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Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest.

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Peer-reviewed

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Article

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Authors

Sandbach, Daniel D 
Nicholls, Tracy L 
Wilson, Alastair W 
Ercole, Ari 

Abstract

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 9109 OHCA attended in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the 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% to 28.6%) and the overall survival to discharge was 7.9% (95% CI 7.3% to 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% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (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.

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Keywords

cardiac arrest, doctors in PHC, prehospital care, prehospital care, clinical management, trauma, major trauma management, Aged, Aged, 80 and over, Cohort Studies, Emergency Medical Services, Emergency Service, Hospital, Female, Humans, Logistic Models, Male, Middle Aged, Out-of-Hospital Cardiac Arrest, Registries, Resuscitation, Retrospective Studies, Survival Analysis

Journal Title

Emerg Med J

Conference Name

Journal ISSN

1472-0205
1472-0213

Volume Title

36

Publisher

BMJ

Rights

All rights reserved