Cardiac Arrest Survival Rises Over Last Two Decades
While the incidence of cardiac arrest occurring outside the hospital has remained relatively stable, at about 81 per 100,000 person-years, between 2001 and 2020, data show survival rates improved from 14.7% to 18.9% during that period. This improvement corresponded with increased bystander cardiopulmonary resuscitation (CPR), from 55.5% to 73.9%, and the use of early automated external defibrillators, from 2.2% to 10.9%.
METHODOLOGY:
Researchers conducted a retrospective cohort analysis of 25,118 adults in King County, Washington, who had experienced an out-of-hospital cardiac arrest (OHCA) treated by emergency medical services (EMS) between 2001 and 2020.
Of those, 15,994 (63.7%) were men and 9124 were women; the median age was 65 years.
Annual incidence calculations were stratified by sex, age group (less than 65 years and 65 years or older), and initial rhythm (shockable, nonshockable).
The tesearchers evaluated temporal trends using Poisson regression for incidence and survival to hospital discharge, with resuscitation assessed in five-year groups.
TAKEAWAY:
Overall survival to hospital discharge improved significantly over time: 14.7% (859 of 5847 individuals) in 2001-2005, 17.4% (1024 of 5885 individuals) in 2006-2010, 19.3% (1232 of 6376 individuals) in 2011-2015, and 18.9% (1322 of 7010 individuals) in 2016-2020 (P < .001 for trend).
Survival rates increased substantially for shockable OHCA, from 35% to 47.5%, and for nonshockable OHCA, from 6.4% to 10.1% between the periods spanning 2001-2005 and 2016-2020 (P < .001 for trend).
Improvements were observed in both prehospital resuscitation (survival to hospital admission) and in-hospital survival (P < .001 for trend).
Community response rose significantly, with bystander CPR increasing from 55.5% to 73.9% and early use of an automated external defibrillator rising from 2.2% to 10.9% (P < .001 for trend).
IN PRACTICE:
'Resuscitation outcomes improved over time, a temporal trend that was evident overall and when stratified by presenting arrest rhythm,' the researchers reported. 'The outcome improvements corresponded to improvements in health services such as increase in bystander CPR, AED application before EMS among patients with shockable rhythm, and hospital-based care with targeted temperature management and coronary intervention. The results demonstrate the dynamic nature of OHCA incidence and resuscitation care and outcome that collectively help provide a foundational context to consider strategies of prevention and treatment.'
SOURCE:
The study was led by Owen McBride, MD, of the Department of Emergency Medicine at the University of Washington in Seattle. It was published online July 16 in JAMA Cardiology.
LIMITATIONS:
According to the authors, while the study represents a singular regional experience that could affect generalizability, as OHCA incidence and outcome can vary based on geography. Some people who experience OHCA have an emergency response but do not receive resuscitation attempts due to signs of irreversible death or do-not-resuscitate orders, whereas some OHCA events do not receive a 911 medical response.
DISCLOSURES:
Michael Sayre, MD, reported receiving personal fees from Styker Emergency Response outside the submitted work. Thomas Rea, MD, MPH, reported receiving grants from Philips Medical Funding and the American Heart Association for research independent of the current publication. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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