Cardiac arrest outcomes before and after the 2005 resuscitation guidelines implementation: evidence of improvement?

Deasy, C., Bray, J.E., Smith, K., Wolfe, R., Harriss, L.R., Bernard, S.A., and Cameron, P. (2011) Cardiac arrest outcomes before and after the 2005 resuscitation guidelines implementation: evidence of improvement? Resuscitation, 82 (8). pp. 984-988.

[img] PDF (Published Version) - Published Version
Restricted to Repository staff only

View at Publisher Website: http://dx.doi.org/10.1016/j.resuscitatio...
 
5


Abstract

Background: Previous studies have reported improvements in out-of-hospital cardiac arrest (OHCA) outcomes with the introduction of the 2005 cardiopulmonary resuscitation guidelines however they have not adjusted for underlying trends in OHCA survival. We compare outcomes before and after the 2005 guideline changes adjusting for underlying trends in OHCA survival.

Methods: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for adult (≥16 years) OHCA of presumed cardiac aetiology, unwitnessed by paramedics with attempted resuscitation. Outcomes for OHCA occurring between 2003 and 2005 were compared with 2007–2009. Segmented regression analysis of interrupted time series data was performed, adjusting for known predictors, to examine changes in survival to hospital and survival to hospital discharge.

Results: For the pre- and post- guideline periods there were 3115 and 3248 OHCAs, respectively. Asystole increased as presenting rhythm (33–43%, p < 0.001) as did median EMS response times (7.1–7.8 min, p < 0.001) over the two periods. VF/VT arrests decreased (40–35.5%, p = 0.001) as did bystander witnessed arrests (63–59%, p = 0.002). On univariate analysis survival to hospital discharge improved between the two periods (9.4–11.8%, p = 0.002) due to improved outcomes in VF/VT (19–28%, p < 0.001). Segmented regression analysis of interrupted time series data showed improvement in the rate of survival to get to hospital for shockable and non-shockable rhythms [OR (95% CI) = 1.54 (1.10–2.15, p = 0.01) and 1.45 (1.10–2.00, p = 0.02), respectively] following implementation of the guidelines however survival to hospital discharge did not improve [OR = 1.07 (0.70–1.62, p = 0.70) and 1.40 (0.69–2.85, p = 0.40), respectively].

Conclusions: OHCA outcomes have improved since introduction of the 2005 CPR guidelines, but multivariable segmented regression analysis adjusting for pre-existing trends in survival suggests that this improvement may not be due to implementation of the 2005 resuscitation guidelines.

Item ID: 40484
Item Type: Article (Refereed Research - C1)
Keywords: prehospital; cardiac arrest; cardiopulmonary resuscitation
ISSN: 1873-1570
Date Deposited: 16 Sep 2015 03:27
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110305 Emergency Medicine @ 34%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 33%
11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110201 Cardiology (incl Cardiovascular Diseases) @ 33%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920208 Health Inequalities @ 40%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 30%
92 HEALTH > 9202 Health and Support Services > 920204 Evaluation of Health Outcomes @ 30%
Downloads: Total: 5
More Statistics

Actions (Repository Staff Only)

Item Control Page Item Control Page