Previous investigations suggest that survival to hospital discharge following out-of-hospital cardiac arrest (OHCA) has remained stable (7%–8%) over the past 30 years. Recent recommendations regarding bystander and rescuer cardiopulmonary resuscitation (CPR) technique, post-resuscitation protocols, and regionalization of post-arrest care were aimed to improve outcomes in OHCA. To evaluate current survival rates and temporal trends, investigators analyzed data from the Resuscitation Outcomes Consortium for adult patients with OHCA who were treated by emergency medical services (EMS) with either chest compressions or defibrillation from 2006 through 2010.
Among 47,148 patients, overall unadjusted survival increased from 8.2% in 2006 to 10.4% in 2010. Improvements in survival were greatest among patients with an initial rhythm of witnessed or unwitnessed ventricular tachycardia/ventricular fibrillation (VT/VF; 21.4% to 29.3%). During the study period, mean patient age, proportion of men, mean EMS response time, and percentage of bystander-witnessed arrests were stable, whereas the proportion of EMS-witnessed arrests, bystander CPR, and use of automated external defibrillators all increased. The percentage of VT/VF arrests decreased slowly over time (24.1% to 21.5%). In multivariable analyses adjusted for factors known to affect survival after OHCA, the odds of survival increased each year compared with 2006, and were greatest in 2010 (odds ratio, 1.72).
Although hard to make a cause and effect conclusion, these data support that 2010 ACLS protocol changes focusing on improved high-quality CPR, compression depth, and no interruption of CPR may be the reason for the improved results.
Daya MR et al. Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC). 9. [e-pub].