Association Between Survival and Early Versus Later Rhythm Analysis in Out-of-Hospital Cardiac Arrest: Do Agency-Level Factors Influence Outcomes? - 19/06/14
, David Prince, PhD b, Laurie Morrison, MD, MS c, Clifton Callaway, MD d, Tom Aufderheide, MD e, Mohamed Daya, MD f, Ian Stiell, MD, MS g, Jim Christenson, MD h, Judy Powell, MS b, Craig Warden, MD f, Lois van Ottingham, RN b, Peter Kudenchuk, MD a, Myron Weisfeldt, MD iAbstract |
Study objective |
Effectiveness of a resuscitation strategy may vary across communities. We hypothesize that a strategy that prioritizes initial emergency medical services (EMS) rhythm analysis (analyze early) will be associated with survival advantage among EMS systems with lower baseline (pretrial) ventricular fibrillation survival, whereas a strategy that prioritizes initial EMS cardiopulmonary resuscitation (analyze late) will be associated with survival advantage among systems with higher ventricular fibrillation baseline survival.
Methods |
We conducted a secondary, post hoc study of a randomized trial of out-of-hospital cardiac arrest. Subjects were stratified according to randomization status (analyze early versus analyze late) and EMS agency baseline ventricular fibrillation survival. We used a mixed-effects model to determine whether the association between favorable functional survival to hospital discharge and trial intervention (analyze late versus analyze early) differed according to EMS agency baseline ventricular fibrillation survival (<20% or >20%).
Results |
Characteristics were similar among patients randomized to analyze early (n=4,964) versus analyze late (n=4,426). For EMS agencies with baseline ventricular fibrillation survival less than 20%, analyze late compared with analyze early was associated with a lower likelihood of favorable functional survival (3.8% versus 5.5%; odds ratio [OR]=0.67 [95% CI 0.50, 0.90]). Conversely, among agencies with a ventricular fibrillation survival greater than 20%, analyze late compared with analyze early was associated with higher likelihood of favorable functional survival (7.5% versus 6.1%; OR=1.22 [95% CI 0.98, 1.52]). In the multivariable-adjusted model, for every 10% increase in baseline ventricular fibrillation survival, analyze late versus analyze early was associated with a 34% increase in odds of favorable functional survival (OR=1.34 [95% CI 1.07 to 1.66]).
Conclusion |
The findings suggest that system-level characteristics may influence resuscitation outcomes.
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| Supervising editor: Daniel W. Spaite, MD |
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| Author contributions: TR conceived the study. All authors had a role in conduct of the original randomized trial, including implementation and data collection. DP provided statistical expertise and analyzed the data. TR drafted the article, and all authors contributed substantially to its revision. TR takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: The Resuscitation Outcomes Consortium is supported by a series of cooperative agreements to 9 regional clinical centers and 1 data coordinating center (5U01 HL077863, University of Washington Data Coordinating Center; HL077866, Medical College of Wisconsin; HL077867, University of Washington; HL077871, University of Pittsburgh; HL077872, St. Michael's Hospital; HL077873, Oregon Health and Science University; HL077881, University of Alabama at Birmingham; HL077885, Ottawa Hospital Research Institute; HL077887, University of Texas Soutwestern Medical Center/Dallas; HL077908, University of California San Diego) from the National Heart, Lung, and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, US Army Medical Research and Material Command, the Canadian Institutes of Health Research–Institute of Circulatory and Respiratory Health, Defence Research and Development Canada and the Heart, Stroke Foundation of Canada; and the American Heart Association. |
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| The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health. |
Vol 64 - N° 1
P. 1-8 - juillet 2014 Retour au numéro
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