Annals of Emergency Medicine
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

      Affiliations

    • University of Washington, Seattle, WA
    • Corresponding Author InformationAddress for correspondence: Thomas Rea, MD, MPH, University of Washington, Department of Medicine, 401 5th Avenue, Suite1200, Seattle, WA; 206-255-5513, fax 206-296-4866
  • ,
  • Andrea J. Cook, PhD

      Affiliations

    • University of Washington, Seattle, WA
    • Group Health Center for Health Studies, Seattle, WA
  • ,
  • Ian G. Stiell, MD, MSc

      Affiliations

    • University of Ottawa, Ottawa, Ontario, Canada
  • ,
  • Judy Powell, BSN

      Affiliations

    • University of Washington, Seattle, WA
  • ,
  • Blair Bigham, PhD

      Affiliations

    • Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
  • ,
  • Clifton W. Callaway, MD, PhD

      Affiliations

    • University of Pittsburgh, Pittsburgh, PA
  • ,
  • Sumeet Chugh, MD

      Affiliations

    • Oregon Health Sciences University, Portland, OR
  • ,
  • Tom P. Aufderheide, MD

      Affiliations

    • Medical College of Wisconsin, Milwaukee, WI
  • ,
  • Laurie Morrison, MD

      Affiliations

    • Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
  • ,
  • Thomas E. Terndrup, MD

      Affiliations

    • Penn State University College of Medicine, Hershey, PA
  • ,
  • Tammy Beaudoin, CHIM

      Affiliations

    • University of Ottawa, Ottawa, Ontario, Canada
  • ,
  • Lynn Wittwer, MD

      Affiliations

    • Southwest Washington Medical Center, Vancouver, WA
  • ,
  • Dan Davis, MD

      Affiliations

    • University of California San Diego, San Diego, CA
  • ,
  • Ahamed Idris, MD

      Affiliations

    • University of Texas Southwestern, Dallas, TX
  • ,
  • Graham Nichol, MD, MS

      Affiliations

    • University of Washington, Seattle, WA
  • ,
  • Resuscitation Outcomes Consortium Investigators

Received 23 April 2009 ,Revised 2 September 2009 ,Accepted 18 September 2009.

References 

  1. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25–e146
  2. Rea TD, Eisenberg MS, Sinibaldi G, et al. Incidence of EMS-treated out-of-hospital cardiac arrest in the United States. Resuscitation. 2004;63:17–24
  3. Nichol G, Thomas E, Callaway CW, et al. Resuscitation Outcomes Consortium Investigators (Regional variation in out-of-hospital cardiac arrest incidence and outcome). JAMA. 2008;300:1423–1431
  4. Cummins RO, Ornato JP, Thies WH, et al. Improving survival from sudden cardiac arrest: the “chain of survival” concept (A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association). Circulation. 1991;83:1832–1847
  5. Jacobs I, Nadkarni V, Bahr J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004;110:3385–3397
  6. Uter W, Pfahlberg A. The application of methods to quantify attributable risk in medical practice. Stat Methods Med Res. 2001;10:231–237
  7. Morrison LJ, Nichol G, Rea TD, et al. Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry–Cardiac Arrest. Resuscitation. 2008;78:161–169
  8. Davis DP, Garberson LA, Andrusiek DL, et al. A descriptive analysis of emergency medical service systems participating in the Resuscitation Outcomes Consortium (ROC) network. Prehosp Emerg Care. 2007;11:369–382
  9. Pepe MS. The Statistical Evaluation of Medical Tests for Classification and Prediction (Oxford Statistical Science Series). New York: Oxford University Press; 2003;
  10. Gilmore CM, Rea TD, Becker LJ, et al. Three-phase model of cardiac arrest: time-dependent benefit of bystander cardiopulmonary resuscitation. Am J Cardiol. 2006;98:497–499
  11. R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2007;http://www.R-project.orgAccessed January 14, 2008
  12. Sing T, Sander O, Beerenwinkel N, et al. ROCR: visualizing the performance of scoring classifiers (R package version 1.0-2). http://rocr.bioinf.mpi-sb.mpg.de/Accessed January 14, 2008
  13. Harrell FE. Hmisc: Harrell Miscellaneous. R package version 3.4-2 http://biostat.mc.vanderbilt.edu/s/Hmisc2007;Accessed January 14, 2008
  14. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–556
  15. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–563
  16. Sunde K, Pytte M, Jacobsen D, et al. Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation. 2007;73:29–39
  17. Bunch TJ, White RD, Gersh BJ, et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med. 2003;348:2626–2633
  18. Rea TD, Crouthamel M, Eisenberg MS, et al. Temporal patterns in long-term survival after resuscitation from out-of-hospital cardiac arrest. Circulation. 2003;108:1196–1201
  19. Stiell I, Nichol G, Wells G, et al. OPALS Study Group Health-related quality of life is better for cardiac arrest survivors who received citizen cardiopulmonary resuscitation. Circulation. 2003;108:1939–1944
  20. Engdahl J, Holmberg M, Karlson BW, et al. The epidemiology of out-of-hospital “sudden” cardiac arrest. Resuscitation. 2002;52:235–245
  21. Hollenberg J, Herlitz J, Lindqvist J, et al. Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew-witnessed cases and bystander cardiopulmonary resuscitation. Circulation. 2008;118:389–396
  22. Stiell IG, Wells GA, Field B, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med. 2004;351:647–656
  23. Valenzuela TD, Roe DJ, Cretin S, et al. Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation. 1997;96:3308–3313
  24. Hallstrom AP, Cobb LA, Yu BH. Influence of comorbidity on the outcome of patients treated for out-of-hospital ventricular fibrillation. Circulation. 1996;93:2019–2022
  25. Tang W, Snyder D, Wang J, et al. One-shock versus three-shock defibrillation protocol significantly improves outcome in a porcine model of prolonged ventricular fibrillation cardiac arrest. Circulation. 2006;113:2683–2689
  26. Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004;109:1960–1965
  27. Kramer-Johansen J, Edelson DP, Losert H, et al. Uniform reporting of measured quality of cardiopulmonary resuscitation (CPR). Resuscitation. 2007;74:406–417
  28. Berg RA, Hilwig RW, Berg MD, et al. Immediate post-shock chest compressions improve outcome from prolonged ventricular fibrillation. Resuscitation. 2008;78:71–76
  29. Edelson DP, Litzinger B, Arora V, et al. Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Arch Intern Med. 2008;168:1063–1069
  30. Carew HT, Zhang W, Rea TD. Chronic health conditions and survival after out-of-hospital ventricular fibrillation cardiac arrest. Heart. 2007;93:728–731
  31. Weisfeldt ML, Becker LB. Resuscitation after cardiac arrest: a 3-phase time-sensitive model. JAMA. 2002;288:3035–3038
  32. Callaway CW, Menegazzi JJ. Waveform analysis of ventricular fibrillation to predict defibrillation. Curr Opin Crit Care. 2005;11:192–199
  33. Hannan EL, Wu C, Walford G, et al. Volume-outcome relationships for percutaneous coronary interventions in the stent era. Circulation. 2005;112:1171–1179
  34. Nichol G, Detsky AS, Stiell IG, et al. Effectiveness of emergency medical services for victims of out-of-hospital cardiac arrest: a metaanalysis. Ann Emerg Med. 1996;27:700–710
  35. Thomas JB, Abo BN, Wang HE. Paramedic perceptions of challenges in out-of-hospital endotracheal intubation. Prehosp Emerg Care. 2007;11:219–223
  36. Wright SW, Trott A, Lindsell CJ, et al. Evidence-based emergency medicine (Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report). Ann Emerg Med. 2008;51:80–86
  37. Gazmuri RJ, Nadkarni VM, Nolan JP, et al. Scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care identified during the 2005 International Consensus Conference on ECC [corrected] and CPR Science with treatment recommendations: a consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian Resuscitation Council, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, and the New Zealand Resuscitation Council); the American Heart Association Emergency Cardiovascular Care Committee; the Stroke Council; and the Cardiovascular Nursing Council.”. Circulation. 2007;116:2501–2512

 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.

 Reprints not available from the authors.

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Please see page 250 for the Editor's Capsule Summary of this article.

 Publication date: Available online November 27, 2009.

PII: S0196-0644(09)01556-X

doi: 10.1016/j.annemergmed.2009.09.018

Annals of Emergency Medicine
Volume 55, Issue 3 , Pages 249-257 , March 2010