Abstract 17194: Intrastate Variation in Treatment and Outcome Measures for Out-of-Hospital Cardiac Arrest
Background: Variations in out-of-hospital cardiac arrest (OHCA) system performance and outcomes have been previously described across North America. We hypothesized that the same level of variation exists within a single US state. Our objective was to analyze and compare OHCA system of care (SOC) performance and outcomes at the Medical Control Authority (MCA) level in the state of Michigan.
Methods: We performed a retrospective, observational study of all non-traumatic EMS-treated OHCA from the state of Michigan CARES registry for 2014-2015. Geocoding of the OHCA incident address was used to assign records to individual MCAs. MCA-based demographics, arrest characteristics, SOC performance and outcomes were quantified and compared. Associations between demographics, SOC parameters, and outcomes were examined at the MCA level.
Results: The study period included 8,185 records, of which 70 were excluded due to incomplete data. A total of 11 MCAs met the study inclusion criteria of ≥ 100 cases, producing a final sample size of 7,788 records. Statistically significant variations in survival to hospital discharge 4.5-15% (Adjusted OR range: 0.6-2.0, p=<0.001) and survival with good neurologic outcome 2.7-12.5% (Adjusted OR range: 0.5-2.2, p=<0.001) were observed across MCAs. Bystander CPR across MCAs ranged from 31-53% (p=<0.001) and bystander AED application ranged from 3.5-11% (p=<0.001). In-hospital mortality of patients that survived to hospital admission varied significantly across MCAs and ranged from 53-74% (Adjusted OR range: 0.6-1.5, p=<0.001). Of patients admitted alive, 29-68% received hypothermic targeted temperature management.
Conclusion: Significant intrastate variations in OHCA SOC performance and outcomes currently exist and are similar to what has been previously reported across North America almost a decade ago. These variations can be used to identify best practices and guide quality improvement measures at the local level.
Author Disclosures: R.A. Coute: Other Research Support; Modest; Sarnoff Cardiovascular Research Foundation Fellowship. T.A. Shields: None. J.A. Cranford: None. S. Ansari: None. M. Tiba: None. R.W. Neumar: Other; Modest; President and Board of Directors Chair, SaveMiHeart.
- © 2016 by American Heart Association, Inc.