Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry–Cardiac Arrest

Abstract

Objectives-To identify variation in patient, event, and scene characteristics of out-of-hospital cardiac arrest (OOHCA) patients assessed by emergency medical services (EMS), and to investigate variation in transport practices in relation to documented prehospital return of spontaneous circulation (ROSC) within eight regional clinical centers participating in the Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac Arrest.Methods-OOHCA patient, event, and scene characteristics were compared to identify variation in treatment and transport practices across sites. Findings were adjusted for site and standard Utstein covariates. Using logistic regression, these covariates were modeled to identify factors related to the initiation of transport without documented prehospital ROSC as well as survival in these patients. Setting: Eight US and Canadian sites participating in the ROC Epistry-Cardiac Arrest. Population: Persons ≥ 20 years with OOHCA who a) received compressions or shock by EMS providers and/or received bystander AED shock or b) were pulseless but received no EMS compressions or shock between December 2005 and May 2007.Results-23,233 OOHCA cases were assessed by EMS in the defined period. Resuscitation (treatment) was initiated by EMS in 13,518 cases (58%, site range: 36-69%, p<0.0001). Of treated cases, 59% were transported (site range: 49-88%, p<0.0001). Transport was initiated in the Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptResuscitation. Author manuscript; available in PMC 2012 March 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript absence of documented ROSC for 58% of transported cases (site range: 14-95%, p<0.0001). Of these transported cases, 8% achieved ROSC before hospital arrival (site range: 5-21%, p<0.0001) and 4% survived to hospital discharge (site range: 1-21%, p<0.0001). In cases with transport from the scene initiated after documented ROSC, 28% survived to hospital discharge (site range: 18-44%, p<0.0001).Conclusion-Initiation of resuscitation and transport of OOHCA and the reporting of ROSC prior to transport markedly varies among ROC sites. This variation may help clarify reported differences in survival rates among sites and provide a target for identifying EMS practices most likely to enhance survival from OOHCA.

Paramedic Exposure to Out-of-Hospital Cardiac Arrest Resuscitation Is Associated With Patient Survival

“…Therefore, it is important that all studies examining the effect of practitioner factors in OHCA consider the influence these factors will also have on the decision to attempt resuscitation to prevent misinterpretation of results. 28 We found that patient survival decreased when paramedics had not treated an OHCA for >6 months. This period of time is similar to the time in which ALS skills deteriorate (6-12 months) after training.…”

Association between hospital post-resuscitative performance and clinical outcomes after out-of-hospital cardiac arrest

“…1 Despite efforts to improve all aspects of the chain of survival, there is significant and important variation in the process and outcome of care among those treated for OHCA by emergency medical services (EMS) providers or admitted to hospital after successful resuscitation efforts. [2][3][4][5] This variation is incompletely explained by http://dx.doi.org/10.1016/j.resuscitation.2015.04.015 0300-9572/© 2015 Elsevier Ireland Ltd. All rights reserved. patient and EMS factors typically measured to standardize reporting of the process and outcomes of care for OHCA in an attempt to facilitate comparisons between communities.…”

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

“…3 Despite robust systems of care for patients with trauma and rapidly evolving systems of care for patients with ST-segment-elevation myocardial infarction (STEMI) and stroke, the majority of communities do not achieve optimal survival after OHCA because of large discrepancies in resuscitation-related processes of care. [4][5][6] As a result, survival to hospital discharge varies significantly both across different regions and by presenting rhythm. 7,8 Survival increases significantly if the OHCA is quickly recognized and responded to with prompt activation of 9-1-1, bystander-initiated cardiopulmonary resuscitation (CPR), bystander and/or basic first responder application of an automated external defibrillator (AED) before arrival of other emergency medical services (EMS) providers on scene, advanced life support, and postresuscitation care.…”