Rates Of Out-of-hospital Cardiac Arrest Research Articles

A two-point strategy to clarify prognosis in >80 year olds experiencing out of hospital cardiac arrest

BackgroundThe global population is aging, with the number of ≥80-year-olds projected to triple over the next 30 years. Rates of out-of-hospital cardiac arrest (OHCA) are also increasing within this age group. MethodsThe Victorian Ambulance Cardiac Arrest Registry was utilised to identify OHCAs in patients aged ≥80 years between 2002–2021. Predictors of survival to discharge were defined and a prognostic score derived from this cohort. Results77,628 patients experienced OHCA of whom 25,269 (32.6%) were ≥80 years (80–90 years = 18,956; 90–100 years = 6,148; >100 years = 209). The number of patients ≥80 years increased over time both absolutely (p = 0.002) and proportionally (p = 0.028). 619 (2.4%) patients survived to discharge without change over time. Older ages had no difference in witnessed OHCA status but were less likely to have shockable rhythm (OR 0.50 (95% CI 0.44–0.57) for 90–100-year-olds, OR 0.28 (95% CI 0.12–0.63) for 90–100-year-olds). If OHCA was witnessed and there was a shockable rhythm then survival was 14%; if one factor was present survival was 5–6% and if neither factor was present, survival was 0.09%. These survival rates enabled derivation of a simplified prognostic assessment score – the ‘15/5/0’ score - highly comparable to a previously-published American cohort. ConclusionsElderly OHCA rates have increased to one-third of caseload. The most important factors predicting survival were whether the OHCA was witnessed and there was a shockable rhythm. We present a simple two-point ‘15/5/0’ prognostic score defining which patients will gain most from advanced resuscitative measures.

A protocol for the Heart Matters stepped wedge cluster randomised trial: The effectiveness of heart attack education in regions at highest-risk

AimTo describe the Heart Matters (HM) trial which aims to evaluate the effectiveness of a community heart attack education intervention in high-risk areas in Victoria, Australia. These local government areas (LGAs) have high rates of acute coronary syndrome (ACS), out-of-hospital cardiac arrest (OHCA), cardiovascular risk factors, and low rates of emergency medical service (EMS) use for ACS. MethodsThe trial follows a stepped-wedge cluster randomised design, with eight clusters (high-risk LGAs) randomly assigned to transition from control to intervention every four months. Two pairs of LGAs will transition simultaneously due to their proximity. The intervention consists of a heart attack education program delivered by trained HM Coordinators, with additional support from opportunistic media and a geo-targeted social media campaign. The primary outcome measure is the proportion of residents from the eight LGAs who present to emergency departments by EMS during an ACS event. Secondary outcomes include prehospital delay time, rates of OHCA and heart attack awareness. The primary and secondary outcomes will be analysed at the patient/participant level using mixed-effects logistic regression models. A detailed program evaluation is also being conducted. The trial was registered on August 9, 2021 (NCT04995900). ResultsThe intervention was implemented between February 2022 and March 2023, and outcome data will be collected from administrative databases, registries, and surveys. Primary trial data is expected to be locked for analysis by October 31st 2023, with a follow-up planned until March 31st 2024. ConclusionThe results from this trial will provide high-level evidence the effectiveness of a community education intervention targeting regions at highest-risk of ACS and low EMS use.

Outcomes of out-of-hospital cardiac arrest in adult congenital heart disease: a Danish nationwide study.

The risk, characteristics, and outcome of out-of-hospital cardiac arrest (OHCA) in patients with congenital heart disease (CHD) remain scarcely investigated. An epidemiological registry-based study was conducted. Using time-dependent Cox regression models fitted with a nested case-control design, hazard ratios (HRs) with 95% confidence intervals of OHCA of presumed cardiac cause (2001-19) associated with simple, moderate, and severe CHD were calculated. Moreover, using multiple logistic regression, we investigated the association between pre-hospital OHCA characteristics and 30-day survival and compared 30-day survival in OHCA patients with and without CHD. Overall, 43 967 cases (105 with simple, 144 with moderate, and 53 with severe CHD) and 219 772 controls (median age 72 years, 68.2% male) were identified. Any type of CHD was found to be associated with higher rates of OHCA compared with the background population [simple CHD: HR 1.37 (1.08-1.70); moderate CHD: HR 1.64 (1.36-1.99); and severe CHD: HR 4.36 (3.01-6.30)]. Pre-hospital cardiopulmonary resuscitation and defibrillation were both associated with improved 30-day survival in patients with CHD, regardless of CHD severity. Among patients with OHCA, simple, moderate, and severe CHD had a similar likelihood of 30-day survival compared with no CHD [odds ratio 0.95 (0.53-1.69), 0.70 (0.43-1.14), and 0.68 (0.33-1.57), respectively]. A higher risk of OHCA was found throughout the spectrum of CHD. Patients with and without CHD showed the same 30-day survival, which relies on the pre-hospital chain of survival, namely cardiopulmonary resuscitation and defibrillation.

Increased risk of out-of-hospital cardiac arrest in patients with congenital heart disease: a nationwide study

Abstract Background The last four decades witnessed substantial improvements in treatment of congenital heart disease (CHD) leading to most children surviving into adulthood. Currently, the number of adults with CHD surpasses that of children. The shift in the CHD population's age composition necessitates focusing on long-term problems. A significant, but not well-investigated, issue is the risk of out-of-hospital cardiac arrest (OHCA) in adults with CHD. Purpose To investigate overall and temporal changes in the rate of OHCA associated with CHD compared with the general population. Method We conducted a nested case-control study matching all adult patients with OHCA of presumed cardiac cause between 2001 and 2015 with up to five controls from the entire Danish population on age, sex, date of OHCA and cardiac comorbidities status (at least one among ischemic heart disease, heart failure and presence of implantable cardioverter-defibrillator). Patients with CHD were identified using in- and out-patient hospital diagnoses any time prior to OHCA and divided into two mutually exclusive subgroups, either non-severe or severe CHD. The subclassification of CHD is based on a hierarchical approach previously used, where at least one severe CHD diagnosis is required to be classified as severe. We used Cox regression models to compute hazard ratios (HRs) and 95% confidence intervals (CI) of OHCA. We stratified on CHD status (non-severe, severe or control), sex and OHCA year group (2001–2008 vs 2009–2015). Results We included 35,005 OHCA cases and 175,025 controls: the median age was 72 years, 66.9% were male and 34.6% had cardiac comorbidities. In total, among cases, we identified 103 patients with non-severe CHD and 51 with severe CHD, while, among controls, 247 with non-severe CHD and 69 with severe CHD. Both non-severe and severe CHD were overall associated with higher rates of OHCA compared with the general population: HR 2.11 (95% CI, 1.68–2.66) and HR 3.93 (95% CI, 2.71–5.69), respectively (Figure A). We found similar results when we stratified the analyses according to the presence of cardiac comorbidities at date of OHCA (Figure B) and sex. When stratified by OHCA year group, we observed stable rates of OHCA associated with non-severe CHD: from HR 2.03 (95% CI, 1.36–3.03) in the period 2001–2008 to HR 2.15 (95% CI, 1.62–2.86) in the period 2009–2015. Conversely, we observed a trend towards decreasing rates of OHCA associated with severe CHD: from HR 5.04 (95% CI, 2.79–9.11) in the period 2001–2008 to HR 3.10 (95% CI, 1.80–5.19) in the period 2009–2015 Conclusions Non-severe and severe CHD were both associated with higher rates of OHCA compared with the general population. While we observed decreasing rates of OHCA over calendar year for severe CHD, they remained stable for non-severe CHD. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Gentofte University Hospital, Hellerup, Denmark

Latest in Resuscitation Research: Highlights From the 2021 American Heart Association's Resuscitation Science Symposium.

Latest in Resuscitation Research: Highlights From the 2021 American Heart Association's Resuscitation Science Symposium.

Higher rates but similar causes of young out-of-hospital cardiac arrest in rural Australian patients.

To determine whether young rural Australians have higher rates or different underlying causes of out-of-hospital cardiac arrest (OHCA). A case-control design identified patients experiencing an OHCA, then compared annual OHCA rates and underlying causes in rural versus metropolitan Victoria. OHCA causes were defined as either cardiac or non-cardiac, with specific aetiologies including coronary disease, cardiomyopathy, unascertained cause of arrest, drug toxicity, respiratory event, neurological event and other cardiac and non-cardiac. For OHCAs with confirmed cardiac aetiology, cardiovascular risk profiles were compared. A state-wide prospective OHCA registry (combining ambulance, hospital and forensic data) in the state of Victoria, Australia (population 6.5 million). Victorians aged 1-50 years old experienced an OHCA between April 2019 and April 2020. Rates and underlying causes of OHCA in young rural and metropolitan Victorians. Rates of young OHCA were higher in rural areas (OHCA 22.5 per 100 000 rural residents vs. 13.4 per 100 000 metropolitan residents, standardised incidence ratio 168 (95% CI 101-235); confirmed cardiac cause of arrest 12.1 per 100 000 rural residents versus 7.5 per 100 000 metropolitan residents, standardised incidence ratio 161 (95% CI 71-251). The underlying causation of the OHCA and cardiovascular risk factor burden did not differ between rural and metropolitan areas. Higher rates of OHCA occur in young rural patients, with standardised incidence ratio of 168 compared to young metropolitan residents. Rural status did not influence causes of cardiac arrest or known cardiovascular risk factor burden in young patients experiencing OHCA.

Outcomes of Cardiopulmonary Resuscitation of Oncologic Patients in Emergency Department.

To evaluate the outcomes of cardiopulmonary resuscitation (CPR) of oncological cases versus non-oncological admitted to the emergency department as out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Descriptive study. Emergency Department (ED) of Eskisehir Osmangazi University Hospital, between January 2014 to January 2020. Victims over the age of 18 years who had OHCA and IHCA were inducted. The outcomes of 109 patients with an oncological diagnosis and 109 controls without cancer underwent CPR and were compared. The median age of the participants was 65 (58-76) years. Patients with an oncological diagnosis were more likely to have an IHCA [OR: 2.98 (95% CI: 1.68-5.30), p <0.001]. The IHCA and OHCA rates of patients without an oncological diagnosis were similar. Solid-organ malignancies were observed in 102 patients (93.6%). The initial rhythm of 88 patients (80.7%) in the oncological arrest group was asystole versus 77 patients (70.6%) in the control group. Pulseless electrical activity was observed in 17 patients (15.6%) in the study group and in 24 patients (22.0%) in the control group. Although the non-oncological group was found to have a longer stay. No statistically significant difference was found between the study and control groups regarding duration of stay in the intensive care unit. Only one patient (2.0%) with cancer was discharged in stable state as against 10 (21.3%) of non-oncological arrests [OR: 12.97 (95% CI: 1.59-105.93), p = 0.008]. The presence of cancer is not a favourable prognostic factor for the success of CPR. Oncology, Cardiac arrest, IHCA, OHCA, Emergency department.

Sex differences in incidence of out-of-hospital cardiac arrest across ethnic and socioeconomic groups: a population-based cohort study in the Netherlands

Abstract Background Current out-of-hospital cardiac arrest (OHCA) prevention strategies are suboptimal due to the inability to identify subgroups at high risk. Insight into the occurrence of OHCA within general populations may help to target prevention strategies. Case registries suggest that there may be substantial differences in emergency medical service (EMS)-attended OHCA incidence between men and women. However, due to a lack of individual-level prospective data, relative sex differences across ethnic groups and socioeconomic (SES) groups have not been studied. Purpose We investigated sex differences in OHCA incidence, overall and across ethnic groups and SES groups. Methods We performed a retrospective population-based cohort study, combining individual-level data on ethnicity and income (as SES measure) from Statistics Netherlands of all men and women aged ≥25 years living in one study region in the Netherlands on 01–01–2009 (n=1,688,285) with prospectively collected EMS-attended OHCA cases (n=5,676) from the ARREST registry until 31-12-2015. We calculated age-standardised incidence rates of OHCA. Sex differences were assessed with Cox proportional hazards regression analyses, adjusted for age, ethnicity and income, in the overall population, and across ethnic and SES groups. Results Overall, the age-standardised incidence rate of OHCA was lower in women than in men (30.9 versus 87.3 per 100,000 person-years), corresponding with a hazard ratio (HR) of 0.33 (95% confidence interval [CI] 0.31–0.35). While incidence rates varied across subgroups (range: 22.6–104.6 per 100,000 person-years), the sex differences in hazard for OHCA existed in all income quintiles (HR range: 0.30–0.35) and ethnic groups (HR range: 0.19–0.40), except among Moroccans (HR 0.89, 95% CI 0.51–1.57). Conclusion In most ethnic groups and all SES groups, women have a substantial, yet lower OHCA incidence rate than men. This confirms that men are an important target group for OHCA prevention strategies across social strata. Nevertheless, considering potentially differential aetiology as well as the lower survival rates among women, women will also benefit from targeted prevention strategies. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET (grant number 733381) and the COST Action PARQ (grant agreement number CA19137).ZonMw Gender and Health (grant number 8492ehab724.06458) and Gender and Prevention (grant number 555003016) programmes.

Sex differences in incidence of out-of-hospital cardiac arrest across ethnic and socioeconomic groups: A population-based cohort study in the Netherlands

BackgroundInsight into the occurrence of out-of-hospital cardiac arrest (OHCA) within general populations may help to target prevention strategies. Case registries suggest that there may be substantial differences in emergency medical service (EMS)-attended OHCA incidence between men and women, but relative sex differences across ethnic groups and socioeconomic (SES) groups have not been studied. We investigated sex differences in OHCA incidence, overall and across these subgroups. MethodsWe performed a retrospective population-based cohort study, combining individual-level data on ethnicity and income (as SES measure) from Statistics Netherlands of all men and women aged ≥25 years living in one study region in the Netherlands on 01-01-2009 (n = 1,688,285) with prospectively collected EMS-attended OHCA cases (n = 5676) from the ARREST registry until 31-12-2015. We calculated age-standardised incidence rates of OHCA. Sex differences were assessed with Cox proportional hazards regression analyses, adjusted for age, ethnicity and income, in the overall population, and across ethnic and SES groups. ResultsThe age-standardised incidence rate of OHCA was lower in women than in men (30.9 versus 87.3 per 100,000 person-years), corresponding with a hazard ratio (HR) of 0.33 (95% confidence interval [CI] 0.31–0.35). These sex differences in hazard for OHCA existed in all income quintiles (HR range: 0.30–0.35) and ethnic groups (HR range: 0.19–0.40), except among Moroccans (HR 0.89, 95% CI 0.51–1.57). ConclusionWomen have a substantial, yet lower OHCA incidence rate than men. The magnitude of these sex differences did not vary across social strata.

Accessibility of automatic external defibrillators and survival rate of people with out-of-hospital cardiac arrest: A systematic review of real-world studies

ObjectiveTo evaluate the relationship between the accessibility of automatic external defibrillators (AEDs) and the survival rate of patients who have out-of-hospital cardiac arrest (OHCA). MethodsThe systematic review was conducted according to the Cochrane Handbook of Systematic Reviews. We searched the Chinese and English literature databases from 2009 to 2019. Study selection and data collection were conducted by three reviewers. One-month survival rates of OHCA with different AEDs accessibility were estimated using meta-analysis. ResultsOverall 16 studies with 55,537 participants were included. The overall one-month survival rate for OHCA was 27.4%. The one-month survival rate was 35.2% for people receiving AEDs within 5 min, 36.6% between 5 min to 10 min, and 28.4% for longer than 10 min. By distance between the location of the AEDs and the location of the cardiac arrest, the one-month survival rate was 37.1% for those ≤100 m, 22.0% for 100 m-200 m, and 12.8% for >200 m, respectively. The one-month survival rate was 39.3% in schools, sports venues and airports compared with 23.5% in other sites. The number of AEDs allocation was positively correlated, while the time and distance were negatively correlated with the one-month survival rate adjusted for other factors, but they were all non-significant correlations. ConclusionThe improvement of accessibility of AEDs may increase the survival rate of OHCA and the survival rate may be higher in playgrounds, airports, and schools equipped with AEDs. However, the strength of evidence was limited by the considerably heterogeneity of included studies. Verification of these findings in further studies is warranted.

Spatiotemporal analysis of out-of-hospital cardiac arrest in the City of Los Angeles, 2011–2019

ObjectiveThe goal of this analysis is to spatiotemporally identify and categorize areas in a large urban city according to Out-of-Hospital Cardiac Arrest (OHCA) rates and No Bystander CPR (NBCPR) risk levels. Study Area and ParticipantsThe study comprised all cardiac arrests within the administrative geographic boundary of the City of Los Angeles. The final sample included 15,904 cases that were geolocated within 985 census tracts. Main Outcomes and MeasuresThe primary outcome was stratification of census tracts into risk levels of OHCA and NBCPR by observed spatiotemporal patterns. ResultsOf 985 census tracts in the analytical sample, 182 census tracts (18.5%) were identified as having higher risk of OHCA and NBCPR. This assessment resulted in 129 census tracts in Tier 3 (moderate risk), 36 in Tier 2 (moderate-high risk), and 17 in Tier 1 (highest risk). Census tracts in Tiers 2 and 3 had higher amounts incident OHCA, while those in tier 1 had more OHCA events with NBCPR. These areas were largely contiguous and located in the Central and South areas of Los Angeles. ConclusionsUsing a novel three-tiered neighborhood risk classification tool, specific neighborhoods have been identified in the second largest city in the U.S. with consistently high or accelerating rates of OHCA and low bystander CPR. Further study of bystander response and community-based public health campaigns are needed in these communities.

Risk of out-of-hospital cardiac arrest in patients with bipolar disorder or schizophrenia

ObjectivePatients with bipolar disorder and schizophrenia are at high cardiovascular risk; yet, the risk of out-of-hospital cardiac arrest (OHCA) compared with the general population remains scarcely investigated.MethodsWe conducted a nested...

Spatio-temporal prediction model of out-of-hospital cardiac arrest: Designation of medical priorities and estimation of human resources requirement.

To determine the out-of-hospital cardiac arrest (OHCA) rates and occurrences at municipality level through a novel statistical model accounting for temporal and spatial heterogeneity, space-time interactions and demographic features. We also aimed to predict OHCAs rates and number at municipality level for the upcoming years estimating the related resources requirement. All the consecutive OHCAs of presumed cardiac origin occurred from 2005 until 2018 in Canton Ticino region were included. We implemented an Integrated Nested Laplace Approximation statistical method for estimation and prediction of municipality OHCA rates, number of events and related uncertainties, using age and sex municipality compositions. Comparisons between predicted and real OHCA maps validated our model, whilst comparisons between estimated OHCA rates in different yeas and municipalities identified significantly different OHCA rates over space and time. Longer-time predicted OHCA maps provided Bayesian predictions of OHCA coverages in varying stressful conditions. 2344 OHCAs were analyzed. OHCA incidence either progressively reduced or continuously increased over time in 6.8% of municipalities despite an overall stable spatio-temporal distribution of OHCAs. The predicted number of OHCAs accounts for 89% (2017) and 90% (2018) of the yearly variability of observed OHCAs with prediction error ≤1OHCA for each year in most municipalities. An increase in OHCAs number with a decline in the Automatic External Defibrillator availability per OHCA at region was estimated. Our method enables prediction of OHCA risk at municipality level with high accuracy, providing a novel approach to estimate resource allocation and anticipate gaps in demand in upcoming years.

Age-specific trends in incidence and survival of out-of-hospital cardiac arrest from presumed cardiac cause in Denmark 2002–2014

BackgroundThe general cardiovascular health has improved throughout the last few decades for middle-aged and older individuals, but the incidence of several cardiovascular diseases is reported to increase in younger people. We aimed to assess the age-specific incidence and mortality rates associated with out-of-hospital-cardiac-arrest (OHCA) between 2002 and 2014. MethodsWe used the Danish Cardiac Arrest Register to identify patients with OHCA of presumed cardiac etiology. We calculated the annual incidence rates (IR) and 30-day mortality rates (MR) in 7 age groups (18–34 years, 35–44 years, 45–54 years, 55–64 years, 65–74 years, 75–84 years and ≥85 years, and ≤50 vs. >50 years). ResultsBetween 2002 and 2014, IR of OHCA decreased in individuals aged 65–74 and 75–84 years (158.08 to 111.2 and 237.5 to 217.09 per 100,000 person-years) and increased in the oldest from 201.01 to 325.4 pr. 100.000 person-years. In 18–34-years incidence of OHCA increased from 1.7 to 2.6 per 100.000 person-years. When stratifying into age ≤50 vs. >50 years, the IR deviated in those >50 years (from 117.8 in 2002 to 91 in 2008 to 117.4 in 2014100,000 person-years). The prevalence of acute myocardial infarction and heart failure prior to OHCA increased in the younger patient group in contrast to the older segment (AMI: ≤50 years: 10% to 16%, vs. >50 years: 25% to 23%, heart failure: ≤50 years 6% to 14%, vs. >50 years: 21% to 24%). ConclusionOver the last decades, incidence rates of OHCA decreased in individuals aged 65–84, but increased in individuals older than 85. An increase was also observed in younger individuals, potentially indicating a need for better cardiovascular disease prevention in younger adults.

Epidemiology, etiology, and outcomes of out-of-hospital cardiac arrest in young patients in lebanon.

The burden of out-of-hospital cardiac arrest (OHCA) on different population segments in developing countries is not well studied. Previous studies from Lebanon report poor survival to hospital discharge (4.8%-5.5%). This study describes characteristics and outcomes of young OHCA victims in Beirut, Lebanon METHODS: This retrospective observational study included young patients (<35 years of age) with OHCA admitted to the emergency department (ED) of a tertiary care center in Lebanon over a 10-year period. Fifty-four patients with OHCA were identified. Most were males (74.1%, n=40) and the mean age was 17.9±10.9 years. The most common arrest location was home (44.4%, n=24). The majority were witnessed (78.8%, n=41) with 15.4% (n=8) witnessed by emergency medical services (EMS). Prehospital cardiopulmonary resuscitation was done for 22 patients (41.5%) mostly by EMS (n=19, 86.4%), 9.1% (n=2) by a bystander, and 4.5% (n=1) by a family member. Prehospital automated external defibrillator use was documented in 13% (n=7) of cases. Most patients (n=48, 88.9%) were resuscitated in the ED where the most common rhythm was asystole (55.6%, n=30). Half of the patients (50%, n=27) survived to hospital admission. Overall survival to hospital discharge was 16.7% (n=9). Good neurologic outcome (cerebral performance category 1 or 2) was documented in seven patients (9.3%). Survival rate of young OHCA victims in Lebanon (16.7%) is higher than previously reported rates of OHCA in the overall population. Targeted community activities and medical oversight of EMS activities are needed to link EMS activities to clinical outcomes.

Abstract P130: Disparities in Out-of-hospital Cardiac Arrest Rates Among Adults, Aged ≥18 Years Old, With 9-1-1 Emergency Medical Service Activation’s in the United States, 2016

Introduction: Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Hypothesis: This study aims to assess whether patients’ age, sex, race/ethnicity, and urban/non-urban status are associated with the rate of OHCA events among adults who accessed 9-1-1 emergency medical services (EMS) in 2016. Methods: We conducted a cross-sectional analysis using the 2016 National Emergency Medical Services Information System (NEMSIS), a national EMS database. OHCA events among adults aged ≥18 years were extracted by sex, age group, race/ethnicity, urban and non-Urban categories. Those with unknown race/ethnicity (45.8%) or of other race (1.3%) were excluded. Rates of OHCA events were calculated and Chi-square tests were used to assess associations. Results: We identified 205,461 OHCA events with EMS activations among non-Hispanic (NH) whites (68.1%), NH blacks (23.2%), and Hispanics (8.7%) in the 2016 NEMSIS dataset. Of the OHCA events, 59.5% were among males, 81.1% among urban residents, and 15.4% among non-urban residents. The overall OHCA rate was 19.6 per 1,000 EMS activations. OHCA rates per 1,000 EMS activations increased with age for adults until age 74, ranging from 11.2 (18-34 years) to 25.1 (65-74 years), then decreased with age for older adults ≥75 ranging from 22.3 (75-84 years) to 20.8 (≥85 years) ( p &lt;.0001). OHCA rates were higher among males 25.3, Hispanics 20.9, and urban residents 21.7 than females 15.6, other race ethnicities (NH whites 19.8 and NH blacks 18.7), and non-urban residents 17.6 ( p &lt;.0001) respectively. Conlusions: OHCA incidence rates among EMS activations increased with age until age 74. Adult males, Hispanics, and urban patients had statistically significant higher EMS activations for OHCA rates. Findings can be incorporated in community planning for improving EMS services.

Relationship between socioeconomic factors, distribution of public access defibrillators and incidence of out-of-hospital cardiac arrest

BackgroundSurvival from out-of-hospital cardiac arrest (OHCA) is improved when public access defibrillators are used. Areas of socioeconomic deprivation may have higher rates of OHCA and thus a greater demand for public access defibrillators. We aimed to determine if there was a relationship between socioeconomic factors, the geographic distribution of public access defibrillators (PADs) and incidence of OHCA. MethodSocioeconomic deprivation data was obtained from the Census-based 2013 Index of Deprivation. Spatial information for PADs was obtained from a New Zealand PAD database (AED Locations) in 2016 and 2018. Location data for OHCA was obtained from the St John New Zealand OHCA registry for the period 1 October 2013 to 30 June 2016. Relationships between these variables were analysed using a Poisson regression analysis. ResultsCardiac arrest incidence increased with increasing deprivation. The incidence in the most deprived areas of 156.5 events per 100,000 person years (135.4–180.9, 95% CI) is double the incidence in the least deprived areas at 78.0 events per 100,000 person years (66.4–91.7, 95% CI). Significant increases in the rates of OHCA were observed with every 1% increase in proportions of Māori (1.0%, 0.61–1.4%, 95% CI, p = 0.001), Pacific Peoples (0.6%, 0.21–0.9%, p = 0.005), >65 year olds (3.7%, 3.0–4.3%, p < 0.001), and males (3.7%, 1.8–5.6%, p < 0.001). In 2018, the decile 10 areas had the lowest coverage of PADs (65% of these areas contained a PAD) compared with less deprived areas (68–84%, median 81%). ConclusionsThe most socioeconomically deprived communities had the highest incidence of OHCA and the least availability of PADs. This provides impetus for targeted PAD placement in areas of higher deprivation.

Predictors of Resuscitation Outcomes with Global Assessment of Neurologic Status and Overall Survival in Sudden Cardiac Arrest (PROGNOSIS Cardiac Arrest): A Prospective Cohort Study

INTRODUCTION: Global survival rates from out-of-hospital cardiac arrest (OHCA) remain poor, particularly in the Asian region. Literature on OHCA in the Philippines is limited. Better characterization of outcomes of patients with OHCA and predictors of improved survival may help improve the management of OHCA. This study aimed to determine the clinical profiles of patients who had OHCA and identify predictors of survival. Methods: This was a single-center, prospective cohort study that included adult patients who had OHCA and brought to the Philippine Heart Center emergency room (ER) from May 2016 to September 2017. The clinical profiles and Utstein-based factors of cardiac arrest were collected and tabulated. The study outcomes were survival at 20 minutes, 24 hours, seven days and 30 days. Predictors of survival were determined using binary logistic regression. Results: Two hundred nine patients were included in the study, with a mean age of 62 ± 16.8 years. Majority were males, had witnessed arrest, had OHCA that occurred during morning hours at the place of residence and had comorbidities. Only 12% received pre-hospital cardiopulmonary resuscitation (CPR) and &lt;1% had automated external defibrillator (AED) administration. The most common initial rhythm was asystole. The mean arrest-to-hospital and initial-in-hospital CPR duration were 25 minutes and 30 minutes, respectively. The survival rate was 26.3% at 20 minutes, 12.0% at 24 hours, 4.8% at 7 days and 2.4% at 30 days. Neurologic outcome was poor across all time intervals. Predictors of survival at 20 minutes included initial rhythm of ventricular fibrillation (VF) (OR 6.64; 95% CI 1.56-28.17; p=0.010), arrest-to-hospital arrival time interval ≤10 minutes (OR 12.02; 95% CI 4.12-35.06; p≤0.001) and initial-in-hospital CPR duration ≤20 minutes (OR 33.89; 95% CI 12.43-92.42; p≤0.001). Conclusion: Overall survival rates of OHCA remain dismal and were associated with poor neurologic outcomes. Initial rhythm of VF, arrest-to-hospital arrival time interval of ≤ 10 minutes, and initial-in-hospital CPR duration of ≤ 20 minutes were positive predictors of survival. Keywords: Sudden cardiac arrest, OHCA, survival predictors, PROGNOSIS.

Presumed Regional Incidence Rate of Out-of-Hospital Cardiac Arrest in Korea.

The regional incidence rates of out-of-hospital cardiac arrest (OHCA) were traditionally calculated with the residential population as the denominator. The aim of this study was to estimate the true incidence rate of OHCA and to investigate characteristics of regions with overestimated and underestimated OHCA incidence rates. We used the national OHCA database from 2006 to 2010. The nighttime residential and daytime transient populations were investigated from the 2010 Census. The daytime population was calculated by adding the daytime influx of population to, and subtracting the daytime outflow from, the nighttime residential population. Conventional age-standardized incidence rates (CASRs) and daytime corrected age-standardized incidence rates (DASRs) for OHCA per 100,000 person-years were calculated in each county. A total of 97,291 OHCAs were eligible. The age-standardized incidence rates of OHCAs per 100,000 person-years were 34.6 (95% CI: 34.3-35.0) in the daytime and 24.8 (95% CI: 24.5-25.1) in the nighttime among males, and 14.9 (95% CI: 14.7-15.1) in the daytime, and 10.4 (95% CI: 10.2-10.6) in the nighttime among females. The difference between the CASR and DASR ranged from 35.4 to -11.6 in males and from 6.1 to -1.0 in females. Through the Bland-Altman plot analysis, we found the difference between the CASR and DASR increased as the average CASR and DASR increased as well as with the larger daytime transient population. The conventional incidence rate was overestimated in counties with many OHCA cases and in metropolitan cities with large daytime population influx and nighttime outflow, while it was underestimated in residential counties around metropolitan cities.

Geospatial Analysis for Targeting Out-of-Hospital Cardiac Arrest Intervention

Bystander cardiopulmonary resuscitation (BCPR) provides an opportunity for decreasing cardiac mortality. Rates of out-of-hospital cardiac arrest (OHCA) in which resuscitation was performed vary within cities and across demographics. To identify contiguous geographic census tracts with high OHCA, low BCPR rates and high-risk demographics to effectively target culturally appropriate community-based intervention planning. In 2012, a cohort of 11,389 emergency medical services (EMS) OHCA cases from Houston TX (2004-2011) was linked to census tracts. Multivariable logistic regression analyses were used to identify demographics of contiguous geographic census tracts with the highest OHCA rates. Within these tracts, BCPR rates were evaluated. The combination of information was used to develop a plan to better target interventions. Contiguous census tracts of high OHCA rates were identified; the average rate per 100,000 within versus outside the identified tracts is 106.0 (SD 23.7) to 55.8 (SD 19.7). Tracts with a low BCPR rate (37.7%) relative to a high OHCA rate were identified. In a separate analysis, individuals at highest relative risk of OHCA were found to be African Americans, to have low income or education levels, and to be older individuals. For every 1% increase in African Americans in a census tract, there is an increase of 2.7% in the relative risk of the census tract belonging to a high-OHCA-rate region (95% CI=2.0%, 3.5%). Geospatial analysis can provide important information on the contiguous areas of high OHCA rates and low BCPR rates with the aim of more effectively targeting interventions and ultimately decreasing cardiac deaths.