Regional Variation in Out-of-Hospital Cardiac Arrest Survival in the United States

• Type of Material: Article
• Authors: Saket Girotra, University of Iowa; Sean van Diepen, University of Alberta; Brahmajee K Nallamothu, University of Michigan; Margaret Carrel, University of Iowa; Kimberly Vellano, Emory University; Monique L Anderson, Duke Clinical Research Institute; Bryan McNally, Emory University; Benjamin Abella, University of Pennsylvania; Comilla Sasson, University of Colorado; Paul S Chan, St Lukes Mid America Heart Institute
• Language: English
• Date: 2016-05-31
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCULATIONAHA.115.018175
• Title of Journal or Parent Work: Circulation
• Volume: 133
• Issue: 22
• Start Page: 2159
• End Page: +
• Grant/Funding Information: CARES was funded by the Centers for Disease Control and Prevention (CDC) from 2004-2012. The program is now supported through private funding from the American Red Cross, the Medtronic Foundation Heart Rescue Program, the American Heart Association, Zoll Corporation, and in-kind support from Emory University.; Drs. Girotra (K08HL122527), Nallamothu (R01HL123980), and Chan (K23HL102224, R01HL123980) are funded by the National Heart Lung and Blood Institute.
• Keywords: OUTCOMES; Cardiovascular System & Cardiology; Peripheral Vascular Disease; CARDIOPULMONARY-RESUSCITATION; Cardiac & Cardiovascular Systems; PROFESSIONALS; cardiopulmonary resuscitation; IMPLEMENTATION; EUROPEAN-RESUSCITATION-COUNCIL; Life Sciences & Biomedicine; Science & Technology; STROKE-FOUNDATION; TASK-FORCE; HEALTH; DEFIBRILLATION; heart arrest; AMERICAN-HEART-ASSOCIATION
• Research Categories: Health Sciences, General

Abstract

Background - Although previous studies have shown marked variation in out-of-hospital cardiac arrest survival across US regions, factors underlying this survival variation remain incompletely explained. Methods and Results - Using data from the Cardiac Arrest Registry to Enhance Survival, we identified 96 662 adult patients with out-of-hospital cardiac arrest in 132 US counties. We used hierarchical regression models to examine county-level variation in rates of survival and survival with functional recovery (defined as Cerebral Performance Category score of 1 or 2) and examined the contribution of demographics, cardiac arrest characteristics, bystander cardiopulmonary resuscitation, automated external defibrillator use, and county-level sociodemographic factors in survival variation across counties. A total of 9317 (9.6%) patients survived to discharge, and 7176 (7.4%) achieved functional recovery. At a county level, there was marked variation in rates of survival to discharge (range, 3.4%-22.0%; median odds ratio, 1.40; 95% confidence interval, 1.32-1.46) and survival with functional recovery (range, 0.8%-21.0%; median odds ratio, 1.53; 95% confidence interval, 1.43-1.62). County-level rates of bystander cardiopulmonary resuscitation and automated external defibrillator use were positively correlated with both outcomes (P<0.0001 for all). Patient demographic and cardiac arrest characteristics explained 4.8% and 27.7% of the county-level variation in survival, respectively. Additional adjustment of bystander cardiopulmonary resuscitation and automated external defibrillator explained 41% of the survival variation, and this increased to 50.4% after adjustment of county-level sociodemographic factors. Similar findings were noted in analyses of survival with functional recovery. Conclusions - Although out-of-hospital cardiac arrest survival varies significantly across US counties, a substantial proportion of the variation is attributable to differences in bystander response across communities.