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Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and Outcome
Graham Nichol, MD, MPH;
Elizabeth Thomas, MSc;
Clifton W. Callaway, MD, PhD;
Jerris Hedges, MD, MS;
Judy L. Powell, BSN;
Tom P. Aufderheide, MD;
Tom Rea, MD;
Robert Lowe, MD, MPH;
Todd Brown, MD;
John Dreyer, MD;
Dan Davis, MD;
Ahamed Idris, MD;
Ian Stiell, MD, MSc
JAMA. 2008;300(12):1423-1431.
Context The health and policy implications of regional variation in incidence and outcome of out-of-hospital cardiac arrest remain to be determined.
Objective To evaluate whether cardiac arrest incidence and outcome differ across geographic regions.
Design, Setting, and Patients Prospective observational study (the Resuscitation Outcomes Consortium) of all out-of-hospital cardiac arrests in 10 North American sites (8 US and 2 Canadian) from May 1, 2006, to April 30, 2007, followed up to hospital discharge, and including data available as of June 28, 2008. Cases (aged 0-108 years) were assessed by organized emergency medical services (EMS) personnel, did not have traumatic injury, and received attempts at external defibrillation or chest compressions or resuscitation was not attempted. Census data were used to determine rates adjusted for age and sex.
Main Outcome Measures Incidence rate, mortality rate, case-fatality rate, and survival to discharge for patients assessed or treated by EMS personnel or with an initial rhythm of ventricular fibrillation.
Results Among the 10 sites, the total catchment population was 21.4 million, and there were 20 520 cardiac arrests. A total of 11 898 (58.0%) had resuscitation attempted; 2729 (22.9% of treated) had initial rhythm of ventricular fibrillation or ventricular tachycardia or rhythms that were shockable by an automated external defibrillator; and 954(4.6% of total) were discharged alive. The median incidence of EMS-treated cardiac arrest across sites was 52.1 (interquartile range [IQR], 48.0-70.1) per 100 000 population; survival ranged from 3.0% to 16.3%, with a median of 8.4% (IQR, 5.4%-10.4%). Median ventricular fibrillation incidence was 12.6 (IQR, 10.6-5.2) per 100 000 population; survival ranged from 7.7% to 39.9%, with a median of 22.0% (IQR, 15.0%-24.4%), with significant differences across sites for incidence and survival (P<.001).
Conclusion In this study involving 10 geographic regions in North America, there were significant and important regional differences in out-of-hospital cardiac arrest incidence and outcome.
Author Affiliations: Department of Biostatistics, University of Washington Clinical Trial Center (Dr Nichol and Mss Thomas and Powell), Department of Medicine, University of Washington–Harborview Center for Prehospital Emergency Care, University of Washington (Dr Nichol), and Seattle–King County Public Health (Dr Rea), Seattle; University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Callaway); Oregon Health and Science University, Portland (Drs Hedges and Lowe); Medical College of Wisconsin, Milwaukee (Dr Aufderheide); University of Alabama, Birmingham (Dr Brown); University of Western Ontario, London, Ontario, Canada (Dr Dreyer); University of California, San Diego (Dr Davis); University of Texas Southwestern, Dallas (Dr Idris); and Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada (Dr Stiell).
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