Abstract 16: Variability in Treated Versus Untreated Out-of-Hospital Cardiac Arrest Episodes Across the Resuscitation Outcomes Consortium
Emergency medical service (EMS) protocols, patient presentation, and provider judgment may influence whether resuscitation is initiated for patients with out-of-hospital cardiac arrest (OHCA). Variability in the proportion of OHCA patients who receive resuscitation attempts could distort comparative analyses. We aimed to determine whether the proportion of OHCA cases having resuscitation attempted varied between study sites within the Resuscitation Outcomes Consortium (ROC). We also explored the relationship between the proportion of patients that were treated and the reported survival by ROC site. This was a retrospective study using the ROC Epistry database. We considered all non-traumatic cardiac arrests from 1/1/2006 to 12/31/2010 for inclusion. We excluded cases from EMS agencies that did not participate in the ROC PRIMED trial and from time periods with incomplete case capture. The proportion of patients who had resuscitation initiated by EMS personnel was the primary outcome. We used Chi-square to test the hypothesis that proportions were equal across all 10 study sites. Correlation between the primary outcome and survival in the treated group was assessed. There were 82,152 eligible EMS-assessed cardiac arrest episodes of which 55.4% had resuscitation initiated. This proportion varied by ROC study site with a range of 35.2% to 70.5% (p < 0.001). Survival by site ranged from 5.1% to 17.0%. There was no strong correlation between proportion treated and survival among the treated patients (r=0.28) (Figure). We conclude that the proportion of patients with OHCA who receive treatment varies markedly across sites in the ROC. The proportion of patients treated within a site and the survival amongst the treated are not strongly correlated. These results suggest that a standardized approach to initiating or withholding resuscitation does not exist and this variability deserves consideration when comparing data from different EMS regions or systems.
Author Disclosures: S.C. Brooks: Expert Witness; Significant; Expert Witness for the Defence in a case of AED non-use during OHCA. R.H. Schmicker: None. S. Cheskes: Speakers Bureau; Significant; Zoll Medical speaker’s honorarium for talks on CPR quality. J. Christenson: None. A. Craig: Employment; Significant; American Medical Response Vice President Clinical Operations. M. Daya: None. P.J. Kudenchuk: None. G. Nichol: Research Grant; Modest; NHLBI ROC Coordinating Centre Co-PI, FDA, Cardiac Science Corp, Heartsine Corp, Phillips Healthcare, Physio-Control, Zoll, Dynamic AED Registry, Velomedix. Other; Modest; Non-provisional patent for novel method of tracking medical devices using smartphone, and dynamic electronic database (assigned to University of Washington. D. Zive: None. L.J. Morrison: Research Grant; Significant; Heart and Stroke Foundation of Canada, NIH, CIHR, Laerdal Foundation.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.