Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest.
Emergency medicine journal : EMJ
BMJ Publishing Group
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Barnard, E. B., Sandbach, D. D., Nicholls, T. L., Wilson, A. W., & Ercole, A. (2019). Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest.. Emergency medicine journal : EMJ, 36 (6), 333-339. https://doi.org/10.1136/emermed-2018-208165
Background Out-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Methods An analysis of 9,109 OHCA attended in East of England between 1st January 2015 and 31st July 2017. Univariate descriptives and multivariable analysis were used to understand determinants of survival for non-traumatic cardiac arrest (NTCA) and traumatic cardiac arrest (TCA). Two Utstein outcome variables were used: survival to hospital admission, and hospital discharge. Results The incidence of OHCA was 55.1 per 100,000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7-28.6) and the overall survival to discharge was 7.9% (95%CI 7.3-8.5). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% versus 19.3% p=0.001, and 8.0% versus 3.8% p=0.012 respectively. Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander-CPR was associated with survival at discharge but not at admission, and the likelihood of bystander CPR was dependent on geographical socioeconomic status. An air ambulance was associated with increased survival to both hospital admission and discharge in NTCA, but only with survival to admission in TCA. Conclusion NTCA and TCA are clinically distinct entities with different predictors for outcome – future OHCA reports should aim to separate arrest aetiologies. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander-CPR public engagement may be best focused in more deprived areas.
Humans, Resuscitation, Registries, Logistic Models, Survival Analysis, Retrospective Studies, Cohort Studies, Aged, Aged, 80 and over, Middle Aged, Emergency Service, Hospital, Emergency Medical Services, Female, Male, Out-of-Hospital Cardiac Arrest
External DOI: https://doi.org/10.1136/emermed-2018-208165
This record's URL: https://www.repository.cam.ac.uk/handle/1810/291323
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