Trends in care processes and survival following prehospital resuscitation improvement initiatives for out-of-hospital cardiac arrest in British Columbia, 2006–2016
| Autor: | Christopher B. Fordyce, Robert Schlamp, Jim Christenson, William Dick, Frank X. Scheuermeyer, Takahisa Kawano, Brian Grunau, Ronald Straight, Helen Connolly, David Barbic, John M. Tallon |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Emergency Medical Services Resuscitation medicine.medical_specialty Cross-sectional study 030204 cardiovascular system & hematology Emergency Nursing Return of spontaneous circulation Rate ratio Time-to-Treatment 03 medical and health sciences symbols.namesake 0302 clinical medicine Outcome Assessment Health Care Humans Medicine Poisson Distribution Prospective Studies Registries Poisson regression Prospective cohort study Aged Univariate analysis British Columbia business.industry 030208 emergency & critical care medicine Middle Aged Quality Improvement Cardiopulmonary Resuscitation Advanced life support Cross-Sectional Studies Emergency medicine Emergency Medicine symbols Female Cardiology and Cardiovascular Medicine business Out-of-Hospital Cardiac Arrest Defibrillators |
| Zdroj: | Resuscitation. 125:118-125 |
| ISSN: | 0300-9572 |
| DOI: | 10.1016/j.resuscitation.2018.01.049 |
| Popis: | British Columbia (BC) Emergency Health Services implemented a strategy to improve outcomes for out-of-hospital cardiac arrest (OHCA), focusing on paramedic-led high-quality on-scene resuscitation. We measured changes in care metrics and survival trends.This was a post-hoc study of prospectively identified consecutive non-traumatic ambulance-treated adult OHCAs from 2006 to 2016 within BC's four metropolitan areas. The primary outcome was survival to hospital discharge; we also described available favourable neurological outcomes (mRS ≤3). We tested the significance of year-by-year trends in baseline characteristics, and calculated risk-adjusted survival rates using multivariable Poisson regression.We included 15 145 patients. In univariate analyses there were significant increases in bystander CPR, chest compression fraction, advanced life support attendance, duration of resuscitation until advanced airway placement, duration of resuscitation until termination, and overall scene time. There was a significant decrease in initial shockable rhythms, bystander witnessed arrests, and transports initiated prior to ROSC. Survival and the proportion of survivors with favourable neurological outcomes increased significantly. In adjusted analyses, there was an improvement in return of spontaneous circulation (risk-adjusted rate 41% in 2006 to 51% in 2016; adjusted rate ratio per year 1.02, 95% CI 1.01-1.02, p 0.01 for trend) and survival at hospital discharge (risk-adjusted rate 8.6% in 2006 to 16% in 2016; adjusted rate ratio per year 1.05, 95% CI 1.04-1.06, p 0.01 for trend).From 2006 to 2016 BC's provincial ambulance system prioritized paramedic-led on-scene resuscitation, during which time there were significant improvements in patient outcomes. Our data may assist other systems, providing a model for prehospital resuscitation quality improvement. |
| Databáze: | OpenAIRE |
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