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Resuscitation. 2015 Jun;91:108-15. doi: 10.1016/j.resuscitation.2015.02.003. Epub 2015 Feb 9.

Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC).

Author information

1
Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States. Electronic address: dayam@ohsu.edu.
2
University of Washington Clinical Trial Center, Seattle, WA, United States.
3
Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States.
4
University of Washington, Seattle, WA, United States.
5
University of Washington Clinical Trial Center, Seattle, WA, United States; University of Washington, Seattle, WA, United States.
6
University of Toronto, Toronto, ON, Canada.
7
Queens University, Kingston, ON, Canada.
8
University of British Columbia, Vancouver, BC, Canada.
9
Wilfrid Laurier University, Waterloo, ON, Canada.
10
University of Pittsburgh, Pittsburgh, PA, United States.
11
University of California at San Diego, San Diego, CA, United States.
12
University of Texas Southwestern, Dallas, TX, United States.
13
University of Alabama at Birmingham, Birmingham, AL, United States.

Abstract

BACKGROUND:

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death and a 2010 meta-analysis concluded that outcomes have not improved over several decades. However, guidelines have changed to emphasize CPR quality, minimization of interruptions, and standardized post-resuscitation care. We sought to evaluate whether OHCA outcomes have improved over time among agencies participating in the Resuscitation Outcomes Consortium (ROC) cardiac arrest registry (Epistry) and randomized clinical trials (RCTs).

METHODS:

Observational cohort study of 47,148 EMS-treated OHCA cases in Epistry from 139 EMS agencies at 10 ROC sites that participated in at least one RCT between 1/1/2006 and 12/31/2010. We reviewed patient, scene, event characteristics, and outcomes of EMS-treated OHCA over time, including subgroups with initial rhythm of pulseless ventricular tachycardia or ventricular fibrillation (VT/VF).

RESULTS:

Mean response interval, median age and male proportion remained similar over time. Unadjusted survival to discharge increased between 2006 and 2010 for treated OHCA (from 8.2% to 10.4%), as well as for subgroups of VT/VF (21.4% to 29.3%) and bystander witnessed VT/VF (23.5% to 30.3%). Compared with 2006, adjusted survival to discharge was significantly higher in 2010 for treated cases (OR = 1.72; 95% CI 1.53, 1.94), VT/VF cases (OR = 1.69; 95% CI 1.45, 1.98) and bystander witnessed VT/VF cases (OR = 1.65; 95% CI 1.36, 2.00). Tests for trend in each subgroup were significant (p < 0.001).

CONCLUSIONS:

ROC-wide survival increased significantly between 2006 and 2010. Additional research efforts are warranted to identify specific factors associated with this improvement.

KEYWORDS:

Emergency Medical Services (EMS); Out-of-hospital cardiac arrest (OHCA); Resucitation

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