Abir Mahshid, Fouche Sydney, Lehrich Jessica, Goldstick Jason, Kamdar Neil, O'Leary Michael, Nelson Christopher, Mendel Peter, Nham Wilson, Setodji Claude, Domeier Robert, Hsu Anthony, Shields Theresa, Salhi Rama, Neumar Robert W, Nallamothu Brahmajee K
University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, United States; Acute Care Research Unit, Institute for Healthcare Policy and Innovation, United States; RAND Corporation, Santa Monica, CA, United States.
Acute Care Research Unit, Institute for Healthcare Policy and Innovation, United States; University of Michigan, Ann Arbor, MI, United States.
Resuscitation. 2021 Jan;158:201-207. doi: 10.1016/j.resuscitation.2020.11.034. Epub 2020 Dec 8.
Care by emergency medical service (EMS) agencies is critical for optimizing prehospital outcomes following out-of-hospital cardiac arrest (OHCA). We explored whether substantial differences exist in prehospital outcomes across EMS agencies in Michigan-specifically focusing on rates of sustained return of spontaneous circulation (ROSC) upon emergency department (ED) arrival.
Using data from Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) for years 2014-2017, we calculated rates of sustained ROSC upon ED arrival across EMS agencies in Michigan. We used hierarchical logistic regression models that accounted for patient, arrest-, community-, and response-level characteristics to determine adjusted rates of sustained ROSC among EMS agencies.
A total of 103 EMS agencies and 20,897 OHCA cases were included. Average age of the cohort was 62.5 years (SD = 19.6), 39.7% were female, and 17.9% had an initial shockable rhythm due to ventricular fibrillation or pulseless ventricular tachycardia. The adjusted rate of sustained ROSC upon ED arrival across all EMS agencies was 23.8% with notable variation across EMS agencies (interquartile range [IQR], 20.5-29.2%). The top five EMS agencies had mean adjusted rates of sustained ROSC upon ED arrival of 42.7% (95% CI: 34.6-51.1%) while the bottom five had mean adjusted rates of 9.8% (95% CI: 7.6-12.7%).
Substantial variation in sustained ROSC upon ED arrival exists across EMS agencies in Michigan after adjusting for patient-, arrest, community-, and response-level features. Such differences suggest opportunities to identify and improve best practices in EMS agencies to advance OHCA care.
紧急医疗服务（EMS）机构的救治对于优化院外心脏骤停（OHCA）后的院前结局至关重要。我们探讨了密歇根州各EMS机构的院前结局是否存在显著差异，特别关注急诊科（ED）到达时自主循环恢复（ROSC）的持续率。
利用2014 - 2017年密歇根州心脏骤停登记以提高生存率（MI - CARES）的数据，我们计算了密歇根州各EMS机构在ED到达时ROSC的持续率。我们使用分层逻辑回归模型，该模型考虑了患者、心脏骤停、社区和反应层面的特征，以确定EMS机构中ROSC持续的调整率。
共纳入103个EMS机构和20,897例OHCA病例。该队列的平均年龄为62.5岁（标准差=19.6），39.7%为女性，17.9%因室颤或无脉性室性心动过速而初始心律可电击复律。所有EMS机构在ED到达时ROSC持续的调整率为23.8%，各EMS机构之间存在显著差异（四分位间距[IQR]，20.5 - 29.2%）。排名前五的EMS机构在ED到达时ROSC持续的平均调整率为42.7%（95%置信区间：34.6 - 51.1%），而排名后五的机构平均调整率为9.8%（95%置信区间：7.6 - 12.7%）。
在调整了患者、心脏骤停、社区和反应层面的特征后，密歇根州各EMS机构在ED到达时ROSC持续情况存在显著差异。这些差异表明有机会识别和改进EMS机构的最佳实践，以推进OHCA救治。
