International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template

RESUSCITATION

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Article

Dyson, Kylie^1,2  Brown, Siobhan P.³  May, Susanne³  Smith, Karen^1,2,4  Koster, Rudolph W.⁵  Beesems, Stefanie G.⁵  Kuisma, Markku⁶  Salo, Ari⁶  Finn, Judith^2,4,7  Sterz, Fritz^8,9  Nuernberger, Alexander^8,9  Morrison, Laurie J.^10,11  Olasveengen, Theresa M.¹²  Callaway, Clifton W.¹³  Shin, Sang Do¹⁴  Graesner, Jan-Thorsten¹⁵  Daya, Mohamud¹⁶  Ma, Matthew Huei-Ming¹⁷  Herlitz, Johan^18,19  Stromsoe, Anneli²⁰  Aufderheide, Tom P.²¹  Masterson, Siobhan^22,23  Wang, Henry²⁴  Christenson, Jim²⁵  Stiell, Ian²⁶  Vilke, Gary M.²⁷  Idris, Ahamed²⁸  Nishiyama, Chika²⁹  Iwami, Taku³⁰  Nichol, Graham^31,32 

[1] Ambulance Victoria, Ctr Res & Evaluat, Doncaster, Vic, Australia

[2] Monash Univ, Dept Epidemiol & Prevent Med, 553 St Kilda Rd, Melbourne, Vic 3004, Australia

[3] Univ Washington, Dept Biostat, Clin Trial Ctr, Seattle, WA 98195 USA

[4] Univ Western Australia, Perth, WA, Australia

[5] Acad Med Ctr, Amsterdam, Netherlands

[6] Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland

[7] Curtin Univ, Sch Nursing Midwifery & Paramed, Perth, WA, Australia

[8] Med Univ Vienna, Dept Emergency Med, Vienna, Austria

[9] Municipal Ambulance Serv, Vienna, Austria

[10] Univ Toronto, Rescu, Li Ka Shing Knowledge Inst, St Michaels Hosp, Toronto, ON, Canada

[11] Univ Toronto, Div Emergency Med, Dept Med, Toronto, ON, Canada

[12] Oslo Univ Hosp, Oslo, Norway

[13] Univ Pittsburgh, Med Ctr, Dept Emergency Med, Pittsburgh, PA USA

[14] Seoul Natl Univ, Coll Med, Seoul, South Korea

[15] Univ Med Ctr Hosp, Dept Anesthesiol & Intens Med, Schleswig Campus Kiel, Kiel, Germany

[16] Oregon Hlth & Sci Univ, Dept Emergency Med, Portland, OR 97201 USA

[17] Natl Taiwan Univ, Dept Emergency Med, Taipei, Taiwan

[18] Univ Boras, Prehospen Ctr Prehosp Res, Boras, Sweden

[19] Univ Boras, Fac Caring Sci Work Life & Social Welf, Boras, Sweden

[20] Univ Dalarna, Sch Hlth & Social Sci, Falun, Sweden

[21] Med Coll Wisconsin, Dept Emergency Med, Milwaukee, WI 53226 USA

[22] Natl Univ Ireland, Natl Out Of Hosp Cardiac Arrest Register OHCAR, Discipline Gen Practice, Galway, Ireland

[23] Natl Ambulance Serv, Galway, Ireland

[24] Univ Texas Hlth Sci Ctr Houston, Dept Emergency Med, Houston, TX 77030 USA

[25] Univ British Columbia, Dept Emergency Med, Vancouver, BC, Canada

[26] Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada

[27] Univ Calif San Diego, Dept Emergency Med, San Diego, CA 92103 USA

[28] Univ Texas Southwester, Dept Emergency Med, Dallas, TX USA

[29] Kyoto Univ, Dept Crit Care Nursing, Grad Sch Human Hlth Sci, Kyoto, Japan

[30] Kyoto Univ Hlth Serv, Kyoto, Japan

[31] Univ Washington, Harborview Ctr Prehosp Emergency Care, Dept Emergency Med, Seattle, WA 98195 USA

[32] Univ Washington, Dept Med, Harborview Ctr Prehosp Emergency Care, Seattle, WA USA

关键词: Out-of-hospital cardiac arrest;    Utstein;    Emergency Medical Services;    Outcomes;    Survival;   

DOI  :  10.1016/j.resuscitation.2019.03.018

来源: Elsevier

【 摘 要 】

Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232). Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8%(range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. Conclusions: The Utstein factors explained 51%. of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.

【 授权许可】

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