EMS agency practices affect out-of-hospital cardiac arrest survival rates


Disclosures: Garcia reports receiving support from the NHLBI. Please see the study for all other authors’ relevant financial disclosures.

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Differences in emergency medical service agency resuscitation practices may partly account for widely varying out-of-hospital cardiac arrest survival rates, researchers reported in Circulation: Cardiovascular Quality and Outcomes.

“Our work highlights how important it is for emergency medical service agencies to review their resuscitation performance, and all related practices, to evaluate for areas that can be improved in order to optimize their response to cardiac arrests, and thus help improve the chances of survival for victims of an out-of-hospital cardiac arrest,” Raul Angel Garcia, DOfellow in training at Saint Luke’s Mid America Heart Institute, told Healio.

Source: Adobe Stock.
Source: Adobe Stock

The Cardiac Arrest Registry to Enhance Survival was used to identify 258,342 out-of-hospital cardiac arrests (OHCAs) from 764 emergency medical service (EMS) agencies that had more than 10 OHCA cases each year from 2015 to 2019.

Each EMS agency received a risk-standardized rate of survival to hospital admission, calculated through a multivariable hierarchical logistic regression model, and were grouped into quartiles based on this rate.

Site-level rates were used to determine whether variation in the EMS resuscitation practices of response time and the proportion of OHCAs with termination of resuscitation without meeting futility criteria were associated with rates of survival to hospital admission, the primary outcome.

The median risk-standardized rate of survival to hospital admission in EMS agencies was 27.3% (interquartile range, 24.5-30.1), and rates varied widely, ranging from 16% to 46%. According to the study, the odds of survival for two patients with OHCA and matched covariates varied by 35% between two randomly selected EMS agencies.

Compared with EMS agencies in the highest quartile (quartile 4) of risk-standardized survival, those in the lowest quartile (quartile 1) had substantially longer response times (9 minutes vs. 12 minutes; P < .001), and a greater proportion of OHCAs with termination of resuscitation without meeting futility criteria (18.9% vs. 27.9%; P < .001), demonstrating lower survival rates to hospital admission.

“In finding the large variations in OHCA survival across EMS agencies, our results speak to the need for further research in order to better understand the reasons for why such variation exists so that we can identify best approaches to improve survival,” Garcia told Healio. “Of the factors that we were able to assess, termination of resuscitation without futility criteria is one that specifically requires deeper understanding. For termination of resuscitation practices between EMS agencies, we understand that there may be sufficient reasons why termination of resuscitation may be implemented at times, even in the absence of futility criteria (eg, CPR being performed for more than an hour). Moreover, although we found that higher rates of termination of resuscitation without futility criteria was associated with lower survival, our scope is limited in understanding which key factors influence the termination of resuscitation practices of a given EMS agency.”

For more information:

Raul Angel Garcia, DO, can be reached at ragarcia@saint-lukes.org.

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