Variation in pre-hospital outcomes after out-of-hospital cardiac arrest in Michigan.
Resuscitation
; 158: 201-207, 2021 01.
Article
em En
| MEDLINE
| ID: mdl-33307157
ABSTRACT
AIM:
Care by emergency medical service (EMS) agencies is critical for optimizing prehospital outcomes following out-of-hospital cardiac arrest (OHCA). We explored whether substantial differences exist in prehospital outcomes across EMS agencies in Michigan-specifically focusing on rates of sustained return of spontaneous circulation (ROSC) upon emergency department (ED) arrival.METHODS:
Using data from Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) for years 2014-2017, we calculated rates of sustained ROSC upon ED arrival across EMS agencies in Michigan. We used hierarchical logistic regression models that accounted for patient, arrest-, community-, and response-level characteristics to determine adjusted rates of sustained ROSC among EMS agencies.RESULTS:
A total of 103 EMS agencies and 20,897 OHCA cases were included. Average age of the cohort was 62.5 years (SDâ¯=â¯19.6), 39.7% were female, and 17.9% had an initial shockable rhythm due to ventricular fibrillation or pulseless ventricular tachycardia. The adjusted rate of sustained ROSC upon ED arrival across all EMS agencies was 23.8% with notable variation across EMS agencies (interquartile range [IQR], 20.5-29.2%). The top five EMS agencies had mean adjusted rates of sustained ROSC upon ED arrival of 42.7% (95% CI 34.6-51.1%) while the bottom five had mean adjusted rates of 9.8% (95% CI 7.6-12.7%).CONCLUSIONS:
Substantial variation in sustained ROSC upon ED arrival exists across EMS agencies in Michigan after adjusting for patient-, arrest, community-, and response-level features. Such differences suggest opportunities to identify and improve best practices in EMS agencies to advance OHCA care.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Reanimação Cardiopulmonar
/
Serviços Médicos de Emergência
/
Parada Cardíaca Extra-Hospitalar
Tipo de estudo:
Guideline
/
Prognostic_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Resuscitation
Ano de publicação:
2021
Tipo de documento:
Article