Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest

Dana Zive, Kent Koprowicz, Terri Schmidt, Ian Stiell, Gena Sears, Lois Van Ottingham, Ahamed Idris, Shannon Stephens, Mohamud Daya

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Objectives: To identify variation in patient, event, and scene characteristics of out-of-hospital cardiac arrest (OOHCA) patients assessed by emergency medical services (EMS), and to investigate variation in transport practices in relation to documented prehospital return of spontaneous circulation (ROSC) within eight regional clinical centers participating in the Resuscitation Outcomes Consortium (ROC) Epistry. -Cardiac Arrest. Methods: OOHCA patient, event, and scene characteristics were compared to identify variation in treatment and transport practices across sites. Findings were adjusted for site and standard Utstein covariates. Using logistic regression, these covariates were modeled to identify factors related to the initiation of transport without documented prehospital ROSC as well as survival in these patients. Setting: Eight US and Canadian sites participating in the ROC Epistry. -Cardiac Arrest. Population: Persons ≥20 years with OOHCA who (a) received compressions or shock by EMS providers and/or received bystander AED shock or (b) were pulseless but received no EMS compressions or shock between December 2005 and May 2007. Results: 23,233 OOHCA cases were assessed by EMS in the defined period. Resuscitation (treatment) was initiated by EMS in 13,518 cases (58%, site range: 36-69%, p< 0.0001). Of treated cases, 59% were transported (site range: 49-88%, p< 0.0001). Transport was initiated in the absence of documented ROSC for 58% of transported cases (site range: 14-95%, p< 0.0001). Of these transported cases, 8% achieved ROSC before hospital arrival (site range: 5-21%, p< 0.0001) and 4% survived to hospital discharge (site range: 1-21%, p< 0.0001). In cases with transport from the scene initiated after documented ROSC, 28% survived to hospital discharge (site range: 18-44%, p< 0.0001). Conclusion: Initiation of resuscitation and transport of OOHCA and the reporting of ROSC prior to transport markedly varies among ROC sites. This variation may help clarify reported differences in survival rates among sites and provide a target for identifying EMS practices most likely to enhance survival from OOHCA.

Original languageEnglish (US)
Pages (from-to)277-284
Number of pages8
JournalResuscitation
Volume82
Issue number3
DOIs
StatePublished - Mar 2011

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Out-of-Hospital Cardiac Arrest
Emergency Medical Services
Heart Arrest
Resuscitation
Shock
Survival
Survival Rate
Logistic Models
Therapeutics
Population

Keywords

  • Out-of-hospital cardiac arrest
  • ROSC
  • Termination of resuscitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium : ROC Epistry-Cardiac Arrest. / Zive, Dana; Koprowicz, Kent; Schmidt, Terri; Stiell, Ian; Sears, Gena; Van Ottingham, Lois; Idris, Ahamed; Stephens, Shannon; Daya, Mohamud.

In: Resuscitation, Vol. 82, No. 3, 03.2011, p. 277-284.

Research output: Contribution to journalArticle

Zive, Dana ; Koprowicz, Kent ; Schmidt, Terri ; Stiell, Ian ; Sears, Gena ; Van Ottingham, Lois ; Idris, Ahamed ; Stephens, Shannon ; Daya, Mohamud. / Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium : ROC Epistry-Cardiac Arrest. In: Resuscitation. 2011 ; Vol. 82, No. 3. pp. 277-284.
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abstract = "Objectives: To identify variation in patient, event, and scene characteristics of out-of-hospital cardiac arrest (OOHCA) patients assessed by emergency medical services (EMS), and to investigate variation in transport practices in relation to documented prehospital return of spontaneous circulation (ROSC) within eight regional clinical centers participating in the Resuscitation Outcomes Consortium (ROC) Epistry. -Cardiac Arrest. Methods: OOHCA patient, event, and scene characteristics were compared to identify variation in treatment and transport practices across sites. Findings were adjusted for site and standard Utstein covariates. Using logistic regression, these covariates were modeled to identify factors related to the initiation of transport without documented prehospital ROSC as well as survival in these patients. Setting: Eight US and Canadian sites participating in the ROC Epistry. -Cardiac Arrest. Population: Persons ≥20 years with OOHCA who (a) received compressions or shock by EMS providers and/or received bystander AED shock or (b) were pulseless but received no EMS compressions or shock between December 2005 and May 2007. Results: 23,233 OOHCA cases were assessed by EMS in the defined period. Resuscitation (treatment) was initiated by EMS in 13,518 cases (58{\%}, site range: 36-69{\%}, p< 0.0001). Of treated cases, 59{\%} were transported (site range: 49-88{\%}, p< 0.0001). Transport was initiated in the absence of documented ROSC for 58{\%} of transported cases (site range: 14-95{\%}, p< 0.0001). Of these transported cases, 8{\%} achieved ROSC before hospital arrival (site range: 5-21{\%}, p< 0.0001) and 4{\%} survived to hospital discharge (site range: 1-21{\%}, p< 0.0001). In cases with transport from the scene initiated after documented ROSC, 28{\%} survived to hospital discharge (site range: 18-44{\%}, p< 0.0001). Conclusion: Initiation of resuscitation and transport of OOHCA and the reporting of ROSC prior to transport markedly varies among ROC sites. This variation may help clarify reported differences in survival rates among sites and provide a target for identifying EMS practices most likely to enhance survival from OOHCA.",
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AU - Zive, Dana

AU - Koprowicz, Kent

AU - Schmidt, Terri

AU - Stiell, Ian

AU - Sears, Gena

AU - Van Ottingham, Lois

AU - Idris, Ahamed

AU - Stephens, Shannon

AU - Daya, Mohamud

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N2 - Objectives: To identify variation in patient, event, and scene characteristics of out-of-hospital cardiac arrest (OOHCA) patients assessed by emergency medical services (EMS), and to investigate variation in transport practices in relation to documented prehospital return of spontaneous circulation (ROSC) within eight regional clinical centers participating in the Resuscitation Outcomes Consortium (ROC) Epistry. -Cardiac Arrest. Methods: OOHCA patient, event, and scene characteristics were compared to identify variation in treatment and transport practices across sites. Findings were adjusted for site and standard Utstein covariates. Using logistic regression, these covariates were modeled to identify factors related to the initiation of transport without documented prehospital ROSC as well as survival in these patients. Setting: Eight US and Canadian sites participating in the ROC Epistry. -Cardiac Arrest. Population: Persons ≥20 years with OOHCA who (a) received compressions or shock by EMS providers and/or received bystander AED shock or (b) were pulseless but received no EMS compressions or shock between December 2005 and May 2007. Results: 23,233 OOHCA cases were assessed by EMS in the defined period. Resuscitation (treatment) was initiated by EMS in 13,518 cases (58%, site range: 36-69%, p< 0.0001). Of treated cases, 59% were transported (site range: 49-88%, p< 0.0001). Transport was initiated in the absence of documented ROSC for 58% of transported cases (site range: 14-95%, p< 0.0001). Of these transported cases, 8% achieved ROSC before hospital arrival (site range: 5-21%, p< 0.0001) and 4% survived to hospital discharge (site range: 1-21%, p< 0.0001). In cases with transport from the scene initiated after documented ROSC, 28% survived to hospital discharge (site range: 18-44%, p< 0.0001). Conclusion: Initiation of resuscitation and transport of OOHCA and the reporting of ROSC prior to transport markedly varies among ROC sites. This variation may help clarify reported differences in survival rates among sites and provide a target for identifying EMS practices most likely to enhance survival from OOHCA.

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KW - Out-of-hospital cardiac arrest

KW - ROSC

KW - Termination of resuscitation

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