Kylie Dyson1, Siobhan P Brown2, Susanne May2, Karen Smith3, Rudolph W Koster4, Stefanie G Beesems4, Markku Kuisma5, Ari Salo5, Judith Finn6, Fritz Sterz7, Alexander Nürnberger7, Laurie J Morrison8, Theresa M Olasveengen9, Clifton W Callaway10, Sang Do Shin11, Jan-Thorsten Gräsner12, Mohamud Daya13, Matthew Huei-Ming Ma14, Johan Herlitz15, Anneli Strömsöe16, Tom P Aufderheide17, Siobhán Masterson18, Henry Wang19, Jim Christenson20, Ian Stiell21, Gary M Vilke22, Ahamed Idris23, Chika Nishiyama24, Taku Iwami25, Graham Nichol26. 1. Centre for Research and Evaluation, Ambulance Victoria, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia. Electronic address: Kylie.Dyson@monash.edu. 2. University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States. 3. Centre for Research and Evaluation, Ambulance Victoria, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia; University of Western Australia, Perth, WA, Australia. 4. Academic Medical Center, Amsterdam, The Netherlands. 5. Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland. 6. School of Nursing, Midwifery and Paramedicine, Curtin University, WA, Australia; University of Western Australia, WA, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia. 7. Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna, Austria. 8. Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 9. Oslo University Hospital, Oslo, Norway. 10. Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. 11. Seoul National University, College of Medicine, Seoul, Republic of Korea. 12. Department of Anesthesiology and Intensive Medicine, University-Medical Center Hospital, Schleswig-Campus Kiel, Kiel, Germany. 13. Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States. 14. Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan. 15. Prehospen-Centre of Prehospital Research; Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Sweden. 16. School of Health and Social Sciences, University of Dalarna, Falun, Sweden. 17. Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States. 18. On behalf of the National Out-of-Hospital Cardiac Arrest Register (OHCAR). Discipline of General Practice, National University of Ireland, Galway, Ireland and National Ambulance Service, Health Service Executive, Dublin, Ireland. 19. Department of Emergency Medicine, University of Texas Health Science Center, Houston, TX, United States. 20. Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada. 21. Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada. 22. Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States. 23. Department of Emergency Medicine, University of Texas Southwester, Dallas, TX, United States. 24. Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan. 25. Kyoto University Health Service, Kyoto, Japan. 26. University of Washington - Harborview Center for Prehospital Emergency Care, Departments of Emergency Medicine and Medicine, University of Washington, Seattle, WA, United States.
Abstract
INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. METHODS: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n=232). RESULTS: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. CONCLUSIONS: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.
INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. METHODS: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n=232). RESULTS: Twelve registries contributed 86,759 cases. Patientarrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. CONCLUSIONS: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.
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