Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest
Barnard, Ed B.G. Sandbach, Daniel D. Nicholls, Tracy L. Wilson, Alastair W. Ercole, Ari
Barnard, Ed B.G.
Sandbach, Daniel D.
Nicholls, Tracy L.
Wilson, Alastair W.
Ercole, Ari
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Abstract
Background Out-of-hospital cardiac arrest (OHCA) is
prevalent in the UK. Reported survival is lower than in
countries with comparable healthcare systems; a better
understanding of outcome determinants may identify
areas for improvement.
Methods An analysis of 9109 OHCA attended in East
of England between 1 January 2015 and 31 July 2017.
Univariate descriptives and multivariable analysis were
used to understand the determinants of survival for nontraumatic cardiac arrest (NTCA) and traumatic cardiac
arrest (TCA). Two Utstein outcome variables were used:
survival to hospital admission and hospital discharge.
Results The incidence of OHCA was 55.1 per 100 000
population/year. The overall survival to hospital admission
was 27.6% (95% CI 26.7% to 28.6%) and the overall
survival to discharge was 7.9% (95% CI 7.3% to
8.5%). Survival to hospital admission and survival
to hospital discharge were both greater in the NTCA
group compared with the TCA group: 27.9% vs 19.3%
p=0.001, and 8.0% vs 3.8% p=0.012 respectively.
Determinants of NTCA and TCA survival were different,
and varied according to the outcome examined. In
NTCA, bystander cardiopulmonary resuscitation (CPR)
was associated with survival at discharge but not at
admission, and the likelihood of bystander CPR was
dependent on geographical socioeconomic status. An
air ambulance was associated with increased survival to
both hospital admission and discharge in NTCA, but only
with survival to admission in TCA.
Conclusion NTCA and TCA are clinically distinct
entities with different predictors for outcome—future
OHCA reports should aim to separate arrest aetiologies.
Determinants of survival to hospital admission and
discharge differ in a way that likely reflects the
determinants of neurological injury. Bystander CPR public
engagement may be best focused in more deprived
areas.
https://emj.bmj.com/content/emermed/36/6/333.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/emermed-2018-208165