Marina Del Rios1, Joseph Weber2, Oksana Pugach3, Hai Nguyen4, Teri Campbell5, Salman Islam6, Leslee Stein Spencer7, Eddie Markul8, E Bradshaw Bunney9, Terry Vanden Hoek10. 1. Department of Emergency Medicine, University of Illinois at Chicago, 808 South Wood Street, 476C, Chicago, IL, 60612, United States. Electronic address: mdelrios@uic.edu. 2. Department of Emergency Medicine, Cook County Health and Hospitals System, Chicago, IL, United States. Electronic address: jweber@cookcountyhhs.org. 3. Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States. Electronic address: opugach@uic.edu. 4. School of Public Health, University of Illinois at Chicago, Chicago, IL, United States. Electronic address: hnguye72@uic.edu. 5. University of Chicago Aeromedical Network, Chicago, IL, United States. Electronic address: tlc.ilhr@outlook.com. 6. Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, United States. Electronic address: ssislam2@uic.edu. 7. Illinois Department of Public Health, United States. Electronic address: lesleess@aol.com. 8. Department of Emergency Medicine, Advocate Illinois Masonic Medical Center, Springfield, IL, United States. Electronic address: eddie.markul@advocatehealth.com. 9. Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, United States. Electronic address: bbunney@uic.edu. 10. Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, United States. Electronic address: tvh@uic.edu.
Abstract
BACKGROUND: Large cities pose unique challenges that limit the effectiveness of system improvement interventions. Successful implementation of integrated cardiac resuscitation systems of care can serve as a model for other urban centers. METHODS: This was a retrospective analysis of prospectively collected data of adult cases of non-traumatic cardiac arrest who received treatment by Chicago Fire Department EMS from September 1, 2013 through December 31, 2016. We measured temporal OHCA outcomes during implementation of system-wide initiatives including telephone-assisted and community CPR training programs; high performance CPR and team based simulation training; new post resuscitation care and destination protocols; and case review for EMS providers. Outcomes measured included bystander CPR rates, return of spontaneous circulation (ROSC), hospital admission and survival, and favorable neurologic outcomes (CPC 1-2). Relative risk was determined by logistic regression model where observed group-specific outcomes are expressed as odds ratios (OR). RESULTS: We included 6103 adult OHCA cases occurring outside of health care facilities from September 1, 2013 through December 31, 2016. Significantly improved outcomes (p < 0.05) were observed between 2013 and 2016 for bystander CPR (11.6% vs 19.4%), ROSC (28.6% vs 36.9%), hospital admission (22.5% vs 29.4%), survival (7.3% vs 9.9%), and CPC 1-2 (4.3% vs 6.4%). Utstein survival increased from 16.3%-35.4% and CPC 1-2 survival from 11.6%-29.1% (p < 0.05). After adjustment for OHCA characteristics, survival with CPC 1-2 increased over time (OR 1.15, p = 0.0277). CONCLUSIONS: Densely populated cities with low survival rates can overcome systematic challenges and improve OHCA survival.
BACKGROUND: Large cities pose unique challenges that limit the effectiveness of system improvement interventions. Successful implementation of integrated cardiac resuscitation systems of care can serve as a model for other urban centers. METHODS: This was a retrospective analysis of prospectively collected data of adult cases of non-traumatic cardiac arrest who received treatment by Chicago Fire Department EMS from September 1, 2013 through December 31, 2016. We measured temporal OHCA outcomes during implementation of system-wide initiatives including telephone-assisted and community CPR training programs; high performance CPR and team based simulation training; new post resuscitation care and destination protocols; and case review for EMS providers. Outcomes measured included bystander CPR rates, return of spontaneous circulation (ROSC), hospital admission and survival, and favorable neurologic outcomes (CPC 1-2). Relative risk was determined by logistic regression model where observed group-specific outcomes are expressed as odds ratios (OR). RESULTS: We included 6103 adult OHCA cases occurring outside of health care facilities from September 1, 2013 through December 31, 2016. Significantly improved outcomes (p < 0.05) were observed between 2013 and 2016 for bystander CPR (11.6% vs 19.4%), ROSC (28.6% vs 36.9%), hospital admission (22.5% vs 29.4%), survival (7.3% vs 9.9%), and CPC 1-2 (4.3% vs 6.4%). Utstein survival increased from 16.3%-35.4% and CPC 1-2 survival from 11.6%-29.1% (p < 0.05). After adjustment for OHCA characteristics, survival with CPC 1-2 increased over time (OR 1.15, p = 0.0277). CONCLUSIONS: Densely populated cities with low survival rates can overcome systematic challenges and improve OHCA survival.
Authors: Daniel M Rolston; Timmy Li; Casey Owens; Ghania Haddad; Timothy J Palmieri; Veronika Blinder; Jennifer L Wolff; Michael Cassara; Qiuping Zhou; Lance B Becker Journal: J Am Heart Assoc Date: 2020-03-10 Impact factor: 5.501