Abstract 73: Ongoing Changes in Resuscitation and Out-of-Hospital Cardiac Arrest Survival in a Major Metropolitan System
Introduction: In 2005, the Prehospital Evaluation of New York City Survival (PHENYCS) study modest improvements in out-of-hospital cardiac arrest survival as a result of the merger of New York City EMS and the Fire Department of New York. Since that time, numerous changes have been implemented with the intent of further improving survival (e.g. compressions only pre-arrival instructions, ventricular fibrillation waveform analysis in automated defibrillators, emphasis on basic resuscitation, de-emphasis of advanced resuscitation, waveform capnography, resuscitation team leaders, integration of therapeutic hypothermia as a post-resuscitation care standard). We sought to assess the effects of these changes and to describe the current OOHCA survival rates for this large urban system.
Methods: We analyzed data from a three-year period (August 1, 2009 - July 31, 2012) and for the purposes of presenting rhythm determination was limited to those OOHCA cases for which paramedics were the first arriving EMS unit.
Results: 717 bystander witnessed OOHCA cases of cardiac etiology were followed to hospital discharge. The presenting rhythm were ventricular fibrillation (VF) / ventricular tachycardia (VT) in 19.4%, pulseless electrical activity (PEA) in 24.1%, asystole in 51.6% and other rhythms in 4.9%. As compared to the PHENYCS study, this is a significant reduction the incidence of VF/VT (19.4% vs 24.7%, p=0.005). As compared to the PHENYCS study, there were significant improvements in all survival endpoints: ROSC (38.5% vs 20.2%, p <0.001), survival to hospital admission (29.7% vs 13.4%, p<0.001), survival to hospital discharge (6.7% vs 3.6%, p=0.001). Survival to hospital discharge was also improved for both VF/VT (20.1% vs 9.6%, p=0.002) and bradyasystolic rhythms (3.5% vs 1.6%, p=0.028).
Conclusions: This most recent analysis of OOHCA outcomes for New York City finds that despite a continuing decline in the incidence of VF/VT as the presenting rhythm, there has been a doubling of survival at all endpoints and for all rhythms. Further work is needed to elucidate the causes of this improvement and to further focus OOHCA care on those interventions that are most likely to contribute to survival.
Author Disclosures: J. Freese: None. M. Menegus: None. J. Rabrich: None. T. Slesinger: None. R. Silverman: None. N. Keller: None. J. Dillworth: None. D. Isaacs: None. D. Ben-Eli: None. G. Asaeda: None. P. Lai: None. D. Prezant: None.
- © 2014 by American Heart Association, Inc.