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 Researchers found a wide variation in cardiac arrest survival rates
depending on which EMS agency provided initial treatment, according
to the study published in JAMA Cardiology.
In fact, the odds of surviving to hospital discharge could vary by
more than 50 percent for two similar patients treated by two
randomly selected EMS agencies.
"We found large outcome variations between EMS agencies that come
after a cardiac arrest even after adjusting for many factors," said
lead author Dr. Masashi Okubo, an instructor of emergency medicine
at the University of Pittsburgh.
The study did not reveal why some EMS agencies did better than
others, however. "We need to determine in future research what are
the underlying factors," Okubo said in a phone interview.
Cardiac arrest "is the abrupt loss of heart function, and if
appropriate steps are not taken immediately it most often is fatal,"
explained Dr. Gregg Fonarow, a professor of cardiovascular medicine
and science at the David Geffen School of Medicine at the University
of California, Los Angeles, and co-director of the UCLA Preventive
Cardiology Program. "Each year in the United states more than
350,000 cardiac arrests occur outside the hospital setting."
Okubo and colleagues analyzed data from the Resuscitation Outcomes
Consortium, a multi-center registry that tracks what happens to
patients who experience a cardiac arrest outside the hospital.
Patients seen at one of 10 sites in North America after initially
being treated by EMS from 2011 to 2015 were included in the
analysis.
Altogether, the researchers studied 43,656 patients treated by 112
EMS agencies. When they looked at how many patients survived long
enough to be discharged from the hospital, variations among
different agencies were quite large: the worst performing agency had
0 survivors out of 36 patients treated, or 0 percent, as compared to
66 survivors out of 228 patients treated, or nearly 30 percent, for
the best-performing agency.
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The pattern was similar when it came to recovery of function by the
time a patient was discharged from the hospital. The worst
performing agency in this category had favorable functional recovery
in 0 out of 87 patients, or 0 percent, while the best had favorable
functional recovery in 11 out of 54 patients, or 20 percent.
"These findings suggest there may be important differences in the
quality of resuscitation efforts among different EMS agencies,"
Fonarow said in an email.
Also, he pointed out, "More layperson interventions such as timely
CPR (cardiopulmonary resuscitation) and more EMS personnel
responding to cardiac arrest patients were associated with better
outcomes.
"These findings suggest that dissemination of best practices and use
of formal quality improvement programs by community-based EMS
agencies may help to improve quality and outcomes in cardiac
arrest."
Can anything be done in the meantime?
Yes, said Fonarow, who was not involved in the new research. "When
performed promptly and properly, CPR can markedly improve the chance
of survival for someone having an out-of-hospital cardiac arrest,"
he explained. "The best advice that might save lives of loved ones
if a cardiac arrest occurs is to learn CPR. Anyone can and everyone
should learn CPR. The American Heart Association offers a variety of
online and in person classes to efficiently and effectively teach
CPR."
SOURCE: http://bit.ly/2Ijlxja JAMA Cardiology, online September 26,
2018.
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