Variability in the initiation of resuscitation attempts by emergency medical services personnel during out-of-hospital cardiac arrest

The Resuscitation Outcomes Consortium Investigators

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Some patients with out-of-hospital cardiac arrest (OHCA) assessed by emergency medical services (EMS) do not receive attempts at resuscitation on the basis of perceived futility. Aims 1) To measure variability in the initiation of resuscitation attempts in EMS-assessed OHCA patients across EMS agencies, 2) to evaluate the association between selected EMS agency characteristics and the proportion of patients receiving resuscitation attempts, and 3) to evaluate the association between proportion receiving resuscitation attempts and survival. Methods A retrospective cohort study using data from 129 EMS agencies participating in the Resuscitation Outcomes Consortium (ROC) epidemiologic registry (EPISTRY) − Cardiac Arrest from 12/01/2005 to 12/31/2010. We included non-traumatic OHCA patients assessed by EMS. Results We included 86,912 OHCA patients. Overall, 54.8% had resuscitation attempted by EMS providers, varying from 23.9% to 100% (p = < 0.001) across EMS agencies. The proportion of patients receiving a resuscitation attempt was 7.87% less (95% CI 3.73-12.0) among agencies with longer average response intervals (≥6 min) compared with shorter average response intervals ( < 6 min) and 16.9% less (95% CI 11.9-21.9) among agencies with higher levels of advanced life support (ALS) availability (≥50% of available units) compared with lower levels of ALS availability (<50% of available units). There was a moderate positive correlation between the proportion of patients with resuscitation attempts and survival to hospital discharge (r = 0.54, p < 0.001). Conclusions The proportion of patients with OHCA who receive resuscitation attempts is variable across EMS agencies and is associated with EMS response interval, ALS unit availability and geographic region. On average, survival was higher among EMS agencies more likely to initiate resuscitation.

Original languageEnglish (US)
Pages (from-to)102-108
Number of pages7
JournalResuscitation
Volume117
DOIs
StatePublished - Aug 1 2017

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Out-of-Hospital Cardiac Arrest
Emergency Medical Services
Resuscitation
Survival
Medical Futility
Heart Arrest
Registries
Cohort Studies
Retrospective Studies

Keywords

  • Cardiac arrest
  • Emergency medical services
  • Health services reserach

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Variability in the initiation of resuscitation attempts by emergency medical services personnel during out-of-hospital cardiac arrest. / The Resuscitation Outcomes Consortium Investigators.

In: Resuscitation, Vol. 117, 01.08.2017, p. 102-108.

Research output: Contribution to journalArticle

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title = "Variability in the initiation of resuscitation attempts by emergency medical services personnel during out-of-hospital cardiac arrest",
abstract = "Background Some patients with out-of-hospital cardiac arrest (OHCA) assessed by emergency medical services (EMS) do not receive attempts at resuscitation on the basis of perceived futility. Aims 1) To measure variability in the initiation of resuscitation attempts in EMS-assessed OHCA patients across EMS agencies, 2) to evaluate the association between selected EMS agency characteristics and the proportion of patients receiving resuscitation attempts, and 3) to evaluate the association between proportion receiving resuscitation attempts and survival. Methods A retrospective cohort study using data from 129 EMS agencies participating in the Resuscitation Outcomes Consortium (ROC) epidemiologic registry (EPISTRY) − Cardiac Arrest from 12/01/2005 to 12/31/2010. We included non-traumatic OHCA patients assessed by EMS. Results We included 86,912 OHCA patients. Overall, 54.8{\%} had resuscitation attempted by EMS providers, varying from 23.9{\%} to 100{\%} (p = < 0.001) across EMS agencies. The proportion of patients receiving a resuscitation attempt was 7.87{\%} less (95{\%} CI 3.73-12.0) among agencies with longer average response intervals (≥6 min) compared with shorter average response intervals ( < 6 min) and 16.9{\%} less (95{\%} CI 11.9-21.9) among agencies with higher levels of advanced life support (ALS) availability (≥50{\%} of available units) compared with lower levels of ALS availability (<50{\%} of available units). There was a moderate positive correlation between the proportion of patients with resuscitation attempts and survival to hospital discharge (r = 0.54, p < 0.001). Conclusions The proportion of patients with OHCA who receive resuscitation attempts is variable across EMS agencies and is associated with EMS response interval, ALS unit availability and geographic region. On average, survival was higher among EMS agencies more likely to initiate resuscitation.",
keywords = "Cardiac arrest, Emergency medical services, Health services reserach",
author = "{The Resuscitation Outcomes Consortium Investigators} and Brooks, {Steven C.} and Schmicker, {Robert H.} and Sheldon Cheskes and Jim Christenson and Alan Craig and Daya, {Mohamud Ramzan} and Kudenchuk, {Peter J.} and Graham Nichol and Dana Zive and Morrison, {Laurie J.}",
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AU - The Resuscitation Outcomes Consortium Investigators

AU - Brooks, Steven C.

AU - Schmicker, Robert H.

AU - Cheskes, Sheldon

AU - Christenson, Jim

AU - Craig, Alan

AU - Daya, Mohamud Ramzan

AU - Kudenchuk, Peter J.

AU - Nichol, Graham

AU - Zive, Dana

AU - Morrison, Laurie J.

PY - 2017/8/1

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N2 - Background Some patients with out-of-hospital cardiac arrest (OHCA) assessed by emergency medical services (EMS) do not receive attempts at resuscitation on the basis of perceived futility. Aims 1) To measure variability in the initiation of resuscitation attempts in EMS-assessed OHCA patients across EMS agencies, 2) to evaluate the association between selected EMS agency characteristics and the proportion of patients receiving resuscitation attempts, and 3) to evaluate the association between proportion receiving resuscitation attempts and survival. Methods A retrospective cohort study using data from 129 EMS agencies participating in the Resuscitation Outcomes Consortium (ROC) epidemiologic registry (EPISTRY) − Cardiac Arrest from 12/01/2005 to 12/31/2010. We included non-traumatic OHCA patients assessed by EMS. Results We included 86,912 OHCA patients. Overall, 54.8% had resuscitation attempted by EMS providers, varying from 23.9% to 100% (p = < 0.001) across EMS agencies. The proportion of patients receiving a resuscitation attempt was 7.87% less (95% CI 3.73-12.0) among agencies with longer average response intervals (≥6 min) compared with shorter average response intervals ( < 6 min) and 16.9% less (95% CI 11.9-21.9) among agencies with higher levels of advanced life support (ALS) availability (≥50% of available units) compared with lower levels of ALS availability (<50% of available units). There was a moderate positive correlation between the proportion of patients with resuscitation attempts and survival to hospital discharge (r = 0.54, p < 0.001). Conclusions The proportion of patients with OHCA who receive resuscitation attempts is variable across EMS agencies and is associated with EMS response interval, ALS unit availability and geographic region. On average, survival was higher among EMS agencies more likely to initiate resuscitation.

AB - Background Some patients with out-of-hospital cardiac arrest (OHCA) assessed by emergency medical services (EMS) do not receive attempts at resuscitation on the basis of perceived futility. Aims 1) To measure variability in the initiation of resuscitation attempts in EMS-assessed OHCA patients across EMS agencies, 2) to evaluate the association between selected EMS agency characteristics and the proportion of patients receiving resuscitation attempts, and 3) to evaluate the association between proportion receiving resuscitation attempts and survival. Methods A retrospective cohort study using data from 129 EMS agencies participating in the Resuscitation Outcomes Consortium (ROC) epidemiologic registry (EPISTRY) − Cardiac Arrest from 12/01/2005 to 12/31/2010. We included non-traumatic OHCA patients assessed by EMS. Results We included 86,912 OHCA patients. Overall, 54.8% had resuscitation attempted by EMS providers, varying from 23.9% to 100% (p = < 0.001) across EMS agencies. The proportion of patients receiving a resuscitation attempt was 7.87% less (95% CI 3.73-12.0) among agencies with longer average response intervals (≥6 min) compared with shorter average response intervals ( < 6 min) and 16.9% less (95% CI 11.9-21.9) among agencies with higher levels of advanced life support (ALS) availability (≥50% of available units) compared with lower levels of ALS availability (<50% of available units). There was a moderate positive correlation between the proportion of patients with resuscitation attempts and survival to hospital discharge (r = 0.54, p < 0.001). Conclusions The proportion of patients with OHCA who receive resuscitation attempts is variable across EMS agencies and is associated with EMS response interval, ALS unit availability and geographic region. On average, survival was higher among EMS agencies more likely to initiate resuscitation.

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KW - Emergency medical services

KW - Health services reserach

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