Mahshid Abir1, Sydney Fouche2, Jessica Lehrich3, Jason Goldstick4, Neil Kamdar5, Michael O'Leary6, Christopher Nelson7, Peter Mendel7, Wilson Nham2, Claude Setodji7, Robert Domeier8, Anthony Hsu9, Theresa Shields10, Rama Salhi10, Robert W Neumar10, Brahmajee K Nallamothu11. 1. University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, United States; Acute Care Research Unit, Institute for Healthcare Policy and Innovation, United States; RAND Corporation, Santa Monica, CA, United States. Electronic address: mahshida@med.umich.edu. 2. Acute Care Research Unit, Institute for Healthcare Policy and Innovation, United States; University of Michigan, Ann Arbor, MI, United States. 3. University of Michigan, Ann Arbor, MI, United States. 4. University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, United States; Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States. 5. University of Michigan, Ann Arbor, MI, United States; Emergency Medicine Research, Institute for Healthcare Policy and Innovation, United States. 6. University of Michigan, Ann Arbor, MI, United States; Data and Methods, Institute for Healthcare Policy and Innovation, United States. 7. RAND Corporation, Santa Monica, CA, United States. 8. St. Joseph Mercy, Department of Emergency Medicine, Ann Arbor, MI, United States. 9. Saint Joseph Mercy Hospital, Ann Arbor, MI, United States. 10. University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, United States. 11. University of Michigan, Michigan Medicine, Ann Arbor, MI, United States; Division of Cardiovascular Diseases and The Department of Internal Medicine, United States.
Abstract
AIM: Care by emergency medical service (EMS) agencies is critical for optimizing prehospital outcomes following out-of-hospital cardiac arrest (OHCA). We explored whether substantial differences exist in prehospital outcomes across EMS agencies in Michigan-specifically focusing on rates of sustained return of spontaneous circulation (ROSC) upon emergency department (ED) arrival. METHODS: Using data from Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) for years 2014-2017, we calculated rates of sustained ROSC upon ED arrival across EMS agencies in Michigan. We used hierarchical logistic regression models that accounted for patient, arrest-, community-, and response-level characteristics to determine adjusted rates of sustained ROSC among EMS agencies. RESULTS: A total of 103 EMS agencies and 20,897 OHCA cases were included. Average age of the cohort was 62.5 years (SD = 19.6), 39.7% were female, and 17.9% had an initial shockable rhythm due to ventricular fibrillation or pulseless ventricular tachycardia. The adjusted rate of sustained ROSC upon ED arrival across all EMS agencies was 23.8% with notable variation across EMS agencies (interquartile range [IQR], 20.5-29.2%). The top five EMS agencies had mean adjusted rates of sustained ROSC upon ED arrival of 42.7% (95% CI: 34.6-51.1%) while the bottom five had mean adjusted rates of 9.8% (95% CI: 7.6-12.7%). CONCLUSIONS: Substantial variation in sustained ROSC upon ED arrival exists across EMS agencies in Michigan after adjusting for patient-, arrest, community-, and response-level features. Such differences suggest opportunities to identify and improve best practices in EMS agencies to advance OHCA care.
AIM: Care by emergency medical service (EMS) agencies is critical for optimizing prehospital outcomes following out-of-hospital cardiac arrest (OHCA). We explored whether substantial differences exist in prehospital outcomes across EMS agencies in Michigan-specifically focusing on rates of sustained return of spontaneous circulation (ROSC) upon emergency department (ED) arrival. METHODS: Using data from Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) for years 2014-2017, we calculated rates of sustained ROSC upon ED arrival across EMS agencies in Michigan. We used hierarchical logistic regression models that accounted for patient, arrest-, community-, and response-level characteristics to determine adjusted rates of sustained ROSC among EMS agencies. RESULTS: A total of 103 EMS agencies and 20,897 OHCA cases were included. Average age of the cohort was 62.5 years (SD = 19.6), 39.7% were female, and 17.9% had an initial shockable rhythm due to ventricular fibrillation or pulseless ventricular tachycardia. The adjusted rate of sustained ROSC upon ED arrival across all EMS agencies was 23.8% with notable variation across EMS agencies (interquartile range [IQR], 20.5-29.2%). The top five EMS agencies had mean adjusted rates of sustained ROSC upon ED arrival of 42.7% (95% CI: 34.6-51.1%) while the bottom five had mean adjusted rates of 9.8% (95% CI: 7.6-12.7%). CONCLUSIONS: Substantial variation in sustained ROSC upon ED arrival exists across EMS agencies in Michigan after adjusting for patient-, arrest, community-, and response-level features. Such differences suggest opportunities to identify and improve best practices in EMS agencies to advance OHCA care.
Authors: Rama A Salhi; Stuart Hammond; Jessica L Lehrich; Michael O'leary; Neil Kamdar; Christine Brent; Carlos F Mendes de Leon; Peter Mendel; Christopher Nelson; Bill Forbush; Robert Neumar; Brahmajee K Nallamothu; Mahshid Abir Journal: Resuscitation Date: 2022-03-04 Impact factor: 6.251
Authors: Summer Chavez; Remle Crowe; Ryan Huebinger; Hei Kit Chan; Joseph Gill; Normandy Villa; Micah Pancyzk; Jeff Jarvis; Bentley Bobrow Journal: Am J Emerg Med Date: 2022-08-28 Impact factor: 4.093