Abstract
Aim
Out-of-hospital cardiac arrest (OOHCA) management dichotomizes strategies to (1) “scoop-and-run”
to a higher level of care or (2) “treat on the X” with the goal of return of spontaneous
circulation (ROSC) before transport, with field termination of resuscitation (FTOR)
of unsuccessful resuscitations. We hypothesized that EMS agencies with greater average
time on-scene and higher rates of field termination of resuscitation would have more
favorable outcomes.
Methods
The Cardiac Arrest Registry to Enhance Survival (CARES) was used to identify OOHCA
cases from 2013 to 2018. Agencies in the top and bottom quartiles of on-scene time
were categorized as high (HiOST) and low (LoOST); in the top and bottom quartiles
of field termination rate were categorized as high (HiTOR) and low (LoTOR). Generalized
estimating equation models compared top and bottom quartiles.
Results
We classified 95 agencies as HiOST (average > 25.1 min) or LoOST (average < 19.3 min).
We classified 95 agencies as HiTOR (average > 46.5% FTOR) or LoTOR (average < 23.5%
FTOR). Controlling for agency characteristics, HiOST had a higher survival to discharge
for transported patients (28.1% vs 23.1%, OR = 2.8, 95 %CI 2.1–3.6, p < 0.001), ROSC
on emergency department arrival, and favorable neurologic outcome than LoOST. HiTOR
had a higher survival to discharge for transported patients (25.6% vs 19.3%, OR = 3.3,
95 %CI 2.5–4.4, p < 0.001), ROSC on emergency department arrival, and favorable neurologic
outcome than LoTOR.
Conclusion
EMS agencies with higher rates of FTOR and longer on-scene times for patients with
OOHCA have higher overall patient survival, ROSC, and favorable neurologic function.
Keywords
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Article info
Publication history
Published online: October 15, 2021
Accepted:
September 20,
2021
Received in revised form:
September 16,
2021
Received:
June 23,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
