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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%