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Volume 55, Issue 3 , Pages 249-257, March 2010

Predicting Survival After Out-of-Hospital Cardiac Arrest: Role of the Utstein Data Elements

Presented as an abstract at the American Heart Association Scientific Sessions, Orlando, FL, November 2007.

Thomas D. Rea, MD, MPH
- University of Washington, Seattle, WA
- Address for correspondence: Thomas Rea, MD, MPH, University of Washington, Department of Medicine, 401 5^th Avenue, Suite1200, Seattle, WA; 206-255-5513, fax 206-296-4866
Andrea J. Cook, PhD
- University of Washington, Seattle, WA
- Group Health Center for Health Studies, Seattle, WA
Ian G. Stiell, MD, MSc
- University of Ottawa, Ottawa, Ontario, Canada
Judy Powell, BSN
- University of Washington, Seattle, WA
Blair Bigham, PhD
- Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
Clifton W. Callaway, MD, PhD
- University of Pittsburgh, Pittsburgh, PA
Sumeet Chugh, MD
- Oregon Health Sciences University, Portland, OR
Tom P. Aufderheide, MD
- Medical College of Wisconsin, Milwaukee, WI
Laurie Morrison, MD
- Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
Thomas E. Terndrup, MD
- Penn State University College of Medicine, Hershey, PA
Tammy Beaudoin, CHIM
- University of Ottawa, Ottawa, Ontario, Canada
Lynn Wittwer, MD
- Southwest Washington Medical Center, Vancouver, WA
Dan Davis, MD
- University of California San Diego, San Diego, CA
Ahamed Idris, MD
- University of Texas Southwestern, Dallas, TX
Graham Nichol, MD, MS
- University of Washington, Seattle, WA
Resuscitation Outcomes Consortium Investigators

Received 23 April 2009; received in revised form 2 September 2009; accepted 18 September 2009. published online 30 November 2009.

Study objective

Survival after out-of-hospital cardiac arrest depends on the links in the chain of survival. The Utstein elements are designed to assess these links and provide the basis for comparing outcomes within and across communities. We assess whether these measures sufficiently predict survival and explain outcome differences.

Methods

We used an observational, prospective data collection, case-series of adult persons with nontraumatic out-of-hospital cardiac arrest from December 1, 2005, through March 1, 2007, from the multisite, population-based Resuscitation Outcomes Consortium Epistry–Cardiac Arrest. We used logistic regression, receiver operating curves, and measures of variance to estimate the extent to which the Utstein elements predicted survival to hospital discharge and explained outcome variability overall and between 7 Resuscitation Outcomes Consortium sites. Analyses were conducted for all emergency medical services–treated cardiac arrests and for the subset of bystander-witnessed patient arrests because of presumed cardiac cause presenting with ventricular fibrillation or ventricular tachycardia.

Results

Survival was 7.8% overall (n=833/10,681) and varied from 4.6% to 14.7% across Resuscitation Outcomes Consortium sites. Among bystander-witnessed ventricular fibrillation or ventricular tachycardia, survival was 22.1% overall (n=323/1459) and varied from 12.5% to 41.0% across sites. The Utstein elements collectively predicted 72% of survival variability among all arrests and 40% of survival variability among bystander-witnessed ventricular fibrillation. The Utstein elements accounted for 43.6% of the between-site survival difference among all arrests and 22.3% of the between-site difference among the bystander-witnessed ventricular fibrillation subset.

Conclusion

The Utstein elements predict survival but account for only a modest portion of outcome variability overall and between Resuscitation Outcomes Consortium sites. The results underscore the need for ongoing investigation to better understand characteristics that influence cardiac arrest survival.

Supervising editor: Amy H. Kaji, MD, PhD, MPH

Author contributions: TDR conceived the study. TDR and AJC designed the study. TDR, IGS, JP, BB, CWC, SC, TPA, LM, TET, TB, LW, DD, AI, and GN were responsible for data collection. AJC, JP, and GN managed the data. AJC provided statistical advice on study design and analyzed the data. TDR drafted the article, and all authors contributed substantially to its revision. TDR takes responsibility for the paper as a whole.

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by a series of cooperative agreements to 10 regional centers and 1 data coordinating center (5U01 HL077863, HL077881, HL077871, HL077872, HL077866, HL077908, HL077867, HL077885, HL077887, HL077873, HL077865) with the National Heart, Lung, and Blood Institute, in partnership with the National Institute of Neurological Disorders and Stroke, US Army Research and Materiel Command, The Canadian Institutes of Health Research-Institute of Circulatory and Respiratory Health, Defense Research and Development Canada, American Heart Association, and the Heart and Stroke Foundation of Canada.