University of Washington. From the SelectedWorks of Kent M Koprowicz
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1 University of Washington From the SelectedWorks of Kent M Koprowicz 2007 Site variation in EMS Treatment, Transport and Survival in relation to Restoration of Spontaneous Circulation (ROSC) for Adult Out-of-Hospital Cardiac Arrest: The Resuscitation Outcomes Consortium (ROC) Epistry Mohamud R Daya, Oregon Health & Science University Kent M Koprowicz, University of Washington Dana M Zive, Oregon Health & Science University Julie E Cummins Gena K Sears, University of Washington, et al. Available at:
2 Resuscitation Outcomes Consortium Site Variation in EMS Treatment and Transport for Adult Out-of- Hospital Cardiac Arrest: The Resuscitation Outcomes Consortium Epistry Dana Zive, MPH Department of Emergency Medicine Oregon Health & Sciences University November 5, 2007
3 Co-Authors Julie Cummins, AEMCA, MSc(A) Ottowa Health Research Institute Mohamud Daya, MD, MS Oregon Health & Sciences University Kent Koprowicz, PhDc Data Coordinating Center, University of Washington Terri Schmidt, MD, MS Oregon Health & Sciences University Gena Sears, BSN Data Coordinating Center, University of Washington Shannon Stephens, EMT-P University of Alabama Ian Stiell, MD, MSc, FRCPC Ottowa Health Research Institute
4 DISCLOSURE INFORMATION The following relationships exist related to this presentation for all authors: NONE
5 ROC Funding Partners
6 Background Reported OHCA survival is variable Eisenberg MS, et al. Cardiac arrest and resuscitation: A tale of 29 cities. Ann Emerg Med Feb;19(2): Other contributors to variability? Rea, et al. Survival differences following out-of-hospital cardiac arrest: The influence of Utstein measures [Abstract], AHA 2007 (Orlando)
7 Objectives Explore and describe site-level variation in proportion of OHCA who are: treated by EMS transported to emergency departments transported with and without ROSC in the field
8 Methods Epistry Data Prospective population based cohort study with uniform Utstein-style data definitions from all ROC sites in North America. Population: 14,604 patients >20 years of age Non-traumatic out-of-hospital cardiac arrest 1 year: 12/1/05 to 11/30/06 8 ROC sites with complete data
9 Methods Definitions: OHCA: Out of Hospital Cardiac Arrest Treated: Received CPR by EMS or any defibrillation Survived: Discharged alive from hospital Limitations: ROSC measured at single point in time Final vital status does not consider neurologic outcome
10 Analysis Adjusted and unadjusted tests of heterogeneity across the sites Covariates adjusted for: Patient Characteristics: sex, age Scene Characteristics: public location, ALS care Cardiac Arrest Characteristics: initial cardiac arrest rhythm, EMS witnessed, bystander witnessed and bystander CPR
11 Treatment, Transport, and Survival: All Sites Adult OHCA N=14,604 Resuscitation Attempted n=8,505 (58%) No Resuscitation Attempted n=6099 (42%) Transported n=4,936 (58% of treated) Survived to Discharge n=664 (13% of transported)
12 All OHCA Patients Treatment and Transport: Site Variation 100% 80% Treated by EMS (38-68%, p<0.0001) Transported from the scene (48-89% of treated, p<0.0001) 60% 40% 20% 0% Site 1 Site 3 Site 2 Site 5 Site 4 Site 8 Site 7 Site 6
13 Transport and ROSC: All Sites Transported N=4,936 Transported After ROSC n=2015 (41%) Decision to Transport in the absence of ROSC n=2921 (59%) Survived to Discharge n=548 (27%) Survived to Discharge n=116 (4%)
14 Transported OHCA Patients ROSC Prior to Transport and Survival: Site Variation 100% 80% Survived (p<0.0001) Died (p<0.0001) 60% 40% 20% 0% Site 1 Site 2 Site 3 Site 7 Site 8 Site 4 Site 6 Site 5
15 Transported OHCA Patients No ROSC Prior to Transport and Survival: Site Variation 100% 80% Survived (p<0.0001) Died (p<0.0001) 60% 40% 20% 0% Site 1 Site 2 Site 3 Site 7 Site 8 Site 4 Site 6 Site 5
16 Conclusions Large inter-site variations in treatment and transport may be one of the causes of variability in reported survival. Survival of patients transported prior to or in the absence of ROSC is poor. Low percentages of transport prior to ROSC do not appear to adversely affect survival.
17 Next Steps Better understand site variability Protocol review and site survey EMS and hospital factors Community and population factors Explore and describe differences between patient groups Treated versus untreated patients Patients transported without versus with ROSC in the field
18 Thank you for your time. Questions?
Disclosure. Co-investigators 1/23/2015
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