TY - JOUR
T1 - Increased survival after EMS witnessed cardiac arrest. Observations from the Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac arrest
AU - Hostler, David
AU - Thomas, Elizabeth G.
AU - Emerson, Scott S.
AU - Christenson, James
AU - Stiell, Ian G.
AU - Rittenberger, Jon C.
AU - Gorman, Kyle R.
AU - Bigham, Blair L.
AU - Callaway, Clifton W.
AU - Vilke, Gary M.
AU - Beaudoin, Tammy
AU - Cheskes, Sheldon
AU - Craig, Alan
AU - Davis, Daniel P.
AU - Reed, Andrew
AU - Idris, Ahamed
AU - Nichol, Graham
N1 - Funding Information:
The Resuscitation Outcome Consortium (ROC) was supported by a series of cooperative agreements to 10 regional clinical centers and one data Coordinating Center (5U01 HL077863, HL077881, HL077871, HL077872, HL077866, HL077908, HL077867, #1HL077885, HL077877, HL077873) from the National Heart, Lung and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, U.S. Army Medical Research & Material Command, The Canadian Institutes of Health Research (CIHR)—Institute of Circulatory and Respiratory Health, Defence Research and Development Canada, the Heart and Stroke Foundation of Canada, and the American Heart Association.
PY - 2010/7
Y1 - 2010/7
N2 - Background: Out of hospital cardiac arrest (OHCA) is common and lethal. It has been suggested that OHCA witnessed by EMS providers is a predictor of survival because advanced help is immediately available. We examined EMS witnessed OHCA from the Resuscitation Outcomes Consortium (ROC) to determine the effect of EMS witnessed vs. bystander witnessed and unwitnessed OHCA. Methods: Data were analyzed from a prospective, population-based cohort study in 10 U.S. and Canadian ROC sites. Individuals with non-traumatic OHCA treated 04/01/06-03/31/07 by EMS providers with defibrillation or chest compressions were included. Cases were grouped into EMS-witnessed, bystander witnessed, and unwitnessed and further stratified for bystander CPR. Multiple logistic regressions evaluated the odds ratio (OR) for survival to discharge relative to the EMS-witnessed group after adjusting for age, sex, public/private location of collapse, ROC site, and initial ECG rhythm. Of 9991 OHCA, 1022 (10.2%) of EMS-witnessed, 3369 (33.7%) bystander witnessed, and 5600 (56.1%) unwitnessed. Results: The most common initial rhythm in the EMS-witnessed group was PEA which was higher than in the bystander- and unwitnessed groups (p<0.001). The adjusted OR (95% CI) of survival compared to the EMS-witnessed group was 0.41, (0.36, 0.46) in bystander witnessed with bystander CPR, 0.37 (0.33, 0.43) in bystander witnessed without bystander CPR, 0.17 (0.14, 0.20) in unwitnessed with bystander CPR and 0.21 (0.18, 0.24) in unwitnessed cases without bystander CPR. Conclusions: Immediate application of prehospital care for OHCA may improve survival. Efforts should be made to educate patients to access 9-1-1 for prodromal symptoms.
AB - Background: Out of hospital cardiac arrest (OHCA) is common and lethal. It has been suggested that OHCA witnessed by EMS providers is a predictor of survival because advanced help is immediately available. We examined EMS witnessed OHCA from the Resuscitation Outcomes Consortium (ROC) to determine the effect of EMS witnessed vs. bystander witnessed and unwitnessed OHCA. Methods: Data were analyzed from a prospective, population-based cohort study in 10 U.S. and Canadian ROC sites. Individuals with non-traumatic OHCA treated 04/01/06-03/31/07 by EMS providers with defibrillation or chest compressions were included. Cases were grouped into EMS-witnessed, bystander witnessed, and unwitnessed and further stratified for bystander CPR. Multiple logistic regressions evaluated the odds ratio (OR) for survival to discharge relative to the EMS-witnessed group after adjusting for age, sex, public/private location of collapse, ROC site, and initial ECG rhythm. Of 9991 OHCA, 1022 (10.2%) of EMS-witnessed, 3369 (33.7%) bystander witnessed, and 5600 (56.1%) unwitnessed. Results: The most common initial rhythm in the EMS-witnessed group was PEA which was higher than in the bystander- and unwitnessed groups (p<0.001). The adjusted OR (95% CI) of survival compared to the EMS-witnessed group was 0.41, (0.36, 0.46) in bystander witnessed with bystander CPR, 0.37 (0.33, 0.43) in bystander witnessed without bystander CPR, 0.17 (0.14, 0.20) in unwitnessed with bystander CPR and 0.21 (0.18, 0.24) in unwitnessed cases without bystander CPR. Conclusions: Immediate application of prehospital care for OHCA may improve survival. Efforts should be made to educate patients to access 9-1-1 for prodromal symptoms.
KW - Bystander
KW - CPR
KW - Prehospital
KW - ROSC
KW - Return of spontaneous circulation
UR - http://www.scopus.com/inward/record.url?scp=77953690380&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77953690380&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2010.02.005
DO - 10.1016/j.resuscitation.2010.02.005
M3 - Article
C2 - 20403656
AN - SCOPUS:77953690380
SN - 0300-9572
VL - 81
SP - 826
EP - 830
JO - Resuscitation
JF - Resuscitation
IS - 7
ER -