Regional variation in out-of-hospital cardiac arrest survival in the United States

Saket Girotra, Sean Van Diepen, Brahmajee K. Nallamothu, Margaret Carrel, Kimberly Vellano, Monique L. Anderson, Bryan McNally, Benjamin S. Abella, Comilla Sasson, Paul S. Chan

Research output: Contribution to journalArticlepeer-review

167 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2159-2168
Number of pages10
JournalCirculation
Volume133
Issue number22
DOIs
StatePublished - May 31 2016
Externally publishedYes

Keywords

  • cardiopulmonary resuscitation
  • heart arrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint

Dive into the research topics of 'Regional variation in out-of-hospital cardiac arrest survival in the United States'. Together they form a unique fingerprint.

Cite this