Variation in Out-of-Hospital Cardiac Arrest Survival Across Emergency Medical Service Agencies

Raul A. Garcia, Saket Girotra, Philip G. Jones, Bryan McNally, John A. Spertus, Paul S. Chan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Although studies have reported variation in out-of-hospital cardiac arrest (OHCA) survival by geographic location, little is known about variation in OHCA survival at the level of emergency medical service (EMS) agencies - which may have modifiable practices, unlike counties and regions. We quantified the variation in OHCA survival across EMS agencies and explored whether variation in 2 specific EMS resuscitation practices were associated with survival to hospital admission. Methods: Within the Cardiac Arrest Registry to Enhance Survival, a prospective registry representing ≈51% of the US population, we identified 258 342 OHCAs from 764 EMS agencies with >10 OHCA cases annually during 2015 to 2019. Using hierarchical logistic regression, risk-standardized rates of survival to hospital admission were computed for each EMS agency. We quantified inter-agency variation in survival with median odds ratios and assessed the association of 2 resuscitation practices (EMS response time and the proportion of OHCAs with termination of resuscitation without meeting futility criteria) with EMS agency survival rates to hospital admission. Results: Across 764 EMS agencies comprising 258 342 OHCAs, the median risk-standardized rate of survival to hospital admission was 27.3% (interquartile range, 24.5%-30.1%; range: 16.0%-45.6%). The adjusted median odds ratio was 1.35 (95% CI, 1.32-1.39), denoting that the odds of survival of 2 patients with identical covariates varied by 35% at 2 randomly selected EMS agencies. EMS agencies in the lowest quartile of risk-standardized survival had longer EMS response times when compared with the highest quartile (12.0±3.4 versus 9.0±2.6 minutes; P<0.001), and a higher proportion of OHCAs with termination of resuscitation without meeting futility criteria (27.9±16.1% versus 18.9±11.4%; P<0.001). Conclusions: Survival after OHCA varies widely across EMS agencies. EMS response times and termination of resuscitation practices were associated with agency-level rates of survival to hospital admission, suggesting potentially modifiable practices which can improve OHCA survival.

Original languageEnglish (US)
Pages (from-to)E008755
JournalCirculation: Cardiovascular Quality and Outcomes
Volume15
Issue number6
DOIs
StatePublished - Jun 1 2022
Externally publishedYes

Keywords

  • emergency medical services
  • geographic locations
  • out-of-hospital cardiac arrest
  • resuscitation
  • survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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