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Observational Study
. 2015 Jun:91:108-15.
doi: 10.1016/j.resuscitation.2015.02.003. Epub 2015 Feb 9.

Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC)

Mohamud R Daya  1 , Robert H Schmicker  2 , Dana M Zive  3 , Thomas D Rea  4 , Graham Nichol  5 , Jason E Buick  6 , Steven Brooks  7 , Jim Christenson  8 , Renee MacPhee  9 , Alan Craig  6 , Jon C Rittenberger  10 , Daniel P Davis  11 , Susanne May  2 , Jane Wigginton  12 , Henry Wang  13 ; Resuscitation Outcomes Consortium Investigators
Affiliations
Observational Study

Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC)

Mohamud R Daya et al. Resuscitation. 2015 Jun.

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death and a 2010 meta-analysis concluded that outcomes have not improved over several decades. However, guidelines have changed to emphasize CPR quality, minimization of interruptions, and standardized post-resuscitation care. We sought to evaluate whether OHCA outcomes have improved over time among agencies participating in the Resuscitation Outcomes Consortium (ROC) cardiac arrest registry (Epistry) and randomized clinical trials (RCTs).

Methods: Observational cohort study of 47,148 EMS-treated OHCA cases in Epistry from 139 EMS agencies at 10 ROC sites that participated in at least one RCT between 1/1/2006 and 12/31/2010. We reviewed patient, scene, event characteristics, and outcomes of EMS-treated OHCA over time, including subgroups with initial rhythm of pulseless ventricular tachycardia or ventricular fibrillation (VT/VF).

Results: Mean response interval, median age and male proportion remained similar over time. Unadjusted survival to discharge increased between 2006 and 2010 for treated OHCA (from 8.2% to 10.4%), as well as for subgroups of VT/VF (21.4% to 29.3%) and bystander witnessed VT/VF (23.5% to 30.3%). Compared with 2006, adjusted survival to discharge was significantly higher in 2010 for treated cases (OR = 1.72; 95% CI 1.53, 1.94), VT/VF cases (OR = 1.69; 95% CI 1.45, 1.98) and bystander witnessed VT/VF cases (OR = 1.65; 95% CI 1.36, 2.00). Tests for trend in each subgroup were significant (p < 0.001).

Conclusions: ROC-wide survival increased significantly between 2006 and 2010. Additional research efforts are warranted to identify specific factors associated with this improvement.

Keywords: Emergency Medical Services (EMS); Out-of-hospital cardiac arrest (OHCA); Resucitation.

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Conflict of interest statement

Conflicts of interest statement

None.

Figures

Fig. 1
Fig. 1
Study sample flowchart.
Fig. 2
Fig. 2
Out of hospital cardiac arrest survival over time – all sites and rhythm groups.
Fig. 3
Fig. 3
Out of hospital cardiac arrest site-level EMS-treated OHCA over time (lowest and highest survival by site by year, with 95% CIs).
See this image and copyright information in PMC

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