Search

For out-of-hospital cardiac arrest (OHCA), assignment of race/ethnicity data can be challenging. Validation of race/ethnicity in registry data with patients' self-reported race/ethnicity would provide insights regarding misclassification.Using recently linked 2013-2019 Cardiac Arrest Registry to Enhance Survival (CARES) data with Medicare files, we examined the concordance of race/ethnicity in CARES with self-reported race/ethnicity in Medicare. Among patients with unknown race/ethnicity in CARES, race/ethnicity data from Medicare files were reported.Of 26,875 patients in the linked data, 5757 (21.4%) had unknown race/ethnicity in CARES. Of the remaining 21,118 patients, 14,284 (67.6%) were identified in CARES as non-Hispanic White, 4771 (22.6%) as non-Hispanic Black, 1213 (5.7%) as Hispanic, 760 (3.6%) as Asian or Pacific Islander, and 90 (0.4%) as American Indian or Alaskan Native. The concordance rate for race/ethnicity between CARES and Medicare was 93.4% for patients reported as non-Hispanic White in CARES, 89.1% for non-Hispanic Blacks, 74.6% for Hispanics, 69.6% for Asians and Pacific Islanders, and 37.8% for American Indian or Alaskan Natives. For the 5757 patients with unknown race/ethnicity in CARES, 3973 (69.0%) self-reported in Medicare as non-Hispanic White, 617 (10.7%) as non-Hispanic Black, 425 (7.4%) as Hispanic, 491 (8.5%) as Asian or Pacific Islander, and 52 (0.9%) as American Indian or Alaskan Native. Race/ethnicity remained unknown in 199 (3.5%) of patients.Race/ethnicity in CARES was highly concordant with self-reported race/ethnicity in Medicare, especially for non-Hispanic White and Black individuals. For patients with unknown race/ethnicity data in CARES, the vast majority were of White race.

BackgroundDespite advances in pre- and post-resuscitation care, percentage of survival to hospital discharge after out-of-hospital cardiac arrest (OHCA) was extremely low. Development of an accurate system to predict the daily incidence of OHCA might provide a significant public health benefit. Here, we developed and validated a machine learning (ML) predictive model for daily OHCA incidence using high-resolution meteorological, chronological, and geographical data.MethodsWe analyzed a dataset from the United States that combined an OHCA nationwide registry, high-resolution meteorological data, chronological data, and geographical data. We developed a model to predict daily OHCA incidence with a training dataset for 2013–2017 using the eXtreme Gradient Boosting algorithm. A dataset for 2018–2019 was used to test the predictive model. The main outcome was the predictive accuracy for the number of daily OHCA events, based on root mean squared error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE). In general, a model with MAPE less than 10% is considered highly accurate.ResultsAmong the 446,830 OHCAs of non-traumatic cause where resuscitative efforts were initiated by a 911 responder, 264,916 in the training dataset and 181,914 in the testing dataset were included in the analysis. The ML model with combined meteorological, chronological, and geographical data had high predictive accuracy in relation to nationwide incidence rate per 100,000 at the nationwide level) in the training dataset (RMSE, 0.016; MAE, 0.013; and MAPE, 7.61%) and in the testing dataset (RMSE, 0.018; MAE, 0.014; and MAPE, 6.52%).ConclusionsA ML predictive model using comprehensive daily meteorological, chronological, and geographical data allows for highly precise estimates of OHCA incidence in the United States.Clinical PerspectiveWhat is new?A machine learning predictive model developed with a high-resolution meteorological dataset and chronological and geographical variables predicted the daily incidence of out-of-hospital cardiac arrest (OHCA) in the U.S. population with high precision. The predictive accuracy at the state level was greater in medium and high-temperature areas than in the low-temperature area.What are the clinical implications?This predictive model revealed complex associations between meteorological, chronological, and geographic variables in relation to predicting daily incidence of OHCA. It might be useful for public health strategies in temperate regions, for example, by providing a warning system for citizens and emergency medical services agencies on high-risk days.

The 0-1 Multidimensional Knapsack Problem (MKP) is a NP-Hard problem that has important applications in business and industry. Approximate solution approaches for the MKP in the literature typically provide no guarantee on how close generated solutions are to the optimum. This article demonstrates how general-purpose integer programming software (Gurobi) is iteratively used to generate solutions for the 270 MKP test problems in Beasley’s OR-Library such that, on average, the solutions are guaranteed to be within 0.094% of the optimums and execute in 88 seconds on a standard PC. This methodology, called the simple sequential increasing tolerance (SSIT) matheuristic, uses a sequence of increasing tolerances in Gurobi to generate a solution that is guaranteed to be close to the optimum in a short time. This solution strategy generates bounded solutions in a timely manner without requiring the coding of a problem-specific algorithm. The SSIT results (although guaranteed within 0.094% of the optimums) when compared to known optimums deviated only 0.006% from the optimums—far better than any published results for these 270 MKP test instances.

The generalized assignment problem (GAP) is a NP-hard problem that has a large and varied number of important applications in business and industry. Approximate solution approaches for the GAP do not require excessive computation time, but typically there are no guarantees on solution quality. In this article, a methodology called the simple sequential increasing tolerance (SSIT) matheuristic that iteratively uses any general-purpose integer programming software is discussed. This methodology uses a sequence of increasing tolerances in conjunction with optimization software to generate a solution that is guaranteed to be within a specified percentage of the optimum in a short time. SSIT requires no problem-specific coding and can be used with any commercial optimization software to generate bounded solutions in a timely manner. Empirically, SSIT is tested on 51 GAP instances (24 medium and 27 large) in the literature. The performance of CPLEX versus Gurobi on these 51 GAP test instances is also statistically analyzed.

Establishing registries to collect demographic characteristics, processes of care, and outcomes of patients with out-of-hospital cardiac arrest (OHCA) can better understand epidemiological trends, measure care quality, and identify opportunities for improvement. This study aimed to describe the design, implementation, and scientific significance of a nationwide registry-the BASIC-OHCA (Baseline Investigation of Out-of-Hospital Cardiac Arrest)-in China.BASIC-OHCA was designed as a prospective, multicenter, observational, population-based study. The BASIC-OHCA registry was developed based on Utstein templates. BASIC-OHCA includes all OHCA patients confirmed by emergency medical services (EMS) personnel regardless of age, sex, or cause. Patients declared dead at the scene by EMS personnel for any reasons are also included. To fully characterize an OHCA event, BASIC-OHCA collects data from 3 sources-EMS, the receiving hospital, and patient follow-up-and links them to form a single record. Once data entry is completed and quality is checked, individual identifiers are stripped from the record.Currently, 32 EMS agencies in 7 geographic regions contribute data to BASIC-OHCA. They are distributed in the urban and rural areas, covering ≈9% of the population of mainland China. Data collection started on August 1, 2019. By July 31, 2020, a total of 92 913 EMS-assessed OHCA patients were enrolled. Among 28969 (31.18%) EMS-treated OHCAs' the mean age was 65.79±17.36 years, and 68.35% were males. The majority of OHCAs (76.85%) occurred at home or residence. A shockable initial rhythm was reported in 5.43% of patients. Any return of spontaneous circulation, survival to hospital discharge, and favorable neurological outcome at hospital discharge were 5.98%, 1.15%, and 0.83%, respectively.BASIC-OHCA is the first nationwide registry on OHCA in China. It can be used as a public health surveillance system and as a platform to produce evidence-based practices to help identify opportunities for improvement.URL: https://www.gov; Unique identifier: NCT03926325.

Background: Most studies on out-of-hospital cardiac arrest have primarily focused on in-hospital or short-term survival. Little is known about long-term outcomes and resource use among survivors of out-of-hospital cardiac arrest. Methods: In this observationsl study, we describe overall long-term outcomes for patients from the national Cardiac Arrest Registry to Enhance Survival linked to Medicare files to create the Cardiac Arrest Registry to Enhance Survival: Mortality, Events, and Costs for Cardiac Arrest survivors dataset. Cardiac Arrest Registry to Enhance Survival data between 2013 and 2019 were linked to Medicare data using probabilistic matching algorithms. Overall long-term mortality, readmissions, and index hospitalization costs are reported for the overall cohort. Results: Among 56 425 patients who were 65 years of age or older in Cardiac Arrest Registry to Enhance Survival who survived to hospital admission, 26 875 (47.6%) were successfully linked to Medicare files. Mean ( + SD) cost of the index hospitalization was $23 262 + $24 199 and the median cost was $14 636 (interquartile range, $9930–$30 033). Overall, 8676 (32.3%) survived to hospital discharge with 38.0% discharged home, 11.8% to hospice care, and the remaining 50.2% to other inpatient, skilled nursing care, or rehabilitation facilities. Mortality after discharge was initially high (27.0% at 3 months) and then increased gradually, with 1- and 3-year mortality of 37.1% and 50.1%, respectively. During the first year, 40.1% were readmitted at least once, with 19.7% readmitted on > 1 occasion. Conclusions: The Cardiac Arrest Registry to Enhance Survival: Mortality, Events, and Costs for Cardiac Arrest survivors registry includes rich data on postdischarge outcomes and resource utilization. Use of this dataset will enable future investigations on the long-term effectiveness, costs, and cost-effectiveness of various interventions for out-of-hospital cardiac arrest in elderly patients.

Sepsis is the most common cause of in-hospital deaths, especially from low-income and lower-middle-income countries (LMICs). This study aimed to investigate the mortality rate and associated factors from sepsis in intensive care units (ICUs) in an LMIC. We did a multicenter cross-sectional study of septic patients presenting to 15 adult ICUs throughout Vietnam on the 4 days representing the different seasons of 2019. Of 252 patients, 40.1% died in hospital and 33.3% died in ICU. ICUs with accredited training programs (odds ratio, OR: 0.309; 95% confidence interval, CI 0.122–0.783) and completion of the 3-h sepsis bundle (OR: 0.294; 95% CI 0.083–1.048) were associated with decreased hospital mortality. ICUs with intensivist-to-patient ratio of 1:6 to 8 (OR: 4.533; 95% CI 1.621–12.677), mechanical ventilation (OR: 3.890; 95% CI 1.445–10.474) and renal replacement therapy (OR: 2.816; 95% CI 1.318–6.016) were associated with increased ICU mortality, in contrast to non-surgical source control (OR: 0.292; 95% CI 0.126–0.678) which was associated with decreased ICU mortality. Improvements are needed in the management of sepsis in Vietnam such as increasing resources in critical care settings, making accredited training programs more available, improving compliance with sepsis bundles of care, and treating underlying illness and shock optimally in septic patients.

There are conflicting data regarding the benefit of compression-only bystander cardiopulmonary resuscitation (CO-CPR) compared with CPR with rescue breathing (RB-CPR) after pediatric out-of-hospital cardiac arrest (OHCA).This study sought to test the hypothesis that RB-CPR is associated with improved neurologically favorable survival compared with CO-CPR following pediatric OHCA, and to characterize age-stratified outcomes with CPR type compared with no bystander CPR (NO-CPR).Analysis of the CARES registry (Cardiac Arrest Registry to Enhance Survival) for nontraumatic pediatric OHCAs (patients aged ≤18 years) from 2013-2019 was performed. Age groups included infants (1 year), children (1 to 11 years), and adolescents (≥12 years). The primary outcome was neurologically favorable survival at hospital discharge.Of 13,060 pediatric OHCAs, 46.5% received bystander CPR. CO-CPR was the most common bystander CPR type. In the overall cohort, neurologically favorable survival was associated with RB-CPR (adjusted OR: 2.16; 95% CI: 1.78-2.62) and CO-CPR (adjusted OR: 1.61; 95% CI: 1.34-1.94) compared with NO-CPR. RB-CPR was associated with a higher odds of neurologically favorable survival compared with CO-CPR (adjusted OR: 1.36; 95% CI: 1.10-1.68). In age-stratified analysis, RB-CPR was associated with better neurologically favorable survival versus NO-CPR in all age groups. CO-CPR was associated with better neurologically favorable survival compared with NO-CPR in children and adolescents, but not in infants.CO-CPR was the most common type of bystander CPR in pediatric OHCA. RB-CPR was associated with better outcomes compared with CO-CPR. These results support present guidelines for RB-CPR as the preferred CPR modality for pediatric OHCA.

Background: The International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in 2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics of OHCA from 2015 through 2017.Methods: We invited national and regional population-based OHCA registries for voluntary participation and included emergency medical services (EMS)-treated OHCA. We collected descriptive summary data of core elements of the latest Utstein style recommendation during 2016 and 2017 at each registry. For registries that participated in the previous 2015 report, we also extracted the 2015 data.Results: Eleven national registries in North America, Europe, Asia, and Oceania, and 4 regional registries in Europe were included in this report. Across registries, the estimated annual incidence of EMS-treated OHCA was 30.0-97.1 individuals per 100,000 population in 2015, 36.4-97.3 in 2016, and 40.8-100.2 in 2017. The provision of bystander cardiopulmonary resuscitation (CPR) varied from 37.2% to 79.0% in 2015, from 2.9% to 78.4% in 2016, and from 4.1% to 80.3% in 2017. Survival to hospital discharge or 30-day survival for EMS-treated OHCA ranged from 5.2% to 15.7% in 2015, from 6.2% to 15.8% in 2016, and from 4.6% to 16.4% in 2017.Conclusion: We observed an upward temporal trend in provision of bystander CPR in most registries. Although some registries showed favourable temporal trends in survival, less than half of registries in our study demonstrated such a trend. Background: The International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in 2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics of OHCA from 2015 through 2017. Methods: We invited national and regional population-based OHCA registries for voluntary participation and included emergency medical services (EMS)-treated OHCA. We collected descriptive summary data of core elements of the latest Utstein style recommendation during 2016 and 2017 at each registry. For registries that participated in the previous 2015 report, we also extracted the 2015 data. Results: Eleven national registries in North America, Europe, Asia, and Oceania, and 4 regional registries in Europe were included in this report. Across registries, the estimated annual incidence of EMS-treated OHCA was 30.0–97.1 individuals per 100,000 population in 2015, 36.4–97.3 in 2016, and 40.8–100.2 in 2017. The provision of bystander cardiopulmonary resuscitation (CPR) varied from 37.2% to 79.0% in 2015, from 2.9% to 78.4% in 2016, and from 4.1% to 80.3% in 2017. Survival to hospital discharge or 30-day survival for EMS-treated OHCA ranged from 5.2% to 15.7% in 2015, from 6.2% to 15.8% in 2016, and from 4.6% to 16.4% in 2017. Conclusion: We observed an upward temporal trend in provision of bystander CPR in most registries. Although some registries showed favourable temporal trends in survival, less than half of registries in our study demonstrated such a trend.

Background Traditional, instructor led, in-person training of CPR skills has become more challenging due to COVID-19 pandemic. We compared the learning outcomes of standard in-person CPR training (ST) with alternative methods of training such as hybrid or online-only training (AT) on CPR performance, quality, and knowledge among laypersons with no previous CPR training. Methods We searched PubMed and Google Scholar for relevant articles from January 1995 to May 2020. Covidence was used to review articles by two independent researchers. Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess quality of the manuscripts. Results Of the 978 articles screened, twenty met the final inclusion criteria. All included studies had an experimental design and moderate to strong global quality rating. The trainees in ST group performed better on calling 911, time to initiate chest compressions, hand placement and chest compression depth. Trainees in AT group performed better in assessing scene safety, calling for help, response time including initiating first rescue breathing, adequate ventilation volume, compression rates, shorter hands-off time, confidence, willingness to perform CPR, ability to follow CPR algorithm, and equivalent or better knowledge retention than standard teaching methodology. Conclusion AT methods of CPR training provide an effective alternative to the standard in-person CPR for large scale public training.

Background The Utstein population is defined by non-traumatic, bystander-witnessed out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF). It is used to compare resuscitation performance across emergency medical services (EMS) systems. We hypothesized a system-specific survival correlation between the current Utstein population and other VF populations defined by unwitnessed VF OHCA and VF OHCA after EMS arrival (EMS-witnessed). Expanding performance metrics to this more comprehensive population would make the Utstein definition more representative of the actual community burden and response to VF OHCA. Methods We performed a cohort investigation of all non-traumatic, VF OHCA in the Cardiac Arrest Registry to Enhance Survival from 1/1/2013-12/31/2018 among EMS agencies that treated > = 100 VF OHCA. We evaluated sample size and survival with the addition of the new VF populations. We used Pearson coefficient to assess whether there was a correlation of agency-specific survival outcomes between the current Utstein population and unwitnessed and EMS-witnessed VF OHCA. Results A total of 107 EMS agencies treated 38,836 VF arrests: 22,918 current Utstein, 11,297 unwitnessed VF, and 4621 EMS-witnessed VF OHCA. Overall, survival was 29.8% (11,567/38,836): 33.9% (7774/22,918) among current Utstein, 17.2% (1942/11,297) among unwitnessed VF, and 40.1% (1851/4621) among EMS-witnessed VF. For agency-specific survival outcome, the Pearson correlation was 0.52 between the current Utstein population versus combined unwitnessed and EMS-witnessed groups. For survival with Cerebral Performance Category 1–2, the Pearson correlation was 0.61. Conclusion Expanding the Utstein population to include unwitnessed and EMS-witnessed VF OHCA achieves a simpler, more inclusive case definition that minimizes variability in case determination and increases the number of survivors and eligible population by ∼50%, while still achieving a distinguishing metric of system-specific performance.

Introduction:The concept of compressions only cardiopulmonary resuscitation (CO-CPR) evolved from a perception that lay rescuers may be less likely to perform mouth-to-mouth ventilations during an emergency. This study hopes to describe the efficacy of bystander compressions and ventilations cardiopulmonary resuscitation (CV-CPR) in cardiac arrest following drowning.Hypothesis/Problem:The aim of this investigation is to test the hypothesis that bystander cardiopulmonary resuscitation (CPR) utilizing compressions and ventilations results in improved survival for cases of cardiac arrest following drowning compared to CPR involving compressions only.Methods:The Cardiac Arrest Registry for Enhanced Survival (CARES) was queried for patients who suffered cardiac arrest following drowning from January 1, 2013 through December 31, 2017, and in whom data were available on type of bystander CPR delivered (ie, CV-CPR CO-CPR). The primary outcome of interest was neurologically favorable survival, as defined by cerebral performance category (CPC).Results:Neurologically favorable survival was statistically significantly associated with CV-CPR in pediatric patients aged five to 15 years (aOR = 2.68; 95% CI, 1.10–6.77; P = .03), as well as all age group survival to hospital discharge (aOR = 1.54; 95% CI, 1.01–2.36; P = .046). There was a trend with CV-CPR toward neurologically favorable survival in all age groups (aOR = 1.35; 95% CI, 0.86–2.10; P = .19) and all age group survival to hospital admission (aOR = 1.29; 95% CI, 0.91–1.84; P = .157).Conclusion:In cases of cardiac arrest following drowning, bystander CV-CPR was statistically significantly associated with neurologically favorable survival in children aged five to 15 years and survival to hospital discharge.

BACKGROUND: Cardiac arrest occurs frequently in outpatient dialysis clinics, and immediate cardiopulmonary resuscitation (CPR) provision improves patient outcomes. However, Black patients in dialysis clinics receive CPR from clinic staff less often compared with White patients. We examined the role of dialysis facility resources and patient factors in the observed racial disparity in CPR receipt and automated external defibrillator application. METHODS: This was a retrospective cohort study linking the National Cardiac Arrest Registry to Enhance Survival and Medicare Annual Dialysis Facility Report registries from 2013 to 2017. We identified patients experiencing cardiac arrests within US outpatient dialysis clinics via geolocation matching (N=1554). Differences in facility size, quality, staffing, and patient-related factors were summarized and compared according to patient race. Multilevel multivariable logistic regression models including these factors were used to examine the influence of these factors on the observed disparity in CPR rates between Black and White patients. RESULTS: Compared with White patients, Black cardiac arrest patients dialyzed in larger facilities (26 versus 21 dialysis stations; P

Prior studies have identified socio-cultural barriers in laypersons performing high-quality cardiopulmonary resuscitation (CPR) in women. Whether the effect of layperson bystander CPR on survival from out-of-hospital cardiac arrest (OHCA) differs by patients' sex is unknown.Using data during 2013-2020 from an OHCA registry in the U.S., we identified adult patients with non-traumatic OHCA. The primary outcome was favorable neurological survival and the secondary outcome was survival to discharge. Multivariable logistic regression models evaluated the interaction between patients' sex and bystander CPR with survival, adjusted for patient and cardiac arrest characteristics.Of 420,671 patients with OHCA, 151,145 (35.9 %) occurred in women and 269,526 (64.1 %) in men. Rates of layperson bystander CPR were similar between women (38.3 %) and men (40.0 %). Rates of favorable neurological survival were 11.4 % in those with bystander CPR and 5.6 % in those without, but the association between bystander CPR and favorable neurological survival was weaker for women than men (women: adjusted OR, 1.33 [95 % CI: 1.27-1.39]; men: adjusted OR, 1.55 [95 % CI: 1.51-1.61]; interaction p 0.001)]. Rates of survival to discharge were 13.1 % and 7.3 % in those with and without layperson bystander CPR, and the association between bystander CPR was weaker for women than men (women: adjusted OR, 1.21 [95 % CI: 1.16-1.26]; men: adjusted OR, 1.43 [95 % CI: 1.39-1.47]; interaction p 0.001).For OHCA, bystander CPR was associated with higher survival in women and men. However, as currently practiced, the association between bystander CPR and higher survival was weaker for women as compared with men.

Everyday, nearly 1000 U.S. adults experience out-of-hospital cardiac arrest (OHCA). Survival to hospital discharge varies across many factors, including sociodemographics, location of arrest, and whether bystander intervention was provided. The current study examines recent trends in OHCA survival by location of arrest using a cohort of emergency medical service (EMS) agencies that contributed data to the Cardiac Arrest Registry to Enhance Survival.The 2015 CARES cohort (N = 122,613) includes EMS agencies contributing data across five consecutive years, 2015-2019. We assessed trends in EMS-attended OHCA survival for the 2015 CARES cohort by location of arrest - public, residential, nursing home. Unadjusted and adjusted percentages were estimated using 3-level hierarchical logistic regression models among cases aged 18-65 years.Overall, survival from EMS-attended OHCA significantly increased from 12.5% in 2015 to 13.8% in 2019 (p = 0.001). Survival from bystander witnessed arrests also increased significantly from 17.8% in 2015 to 19.7% in 2019 (p = 0.004). The trend for survival increased overall and for bystander witnessed OHCAs occurring in public places and nursing homes.Increasing trends for EMS-attended OHCA survival were observed in the overall and bystander witnessed groups. No change in the trend for survival was observed among OHCAs in the groups most likely to have a desirable outcome - bystander witnessed, with a shockable rhythm, and receiving bystander intervention. Reporting and monitoring of OHCA may be an important first step in improving outcomes. Additional community interventions focused on bystander CPR and AED use may be warranted.

Background: Bystander cardiopulmonary resuscitation (CPR) is associated with a better survival outcome in patients with out-of-hospital cardiac arrest (OHCA). However, there may be cultural barriers in performing high-quality bystander CPR in women in some non-Western countries and the effect of bystander CPR on survival outcomes may differ by patients’ sex. Methods: Using data between 2012-2018 from a national OHCA registry from the Republic of Korea, we identified adult patients with OHCA of presumed cardiac etiology. The main exposures were bystander CPR and patients’ sex. The primary outcome was survival discharge and the secondary outcome was favorable neurological survival. Multivariable logistic regression evaluated the association between bystander CPR and survival, adjusted for patients’ age, sex, socio-economic status, year of arrest, witnessed arrest status, initial OHCA rhythm, location of arrest, urbanization level of arrest location, and type of bystander. The interaction between bystander CPR and sex was explicitly evaluated in the models. Results: Of 101,505 patients with OHCA in the cohort, 34,124 (33.6 %) were women and 67,381 (64.4 %) were men. Bystander CPR was performed on 18,481 (54.2%) women and 35,904 (53.3%) men (p=0.07). Unadjusted rates of survival discharge were 4.5% in women and 9.5 % in men (p Conclusions: In a national registry of OHCA from the Republic of Korea, men who received bystander CPR were more likely to survive whereas women who received bystander CPR were not.

Background: Given the diversity of patients resuscitated from out-of-hospital cardiac arrest (OHCA) complicated by STEMI, adequate risk adjustment is needed to account for potential differences in case-mix to reflect the quality of percutaneous coronary intervention. Objectives: We sought to build a risk-adjustment model of in-hospital mortality outcomes for patients with OHCA and STEMI requiring emergent angiography. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we included adult patients with OHCA and STEMI who underwent angiography within 2 hours from January 2013 to December 2019. Using pre-hospital patient and arrest characteristics, multivariable logistic regression models were developed for in-hospital mortality. We then described model calibration, discrimination, and variability in patients’ unadjusted and adjusted mortality rates. Results: Of 2,999 hospitalized patients with OHCA and STEMI who underwent emergent angiography (mean age 61.2 ±12.0, 23.1% female, 64.6% white), 996 (33.2%) died. The final risk-adjustment model for mortality included higher age, unwitnessed arrest, non-shockable rhythms, not having sustained return of spontaneous circulation upon hospital arrival, and higher total resuscitation time on scene ( C -statistic, 0.804 with excellent calibration). The risk-adjusted proportion of patients died varied substantially and ranged from 7.8% at the 10 th percentile to 74.5% at the 90 th percentile (Figure). Conclusions: Through leveraging data from a large, multi-site registry of OHCA patients, we identified several key factors for better risk-adjustment for mortality-based quality measures. We found that STEMI patients with OHCA have highly variable mortality risk and should not be considered as a single category in public reporting. These findings can lay the foundation to build quality measures to further optimize care for the patient with OHCA and STEMI.

Variations in the impact of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) have been reported. We aimed to, using population-based registries, compare community response, Emergency Medical Services (EMS) interventions and outcomes of adult, EMS-treated, non-traumatic OHCA in Singapore and metropolitan Atlanta, before and during the pandemic. Associations of OHCA characteristics, pre-hospital interventions and pandemic with survival to hospital discharge were analyzed using logistic regression. There were 2084 cases during the pandemic (17 weeks from the first confirmed COVID-19 case) and 1900 in the pre-pandemic period (corresponding weeks in 2019). Compared to Atlanta, OHCAs in Singapore were older, received more bystander interventions (cardiopulmonary resuscitation (CPR): 65.0% vs. 41.4%; automated external defibrillator application: 28.6% vs. 10.1%), yet had lower survival (5.6% vs. 8.1%). Compared to the pre-pandemic period, OHCAs in Singapore and Atlanta occurred more at home (adjusted odds ratio (aOR) 2.05 and 2.03, respectively) and were transported less to hospitals (aOR 0.59 and 0.36, respectively) during the pandemic. Singapore reported more witnessed OHCAs (aOR 1.96) yet less bystander CPR (aOR 0.81) during pandemic, but not Atlanta (p < 0.05). The impact of COVID-19 on OHCA outcomes did not differ between cities. Changes in OHCA characteristics and management during the pandemic, and differences between Singapore and Atlanta were likely the result of systemic and sociocultural factors.

Background Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. Methods We performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. Results Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively). Conclusion In this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.

Background Approximately 1000 out-of-hospital cardiac arrest (OHCA) occur each day in the United States. Although sex differences exist for other cardiovascular conditions such as stroke and acute myocardial infarction, they are less well understood for OHCA. Specifically, the extent to which neurological and survival outcomes after OHCA differ between men and women remains poorly characterized in the U.S. Methods and results Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 326,138 adults with an OHCA from 2013 to 2019. Using multivariable logistic regression, we evaluated for sex differences in rates of survival to hospital admission, survival to hospital discharge, and favorable neurological survival (i.e., without severe neurological disability), adjusted for demographics, cardiac arrest characteristics and bystander interventions. Overall, 117,281 (36%) patients were women. Median age was 62 and 65 years for men and women, respectively. An initial shockable rhythm (25.1% vs 14.7%, standardized difference of 0.26) and an arrest in a public location (22.2% vs. 11.3%; standardized difference of 0.30) were more common in men, but there were no meaningful sex differences in rates of witnessed arrests, bystander cardiopulmonary resuscitation, intra-venous access, or use of mechanical devices for delivering cardiopulmonary resuscitation. Overall, the unadjusted rates of all survival outcomes were similar between men and women: survival to hospital admission (27.0% for men vs. 27.9% for women, standardized difference of −0.02), survival to hospital discharge (10.5% for men vs. 8.6% for women, standardized difference of 0.07), and favorable neurological survival (9.0% for men vs. 6.6% for women, standardized difference of 0.09). After multivariable adjustment, however, men were less likely to survive to hospital admission (adjusted OR = 0.75, 95% CI: 0.73, 0.77), survive to hospital discharge (adjusted OR = 0.83, 95% CI: 0.80, 0.85), or have favorable neurological survival (adjusted OR = 0.88, 95% CI: 0.85, 0.91). Conclusions Compared to women, men with OHCA have more favorable cardiac arrest characteristics but were less likely to survive to hospital admission, survive to discharge, nor have favorable neurological survival.

Objective To estimate the annual and lifetime economic productivity loss due to adult out-of-hospital cardiac arrest (OHCA) in the United States (U.S.). Methods All adult (age ≥ 18 years) non-traumatic EMS-treated OHCA with complete data for age, sex, race, and survival outcomes from the CARES database for 2013–2018 were included. Annual and lifetime labor productivity values, based on age and gender, were obtained from previously published national economic data. Productivity losses for OHCA events were calculated by year in U.S. dollars. Productivity losses for survivors were assigned by cerebral performance category score (CPC): CPC 1 and 2 = 0% productivity loss; CPC 3–5 = 100% productivity loss. Sensitivity analyses were performed assigning CPC 2 varying productivity losses (0–100%) based on CPC score and discharge location. Lifetime productivity values assumed 1% annual growth and 3% discount rate and were adjusted for inflation based on 2016 values. Results were extrapolated to annual U.S. population estimates for the study period. Results A total of 338,492 (96.5%) cases met inclusion criteria. The mean annual and lifetime productivity losses per OHCA in 2018 were $48,224 and $638,947 respectively. The total annual economic productivity loss due to OHCA in the U.S. increased from $7.4B in 2013 to $11.3B in 2018. Lifetime economic productivity loss increased from $95.2B in 2013 to $150.2B in 2018. Sensitivity analyses yielded similar findings. Per annual death, OHCA ranked third ($10.2B) in annual economic productivity loss in the U.S. behind cancer ($22.9B) and heart disease ($20.3B) in 2018. Conclusion Adult non-traumatic OHCA events are associated with significant annual and lifetime economic productivity losses and should be the focus of public health resources to improve preventative measures and survival outcomes.

Background: Left heart catheterization (LHC) and TTM are proven beneficial after OHCA. Detroit CARES data found a strong, though insignificant, trend for LHC rate and survival (p = 0.1). In 2018, the rate of patients with LHC and good CPC nearly doubled, despite an overall decrease in LHC rate. Therefore, we hypothesize LHC is performed later (after second day of hospitalization) nationwide and a good CPC is likely associated with selection of patients expected to survive. Methods: We analyzed the national CARES registry (2013 - 2018) to investigate whether delayed LHC after OHCA was occurring nationally. Included were patients 18 or older, non-skilled care facility patients and surviving to admission. The primary outcome was the CPC dichotomized into good (1 or 2) and poor (3 - 5). A propensity score was derived to predict early LHC that incorporated factors associated with LHC and outcome. A multi-level logistic regression analyses was fit using inverse weighted propensity scores. The primary predictor of interest was early LHC relative to no or late LHC. Also examined were TTM, year of cardiac arrest, and other predictors. Results reported are odds ratios (OR) and the corresponding 95% confidence intervals (95% CI). Results: 62,195 individual cases were identified; the median age was 61, (IQR-16), 62% male, 32% unwitnessed, 37% bystander CPR, and 35% initial shockable rhythm. 29% had good outcome and 22% received early LHC, 6% late LHC and 72% no LHC. 13% of patients receiving early LHC and 23% with no or late LHC had a good outcome. OR and 95% CI for good outcome were: 2.4 (2.2-2.7) for early LHC, 3.6 (3.3-3.8) for shockable rhythm, 1.9 (1.7-2.0) for public location and 2.0 (1.8-2.2) for witnessed arrest. Over the five-year period, no change in the total LHC occurred and a slight decrease in early LHC, (25%-23%), (Fig 1). Conclusion: Early LHC was associated with good outcome (CPC) at hospital discharge. The overall LHC rate is unchanged from 2013-18 with a slight decrease in early LHC.

Objective: To estimate the annual and lifetime economic productivity loss due to adult out-of-hospital cardiac arrest (OHCA) in the United States (U.S.) over a 5-year study period between 2013-2018. Methods: All adult (age≥ 18 years) non-traumatic EMS-treated OHCA with complete data for age, sex, race, and survival outcomes from the CARES database for the most recently available 5-year period were included. Annual and lifetime labor productivity values, based on age and gender, were obtained from previously published national economic data. Productivity losses for OHCA events were calculated by year. Productivity losses for survivors were assigned by cerebral performance category score (CPC): CPC 1 and 2 = 0% productivity loss; CPC 3-5 = 100% productivity loss. Sensitivity analyses were performed assigning CPC 2 varying productivity losses (0-100%). Lifetime productivity values assumed 1% annual growth and 3% discount rate. Productivity data are presented in U.S. dollars and adjusted for inflation based on 2016 values. Results were extrapolated to the annual U.S. population. Results: A total of 338,492 (96.5%) cases met inclusion criteria. The mean annual and lifetime productivity losses per OHCA in 2018 were $48,224 and $638,947 respectively. Total annual and lifetime productivity losses for the study population in 2018 were $3.8 billion and $50.6 billion, respectively. Sensitivity analyses assigning CPC 2 varying productivity losses yielded similar findings. Males had a much larger lifetime productivity loss to approximately age 65 years compared to females (FIGURE 1). For the U.S. population in 2018, the total annual and lifetime productivity losses due to OHCA were $11.3 billion and $150.2 billion, respectively. Conclusion: Adult non-traumatic OHCA events are associated with significant annual and lifetime economic productivity losses and should be the focus of public health resources to improve preventative measures and survival outcomes.

Background: The Utstein population is defined by non-traumatic, bystander-witnessed out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF). It is used to compare resuscitation performance across emergency medical services (EMS) systems. We hypothesized there being a system-specific survival correlation between the current Utstein and other VF populations inclusive of unwitnessed and EMS-witnessed VF OHCA that supports expanding performance metrics to this more comprehensive population that is more representative of the actual community burden of VF OHCA. Methods: We performed a cohort investigation of all non-traumatic, VF OHCA in the Cardiac Arrest Registry to Enhance Survival from 1/1/2013-12/31/2018 among EMS agencies that treated >=100 VF OHCA. We evaluated sample size and survival with the addition of the new VF populations. We used the Pearson coefficient to assess the correlation of agency-specific survival between the current Utstein population and unwitnessed and EMS-witnessed VF OHCA. Results: A total of 107 EMS agencies treated 38,836 VF arrests: 22,918 current Utstein, 11,297 unwitnessed VF, and 4621 EMS-witnessed VF OHCA. Overall, survival was 29.8% (11,567/38,836): 33.9% (7,774/22,918) among current Utstein, 17.2% (1942/11,297) among unwitnessed VF, and 40.1% (1851/4621) among EMS-witnessed VF. For agency-specific survival outcome, the Pearson correlation was 0.52 between current the Utstein population versus combined unwitnessed and EMS-witnessed groups. For survival with Cerebral Performance Category 1-2, the Pearson correlation was 0.61. Conclusion: Expanding the Utstein population to include unwitnessed and EMS-witnessed VF OHCA achieves a simpler, more inclusive case definition that minimizes variability in case determination and increases the number of survivors and eligible population by ~50%, while still achieving a distinguishing metric of system-specific performance.

Introduction: Bystander CPR (B-CPR) and defibrillation for sudden cardiac arrest (SCA) vary by gender with females being less likely to receive these interventions. Despite known differences by race and ethnicity, it is unknown whether gender disparities in B-CPR and defibrillation persist by neighborhood race and ethnicity. Objectives: We examined the likelihood of receiving B-CPR and defibrillation by gender stratified by public location and neighborhood racial/ethnic composition. We hypothesized that in public locations within Black neighborhoods, females will have a lower likelihood of receiving B-CPR compared to males. Methods: We conducted a retrospective cohort study using data from the US Cardiac Arrest Registry to Enhance Survival (CARES) registry. Neighborhoods were classified by census tract based on percent of Black or Hispanic residents using the threshold in the definition of “White flight” where Whites leave a neighborhood when it exceeds >30% of a minority population. We independently modeled the likelihood of receipt of B-CPR and defibrillation by gender stratified by public location and neighborhood racial/ethnic composition controlling for confounding variables. Results: From 2013-2018, CARES collected 350,722 US arrests; after excluding pediatric arrests, those witnessed by EMS, or those that occurred in a healthcare facility, 214,464 were included. Mean age was 64±16 and 65% were male; 39% received B-CPR, 9% received bystander defibrillation prior to 9-1-1 responders arrival, and 18% occurred in the public. In Black neighborhoods, females who had SCA in public locations were 22% less likely to receive B-CPR (OR: 0.78 (0.64-0.95), p=0.01) and 42% less likely to receive defibrillation (OR: 0.58 (0.45-0.74), p Conclusion: Females with public SCA have a decreased likelihood of receiving B-CPR and defibrillation, and these findings persist in Black and Hispanic neighborhoods. This has implications for strategies to reduce disparities around bystander response to SCA.

Introduction: Pre-hospital capabilities are minimally developed in Vietnam; therefore, the prognosis of OHCA might differ from that of other countries. The aim of this study was to investigate survival rate from OHCA and potential determinants of the chain of survival following an OHCA in a developing country. Hypothesis: Understanding the country-specific etiologies and the disease risk and prognosis of OHCA are crucial for reducing mortality in Vietnam, as well as in other countries that face challenges in clinical practice owing to limited medical resources. Methods: This is a multi-center prospective observational study of OHCA patients (age>18 years) presenting to the ED of three tertiary hospitals from February 2014 to December 2018. Factors associated with survival following OHCA were collected and compared among types of pre-hospital care transportation and between survival and non-survival to admission. Factors for survival to admission were assessed using logistic regression analysis. Results: Among 590 OHCA patients (male, 74.6%; age, 56.1±17.2 years), we observed low rates of survival to admission (24.2%) and discharge (14.1%). Of total patients, 67.8% occurred at home, 79.4% witnessed by bystanders, 124/555 (22.3%) received bystander CPR, a minority of patients (8.64%) was conveyed by EMS, and 49/152 (32.2%) received pre-hospital defibrillation. Multivariate analysis revealed that past medical history (PMH) of respiratory disease (OR, 3.128; 95% CI, 1.197-8.173), pre-hospital defibrillation (OR, 3.904; 95% CI, 1.540-9.898), pre-hospital advanced airway (OR, 3.441; 95% CI, 1.203-9.844) and ROSC at ED (OR, 2.891; 95% CI, 1.030-8.115) were independent factors for survival to admission. Following OHCA with cardiac etiology, EMS use (OR, 0.203; 95% CI, 0.044-0.935) was also an independent factor for survival to admission. Conclusions: This was a highly selected cohort of OHCA patients presenting to the ED. Many OHCA victims in Vietnam do not come to the ED. PMH of respiratory disease, pre-hospital defibrillation and advanced airway, and ROSC at ED were independent factors predicting survival to admission. EMS use was also an inverse and independent predictor of survival to admission among patients following OHCA with cardiac etiology.

IMPORTANCE: Recent reports from communities severely affected by the coronavirus disease 2019 (COVID-19) pandemic found lower rates of sustained return of spontaneous circulation (ROSC) for out-of-hospital cardiac arrest (OHCA). Whether the pandemic has affected OHCA outcomes more broadly is unknown. OBJECTIVE: To assess the association between the COVID-19 pandemic and OHCA outcomes, including in areas with low and moderate COVID-19 disease burden. DESIGN, SETTING, AND PARTICIPANTS: This study used a large US registry of OHCAs to compare outcomes during the pandemic period of March 16 through April 30, 2020, with those from March 16 through April 30, 2019. Cases were geocoded to US counties, and the COVID-19 mortality rate in each county was categorized as very low (0-25 per million residents), low (26-100 per million residents), moderate (101-250 per million residents), high (251-500 per million residents), or very high (>500 per million residents). As additional controls, the study compared OHCA outcomes during the prepandemic period (January through February) and peripandemic period (March 1 through 15). EXPOSURE: The COVID-19 pandemic. MAIN OUTCOMES AND MEASURES: Sustained ROSC (≥20 minutes), survival to discharge, and OHCA incidence. RESULTS: A total of 19 303 OHCAs occurred from March 16 through April 30 in both years, with 9863 cases in 2020 (mean [SD] age, 62.6 [19.3] years; 6040 men [61.3%]) and 9440 in 2019 (mean [SD] age, 62.2 [19.2] years; 5922 men [62.7%]). During the pandemic, rates of sustained ROSC were lower than in 2019 (23.0% vs 29.8%; adjusted rate ratio, 0.82 [95% CI, 0.78-0.87]; P

Aim To estimate and trend disability-adjusted life years (DALY) following adult out-of-hospital cardiac arrest (OHCA) over time, and to compare OHCA DALY to other leading causes of death and disability in the U.S. Methods DALY were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). Adult non-traumatic emergency medical services-treated OHCA from the Cardiac Arrest Registry to Enhance Survival (CARES) database for 2013–2018 were used to estimate YLL. Cerebral performance category score disability weights were used to estimate YLD. The calculated DALY for the study population was extrapolated to a national level to estimate total U.S. DALY. Data were reported as DALY total and rate. Data were compared to the top 10 causes of DALY in the U.S. Results 337,991 OHCA met study inclusion criteria. Total U.S. OHCA DALY increased from 3,005,308 in 2013 to 4,326,745 in 2018. The DALY rate increased from 950.9 per 100,000 individuals to 1322.4 per 100,000 individuals. OHCA DALY ranked fifth in the U.S. behind ischemic heart disease (2470), drug use disorders (1703), chronic obstructive pulmonary disease (1449), and back pain (1336). OHCA represented the largest percent increase in DALY rate (40.3%) over the study period. Conclusion Adult non-traumatic OHCA is a leading cause of DALY in the U.S. and the burden of disease due to OHCA has increased rapidly over time. These findings are likely due to more precise national OHCA surveillance, and suggest that the public health impact of OHCA is larger than previously described.

To investigate factors associated with survival after out-of-hospital cardiac arrest in Viet Nam.We did a multicentre prospective observational study of people ( 18 years) presenting with out-of-hospital cardiac arrest (not caused by trauma) to three tertiary hospitals in Viet Nam from February 2014 to December 2018. We collected data on characteristics, management and outcomes of patients with out-of-hospital cardiac arrest and compared these data by type of transportation to hospital and survival to hospital admission. We assessed factors associated with survival to admission to and discharge from hospital using logistic regression analysis.Of 590 eligible people with out-of-hospital cardiac arrest, 440 (74.6%) were male and the mean age was 56.1 years (standard deviation: 17.2). Only 24.2% (143/590) of these people survived to hospital admission and 14.1% (83/590) survived to hospital discharge. Most cardiac arrests (67.8%; 400/590) occurred at home, 79.4% (444/559) were witnessed by bystanders and 22.3% (124/555) were given cardiopulmonary resuscitation by a bystander. Only 8.6% (51/590) of the people were taken to hospital by the emergency medical services and 32.2% (49/152) received pre-hospital defibrillation. Pre-hospital defibrillation (odds ratio, OR: 3.90; 95% confidence interval, CI: 1.54-9.90) and return of spontaneous circulation in the emergency department (OR: 2.89; 95% CI: 1.03-8.12) were associated with survival to hospital admission. Hypothermia therapy during post-resuscitation care was associated with survival to discharge (OR: 5.44; 95% CI: 2.33-12.74).Improvements are needed in the emergency medical services in Viet Nam such as increasing bystander cardiopulmonary resuscitation and public access defibrillation, and improving ambulance and post-resuscitation care.Examiner les facteurs associés à la survie après un arrêt cardiaque hors hôpital au Viet Nam.Nous avons mené une étude d'observation prospective multicentrique sur des personnes ( 18 ans) ayant subi un arrêt cardiaque hors hôpital (non traumatique) et admis dans trois hôpitaux tertiaires au Viet Nam entre février 2014 et décembre 2018. Nous avons récolté des données sur les caractéristiques, la gestion et l'issue de ces patients, puis les avons comparés en fonction du moyen de transport vers l'hôpital et de la survie après leur admission. Enfin, nous avons mesuré des facteurs associés à la survie lors de l'admission et de la sortie de l'établissement à l'aide d'une analyse de régression logistique.Sur les 590 patients éligibles ayant subi un arrêt cardiaque hors hôpital, 440 (74,6%) étaient des hommes et l'âge moyen s'élevait à 56,1 ans (écart type: 17.2). Seulement 24,2% (143/590) d'entre eux ont survécu à leur admission à l'hôpital, et 14,1% (83/590) à leur sortie. La plupart des arrêts cardiaques (67,8%; 400/590) ont eu lieu à domicile, 79,4% (444/559) se sont déroulés en présence de passants et 22,3% (124/555) ont fait l'objet d'une réanimation cardiopulmonaire pratiquée par un témoin. À peine 8,6% (51/590) des patients ont été emmenés à l'hôpital par les services médicaux d'urgence, et 32,2% (49/152) ont reçu une défibrillation avant d'arriver à l'hôpital. La défibrillation préhospitalière (odds ratio, OR: 3,90; intervalle de confiance de 95%, IC: 1,54–9,90) et le rétablissement d'une circulation spontanée aux urgences (OR: 2,89; IC de 95%: 1,03–8,12) allaient de pair avec la survie après admission. L'hypothermie thérapeutique administrée durant les soins post-réanimation était liée à un meilleur taux de survie au moment de la sortie (OR: 5,44; IC de 95%: 2,33-12,74).Des aménagements sont requis en matière de services médicaux d'urgence au Viet Nam, notamment pour encourager la pratique de la réanimation cardiopulmonaire auprès de la population, garantir l'accès à des défibrillateurs publics, mais aussi améliorer les soins en ambulance et en post-réanimation.Investigar los factores relacionados con la supervivencia después de un paro cardíaco extrahospitalario en Vietnam.Se realizó un estudio observacional prospectivo multicéntrico de personas (18 años) que sufrieron un paro cardíaco extrahospitalario (no causado por traumatismo) en tres hospitales terciarios de Vietnam entre febrero de 2014 y diciembre de 2018. Se recopilaron los datos sobre las características, el tratamiento y los resultados de los pacientes con paro cardíaco extrahospitalario y se compararon según el tipo de transporte hasta el hospital y la supervivencia hasta el ingreso en el hospital. Se evaluaron los factores de supervivencia hasta el ingreso y el alta hospitalaria mediante un análisis de regresión logística.De las 590 personas que cumplían los requisitos y sufrieron un paro cardíaco extrahospitalario, 440 (74,6 %) eran hombres, cuya edad media era de 56,1 años (desviación estándar: 17,2). Solo el 24,2 % (143/590) de estas personas sobrevivieron al ingreso en el hospital y el 14,1 % (83/590) sobrevivieron al alta hospitalaria. La mayoría de los paros cardíacos (67,8 %; 400/590) ocurrieron en el hogar, el 79,4 % (444/559) fueron presenciados por transeúntes y el 22,3 % (124/555) recibieron reanimación cardiopulmonar por un transeúnte. Solo el 8,6 % (51/590) de las personas fueron trasladadas al hospital por los servicios médicos de emergencia y el 32,2 % (49/152) recibieron desfibrilación prehospitalaria. La desfibrilación prehospitalaria (oportunidad relativa, OR: 3,90; intervalo de confianza del 95 %, IC: 1,54-9,90) y la recuperación de la circulación espontánea en el servicio de urgencias (OR: 2,89; IC del 95 %: 1,03-8,12) se asociaron a la supervivencia hasta el ingreso hospitalario. La hipotermia terapéutica durante la atención posterior a la reanimación se asoció a la supervivencia hasta el alta (OR: 5,44; IC del 95 %: 2,33-12,74).Se necesitan mejoras en los servicios médicos de emergencia de Vietnam, como el aumento de las intervenciones de reanimación cardiopulmonar para transeúntes y de desfibrilación de acceso público, así como el mejoramiento de la atención en las ambulancias y de los cuidados posteriores a la reanimación.الغرض تقصي العوامل المرتبطة بالبقاء على قيد الحياة بعد السكتة القلبية خارج المستشفى في فييت نام. الطريقة قمنا بإجراء دراسة مستقبلية قائمة على الملاحظة متعددة المراكز للأشخاص (الأكبر من 18 عامًا) الذين يعانون من سكتة قلبية خارج المستشفى (ليس بسبب إصابة في الحوادث) في ثلاثة مستشفيات من الدرجة الثالثة في فيتنام، من فبراير/شباط 2014 إلى ديسمبر/كانون أول 2018. قمنا بجمع بيانات عن الخصائص، والإدارة، ونتائج المرضى الذين يعانون من السكتة القلبية خارج المستشفى، ومقارنة هذه البيانات حسب نوع النقل إلى المستشفى والبقاء على قيد الحياة حتى الدخول إلى المستشفى. قمنا بتقييم العوامل المرتبطة بالبقاء على قيد الحياة حتى الدخول إلى المستشفى والخروج منها باستخدام تحليل التحوّف اللوجيستي. النتائج من بين 590 شخصًا مؤهلاً مصابًا بالسكتة القلبية خارج المستشفى، كان 440 (74.6%) منهم من الذكور، وكان متوسط ​​العمر 56.1 عامًا (الانحراف المعياري: 17.2). استمر 24.2% فقط (143/590) من هؤلاء الأشخاص على قيد الحياة حتى الدخول إلى المستشفى، واستمر 14.1% (83/590) على قيد الحياة حتى الخروج من المستشفى. حدثت معظم حالات السكتة القلبية (67.8%؛ 400/590) في المنزل، وحدثت 79.4% (444/559) من الحالات أمام المارة في الشارع، وحصل 22.3% (124/555) من الحالات على الإنعاش القلبي الرئوي من أحد المارة. تم نقل 8.6% فقط (51/590) من الأشخاص إلى المستشفى بواسطة خدمات الطوارئ الطبية، وحصل 32.2% (49/152) على عملية إزالة الرجفان قبل دخول المستشفى. عملية إزالة الرجفان قبل دخول المستشفى (نسبة الاحتمالات: 3.90؛ فاصل الثقة 95%: 1.54 إلى 9.90) وعودة الدورة الدموية التلقائية في قسم الطوارئ (نسبة الاحتمالات: 2.89؛ فاصل الثقة 95%: 1.03 إلى 8.12) ارتبطت بالبقاء على قيد الحياة حتى دخول المستشفى. ارتبط علاج انخفاض حرارة الجسم أثناء الرعاية اللاحقة للإنعاش بالبقاء على قيد الحياة حتى الخروج من المستشفى (نسبة الأرجحية: 5.44؛ فاصل الثقة 95%: 2.33 إلى 12.74). الاستنتاج هناك حاجة إلى تحسينات في الخدمات الطبية الطارئة في فييت نام، مثل زيادة عمليات الإنعاش القلبي الرئوي من جانب المارة، وإمكانية حصول العامة على عملية إزالة الرجفان، وتحسين خدمات الإسعاف والرعاية بعد الإنعاش.研究越南院外心脏骤停存活率的相关因素。.我们针对越南三家三级医院在 2014 年 2 月至 2018 年 12 月期间接收的院外心脏骤停（非创伤引起）患者（18 岁）进行了跨中心前瞻性观察研究。我们收集了与院外心脏骤停患者的特征、诊治情况以及疗效相关的数据，并根据送至医院时采用的交通方式以及存活入院率对这些数据进行了比较。我们使用逻辑回归分析方法评估与存活入院率和存活出院率相关的因素。.590 名参加调查的院外心脏骤停患者中，440 名 (74.6%) 为男性，平均年龄为 56.1 岁（标准偏差：17.2）。这些人中仅 24.2% (143/590) 存活入院，14.1% (83/590) 存活出院。心脏骤停多发生于家中 (67.8%; 400/590)，其中有旁观者目击的情况占 79.4％ (444/559)，旁观者介入实施心肺复苏术的情况占 22.3％ (124/555)。其中仅 8.6% (51/590) 通过紧急医疗服务送至医院，32.2% (49/152) 接受了院前除颤。院前除颤（优势比，OR：3.90；95% 置信区间，CI：1.54–9.90）和急诊室自主循环恢复 (OR: 2.89; 95% CI: 1.03–8.12) 与存活入院率有关。复苏后护理期间的低温疗法与存活出院率相关 (OR: 5.44; 95% CI: 2.33-12.74）。.越南需要提升紧急医疗服务，如增加旁观者介入实施心肺复苏术的比例、普及公众除颤以及改善救护车和复苏后护理服务。.Изучить факторы, связанные с выживанием после внебольничной остановки сердца во Вьетнаме.Авторы провели многоцентровое проспективное обсервационное исследование среди пациентов (старше 18 лет), поступивших с внебольничной остановкой сердца (не связанной с травмой) в три специализированные больницы во Вьетнаме с февраля 2014 г. по декабрь 2018 г. Были собраны данные о характеристиках и результатах лечения пациентов с внебольничной остановкой сердца, которые затем сравнивались по видам транспортировки в больницу и показателям выживаемости до момента госпитализации. Авторы оценили факторы, связанные с выживаемостью при поступлении в больницу и выписке из нее, используя анализ на основании модели логистической регрессии.Из 590 человек с внебольничной остановкой сердца, отвечающих установленным критериям, было 440 (74,6%) мужчин, средний возраст которых составлял 56,1 года (стандартное отклонение: 17,2). Лишь 24,2% (143/590) из указанных пациентов выжили до поступления в больницу, а 14,1% (83/590) выжили до выписки из больницы. Большинство сердечных приступов (67,8%; 400/590) произошли дома, 79,4% (444/559) произошли на глазах у других людей, а 22,3% (124/555) пострадавших была проведена сердечно-легочная реанимация свидетелями происшествия. Только 8,6% (51/590) человек были доставлены в больницу службами скорой медицинской помощи, а 32,2% (49/152) была проведена догоспитальная дефибрилляция. Догоспитальная дефибрилляция (отношение шансов, ОШ: 3,90; 95%-й доверительный интервал, ДИ: 1,54–9,90) и спонтанное восстановление кровообращения в отделении скорой помощи (ОШ: 2,89; 95%-й ДИ: 1,03–8,12) ассоциировались с выживаемостью до госпитализации. Лечение с применением искусственного понижения температуры тела в постреанимационный период ассоциируется с выживанием после выписки (ОШ: 5,44; 95%-й ДИ: 2,33–12,74).Необходимо совершенствовать работу служб неотложной медицинской помощи во Вьетнаме, в частности повысить вероятность оказания сердечно-легочной реанимации свидетелями происшествия и обеспечить общедоступность дефибрилляторов, а также совершенствовать работу машин скорой помощи и лечение в постреанимационный период.