International variation in survival after out-of-hospital ... · Methods • 12 cardiac arrest...

Dr Kylie Dyson

International variation in survival after out-of-hospital cardiac arrest: a validation study of the Utstein templateDyson K, Brown SP, May S, Koster RW, Beesems SG, Kuisma M, Salo A, Finn J, Sterz F, Nürnberger A, Smith K, Morrison LJ, Olasveengen TM, Callaway CW, Shin SD, Gräsner JT, Daya M, Ma MH, Herlitz J, Strömsöe A, Aufderheide TP, Masterson S, Wang H, Christenson J, Stiell I, Vilke G, Idris A, Nishiyama C, Iwami T, Nichol G

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Utstein template

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46% 13%29%

12%

German Resuscitation RegistryHelsinki Cardiac Arrest RegistryIrish OHCAR CAVAS Project

ARRESTVACARVICARROC

Swedish Register of CPRTaipei OHCA RegistryOslo and Akershus RegistrySJA-WA Cardiac Arrest Registry

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Methods• 12 cardiac arrest registries• 2006-2011 (6 years)• Generalized linear mixed models• 2004 Utstein template• 21 core data elements • 6 core time events

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34% FEMALE

66%MALE

n=86,759 65

YEARS 25%SHOCKABLE

Results

Overall survival to hospital discharge

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Range 2% to 22%

10%

Overall survival cerebral performance category 1 or 2

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Range 2% to 20% (available for 9/12 registries)

8%

Adjusted association between age and survival

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Adjusted association between EMS response time and survival

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Adjusted association between witness and survival

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Adjusted association between bystander actions and survival

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Adjusted association between initial rhythm and survival

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Subgroup analysis

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Aetiology

Non-traumatic

Cardiac

Non-cardiac

Initial rhythm

Shockable

Non-shockable

Witness

EMS witnessed

Not EMS witnessed

Age group

Adults (≥18 years)

Child (1 to <18 years)

Bystander witnessed Shockable

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Survival

↑ Patient age

EMS response time

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Survival

Public location

Witnessed event

Bystander defibrillation

Extent of survival predicted by the Utstein data elements

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Area-under-the-curve for the Utstein model 0.85 (Wald CI: 0.85-0.85)

How much of the variation in survival is explained by

the Utstein factors?

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Variation in OHCA survival explained by Utsteinfactors

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51%

The 49%... • Factors in the 2015 Utstein template• Supplementary (non-core) Utstein data elements • Other non-Utstein factors• Community and population factors• EMS performance and initiatives

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Utstein factors explain 51% of the variation in OHCA survival

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51%