Emergency Medical Services
Background: Emergency medical services (EMS) agencies with higher field termination of resuscitation (TOR) rates also tend to have higher survival rates from out of hospital cardiac arrest (OHCA). It is not known if individual EMS agencies can improve their survival rates through programs designed to optimize their TOR rate. The purpose of this analysis was to determine if an EMS agency’s efforts to optimize its TOR rate was associated with an increased rate of OHCA survival with favorable neurologic outcome.
Methods: This was a before and after, single city, retrospective review of prospectively obtained quality assurance data gathered through the Cardiac Arrest Registry to Enhance Survival (CARES). Traumatic OHCA, pediatric OHCA and OHCA occurring after the arrival of first responders were excluded. Patient demographics, process measures and outcome measures were compared before and after an educational initiative designed to increase field TOR. The primary outcome measure was survival to hospital discharge with favorable neurologic status.
Results: 320 cases met the inclusion criteria and were included in the analysis. No difference in average age, gender, location, witnessed arrest, bystander CPR, initial shockable rhythm or presumed cardiac etiology was found between the time periods. The rate of field termination increased from 39.56% to 51.09% (p = 0.064). Among cases transported without return of spontaneous circulation (ROSC), the median on scene time increased from 22.47 minutes to 35.57 minutes. The rate of discharge with favorable neurologic status increased from 1.11% to 6.55% (p = 0.047). The relative risk of death or non-favorable neurologic outcome was 0.94 (95%CI: 0.91-0.98).
Conclusion: In this study, a single agency demonstrated an increase in survival with favorable neurologic outcomes coincident with optimizing field TOR rate and increasing the time spent preforming resuscitation on scene. This study supports the concept that resuscitating patients on the scene, rather than rapid transport, is a better strategy for OHCA care.