Abstract 12956: Racial and Ethnic Disparities in Post-Arrest Care

Abstract

Introduction: Post-arrest care is essential to the chain of survival after out-of-hospital cardiac arrest (OHCA). While racial/ethnic disparities in prehospital care are well studied, there is sparse literature evaluating these disparities in post-arrest care. We sought to measure post-arrest care disparities in a statewide OHCA registry. Methods: We evaluated 2014-2020 data in Texas from the Cardiac Arrest Registry to Enhance Survival (CARES) and included all adult OHCAs surviving to hospital admission. We stratified subjects by race and ethnicity. We defined outcomes as targeted temperature management (TTM), percutaneous intervention (PCI), and early prognostication (made DNR and died <72 hours of arrest), survival to discharge, and survival with CPC of 1-2 (good CPC). We used a mixed effects model logistic regression to evaluate the association between strata and outcomes, modeling receiving hospital as the random intercept. We adjusted for age, household income, sex, witnessed arrest, bystander CPR (B-CPR), and initial shockable rhythm. For early prognostication, we performed a multivariable logistic regression adjusted for bystander witnessed arrest and B-CPR. Results: Of 37,055 adult OHCAs, 9,346 (25.2%) survived to admission; median age was 62, 60.7% were male, 3,036 (32.5%) received TTM, 533 (5.7%) received PCI, 93 (1.0%) had early prognostication, 34.9% survived to discharge, and 22.0% survived with good CPC. Blacks were less likely than whites to receive PCI (2.7% v 7.9%, aOR 0.6, 95% CI 0.4-0.8), less likely to receive early prognostication (0.3% v 1.0%, aOR 0.3, 95% CI 0.1-0.6), and less likely to have good CPC (17.3% v 26.0%, aOR 0.8, 0.7-0.9). Despite a lower percentage receiving TTM, blacks had a higher odds of TTM (30.7% v 34.5%, aOR 1.2, 95% CI 1.03-1.4). Blacks had a similar survival (1.0, 95% CI 0.9-1.2). Compared to whites, Latinos had higher early prognostication (1.7%, aOR 1.7, 95% CI 1.1-2.7), worse survival (30.3%, v 37.1%, aOR 0.9, 95% CI 0.8-0.99), lower good CPC (17.8%, aOR 0.8, 95% CI 0.7-0.96). Latinos had a similar rate of TTM (aOR 1.0, 95%CI 0.8-1.2) and PCI (aOR 1.0, 95% CI 0.8-1.4). Conclusions: Black and Latino OHCA victims experienced disparities in post arrest care and outcomes, even when adjusted for receiving hospital.