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Regional Differences in Management of Out-of-Hospital Cardiac Arrest

In a prospective study in the U.S. and Canada, incidence and outcomes varied widely.

Out-of-hospital cardiac arrest (OHCA) is an important contributor to cardiovascular morbidity and mortality. However, relatively little is known about regional variation in OHCA incidence and outcomes; without such knowledge, evidence-based improvements in healthcare systems cannot be made. To collect essential data, the Resuscitation Outcomes Consortium (ROC), a clinical research network, developed a registry of OHCA among EMS agencies and receiving institutions in the U.S. and Canada. This prospective, observational study includes all OHCA cases occurring within the catchment area of each EMS agency at 10 ROC sites during 1 year.

Overall, the unadjusted incidence of EMS-assessed OHCA was 95.7 per 100,000 person-years. The adjusted incidence ranged from 71.8 to 159.0 per 100,000 census population. Bystander CPR was administered in 19% of cases. Median time from call to first advanced life support contact was 7 minutes. The rate of survival to discharge ranged from 1.1% to 8.1%.

Considering only EMS-treated cases, the unadjusted incidence of OHCA was 55.6 per 100,000 person-years. The adjusted incidence ranged from 36.9 to 78.0 per 100,000 census population. The rate of survival to discharge ranged from 3.0% to 16.3%. The Seattle site had the best performance.

Comment: These findings reveal marked regional variation in the incidence and outcomes of out-of-hospital cardiac arrest. They should serve to alert us to opportunities to improve our approach to prevention and treatment. Many lives could be saved if all sites performed at the level of the best site in this study.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology September 23, 2008

Citation(s):

Nichol G et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008 Sep 24; 300:1423.

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