Regional variation in out-of-hospital cardiac arrest incidence and outcome

Graham Nichol, Elizabeth Thomas, Clifton W. Callaway, Jerris Hedges, Judy L. Powell, Tom P. Aufderheide, Tom Rea, Robert Lowe, Todd Brown, John Dreyer, Dan Davis, Ahamed Idris, Ian Stiell

Research output: Contribution to journalArticle

1353 Scopus citations

Abstract

Context: The health and policy implications of regional variation in incidence and outcome of out-of-hospital cardiac arrest remain to be determined. Objective: To evaluate whether cardiac arrest incidence and outcome differ across geographic regions. Design, Setting, and Patients: Prospective observational study (the Resuscitation Outcomes Consortium) of all out-of-hospital cardiac arrests in 10 North American sites (8 US and 2 Canadian) from May 1, 2006, to April 30, 2007, followed up to hospital discharge, and including data available as of June 28, 2008. Cases (aged 0-108 years) were assessed by organized emergency medical services (EMS) personnel, did not have traumatic injury, and received attempts at external defibrillation or chest compressions or resuscitation was not attempted. Census data were used to determine rates adjusted for age and sex. Main Outcome Measures: Incidence rate, mortality rate, case-fatality rate, and survival to discharge for patients assessed or treated by EMS personnel or with an initial rhythm of ventricular fibrillation. Results: Among the 10 sites, the total catchment population was 21.4 million, and there were 20 520 cardiac arrests. A total of 11 898 (58.0%) had resuscitation attempted; 2729 (22.9% of treated) had initial rhythm of ventricular fibrillation or ventricular tachycardia or rhythms that were shockable by an automated external defibrillator; and 954 (4.6% of total) were discharged alive. The median incidence of EMS-treated cardiac arrest across sites was 52.1 (interquartile range [IQR], 48.0-70.1) per 100 000 population; survival ranged from 3.0% to 16.3%, with a median of 8.4% (IQR, 5.4%-10.4%). Median ventricular fibrillation incidence was 12.6 (IQR, 10.6-5.2) per 100 000 population; survival ranged from 7.7% to 39.9%, with a median of 22.0% (IQR, 15.0%-24.4%), with significant differences across sites for incidence and survival (P<.001). Conclusion: In this study involving 10 geographic regions in North America, there were significant and important regional differences in out-of-hospital cardiac arrest incidence and outcome.

Original languageEnglish (US)
Pages (from-to)1423-1431
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume300
Issue number12
DOIs
StatePublished - Sep 24 2008

ASJC Scopus subject areas

  • Medicine(all)

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    Nichol, G., Thomas, E., Callaway, C. W., Hedges, J., Powell, J. L., Aufderheide, T. P., Rea, T., Lowe, R., Brown, T., Dreyer, J., Davis, D., Idris, A., & Stiell, I. (2008). Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA - Journal of the American Medical Association, 300(12), 1423-1431. https://doi.org/10.1001/jama.300.12.1423