Outcomes of out-of-hospital cardiac arrests after a decade of system-wide initiatives optimising community chain of survival in Taipei city

Abstract

ObjectiveA strengthened chain of survival benefits patient outcomes after out-of-hospital cardiac arrest (OHCA).22OHCA, out-of-hospital cardiac arrest; TFD, Taipei Fire Department; CPR, cardiopulmonary resuscitation; PAD, public-access defibrillation; EMS, emergency medical service; GRA, Global Resuscitation Alliance; QA, quality assurance; BLS, basic life support; ALS, advanced life support; AED, automated external defibrillator; OR, odds ratio; CI, confidence interval; STHD, survival to hospital discharge; CPC, cerebral performance category; ROSC, return of spontaneous circulation; aOR, adjusted odds ratio; PEA, pulseless electrical activity; AHA, American Heart Association; TOR, termination of resuscitation. Over the past decade, the Taipei Fire Department (TFD) has continuously implemented system-wide initiatives on this issue.We hypothesised that for adult, non-trauma OHCA patients, the bundle of these system-wide initiatives are associated with better outcomes. MethodsWe conducted a registry-based, retrospective study to examine the association between consecutive system-level initiatives and OHCA survival on a two-yearly basis using trend analysis and multivariable logistic regression. The primary outcome was survival to hospital discharge (STHD) and favourable neurological status. ResultsWe analysed 18,076 cases from 2008 to 2017. The numbers of two-yearly cases of OHCA with resuscitation attempts from 2008 to 2017 were 3,576, 3,456, 3,822, 3,811, and 3,411. There was a significant trend of improved STHD (Two-fold) and favourable neurological outcome (Six-fold) over the past decade. Similar trends were observed in the shockable and non-shockable groups. Considering the first 2 years as baseline, the odds of STHD and favourable neurological status in the end of the initiatives increased significantly after adjusting for universally recognised predictors for OHCA survival. ConclusionFor non-trauma adult OHCA in Taipei, continuous, multifaceted system-wide initiatives on the community chain of survival were associated with improved odds of STHD and favourable neurologic outcomes.