Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008 Sep 24;300(12):1423-31
Date
09/25/2008Pubmed ID
18812533Pubmed Central ID
PMC3187919DOI
10.1001/jama.300.12.1423Scopus ID
2-s2.0-52449090787 (requires institutional sign-in at Scopus site) 1676 CitationsAbstract
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.
Author List
Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, Rea T, Lowe R, Brown T, Dreyer J, Davis D, Idris A, Stiell I, Resuscitation Outcomes Consortium InvestigatorsAuthor
Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Canada
Demography
Emergency Medical Services
Female
Heart Arrest
Hospitalization
Humans
Incidence
Male
Middle Aged
Resuscitation
Survival Analysis
United States
Ventricular Fibrillation
