term Survival Among Out-of-Hospital Cardiac Arrest Patients Alive at Hospital Arrival

Abstract

Many of these countries have a nationwide surveillance or a nationally coordinated system to manage patients with out-of-hospital emergencies. In these contexts, it is possible that quality improvement initiatives could be designed and translated more effectively, leading to improved survival for OHCA patients. It remains unclear whether findings from these studies are applicable in North America, where emergency medical services are organized by smaller jurisdictions and patients are managed by hundreds of destination hospitals. 2 In Ontario, for example, the population of 13.8 million is served by 53 individual land-based emergency medical service providers, with ≈280 destination hospitals providing postarrest care. 8 Population-level surveillance studies are critical to inform policy and evaluate current systems of care.Background-Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis and poses a significant burden to the healthcare system, but few studies have evaluated whether OHCA incidence and survival have changed over time. Methods and Results-A population-based cohort study was conducted, including 34 291 OHCA patients >20 years of age who were transported alive to the emergency department of an acute-care hospital from April 1, 2002, to March 31, 2012 Patients with life-threatening trauma and those who died before hospital arrival were excluded. The overall age-and sex-standardized incidence of OHCA patients who were transported alive was 36 cases per 100 000 persons and did not significantly change over the study period. Cardiac risk factor prevalence increased significantly, whereas the rate of most cardiovascular conditions decreased significantly. The 30-day survival improved from 9.4% in 2002 to 13.6% in 2011; 1-year survival improved from 7.7% to 11.8% (P<0.001). Patients hospitalized in 2011 were significantly more likely to survive 30 days (adjusted odds ratio, 1.47 [95% CI, 1.22-1.77]) and 1 year (adjusted odds ratio, 1.55 [95% CI, 1.27-1.91]) compared with 2002. A significant interaction between temporal trends in survival improvement and age group was observed in which the improvement in survival was largest in the youngest age groups. Conclusions-OHCA patients who were transported alive are increasingly likely to have cardiovascular risk factors but less likely to have previous cardiovascular conditions. The overall incidence of OHCA patients transported to hospital alive did not change over the past decade. Short-and longer-term survival after OHCA has substantially improved, with younger patients experiencing the greatest improvement. Accordingly, the main objective of this study was to evaluate recent trends in the patient characteristics, incidence, and the survival of patients after OHCA. Methods Data SourcesOur analytic data sets were created by linking together multiple large administrative databases in Ontario using unique encrypted patient identification numbers to protect patient confidentiality. The Canadian Institute of Health Information Discharge Abstract...

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

“…8,[32][33][34][35] In areas where such campaigns have been conducted over a sustained period of time, the majority of citizens in these select communities report that they have been trained in CPR at some point in their life. 36 Furthermore, data from the Cardiac Arrest Registry to Enhance Survival demonstrate that both bystander CPR and AED use have significant direct impacts on improving survival.…”

A Clinical Perspective on Sudden Cardiac Death

“…71 Survival is better in places with facilities for bystander resuscitation. 15 Defibrillators in public locations (Table 4), such as train stations, 13 however, only reduce the incidence of SCD when the local population is trained to use them.…”

Alternative Research Funding to Improve Clinical Outcomes

“…The importance of identification within this subgroup is further highlighted by a recent observation that OHCA victims who are admitted to a hospital alive are increasingly likely to have only risk factors, as opposed to manifest disease. 8 The complexity within both of these first two-categories is that the number and power of the specific risk factors available for either groups or individuals establish gradients of risk, based on the sizes of the denominators and event rates (Figure 1).…”