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

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.

[1]  Benjamin S. Abella,et al.  Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital A Consensus Statement From the American Heart Association , 2013, Circulation.

[2]  D. Davis,et al.  Cardiac arrest survival did not increase in the Resuscitation Outcomes Consortium after implementation of the 2005 AHA CPR and ECC guidelines. , 2011, Resuscitation.

[3]  W A Watson,et al.  Hawthorne effect: implications for prehospital research. , 1995, Annals of emergency medicine.

[4]  M. Gratton,et al.  Improved Patient Survival Using a Modified Resuscitation Protocol for Out-of-Hospital Cardiac Arrest , 2009, Circulation.

[5]  S. Trzeciak,et al.  Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of-Hospital Cardiac Arrest , 2009 .

[6]  Graham Nichol,et al.  Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. , 2008, Resuscitation.

[7]  Harlan M Krumholz,et al.  What Distinguishes Top-Performing Hospitals in Acute Myocardial Infarction Mortality Rates? , 2011, Annals of Internal Medicine.

[8]  John Kattwinkel,et al.  Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. , 2010, Resuscitation.

[9]  J. Herlitz,et al.  Improvements in logistics could increase survival after out‐of‐hospital cardiac arrest in Sweden , 2013, Journal of internal medicine.

[10]  D. Davis,et al.  Relationship Between Chest Compression Rates and Outcomes From Cardiac Arrest , 2012, Circulation.

[11]  C. Callaway,et al.  Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial , 2011, BMJ : British Medical Journal.

[12]  C. Callaway,et al.  Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. , 2010, Annals of Emergency Medicine.

[13]  R. Lilford,et al.  Are randomized clinical trials good for us (in the short term)? Evidence for a "trial effect". , 2001, Journal of clinical epidemiology.

[14]  Joel Stein,et al.  Executive summary: heart disease and stroke statistics--2014 update: a report from the American Heart Association. , 2014, Circulation.

[15]  Samantha Mauck,et al.  What Distinguishes Top-performing Hospitals in Acute Myocardial Infarction Mortality Rates? A Qualitative Study , 2011 .

[16]  P. Steen,et al.  Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. , 2007, Resuscitation.

[17]  L. Rasmussen,et al.  Improved survival after an out‐of‐hospital cardiac arrest using new guidelines , 2008, Acta anaesthesiologica Scandinavica.

[18]  J P Ornato,et al.  Public-access Defibrillation and Survival after Out-of-hospital Cardiac Arrest Recommended Citation Public-access Defibrillation and Survival after Out-of-hospital Cardiac Arrest , 2022 .

[19]  B. Bobrow,et al.  Dispatch-assisted cardiopulmonary resuscitation: the anchor link in the chain of survival , 2012, Current opinion in critical care.

[20]  Gary B. Smith,et al.  Chest compression depth and survival in out-of-hospital cardiac arrest. , 2014, Resuscitation.

[21]  M. Hazinski,et al.  Major changes in the 2005 AHA Guidelines for CPR and ECC: reaching the tipping point for change. , 2005, Circulation.

[22]  C. Callaway,et al.  Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest. , 2014, Resuscitation.

[23]  Ems Division.  Increasing use of cardiopulmonary resuscitation during out-of-hospital ventricular fibrillation arrest:Survival implications of guideline changes , 2007 .

[24]  R. Neumar,et al.  Clinical applications of targeted temperature management. , 2014, Chest.

[25]  David D. Salcido,et al.  The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. , 2014, Resuscitation.

[26]  A. Hallstrom,et al.  Predicting survival from out-of-hospital cardiac arrest: a graphic model. , 1993, Annals of emergency medicine.

[27]  G. Nichol,et al.  Registries to measure and improve outcomes after cardiac arrest , 2013, Current opinion in critical care.

[28]  M. Sayre,et al.  Impact of the 2005 American Heart Association Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guidelines on Out-of-Hospital Cardiac Arrest Survival , 2009, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[29]  John E Billi,et al.  Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. , 2010, Circulation.

[30]  D. Davis,et al.  A Descriptive Analysis of Emergency Medical Service Systems Participating in the Resuscitation Outcomes Consortium (ROC) Network , 2007, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[31]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2014 update: a report from the American Heart Association. , 2014, Circulation.

[32]  R. Neumar,et al.  Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association. , 2010, Circulation.

[33]  Michael Behnke,et al.  Compliance With Antiseptic Hand Rub Use in Intensive Care Units The Hawthorne Effect , 2006, Infection Control &#x0026; Hospital Epidemiology.

[34]  R. Wolfe,et al.  Cardiac arrest outcomes before and after the 2005 resuscitation guidelines implementation: evidence of improvement? , 2010, Resuscitation.

[35]  M. Rosenqvist,et al.  Improved Survival After Out-of-Hospital Cardiac Arrest Is Associated With an Increase in Proportion of Emergency Crew–Witnessed Cases and Bystander Cardiopulmonary Resuscitation , 2008, Circulation.

[36]  Roger D. White,et al.  Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. , 2008, Circulation.

[37]  Judy Powell,et al.  Perishock Pause: An Independent Predictor of Survival From Out-of-Hospital Shockable Cardiac Arrest , 2011, Circulation.

[38]  T. Rea,et al.  Cpr with Chest Compression Alone or with Rescue Breathing , 2022 .

[39]  J. Stockman.  Compression-Only CPR or Standard CPR in Out-of-Hospital Cardiac Arrest , 2012 .

[40]  Arthur L. Kellermann,et al.  Predictors of Survival From Out-of-Hospital Cardiac Arrest A Systematic Review and Meta-Analysis , 2013 .

[41]  Daniel Davis,et al.  Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest. , 2011, The New England journal of medicine.

[42]  R. Berg,et al.  Statewide regionalization of postarrest care for out-of-hospital cardiac arrest: association with survival and neurologic outcome. , 2014, Annals of emergency medicine.

[43]  Henry E. Wang,et al.  A trial of an impedance threshold device in out-of-hospital cardiac arrest. , 2011, The New England journal of medicine.