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Bystander response, demographics affect survival variation for out-of-hospital cardiac arrest
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Bystander response and county-level demographics play key roles in the variation in survival rates of patients with out-of-hospital cardiac arrest, according to study data published in Circulation.
Saket Girotra, MD, SM, assistant professor, internal and cardiovascular medicine, University of Iowa Carver College of Medicine, Iowa City, and colleagues found a large variation in rates of survival to discharge (range, 3.4%-22%; median OR = 1.4; 95% CI, 1.32-1.46) in 96,662 patients across 132 U.S. counties.
Saket Girotra
That large variation also applied to rates of survival to functional recovery (range, 0.8%-21%; median OR = 1.53, 95% CI, 1.43-1.62). The data, taken from the Cardiac Arrest Registry to Enhance Survival, show that, overall, 9,317 patients (9.6%) survived to discharge, whereas 7,176 (7.4%) functionally recovered.
The researchers took into account the role of bystanders, specifically whether they performed CPR or had access to an automated external defibrillator. They found county-level rates of bystander CPR and AED use correlated with survival and functional recovery (P < .0001 for all).
Other factors in the study included demographics such as age, sex and race; cardiac arrest characteristics; and county-level socioeconomic demographic factors.
Adjustment for demographics explained 4.8% of survival-to-discharge variation (median OR = 1.38; 95% CI, 1.31-1.45), further adjustment for cardiac arrest characteristics explained 27.7% of the variation (median OR = 1.33; 95% CI, 1.26-1.39), further adjustment for CPR and AED use explained 41% of the variation (median OR = 1.29; 95% CI, 1.23-1.35) and further adjustment for county-level sociodemographics explained 50.4% (median OR = 1.26; 95% CI, 1.2-1.32), according to the researchers.
All of the adjustments explained 49.9% of the variation in rates of survival to functional recovery (median OR = 1.35; 95% CI, 1.28-1.42), Girotra and colleagues wrote.
“Odds of receiving bystander CPR for a person with cardiac arrest were 51% lower if the arrest occurred in a low-income black neighborhood than a high-income white neighborhood,” the researchers wrote. “Our findings suggest ... improving rates of bystander CPR in communities with low rates ... could be a potential strategy to reduce existing racial disparities [in survival rates].”
Surveys have shown that “bystanders may be reluctant to perform CPR [due to] concerns about transmission of infectious diseases, legal liability or fear of failure,” Girotra and colleagues wrote. – by James Clark
Disclosure: The Cardiac Arrest Registry to Enhance Survival is supported in part by funds from the Medtronic Foundation Heart Rescue Program and Zoll Corp. The researchers report no relevant financial disclosures.
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