EMS agencies with high rates of field termination of resuscitation and longer scene times also have high rates of survival

Abstract

Aim: Out-of-hospital cardiac arrest (OOHCA) management dichotomizes strategies to (1) "scoop-and-run" to a higher level of care or (2) "treat on the X" with the goal of return of spontaneous circulation (ROSC) before transport, with field termination of resuscitation (FTOR) of unsuccessful resuscitations. We hypothesized that EMS agencies with greater average time on-scene and higher rates of field termination of resuscitation would have more favorable outcomes.

Methods: The Cardiac Arrest Registry to Enhance Survival (CARES) was used to identify OOHCA cases from 2013 to 2018. Agencies in the top and bottom quartiles of on-scene time were categorized as high (HiOST) and low (LoOST); in the top and bottom quartiles of field termination rate were categorized as high (HiTOR) and low (LoTOR). Generalized estimating equation models compared top and bottom quartiles.

Results: We classified 95 agencies as HiOST (average > 25.1 min) or LoOST (average < 19.3 min). We classified 95 agencies as HiTOR (average > 46.5% FTOR) or LoTOR (average < 23.5% FTOR). Controlling for agency characteristics, HiOST had a higher survival to discharge for transported patients (28.1% vs 23.1%, OR = 2.8, 95 %CI 2.1-3.6, p < 0.001), ROSC on emergency department arrival, and favorable neurologic outcome than LoOST. HiTOR had a higher survival to discharge for transported patients (25.6% vs 19.3%, OR = 3.3, 95 %CI 2.5-4.4, p < 0.001), ROSC on emergency department arrival, and favorable neurologic outcome than LoTOR.

Conclusion: EMS agencies with higher rates of FTOR and longer on-scene times for patients with OOHCA have higher overall patient survival, ROSC, and favorable neurologic function.

Keywords: Emergency medical services; Field termination of resuscitation; On scene times; Out of hospital cardiac arrest.