The impact of partial resuscitation attempts on the reported outcomes of out-of-hospital cardiac arrest in Victoria, Australia: implications for Utstein-style outcome reports.

BACKGROUND

Success rates from cardiopulmonary resuscitation (CPR) are often quantified by Utstein-style outcome reports in populations who receive an attempted resuscitation. In some cases, evidence of futility is ascertained after a partial resuscitation attempt has been administered, and these cases reduce the overall effectiveness of CPR. We examine the impact of partial resuscitation attempts on the reported outcomes of out-of-hospital cardiac arrest (OHCA) in Victoria, Australia.

METHODS

Between 2002 and 2012, 34,849 adult OHCA cases of presumed cardiac aetiology were included from the Victorian Ambulance Cardiac Arrest Registry. Resuscitation attempts lasting ≤10min in cases which died on scene were defined as a partial resuscitation. We used logistic regression to identify factors associated with a partial resuscitation attempt in the emergency medical service (EMS) treated population. Survival outcomes with and without partial resuscitations were compared across included years.

RESULTS

The proportion of partial resuscitations in the overall EMS treated population increased significantly from 8.6% in 2002 to 18.8% in 2012 (p for trend<0.001), and were largely supported by documented evidence of irreversible death. Partial resuscitations were independently associated with older age, female gender, initial non-shockable rhythm, prolonged downtime, and lower skill level of EMS personnel. Selectively excluding partial resuscitations increased event survival by 7.6% (95% CI 4.1-11.2%), and survival to hospital discharge increased by 3.1% (95% CI 0.5-5.7%) in 2012 (p<0.001 for both).

CONCLUSION

In our EMS system, evidence of futility was often identified after the commencement of a partial resuscitation attempt. Excluding these events from OHCA outcome reports may better reflect the overall effectiveness of CPR.