Elsevier

Resuscitation

Volume 72, Issue 3, March 2007, Pages 415-424
Resuscitation

Clinical paper
Epidemiology and outcomes of out-of-hospital cardiac arrest in Rochester, New York

https://doi.org/10.1016/j.resuscitation.2006.06.135Get rights and content

Summary

Objective

To characterize out-of-hospital cardiac arrest (OHCA) and factors that affect survival in a medium sized city that uses system status management for dispatch.

Methods

A retrospective cohort study of all adult OHCA patients treated by EMS between 1998 and 2001 was conducted using Utstein definitions. The primary endpoint was 1-year survival.

Results

Of the 1177 patients who experienced OHCA during the study period, 539 (46%) met inclusion criteria. Age ranged from 18 to 98 years (median 67). The median call-response interval was 5 min (range 0–21), and 93% were 9 min or less. There was no significant difference in the median call-response intervals between call location zip (Post) codes (p = 0.07). Twenty percent of experienced ROSC (95% CI 17–23), 7% survived more than 30 days (95% CI 5–9%), and 5% survived to 1 year (95% CI 3–7%). In bivariate analysis, first rhythm and bystander CPR affected survival to 1 year. There was no significant difference in survival between male (4%) and female (7%), black (4%) and white (6%), or witnessed (7%) and unwitnessed arrest (4%). Logistic regression identified younger age, CPR initiated by bystander (19%) or first responder (41%), and presenting rhythm of VF/VT (32%) as factors associated with survival to 1 year.

Conclusions

This study finds a 5% survival to 1 year among OHCA patients in Rochester, NY. A presenting rhythm of VF/VT and bystander CPR were associated with increased survival.

Introduction

Heart disease is the leading cause of mortality in the United States,1 and death from heart disease most frequently presents as sudden death outside of the hospital, or out-of-hospital cardiac arrest (OHCA).2 Many factors have been shown to influence OHCA survival, including demographic, clinical, and treatment factors, and attempts have been made to modify those factors that are modifiable. One factor shown to influence survival in multiple studies has been the call-response interval for emergency medical services (EMS).3, 4, 5, 6

System status management (SSM) is a dynamic dispatch system commonly used in EMS.7 SSM uses historical data to predict future requests for EMS responses. EMS dispatchers use this information to locate ambulances strategically throughout a service area. Theoretically, use of this system will result in approximately equal and more rapid call-response intervals throughout a service area.8 To our knowledge, no study has described the epidemiology of OHCA in an EMS system that uses system status management exclusively.

This study describes the epidemiology and outcome of patients suffering from OHCA in Rochester, New York, a medium sized city with an EMS system that utilizes SSM. It also evaluates predictors of OHCA resuscitation and survival.

Section snippets

Research design

A retrospective cohort study of all adult patients (18 and older) experiencing OHCA between 1 January 1998 and 31 December 2001 was conducted in Rochester, New York. The University of Rochester Research Subjects Review Board approved this study, and consent was waived. The Utstein recommendations and definitions were followed for data collection, analysis and reporting to allow comparison of our findings with other systems.9, 10, 11

Setting

The city of Rochester has a population of 220,000 and spans 36

Results

A total of 1177 patients experienced OHCA during the study period. Five hundred and thirty-nine (46%) patients met inclusion criteria. Patient age ranged from 18 to 98 years (median 67). Figure 1 shows the distribution of OHCA inclusions and exclusions according to the Utstein template. The demographic characteristics are reported in Table 1. Social security number was not available for seven patients (1%) and there was no known date of death from other sources (medical examiner or hospital

Discussion

We found an overall 5% survival at 1 year for OHCA patients in the medium-sized city of Rochester, NY, with a 9% survival among patients presenting with ventricular fibrillation, and a 9% survival among patients who received bystander CPR. With the notable exception of data from King County, Washington, this rate is comparable to or higher than most American cities with published data (see Table 5). Assuming that survival to 1 year is comparable to survival to discharge, two locations in the US

Conclusions

This study reveals a 5% overall survival to 1 year among OHCA patients in Rochester, NY, with a 9% survival among patients with a presenting rhythm of VF/VT or who received bystander CPR. In this system which utilized system status management there was no difference in survival based on race, gender, or socioeconomic status of patients, or in patients defibrillated by fire department personnel, witnessed collapse, or call-response intervals greater than 9 min.

Conflict of interest

The authors report no real or perceived conflicts of interest.

Acknowledgements

The authors wish to recognize the following individuals and organizations for their contribution to this project: Jennifer Williams, James Wood, Marlene Terrana, Mike Kuder, Robert Zerby, Robin Dick, Rural/Metro Medical Services-Rochester, the Monroe County Medical Examiners Office, Highland Hospital, and Rochester General Hospital.

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  • Cited by (0)

    A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2006.06.135

    1

    Present address: The Medical College of Wisconsin, Milwaukee, WI, United States.

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