Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, United States.
Department of Emergency Medicine, McGaw Medical Center of Northwestern, Chicago, IL, United States.
Resuscitation. 2024 Jul;200:110238. doi: 10.1016/j.resuscitation.2024.110238. Epub 2024 May 10.
Out-of-hospital cardiac arrest (OHCA) patients from minoritized communities have lower rates of initial shockable rhythm, which is linked to favorable outcomes. We sought to evaluate the importance of initial shockable rhythm on OHCA outcomes and factors that mediate differences in initial shockable rhythm.
We performed a retrospective study of the 2013-2022 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES). Using census tract data, we stratified OHCAs into majority race/ethnicity communities: >50% White, >50% Black, and >50% Hispanic/Latino. We compared logistic regression models between community race/ethnicity and OHCA outcome: (1) unadjusted, (2) adjusting for bystander CPR (bCPR), and (3) adjusting for initial rhythm. Using structural equation modeling, we performed mediation analyses between community race/ethnicity, OHCA characteristics, and initial shockable rhythm.
We included 22,730 OHCAs from majority White (21.1% initial shockable rhythm), 4,749 from majority Black (15.3% shockable), and 16,054 majority Hispanic/Latino (16.1% shockable) communities. Odds of favorable neurologic outcome were lower for majority Black (0.4 [0.3-0.5]) and Hispanic/Latino (0.6 [0.6-0.7]). While adjusting for bCPR minimally changed outcome odds, adjusting for shockable rhythm increased odds for Black (0.5 [0.4-0.5]) and Hispanic/Latino (0.7 [0.6-0.8]) communities. On mediation analysis for majority Black, the top mediators of initial shockable rhythm were public location (14.6%), bystander witnessed OHCA (11.6%), and female gender (5.7%). The top mediators for majority Hispanic/Latino were bystander-witnessed OHCA (10.2%), public location (3.52%), and bystander CPR (3.49%), CONCLUSION: Bystander-witnessed OHCA and public location were the largest mediators of shockable rhythm for OHCAs from minoritized communities.
来自少数族裔社区的院外心脏骤停（OHCA）患者初始可电击节律的比例较低，而初始可电击节律与良好的预后相关。我们旨在评估初始可电击节律对 OHCA 结局的重要性，以及介导初始可电击节律差异的因素。
我们对 2013-2022 年德克萨斯心脏骤停登记处以提高生存能力（TX-CARES）进行了回顾性研究。使用人口普查区数据，我们将 OHCA 分为主要种族/族裔社区：白人>50%、黑人>50%和西班牙裔/拉丁裔>50%。我们比较了社区种族/族裔与 OHCA 结局之间的逻辑回归模型：（1）未调整，（2）调整旁观者心肺复苏术（bCPR），和（3）调整初始节律。使用结构方程模型，我们对社区种族/族裔、OHCA 特征和初始可电击节律之间的中介分析进行了。
我们纳入了 22730 例来自白人为主（初始可电击节律 21.1%）、4749 例来自黑人为主（可电击节律 15.3%）和 16054 例西班牙裔/拉丁裔为主（可电击节律 16.1%）社区的 OHCA。黑人（0.4 [0.3-0.5]）和西班牙裔/拉丁裔（0.6 [0.6-0.7]）社区的有利神经结局的可能性较低。虽然调整 bCPR 可最小程度地改变结局的可能性，但调整可电击节律可增加黑人（0.5 [0.4-0.5]）和西班牙裔/拉丁裔（0.7 [0.6-0.8]）社区的可能性。在对黑人主要社区的中介分析中，初始可电击节律的主要中介因素是公共位置（14.6%）、旁观者目击 OHCA（11.6%）和女性性别（5.7%）。西班牙裔/拉丁裔主要社区的主要中介因素是旁观者目击 OHCA（10.2%）、公共位置（3.52%）和旁观者 CPR（3.49%）。
旁观者目击 OHCA 和公共位置是少数族裔社区 OHCA 初始可电击节律的最大中介因素。
