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Outcomes variation wide across EMS agencies in out-of-hospital cardiac arrest
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In a review of out-of-hospital cardiac arrest outcomes by region, there was substantial variation in outcomes across Emergency Medical Services agencies.
The researchers conducted an observational cohort study of 43,656 patients (median age, 66 years; 63% men) treated for out-of-hospital cardiac arrest by 112 Emergency Medical Services (EMS) agencies from the U.S. and Canada to determine the extent to which outcomes vary by region.
All patients had out-of-hospital cardiac arrest between April 2011 and June 2015 and were documented in the Resuscitation Outcomes Consortium Epistry, a prospective, multicenter registry.
The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation at ED arrival and favorable functional outcome, defined as modified Rankin scale score of 3 or less, at hospital discharge.
At the EMS agency level, the rate of survival to hospital discharge ranged from 0% to 28.9% (median OR = 1.43; 95% CI, 1.34-1.54), Masashi Okubo, MD, MS, from the department of emergency medicine at the University of Pittsburgh School of Medicine, and colleagues wrote.
The rate of return of spontaneous circulation at ED arrival ranged from 9% to 57.1% (median OR = 1.53; 95% CI, 1.43-1.65), and the rate of favorable functional outcome at hospital discharge ranged from 0% to 20.4% (median OR = 1.54; 95% CI, 1.4-1.73), according to the researchers.
After adjustment for patient-level and EMS agency-level factors known to be associated with outcomes, the variation for all three outcomes remained significant (adjusted median OR for survival to hospital discharge = 1.56; 95% CI, 1.44-1.73; adjusted median OR for return of spontaneous circulation at ED arrival = 1.5; 95% CI, 1.41-1.62; adjusted median OR for favorable functional outcome at hospital discharge = 1.53; 95% CI, 1.37-1.78).
The survival outcomes did not change after further adjustment for hospital treatment characteristics and exclusion of anyone who did not survive 60 minutes after hospital arrival (adjusted median OR for survival to hospital discharge = 1.49; 95% CI, 1.36-1.69; adjusted median OR for favorable functional outcome at hospital discharge = 1.34; 95% CI, 1.2-1.59).
“These data suggest that the between-agency variation resulted from unmeasured patient, EMS agency, hospital and/or community characteristics, because the variation in outcomes persisted after adjustment for multiple measured factors,” Okubo and colleagues wrote. – by Erik Swain
Disclosures: Okubo reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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