The impact of partial resuscitation attempts on the reported outcomes of out-of-hospital cardiac arrest in Victoria, Australia: implications for Utstein-style outcome reports

Z Nehme; E Andrew; S Bernard; K Smith

doi:10.1016/j.resuscitation.2014.05.032

The impact of partial resuscitation attempts on the reported outcomes of out-of-hospital cardiac arrest in Victoria, Australia: implications for Utstein-style outcome reports

Resuscitation. 2014 Sep;85(9):1185-91. doi: 10.1016/j.resuscitation.2014.05.032. Epub 2014 Jun 7.

Authors

Z Nehme¹, E Andrew², S Bernard³, K Smith⁴

Affiliations

¹ Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia. Electronic address: ziad.nehme@ambulance.vic.gov.au.
² Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
³ Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia; Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia.
⁴ Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia; Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia.

PMID: 24914831
DOI: 10.1016/j.resuscitation.2014.05.032

Abstract

Background: Success rates from cardiopulmonary resuscitation (CPR) are often quantified by Utstein-style outcome reports in populations who receive an attempted resuscitation. In some cases, evidence of futility is ascertained after a partial resuscitation attempt has been administered, and these cases reduce the overall effectiveness of CPR. We examine the impact of partial resuscitation attempts on the reported outcomes of out-of-hospital cardiac arrest (OHCA) in Victoria, Australia.

Methods: Between 2002 and 2012, 34,849 adult OHCA cases of presumed cardiac aetiology were included from the Victorian Ambulance Cardiac Arrest Registry. Resuscitation attempts lasting ≤10min in cases which died on scene were defined as a partial resuscitation. We used logistic regression to identify factors associated with a partial resuscitation attempt in the emergency medical service (EMS) treated population. Survival outcomes with and without partial resuscitations were compared across included years.

Results: The proportion of partial resuscitations in the overall EMS treated population increased significantly from 8.6% in 2002 to 18.8% in 2012 (p for trend<0.001), and were largely supported by documented evidence of irreversible death. Partial resuscitations were independently associated with older age, female gender, initial non-shockable rhythm, prolonged downtime, and lower skill level of EMS personnel. Selectively excluding partial resuscitations increased event survival by 7.6% (95% CI 4.1-11.2%), and survival to hospital discharge increased by 3.1% (95% CI 0.5-5.7%) in 2012 (p<0.001 for both).

Conclusion: In our EMS system, evidence of futility was often identified after the commencement of a partial resuscitation attempt. Excluding these events from OHCA outcome reports may better reflect the overall effectiveness of CPR.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Cessation of treatment; Emergency medical services; Futile treatment.

MeSH terms

Adolescent
Adult
Aged
Cardiopulmonary Resuscitation / methods*
Emergency Medical Services
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / therapy*
Research Report
Retrospective Studies
Treatment Outcome
Victoria
Young Adult