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Resuscitation. 2014 Nov;85(11):1599-609. doi: 10.1016/j.resuscitation.2014.06.031. Epub 2014 Jul 8.

Apples to apples or apples to oranges? International variation in reporting of process and outcome of care for out-of-hospital cardiac arrest.

Author information

1
University of Washington, Harborview Center for Prehospital Emergency Care, Department of Medicine, University of Washington, Seattle, WA, United States.
2
University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States.
3
Kyoto University Health Service, Kyoto, Japan.
4
Academic Medical Center, Amsterdam, The Netherlands.
5
Helsinki Emergency Medical Service, Helsinki University Central Hospital, Helsinki, Finland.
6
St John Ambulance, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia.
7
University of Western Australia, Perth, WA, Australia; Monash University, Melbourne, Vic., Australia.
8
Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna, Austria.
9
University of Western Australia, Perth, WA, Australia; Monash University, Melbourne, Vic., Australia; Ambulance Victoria, Vic., Australia.
10
Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont., Canada.
11
Oslo University Hospital, Oslo, Norway.
12
Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
13
Seoul National University, College of Medicine, Seoul, Republic of Korea.
14
Department of Anesthesiology and Intensive Medicine, University-Medical Center Hospital, Schleswig-Campus Kiel, Kiel, Germany.
15
Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States.
16
Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan.
17
University of Borås, Sahlgrenska University Hospital, Göteborg, Sweden.
18
School of Health and Social Sciences, University of Dalarna, Falun, Sweden.
19
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
20
Discipline of General Practice, National University of Ireland, Galway, Ireland and Department of Public Health Medicine, Health Service Executive, Donegal, Ireland.
21
Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States.
22
Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
23
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont., Canada.
24
Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States.
25
University of Washington, Harborview Center for Prehospital Emergency Care, Department of Medicine, University of Washington, Seattle, WA, United States; University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States. Electronic address: nichol@uw.edu.

Abstract

OBJECTIVES:

Survival after out-of-hospital cardiac arrest (OHCA) varies between communities, due in part to variation in the methods of measurement. The Utstein template was disseminated to standardize comparisons of risk factors, quality of care, and outcomes in patients with OHCA. We sought to assess whether OHCA registries are able to collate common data using the Utstein template. A subsequent study will assess whether the Utstein factors explain differences in survival between emergency medical services (EMS) systems.

STUDY DESIGN:

Retrospective study.

SETTING:

This retrospective analysis of prospective cohorts included adults treated for OHCA, regardless of the etiology of arrest. Data describing the baseline characteristics of patients, and the process and outcome of their care were grouped by EMS system, de-identified, and then collated. Included were core Utstein variables and timed event data from each participating registry. This study was classified as exempt from human subjects' research by a research ethics committee.

MEASUREMENTS AND MAIN RESULTS:

Thirteen registries with 265 first-responding EMS agencies in 13 countries contributed data describing 125,840 cases of OHCA. Variation in inclusion criteria, definition, coding, and process of care variables were observed. Contributing registries collected 61.9% of recommended core variables and 42.9% of timed event variables. Among core variables, the proportion of missingness was mean 1.9±2.2%. The proportion of unknown was mean 4.8±6.4%. Among time variables, missingness was mean 9.0±6.3%.

CONCLUSIONS:

International differences in measurement of care after OHCA persist. Greater consistency would facilitate improved resuscitation care and comparison within and between communities.

KEYWORDS:

Cardiac arrest; Cardiopulmonary resuscitation; Epidemiology; Resuscitation; Utstein template

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