Predictors of Out of Hospital Cardiac Arrest Outcomes in Pre-Hospital Settings; a Retrospective Cross-sectional Study
Archives of Academic Emergency Medicine,
Vol. 7 No. 1 (2019),
11 November 2018
Introduction: Different potential factors can affect the outcomes of Out of Hospital Cardiac Arrest (OHCA). The present study aimed to identify important factors contributing to the Return of Spontaneous CirculationÂ (ROSC) and Survival to Hospital Discharge (SHD) in these patients.
Methods: This cross-sectional study was conducted on all the OHCA patients who underwent Cardiopulmonary Resuscitation (CPR) in emergency medical service (EMS) of Hamadan province during 2016-2017. All the relevant data were retrieved from three sources, according to Utsteinâ€™s style. In addition, univariate and multivariate logistic regressions were employed to identify predictive factors of ROSC and SHD using SPSS software, version 20.
Results: Among the 3214 eligible patients whose data were collected, most OHCA patients were female (59.7%) with the mean age of 58 years. Moreover,Â the majority of OHCAs (77.8%) occurred at home during 8pm-8am (65.1%) and about 26.3% of OHCAs were witnessed, with only 5.1% bystander-initiated CPR. Furthermore, the median ambulance response time and CPR duration were 6.0 and 20 minutes, respectively. Overall, ROSC and SHD success rates were 8.3 and 4.1%, respectively. Bystander CPR was found to be the most effective predicting factor for the success rate of ROSC (AOR=3.26, P<0.001) and SHD (AOR=3.04, P<0.001) after adjusting for the Utstein variables including the patientsâ€™ age, gender, cardiac disease history, arrest time, CPR duration, response time, being witnessed, bystander CPR, and endotracheal intubation (ETI).
Conclusion: The overall success rates of ROSC and SHD were 8.3% and 4.1%, respectively. The age, ambulance response time, CPR duration, and cardiac disease history were negatively associated with the outcomes of ROSC and SHD, while being witnessed, bystander CPR, ETI, and initial shockable rhythm were positively related to both of the above-mentioned outcomes.
- Out-of-Hospital Cardiac Arrest
- Emergency Medical Services
- Emergency Medical Technicians
- Cardiopulmonary Resuscitation
How to Cite
Linderoth, G., P. Hallas, F.K. Lippert, I. Wibrandt, S. Loumann, T.P. Moller, and D. Ostergaard, Challenges in out-of-hospital cardiac arrest - A study combining closed-circuit television (CCTV) and medical emergency calls. Resuscitation, 2015. 96: p. 317-22.
Grasner, J.T., R. Lefering, R.W. Koster, S. Masterson, B.W. Bottiger, J. Herlitz, J. Wnent, I.B. Tjelmeland, F.R. Ortiz, H. Maurer, M. Baubin, P. Mols, I. Hadzibegovic, M. Ioannides, R. Skulec, M. Wissenberg, A. Salo, H. Hubert, N.I. Nikolaou, G. Loczi, H. Svavarsdottir, F. Semeraro, P.J. Wright, C. Clarens, R. Pijls, G. Cebula, V.G. Correia, D. Cimpoesu, V. Raffay, S. Trenkler, A. Markota, A. Stromsoe, R. Burkart, G.D. Perkins, and L.L. Bossaert, EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation, 2016. 105: p. 188-95.
Nichol, G., J. Rumsfeld, B. Eigel, B.S. Abella, D. Labarthe, Y. Hong, R.E. O'Connor, V.N. Mosesso, R.A. Berg, B.B. Leeper, and M.L. Weisfeldt, Essential features of designating out-of-hospital cardiac arrest as a reportable event: a scientific statement from the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation, 2008. 117(17): p. 2299-308.
McCarthy, J.J., B. Carr, C. Sasson, B.J. Bobrow, C.W. Callaway, R.W. Neumar, J.M.E. Ferrer, J.L. Garvey, J.P. Ornato, L. Gonzales, C.B. Granger, M.E. Kleinman, C. Bjerke, and G. Nichol, Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association. Circulation, 2018. 137(21): p. e645-e660.
Doctor, N.E., N.S. Ahmad, P.P. Pek, S. Yap, and M.E. Ong, The Pan-Asian Resuscitation Outcomes Study (PAROS) clinical research network: what, where, why and how. Singapore Med J, 2017. 58(7): p. 456-458.
Ong, M.E., S.D. Shin, N.N. De Souza, H. Tanaka, T. Nishiuchi, K.J. Song, P.C. Ko, B.S. Leong, N. Khunkhlai, G.Y. Naroo, A.K. Sarah, Y.Y. Ng, W.Y. Li, and M.H. Ma, Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: The Pan Asian Resuscitation Outcomes Study (PAROS). Resuscitation, 2015. 96: p. 100-8.
Hollenberg, J., L. Svensson, and M. Rosenqvist, Out-of-hospital cardiac arrest: 10 years of progress in research and treatment. J Intern Med, 2013. 273(6): p. 572-83.
Neumar, R.W., M. Shuster, C.W. Callaway, L.M. Gent, D.L. Atkins, F. Bhanji, S.C. Brooks, A.R. de Caen, M.W. Donnino, J.M. Ferrer, M.E. Kleinman, S.L. Kronick, E.J. Lavonas, M.S. Link, M.E. Mancini, L.J. Morrison, R.E. O'Connor, R.A. Samson, S.M. Schexnayder, E.M. Singletary, E.H. Sinz, A.H. Travers, M.H. Wyckoff, and M.F. Hazinski, Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2015. 132(18 Suppl 2): p. S315-67.
Okubo, M., R.H. Schmicker, D.J. Wallace, A.H. Idris, G. Nichol, M.A. Austin, B. Grunau, L.K. Wittwer, N. Richmond, L.J. Morrison, M.C. Kurz, S. Cheskes, P.J. Kudenchuk, D.M. Zive, T.P. Aufderheide, H.E. Wang, H. Herren, C. Vaillancourt, D.P. Davis, G.M. Vilke, F.X. Scheuermeyer, M.L. Weisfeldt, J. Elmer, R. Colella, and C.W. Callaway, Variation in Survival After Out-of-Hospital Cardiac Arrest Between Emergency Medical Services Agencies. JAMA Cardiol, 2018.
Chan, P.S., B. McNally, F. Tang, and A. Kellermann, Recent trends in survival from out-of-hospital cardiac arrest in the United States. Circulation, 2014. 130(21): p. 1876-82.
Perkins, G.D., I.G. Jacobs, V.M. Nadkarni, R.A. Berg, F. Bhanji, D. Biarent, L.L. Bossaert, S.J. Brett, D. Chamberlain, A.R. de Caen, C.D. Deakin, J.C. Finn, J.T. Grasner, M.F. Hazinski, T. Iwami, R.W. Koster, S.H. Lim, M. Huei-Ming Ma, B.F. McNally, P.T. Morley, L.J. Morrison, K.G. Monsieurs, W. Montgomery, G. Nichol, K. Okada, M. Eng Hock Ong, A.H. Travers, and J.P. Nolan, Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation, 2015. 132(13): p. 1286-300.
Sasson, C., M.A. Rogers, J. Dahl, and A.L. Kellermann, Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes, 2010. 3(1): p. 63-81.
Wissenberg, M., F.K. Lippert, F. Folke, P. Weeke, C.M. Hansen, E.F. Christensen, H. Jans, P.A. Hansen, T. Lang-Jensen, J.B. Olesen, J. Lindhardsen, E.L. Fosbol, S.L. Nielsen, G.H. Gislason, L. Kober, and C. Torp-Pedersen, Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. Jama, 2013. 310(13): p. 1377-84.
Bougouin, W., L. Lamhaut, E. Marijon, D. Jost, F. Dumas, N. Deye, F. Beganton, J.P. Empana, E. Chazelle, A. Cariou, and X. Jouven, Characteristics and prognosis of sudden cardiac death in Greater Paris: population-based approach from the Paris Sudden Death Expertise Center (Paris-SDEC). Intensive Care Med, 2014. 40(6): p. 846-54.
Tanaka, H., M.E.H. Ong, F.J. Siddiqui, M.H.M. Ma, H. Kaneko, K.W. Lee, K. Kajino, C.H. Lin, H.N. Gan, P. Khruekarnchana, O. Alsakaf, N.H. Rahman, N.E. Doctor, P. Assam, and S.D. Shin, Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study. Ann Emerg Med, 2018. 71(5): p. 608-617.e15.
Lai, C.-Y., F.-H. Lin, H. Chu, C.-H. Ku, S.-H. Tsai, C.-H. Chung, W.-C. Chien, C.-H. Wu, C.-M. Chu, and C.-W. Chang, Survival factors of hospitalized out-of-hospital cardiac arrest patients in Taiwan: A retrospective study. PLoS ONE, 2018. 13(2): p. e0191954.
Oh, S.H., K.N. Park, J. Lim, S.P. Choi, J.S. Oh, I.S. Cho, B.K. Lee, Y.H. Kim, Y.-M. Kim, H.J. Kim, C.S. Youn, S.H. Kim, and I. On behalf of the Korean Hypothermia Network, The impact of sex and age on neurological outcomes in out-of-hospital cardiac arrest patients with targeted temperature management. Critical Care, 2017. 21: p. 272.
Hiemstra, B., R. Bergman, A.R. Absalom, J. van der Naalt, P. van der Harst, R. de Vos, W. Nieuwland, M.W. Nijsten, and I.C.C. van der Horst, Long-term outcome of elderly out-of-hospital cardiac arrest survivors as compared with their younger counterparts and the general population. Ther Adv Cardiovasc Dis, 2018: p. 1753944718792420.
Drennan, I.R., S. Lin, K.E. Thorpe, and L.J. Morrison, The effect of time to defibrillation and targeted temperature management on functional survival after out-of-hospital cardiac arrest. Resuscitation, 2014. 85(11): p. 1623-8.
Holmberg, M.J., M. Vognsen, M.S. Andersen, M.W. Donnino, and L.W. Andersen, Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation, 2017. 120: p. 77-87.
Park, G.J., K.J. Song, S.D. Shin, K.W. Lee, K.O. Ahn, E.J. Lee, K.J. Hong, and Y.S. Ro, Timely bystander CPR improves outcomes despite longer EMS times. Am J Emerg Med, 2017. 35(8): p. 1049-1055.
Rajan, S., M. Wissenberg, F. Folke, S.M. Hansen, T.A. Gerds, K. Kragholm, C.M. Hansen, L. Karlsson, F.K. Lippert, L. Kober, G.H. Gislason, and C. Torp-Pedersen, Association of Bystander Cardiopulmonary Resuscitation and Survival According to Ambulance Response Times After Out-of-Hospital Cardiac Arrest. Circulation, 2016. 134(25): p. 2095-2104.
Baekgaard, J., S. Viereck, T. Moller, A. Ersboll, F. Lippert, and F. Folke, The Effects of Public Access Defibrillation on Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review of Observational Studies. Circulation, 2017.
Morgan, D.P., D. Muscatello, A. Hayen, and J. Travaglia, Human factors influencing out-of-hospital cardiac arrest survival. Emerg Med Australas, 2019.
Colquhoun, M.C., D.A. Chamberlain, R.G. Newcombe, R. Harris, S. Harris, K. Peel, C.S. Davies, and R. Boyle, A national scheme for public access defibrillation in England and Wales: early results. Resuscitation, 2008. 78(3): p. 275-80.
Stammet, P., D. Collas, C. Werer, L. Muenster, C. Clarens, and D. Wagner, Impact of initial intervention on long-term neurological recovey after cardiac arrest: data from the Luxembourg "North Pole" cohort. Bull Soc Sci Med Grand Duche Luxemb, 2012(1): p. 60-70.
Nakahara, S. and T. Sakamoto, Effective deployment of publicâ€access automated external defibrillators to improve outâ€ofâ€hospital cardiac arrest outcomes. Journal of General and Family Medicine, 2017. 18(5): p. 217-224.
Perkins, G.D., A.J. Handley, R.W. Koster, M. Castren, M.A. Smyth, T. Olasveengen, K.G. Monsieurs, V. Raffay, J.T. Grasner, V. Wenzel, G. Ristagno, and J. Soar, European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation, 2015. 95: p. 81-99.
Kronick, S.L., M.C. Kurz, S. Lin, D.P. Edelson, R.A. Berg, J.E. Billi, J.G. Cabanas, D.C. Cone, D.B. Diercks, J.J. Foster, R.A. Meeks, A.H. Travers, and M. Welsford, Part 4: Systems of Care and Continuous Quality Improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2015. 132(18 Suppl 2): p. S397-413.
Lin, P., F. Shi, L. Wang, and Z.A. Liang, Nighttime is associated with decreased survival for out of hospital cardiac arrests: A meta-analysis of observational studies. Am J Emerg Med, 2019. 37(3): p. 524-529.
Reynolds, J.C., A. Frisch, J.C. Rittenberger, and C.W. Callaway, Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation, 2013. 128(23): p. 2488-94.
Cooper, S. and C. Evans, Resuscitation Predictor Scoring Scale for inhospital cardiac arrests. Emergency Medicine Journal : EMJ, 2003. 20(1): p. 6-9.
Funada, A., Y. Goto, H. Tada, R. Teramoto, M. Shimojima, K. Hayashi, M.A. Kawashiri, and M. Yamagishi, Duration of cardiopulmonary resuscitation in patients without prehospital return of spontaneous circulation after out-of-hospital cardiac arrest: Results from a severity stratification analysis. Resuscitation, 2018. 124: p. 69-75.
Nehme, Z., S. Bernard, and K. Smith, Duration of cardiopulmonary resuscitation efforts in paediatric out-of-hospital cardiac arrests: is there an optimal endpoint? Resuscitation, 2018. 130: p. e2.
Sherbino, J., S.M. Keim, and D.P. Davis, Clinical decision rules for termination of resuscitation in out-of-hospital cardiac arrest. J Emerg Med, 2010. 38(1): p. 80-6.
Goto, Y., A. Funada, and Y. Goto, Relationship Between the Duration of Cardiopulmonary Resuscitation and Favorable Neurological Outcomes After Outâ€ofâ€Hospital Cardiac Arrest: A Prospective, Nationwide, Populationâ€Based Cohort Study. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 2016. 5(3): p. e002819.
Nagao, K., Chest compression-only cardiocerebral resuscitation. Curr Opin Crit Care, 2009. 15(3): p. 189-97.
Gold, L.S., C.E. Fahrenbruch, T.D. Rea, and M.S. Eisenberg, The relationship between time to arrival of emergency medical services (EMS) and survival from out-of-hospital ventricular fibrillation cardiac arrest. Resuscitation, 2010. 81(5): p. 622-625.
Sladjana, A., P. Gordana, and S. Ana, Emergency response time after out-of-hospital cardiac arrest. Eur J Intern Med, 2011. 22(4): p. 386-93.
Burger, A., J. Wnent, A. Bohn, T. Jantzen, S. Brenner, R. Lefering, S. Seewald, J.T. Grasner, and M. Fischer, The Effect of Ambulance Response Time on Survival Following Out-of-Hospital Cardiac Arrest. Dtsch Arztebl Int, 2018. 115(33-34): p. 541-548.
Lee, Y.J., S.S. Hwang, S.D. Shin, S.C. Lee, and K.J. Song, Effect of National Implementation of Telephone CPR Program to Improve Outcomes from Out-of-Hospital Cardiac Arrest: an Interrupted Time-Series Analysis. J Korean Med Sci, 2018. 33(51): p. e328.
Chiang, W.C., M.J. Hsieh, H.L. Chu, A.Y. Chen, S.Y. Wen, W.S. Yang, Y.C. Chien, Y.C. Wang, B.C. Lee, H.C. Wang, E.P. Huang, C.W. Yang, J.T. Sun, K.M. Chong, H.Y. Lin, S.H. Hsu, S.Y. Chen, and M.H. Ma, The Effect of Successful Intubation on Patient Outcomes After Out-of-Hospital Cardiac Arrest in Taipei. Ann Emerg Med, 2018. 71(3): p. 387-396.e2.
Jacobs, P.E. and A. Grabinsky, Advances in prehospital airway management. International Journal of Critical Illness and Injury Science, 2014. 4(1): p. 57-64.
Ghiyasvandian, S., A. Khazaei, M. Zakerimoghadam, R. Salimi, A. Afshari, and A. Mogimbeigi, Evaluation of Airway Management Proficiency in Pre-Hospital Emergency Setting; a Simulation Study. 2018, 2018. 6(1).
Izawa, J., S. Komukai, K. Gibo, M. Okubo, K. Kiyohara, C. Nishiyama, T. Kiguchi, T. Matsuyama, T. Kawamura, T. Iwami, C.W. Callaway, and T. Kitamura, Pre-hospital advanced airway management for adults with out-of-hospital cardiac arrest: nationwide cohort study. Bmj, 2019. 364: p. l430.
Howard, C.E., J.S. Garrett, R.C. Stoler, and J.M. Schussler, Overall survival and brain death frequency following out-of-hospital cardiac arrest. Proc (Bayl Univ Med Cent), 2018. 31(1): p. 6-8.
Stein, P., G.H. Spahn, S. Muller, A. Zollinger, W. Baulig, M. Bruesch, B. Seifert, and D.R. Spahn, Impact of city police layperson education and equipment with automatic external defibrillators on patient outcome after out of hospital cardiac arrest. Resuscitation, 2017. 118: p. 27-34.
Park, J.H., Y.S. Ro, S.D. Shin, K.J. Song, K.J. Hong, and S.Y. Kong, Dispatcher-assisted bystander cardiopulmonary resuscitation in rural and urban areas and survival outcomes after out-of-hospital cardiac arrest. Resuscitation, 2018. 125: p. 1-7.
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