Document Detail


Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements.
MedLine Citation:
PMID:  19944488     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: Survival after out-of-hospital cardiac arrest depends on the links in the chain of survival. The Utstein elements are designed to assess these links and provide the basis for comparing outcomes within and across communities. We assess whether these measures sufficiently predict survival and explain outcome differences. METHODS: We used an observational, prospective data collection, case-series of adult persons with nontraumatic out-of-hospital cardiac arrest from December 1, 2005, through March 1, 2007, from the multisite, population-based Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. We used logistic regression, receiver operating curves, and measures of variance to estimate the extent to which the Utstein elements predicted survival to hospital discharge and explained outcome variability overall and between 7 Resuscitation Outcomes Consortium sites. Analyses were conducted for all emergency medical services-treated cardiac arrests and for the subset of bystander-witnessed patient arrests because of presumed cardiac cause presenting with ventricular fibrillation or ventricular tachycardia. RESULTS: Survival was 7.8% overall (n=833/10,681) and varied from 4.6% to 14.7% across Resuscitation Outcomes Consortium sites. Among bystander-witnessed ventricular fibrillation or ventricular tachycardia, survival was 22.1% overall (n=323/1459) and varied from 12.5% to 41.0% across sites. The Utstein elements collectively predicted 72% of survival variability among all arrests and 40% of survival variability among bystander-witnessed ventricular fibrillation. The Utstein elements accounted for 43.6% of the between-site survival difference among all arrests and 22.3% of the between-site difference among the bystander-witnessed ventricular fibrillation subset. CONCLUSION: The Utstein elements predict survival but account for only a modest portion of outcome variability overall and between Resuscitation Outcomes Consortium sites. The results underscore the need for ongoing investigation to better understand characteristics that influence cardiac arrest survival.
Authors:
Thomas D Rea; Andrea J Cook; Ian G Stiell; Judy Powell; Blair Bigham; Clifton W Callaway; Sumeet Chugh; Tom P Aufderheide; Laurie Morrison; Thomas E Terndrup; Tammy Beaudoin; Lynn Wittwer; Dan Davis; Ahamed Idris; Graham Nichol;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2009-11-27
Journal Detail:
Title:  Annals of emergency medicine     Volume:  55     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-22     Completed Date:  2010-03-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  249-57     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2009. Published by Mosby, Inc.
Affiliation:
Department of Medicine, University of Washington, 401 5th Avenue, Seattle, WA, USA. rea123@u.washington.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cardiopulmonary Resuscitation
Emergency Medical Services / statistics & numerical data*
Female
Heart Arrest / epidemiology,  mortality*,  therapy
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Prospective Studies
ROC Curve
Survival Analysis
Tachycardia, Ventricular / mortality
Treatment Outcome
Ventricular Fibrillation / mortality
Young Adult
Grant Support
ID/Acronym/Agency:
5U01 HL077863/HL/NHLBI NIH HHS; HL077865/HL/NHLBI NIH HHS; HL077866/HL/NHLBI NIH HHS; HL077867/HL/NHLBI NIH HHS; HL077871/HL/NHLBI NIH HHS; HL077872/HL/NHLBI NIH HHS; HL077873/HL/NHLBI NIH HHS; HL077881/HL/NHLBI NIH HHS; HL077885/HL/NHLBI NIH HHS; HL077887/HL/NHLBI NIH HHS; HL077908/HL/NHLBI NIH HHS; //Canadian Institutes of Health Research

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