Abstract 341: Regional Variation in Cardiac Arrest Response and Outcomes in North Carolina - A Call to Action

Abstract

Background: In the United States, despite advances in cardiac arrest systems of care, out of hospital cardiac arrest (OHCA) treatment and survival are highly variable. In North Carolina, intensive efforts to improve prehospital care are ongoing. We sought to investigate the variation in OHCA community response and outcomes in North Carolina (NC), and to assess underlying differences in system-, patient- and county-level characteristics in an effort to optimize regional cardiac arrest care. Methods: All adult (age >18 years) OHCAs from 2016-2020 in 36 counties of North Carolina were included from the Cardiac Arrest Registry to Enhance Survival. We excluded cases that were EMS witnessed and that occurred in nursing homes. Response and outcome variation as well as county characteristics were described according to tertile of survival with good neurologic outcome (CPC 1/2). Results: Overall, 18,563 OHCAs occurred of which 22.4% had a shockable rhythm, 84.7% occurred at home and 50.7% were witnessed. Overall survival to hospital discharge with good neurologic outcome was 8.1%, with a state-wide variation among counties between 0% and 21.2% while Utstein survival was 26.1% overall, ranging between 0% and 47.8%. Bystander CPR rates were 41.8% (variation between 22.6% - 64.5%). First responder or bystander AED application was 42.9% of cases (variation between 8.6% - 66.6%) and 11.1% (variation between 2.7% and 19.7%) received defibrillation before EMS arrival. Counties within the highest tertile of survival were characterized by higher population density, lower unemployment rates and higher average household income. Such counties were further characterized by higher rates of bystander and first responder CPR and AED use prior to EMS arrival (Table 1). Conclusion: In NC, cardiac arrest response metrics and survival rates showed a dramatic regional variation, with particularly low survival in rural settings, calling for regional efforts to optimize cardiac arrest care.