Abstract 259: National Variability in Survival Outcomes of Out-of-Hospital Cardiac Arrest: The All-Japan Utstein Registry

Abstract

Introduction Health and policy implications of national variability in survival outcomes of out-of-hospital cardiac arrest (OHCA) remain to be determined. Hypothesis We tested the hypothesis that survival outcomes of OHCA would differ across geographic regions in Japan. Methods Analysis of a prospective nation-wide population-based dataset of the whole population across Japan involving all patients who had a non-traumatic OHCA resuscitated by emergency responders from January 2005 through December 2010. The study endpoints were 1-month survival and favorable neurological survival 1 month after an OHCA, defined as Cerebral Performance Category 1 or 2. We compared unadjusted and multivariable-adjusted rates of the outcomes among 7 geographic regions using regression model with generalized estimating equations to control for patient- and prehospital-level characteristics (Table). Results In the total catchment population of 128 million, 670 313 patients with OHCA were documented. Of 660 672 resuscitation attempts, 539 641 non-traumatic OHCA patients were eligible for analysis. The adjusted incidence of OHCA per 100 000 population ranged from 58.9 to 78.8 (median, 65.3). One-month survival ranged from 3.7% to 6.1%, with a median of 5.6%; we observed a large variation among regions in multivariable adjusted rate of 1-month survival, ranging from 3.8% to 6.5% (median, 4.7%). Similarly, neurologically favorable survival varied by region from 1.9% to 3.0%, with a median of 2.5%; adjusted rate of neurologically favorable survival ranged from 1.9% to 3.6% (median, 2.7%), with significant differences across regions (P<.001). Conclusion In this nation-wide population-based study in Japan, there were significant and important regional differences in OHCA survival outcomes.