Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 May 31;133(22):2159-68.
doi: 10.1161/CIRCULATIONAHA.115.018175. Epub 2016 Apr 14.

Regional Variation in Out-of-Hospital Cardiac Arrest Survival in the United States

Saket Girotra  1 , Sean van Diepen  2 , Brahmajee K Nallamothu  2 , Margaret Carrel  2 , Kimberly Vellano  2 , Monique L Anderson  2 , Bryan McNally  2 , Benjamin S Abella  2 , Comilla Sasson  2 , Paul S Chan  2 ; CARES Surveillance Group and the HeartRescue Project
Affiliations

Regional Variation in Out-of-Hospital Cardiac Arrest Survival in the United States

Saket Girotra et al. Circulation. .

Abstract

Background: Although previous studies have shown marked variation in out-of-hospital cardiac arrest survival across US regions, factors underlying this survival variation remain incompletely explained.

Methods and results: Using data from the Cardiac Arrest Registry to Enhance Survival, we identified 96 662 adult patients with out-of-hospital cardiac arrest in 132 US counties. We used hierarchical regression models to examine county-level variation in rates of survival and survival with functional recovery (defined as Cerebral Performance Category score of 1 or 2) and examined the contribution of demographics, cardiac arrest characteristics, bystander cardiopulmonary resuscitation, automated external defibrillator use, and county-level sociodemographic factors in survival variation across counties. A total of 9317 (9.6%) patients survived to discharge, and 7176 (7.4%) achieved functional recovery. At a county level, there was marked variation in rates of survival to discharge (range, 3.4%-22.0%; median odds ratio, 1.40; 95% confidence interval, 1.32-1.46) and survival with functional recovery (range, 0.8%-21.0%; median odds ratio, 1.53; 95% confidence interval, 1.43-1.62). County-level rates of bystander cardiopulmonary resuscitation and automated external defibrillator use were positively correlated with both outcomes (P<0.0001 for all). Patient demographic and cardiac arrest characteristics explained 4.8% and 27.7% of the county-level variation in survival, respectively. Additional adjustment of bystander cardiopulmonary resuscitation and automated external defibrillator explained 41% of the survival variation, and this increased to 50.4% after adjustment of county-level sociodemographic factors. Similar findings were noted in analyses of survival with functional recovery.

Conclusions: Although out-of-hospital cardiac arrest survival varies significantly across US counties, a substantial proportion of the variation is attributable to differences in bystander response across communities.

Keywords: cardiopulmonary resuscitation; heart arrest.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study Cohort
Figure 2
Figure 2
Variation in county-level rates of A) survival to discharge and B) survival with functional recovery.
Figure 2
Figure 2
Variation in county-level rates of A) survival to discharge and B) survival with functional recovery.
Figure 3
Figure 3
Correlation between county-level rates of survival outcomes and A) rates of bystander CPR, and B) rates of bystander AED.
Figure 3
Figure 3
Correlation between county-level rates of survival outcomes and A) rates of bystander CPR, and B) rates of bystander AED.
See this image and copyright information in PMC

Comment in

References

    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, 3rd, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2014 update: A report from the american heart association. Circulation. 2014;129:e28–e292. - PMC - PubMed
    1. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, Rea T, Lowe R, Brown T, Dreyer J, Davis D, Idris A, Stiell I. Resuscitation Outcomes Consortium I. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008;300:1423–1431. - PMC - PubMed
    1. Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: A systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63–81. - PubMed
    1. Herlitz J, Engdahl J, Svensson L, Angquist KA, Young M, Holmberg S. Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in sweden. AmHeart J. 2005;149:61–66. - PubMed
    1. Herlitz J, Engdahl J, Svensson L, Young M, Angquist KA, Holmberg S. A short delay from out of hospital cardiac arrest to call for ambulance increases survival. Eur Heart J. 2003;24:1750–1755. - PubMed

Publication types