Abstract 208: Innovative Web-Based e-Registry Enhances Survival After Out-of-Hospital Cardiac Arrest
Patient and prehospital predictors of survival after OHCA include ventricular fibrillation, witnessed arrest, and receiving bystander cardiopulmonary resuscitation. Whether systems-based approaches on Emergency Medical Service (EMS) such as new registry or reform could improve survival have not been well studied.
An innovative web-based e-registry may enhance survival after OHCA.
An urban EMS with 2.62 million residents in 272 squared km was studied. Traditionally the EMS operated an OHCA Registry by manual-traced paper archives that coordinated data collections across dispatch center, ambulance teams and receiving hospitals. After a 2-year redesign, a computerized Web e-Registry in 2010 was established. The ambulance team initiated an individual patient data block right after an OHCA event, and that data block was immediately pushed to the customized webpage of receiving hospital so that they could easily upload patient outcomes anytime online, and periodically update patient status to the Web system. Health Bureau tracked the compliance with data uploading among receiving hospitals. Fire Department staff reviewed and uploaded prehospital and defibrillator data to the Web. The outcomes of 2-hour sustained return of spontaneous circulation (2hr ROSC), survival to discharge, and favorable Cerebral Performance Category 1 and 2 at discharge (fCPC), and data-missing rate for 4 years before the e-Registry (n=7,499) were compared to those 1 year after (n=1,777).
After e-Registry, for arrest of shockable rhythm, fCPC increased by 9.5% (95% CI: 4.2-16.1%); for non-shockable arrest, 2hr ROSC (4.2%, 95% CI: 1.4-7.1%) and fCPC (0.7%, 95% CI: 0.2-1.4%) increased significantly. After adjusting for patient and EMS variables, e-Registry was associated with fCPC (adjusted odds ratio: 1.9, 95% CI: 1.1-3.6) for shockable arrest, 2hr ROSC (adjusted OR: 1.2, 95% CI: 1.1-1.4) and fCPC (adjusted OR: 2.3, 95% CI: 1.1-5.1) for non-shockable arrest. Outcomes data-missing rate was significantly reduced by 5.3% (95% CI: 2.8-7.9%).
Compared to paper archives, systems-based intervention by launching web-based e-registry may enhance favorable CPC after OHCA and reduce outcomes data-missing rate.
- © 2012 by American Heart Association, Inc.