Abstract 5: Secular Trends in Community Cardiac Arrest Survival: Results From the Resuscitation Outcomes Consortium (ROC)
Background: The Resuscitation Outcomes Consortium (ROC) is a research network evaluating interventions in out-of-hospital cardiac arrest (OHCA) which maintains an epidemiologic registry of consecutive cases of OHCA assessed by emergency medical services (EMS) agencies. ROC has completed 3 cardiac arrest clinical trials with no significant survival differences. However, we hypothesize that OHCA survival may have changed over time due to participation in ROC.
Objectives: To evaluate changes in OHCA survival to hospital discharge over time in ROC sites.
Methods: We included OHCA cases treated by 139 participating EMS agencies between 1/1/06-12/31/10. We excluded cases with definite non-cardiac etiology and months with incomplete case capture. The association between survival and year was assessed using multi-level mixed effects logistic regression with agency nested in region and region nested in site. Covariates included: age; sex; EMS response interval; witness status; bystander CPR; location of arrest and first rhythm. We used an independent covariance structure with random intercepts.
Results: Mean EMS response interval, median age and male gender proportion were similar over time. Survival to hospital discharge increased over time for treated cases between 2006 and 2010, as well as for the subgroups of VT/VF and witnessed VT/VF (Table). Survival increase compared to 2006 remained significant for each subsequent year after covariate adjustment with OR’s (95% CI) for survival in 2010 of 1.73 (1.52, 1.95) for all cases, 1.66 (1.42, 1.95) for VT/VF and 1.59 (1.33, 1.89) for witnessed VT/VF. Test for trend according to year was significant for all cases and among the VT/VF subgroups (p=<0.001).
Conclusion: Survival from OHCA increased over time within the ROC research network despite a lack of survival differences in the clinical trials. Further research is required to identify the specific factors associated with this improvement.
- © 2013 by American Heart Association, Inc.