Coute Ryan A, Shields Theresa A, Cranford James A, Ansari Sardar, Abir Mahshid, Tiba M Hakam, Dunne Robert, O'Neil Brian, Swor Robert, Neumar Robert W
Prehosp Emerg Care. 2018 Nov-Dec;22(6):743-752. doi: 10.1080/10903127.2018.1448913. Epub 2018 Apr 6.
Our objective was to analyze and compare out-of-hospital cardiac arrest (OHCA) system of care performance and outcomes at the Medical Control Authority (MCA) level in the state of Michigan. We hypothesized that clinically and statistically significant variations in treatment and outcomes of OHCA exists within a single U.S. state.
We performed a retrospective, observational study of all non-traumatic EMS-treated OHCA from the state of Michigan CARES registry for 2014-2015. Geocoding of the OHCA incident address was used to assign records to individual MCAs. MCA-based demographics, arrest characteristics, system of care performance and outcomes were quantified and compared. Associations between demographics, system of care parameters, and outcomes were examined at the MCA level.
A total of 8,115 records with complete data were available for analysis. Eleven MCAs met study inclusion criteria of >100 cases, producing a final sample size of 7,788 records (96%). Statistically significant variations in survival to hospital discharge ranged from 4.5% to 15% (p < 0.001) (Adjusted odds ratio [AOR] range 0.6-2.0) and survival with good neurologic outcome 2.7-12.5% (p < 0.001; AOR range 0.5-2.2,) were observed across MCAs. Bystander CPR ranged from 32% to 53% (p < 0.001) and bystander AED application ranged from 3.5% 11.5% (p < 0.05). Of patients admitted to the hospital alive, 29-68% received targeted temperature management. In hospital mortality ranged from 53.1% to 73.9% (p < 0.05).
Significant intrastate variability in OHCA system of care performance and outcomes currently exist and are similar to what has been previously reported across North America almost a decade ago. This degree of variability highlights the opportunity to optimize modifiable factors within local systems of care to improve OHCA outcomes.
我们的目的是分析和比较密歇根州医疗控制机构（MCA）层面的院外心脏骤停（OHCA）护理系统的性能和结果。我们假设在美国的一个州内，OHCA的治疗和结果存在临床和统计学上的显著差异。
我们对2014 - 2015年密歇根州CARES登记处所有非创伤性经紧急医疗服务（EMS）治疗的OHCA进行了一项回顾性观察研究。通过对OHCA事件地址进行地理编码，将记录分配给各个MCA。对基于MCA的人口统计学、心脏骤停特征、护理系统性能和结果进行量化和比较。在MCA层面检查人口统计学、护理系统参数和结果之间的关联。
共有8115条完整数据记录可供分析。11个MCA符合>100例的研究纳入标准，最终样本量为7788条记录（96%）。各MCA之间观察到，出院存活率在4.5%至15%之间存在统计学显著差异（p < 0.001）（调整优势比[AOR]范围为0.6 - 2.0），良好神经功能预后的存活率在2.7%至12.5%之间（p < 0.001；AOR范围为0.5 - 2.2）。旁观者实施心肺复苏（CPR）的比例在32%至53%之间（p < 0.001），旁观者使用自动体外除颤器（AED）的比例在3.5%至11.5%之间（p < 0.05）。存活入院的患者中，29%至68%接受了目标温度管理。住院死亡率在53.1%至73.9%之间（p < 0.05）。
目前该州OHCA护理系统的性能和结果存在显著的州内差异，这与近十年前北美地区此前报道的情况类似。这种差异程度凸显了优化当地护理系统中可改变因素以改善OHCA结果的机会。
