Abstract
Aims
There are large differences between emergency medical systems, which may account for
variability in outcomes. We seek to compare prehospital organizations, response modes,
patient characteristics and outcomes after out-of-hospital cardiac arrest, between
France and Canada, and discuss the need for the first European–North American prehospital
research network on out-of-hospital cardiac arrest.
Methods
Preliminary comparative description of data drawn from two nation-wide, population-based,
Utstein-style prospectively implemented registries for out-of-hospital cardiac arrest
in France and Canada (France: RéAC, Canada: CanROC), covering approximately 80 million
people, and soon to be participating in an international research network in 2020.
Results
Since creation, 103,722 cases were included in France and approximately 99,317 in
Canada. Data used in this work were drawn from 2011 to 2016, and comprised around
33,688 adult, non-traumatic, treated cases in Canada, and 55,358 in France, leading
to estimated incidence rates of 75.3/100,000 inhabitants in France and 83/100,000
in Canada. In both countries, out-of-hospital cardiac arrest predominantly occurred
in male patients, in their late sixties, at home, of presumed cardiac aetiology. Bystander
cardiopulmonary resuscitation was provided in half of the cases. First assessed cardiac
rhythm was shockable in 16% (France) vs. 22% (Canada). Professional resuscitation
was attempted in 82% (France) and 60% (Canada). Prehospital organizations and response
modes differed in the constitution of responding teams (France: physician-led advanced
life support, Canada: trained paramedics), in response time intervals (call to first
professional responders’ arrival at scene 6.5 min (interquartile range IQR [5.2–8.3])
(Canada) vs. 10 min [7–15] (France)), in on-scene interventions, type of referral
at hospital (France: systematic bypass of emergency department, tertiary hospital
first, Canada: occasional bypass, mainly closest hospital first), and in outcomes
(overall survival at hospital discharge in France: 5% vs. Canada: 11%).
Conclusion
Despite similarities in some out-of-hospital cardiac arrest Utstein variables, several
differences exist between French and Canadian prehospital systems, and ultimately,
between outcomes. The creation of the ReACanROC research network will facilitate the
conduction of further analyses to better understand predictors of this variability.
Keywords
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References
- Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81
- Variation in survival after out-of-hospital cardiac arrest between emergency medical services agencies.JAMA Cardiol. 2018; 3: 989
- International EMS systems: Canada.Resuscitation. 2004; 63: 119-122
- International EMS systems: France.Resuscitation. 2004; 63: 7-9
- Need for speed in out-of-hospital cardiac arrest.Resuscitation. 2019; (S0300957219305945)
- Ambulance density and outcomes after out-of-hospital cardiac arrest: insights from the Paris – sudden death expertise centre registry.Circulation. 2018; (Dec 4 (ahead of pub))
- Trends in care processes and survival following prehospital resuscitation improvement initiatives for out-of-hospital cardiac arrest in British Columbia, 2006–2016.Resuscitation. 2018; 125: 118-125
- Population density, call-response interval, and survival of out-of-hospital cardiac arrest.Int J Health Geogr. 2011; 10: 26
- Factors impacting patient outcomes associated with use of emergency medical services operating in urban versus rural areas: a systematic review.Int J Environ Res Public Health. 2019; 16: 1728
- Bystander CPR: location, location, location.Resuscitation. 2013; 84: 711-712
- Out-of-hospital cardiac arrest in high-rise buildings: delays to patient care and effect on survival.Can Med Assoc J. 2016; 188 (Apr 5): 413-419
- Response times and outcomes for cardiac arrests in Las Vegas casinos.Am J Emerg Med. 1998; 16: 249-253
- Simulated EMS response times until patients located in public train stations: a geospatial model to improve on-foot accessibility.Resuscitation. 2018; 131: e3-e5
- The “vertical response time”: barriers to ambulance response in an urban area.Acad Emerg Med Off J Soc Acad Emerg Med. 2007; 14: 772-778
- Emergency medical services response times in rural, suburban, and urban areas.JAMA Surg. 2017; 152: 983
- A US national study of the association between income and ambulance response time in cardiac arrest.JAMA Netw Open. 2018; 1: e185202
- Association of neighborhood characteristics with incidence of out-of-hospital cardiac arrest and rates of bystander-initiated CPR: implications for community-based education intervention.Resuscitation. 2014; 85: 1512-1517
- Socioeconomic status and incidence of cardiac arrest: a spatial approach to social and territorial disparities.Eur J Emerg Med. 2019; 26: 180-187
- Employment and residential characteristics in relation to automated external defibrillator locations.Am Heart J. 2016; 172: 185-191
- The impact of first responder turnout and curb-to-care intervals on survival from out-of-hospital cardiac arrest.Resuscitation. 2017;
- A trend in epidemiology and outcomes of out-of-hospital cardiac arrest by urbanization level: a nationwide observational study from 2006 to 2010 in South Korea.Resuscitation. 2013; 84: 547-557
- Association of neighborhood demographics with out-of-hospital cardiac arrest treatment and outcomes: where you live may matter.JAMA Cardiol [Internet]. 2017; (Aug 30 [cited 2017 Sep 18]; Available from: http://cardiology.jamanetwork.com/article.aspx?)https://doi.org/10.1001/jamacardio.2017.2671
Observatoires régionaux des urgences – FHP-MCO [Internet] [cited 2019 Nov 18]. Available from: http://www.fhpmco.fr/2016/12/27/observatoires-regionaux-urgences/.
l’Intérieur M de. Les statistiques des services d’incendie 1 et de secours. Édition 2018. [Internet]. http://www.interieur.gouv.fr/Publications/Statistiques/Securite-civile/2017 [cited 2019 Nov 18]. Available from: http://www.interieur.gouv.fr/Publications/Statistiques/Securite-civile/2017.
- Rationale, development and implementation of the resuscitation outcomes consortium epistry—cardiac arrest.Resuscitation. 2008; 78: 161-169
- Rationale, methodology, implementation, and first results of the French out-of-hospital cardiac arrest registry.Prehosp Emerg Care. 2014; 18: 511-519
- Epidemiology of out-of-hospital cardiac arrest: a French national incidence and mid-term survival rate study.Anaesth Crit Care Pain Med. 2019; 38: 131-135
- International variation in survival after out-of-hospital cardiac arrest: a validation study of the Utstein template.Resuscitation. 2019; 138: 168-181
- Health systems around the world – a comparison of existing health system rankings.J Glob Health. 2018; 8: 010407
Article info
Publication history
Published online: May 15, 2020
Accepted:
May 3,
2020
Received in revised form:
April 28,
2020
Received:
December 9,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
