International variation in survival after out-of-hospital cardiac arrest

A validation study of the Utstein template

Kylie Dyson, Siobhan P. Brown, Susanne May, Karen Smith, Rudolph W. Koster, Stefanie G. Beesems, Markku Kuisma, Ari Salo, Judith Finn, Fritz Sterz, Alexander Nürnberger, Laurie J. Morrison, Theresa M. Olasveengen, Clifton W. Callaway, Sang Do Shin, Jan Thorsten Gräsner, Mohamud Daya, Matthew Huei Ming Ma, Johan Herlitz, Anneli Strömsöe & 10 others Tom P. Aufderheide, Siobhán Masterson, Henry Wang, Jim Christenson, Ian Stiell, Gary M. Vilke, Ahamed Idris, Chika Nishiyama, Taku Iwami, Graham Nichol

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232). Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85–0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. Conclusions: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.

Original languageEnglish
Pages (from-to)168-181
Number of pages14
JournalResuscitation
Volume138
DOIs
Publication statusPublished - 1 May 2019

Keywords

  • Emergency Medical Services
  • Out-of-hospital cardiac arrest
  • Outcomes
  • Survival
  • Utstein

Cite this

Dyson, Kylie ; Brown, Siobhan P. ; May, Susanne ; Smith, Karen ; Koster, Rudolph W. ; Beesems, Stefanie G. ; Kuisma, Markku ; Salo, Ari ; Finn, Judith ; Sterz, Fritz ; Nürnberger, Alexander ; Morrison, Laurie J. ; Olasveengen, Theresa M. ; Callaway, Clifton W. ; Shin, Sang Do ; Gräsner, Jan Thorsten ; Daya, Mohamud ; Ma, Matthew Huei Ming ; Herlitz, Johan ; Strömsöe, Anneli ; Aufderheide, Tom P. ; Masterson, Siobhán ; Wang, Henry ; Christenson, Jim ; Stiell, Ian ; Vilke, Gary M. ; Idris, Ahamed ; Nishiyama, Chika ; Iwami, Taku ; Nichol, Graham. / International variation in survival after out-of-hospital cardiac arrest : A validation study of the Utstein template. In: Resuscitation. 2019 ; Vol. 138. pp. 168-181.
@article{16e98e2e11934046b2d11c6c560f7b9b,
title = "International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template",
abstract = "Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232). Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10{\%} (range, 6{\%} to 22{\%}). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8{\%} (range, 2{\%} to 20{\%}). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85–0.85). The Utstein factors explained 51{\%} of the EMS agency variation in OHCA survival. Conclusions: The Utstein factors explained 51{\%} of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.",
keywords = "Emergency Medical Services, Out-of-hospital cardiac arrest, Outcomes, Survival, Utstein",
author = "Kylie Dyson and Brown, {Siobhan P.} and Susanne May and Karen Smith and Koster, {Rudolph W.} and Beesems, {Stefanie G.} and Markku Kuisma and Ari Salo and Judith Finn and Fritz Sterz and Alexander N{\"u}rnberger and Morrison, {Laurie J.} and Olasveengen, {Theresa M.} and Callaway, {Clifton W.} and Shin, {Sang Do} and Gr{\"a}sner, {Jan Thorsten} and Mohamud Daya and Ma, {Matthew Huei Ming} and Johan Herlitz and Anneli Str{\"o}ms{\"o}e and Aufderheide, {Tom P.} and Siobh{\'a}n Masterson and Henry Wang and Jim Christenson and Ian Stiell and Vilke, {Gary M.} and Ahamed Idris and Chika Nishiyama and Taku Iwami and Graham Nichol",
year = "2019",
month = "5",
day = "1",
doi = "10.1016/j.resuscitation.2019.03.018",
language = "English",
volume = "138",
pages = "168--181",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier",

}

Dyson, K, Brown, SP, May, S, Smith, K, Koster, RW, Beesems, SG, Kuisma, M, Salo, A, Finn, J, Sterz, F, Nürnberger, A, Morrison, LJ, Olasveengen, TM, Callaway, CW, Shin, SD, Gräsner, JT, Daya, M, Ma, MHM, Herlitz, J, Strömsöe, A, Aufderheide, TP, Masterson, S, Wang, H, Christenson, J, Stiell, I, Vilke, GM, Idris, A, Nishiyama, C, Iwami, T & Nichol, G 2019, 'International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template', Resuscitation, vol. 138, pp. 168-181. https://doi.org/10.1016/j.resuscitation.2019.03.018

International variation in survival after out-of-hospital cardiac arrest : A validation study of the Utstein template. / Dyson, Kylie; Brown, Siobhan P.; May, Susanne; Smith, Karen; Koster, Rudolph W.; Beesems, Stefanie G.; Kuisma, Markku; Salo, Ari; Finn, Judith; Sterz, Fritz; Nürnberger, Alexander; Morrison, Laurie J.; Olasveengen, Theresa M.; Callaway, Clifton W.; Shin, Sang Do; Gräsner, Jan Thorsten; Daya, Mohamud; Ma, Matthew Huei Ming; Herlitz, Johan; Strömsöe, Anneli; Aufderheide, Tom P.; Masterson, Siobhán; Wang, Henry; Christenson, Jim; Stiell, Ian; Vilke, Gary M.; Idris, Ahamed; Nishiyama, Chika; Iwami, Taku; Nichol, Graham.

In: Resuscitation, Vol. 138, 01.05.2019, p. 168-181.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - International variation in survival after out-of-hospital cardiac arrest

T2 - A validation study of the Utstein template

AU - Dyson, Kylie

AU - Brown, Siobhan P.

AU - May, Susanne

AU - Smith, Karen

AU - Koster, Rudolph W.

AU - Beesems, Stefanie G.

AU - Kuisma, Markku

AU - Salo, Ari

AU - Finn, Judith

AU - Sterz, Fritz

AU - Nürnberger, Alexander

AU - Morrison, Laurie J.

AU - Olasveengen, Theresa M.

AU - Callaway, Clifton W.

AU - Shin, Sang Do

AU - Gräsner, Jan Thorsten

AU - Daya, Mohamud

AU - Ma, Matthew Huei Ming

AU - Herlitz, Johan

AU - Strömsöe, Anneli

AU - Aufderheide, Tom P.

AU - Masterson, Siobhán

AU - Wang, Henry

AU - Christenson, Jim

AU - Stiell, Ian

AU - Vilke, Gary M.

AU - Idris, Ahamed

AU - Nishiyama, Chika

AU - Iwami, Taku

AU - Nichol, Graham

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232). Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85–0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. Conclusions: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.

AB - Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232). Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85–0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. Conclusions: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.

KW - Emergency Medical Services

KW - Out-of-hospital cardiac arrest

KW - Outcomes

KW - Survival

KW - Utstein

UR - http://www.scopus.com/inward/record.url?scp=85063343143&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2019.03.018

DO - 10.1016/j.resuscitation.2019.03.018

M3 - Article

VL - 138

SP - 168

EP - 181

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

ER -