Using a cardiac arrest registry to measure the quality of emergency medical service care: decade of findings from the victorian ambulance cardiac arrest registry (original) (raw)
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Resuscitation, 2018
The aim of this study was to investigate regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand. This was a population-based cohort study of OHCA using data from the Aus-ROC Australian and New Zealand OHCA Epistry over the period of 01 January 2015-31 December 2015. Seven ambulance services contributed data to the Epistry with a capture population of 19.8 million people. All OHCA attended by ambulance, regardless of aetiology or patient age, were included. In 2015, there were 19,722 OHCA cases recorded in the Aus-ROC Epistry with an overall crude incidence of 102.5 cases per 100,000 population (range: 51.0-107.7 per 100,000 population). Of all OHCA cases attended by EMS (excluding EMS-witnessed cases), bystander CPR was performed in 41% of cases (range: 36%-50%). Resuscitation was attempted (by EMS) in 48% of cases (range: 40%-68%). The crude incidence for attempted resuscitation cases was 47.6 per 100,...
Establishing the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry
BMJ Open, 2016
Introduction: Out-of-hospital cardiac arrest (OHCA) is a global health problem with low survival. Regional variation in survival has heightened interest in combining cardiac arrest registries to understand and improve OHCA outcomes. While individual OHCA registries exist in Australian and New Zealand ambulance services, until recently these registries have not been combined. The aim of this protocol paper is to describe the rationale and methods of the Australian Resuscitation Outcomes Consortium (Aus-ROC) OHCA epidemiological registry (Epistry). Methods and analysis: The Aus-ROC Epistry is designed as a population-based cohort study. Data collection started in 2014.
Epidemiology of pre-hospital outcomes of out-of- hospital cardiac arrest in Queensland, Australia
Objective: To describe incidence in pre-hospital outcomes of adult outof-hospital cardiac arrest (OHCA) of presumed cardiac aetiology, attended by Queensland Ambulance Service (QAS) paramedics between 2002 and 2014, by age, gender, geographical remoteness and socio-economic status. Methods: The QAS OHCA Registry was used to identify cases, which was then linked with Queensland Hospital Admitted Patient Data Collection and Queensland Death Registry. Population data were obtained for each calendar year by age and gender from the Australian Bureau of Statistics in order to calculate incidence rates. Four mutually exclusive pre-hospital outcomes were analysed: (i) no resuscitation (No-Resus); (ii) resuscitation, no pre-hospital return of spontaneous circulation (No-ROSC); (iii) resuscitation, pre-hospital return of spontaneous circulation not sustained to hospital (Unsustained-ROSC); and (iv) resuscitation, pre-hospital return of spontaneous circulation sustained to hospital (Sustained-ROSC). Results: Over the 13 years, there were 30 560 OHCA cases for analyses. Incidence was significantly greater in males than females and incrementally increased with age, for each outcome. Incidence of total OHCA events generally increased as remoteness increased cities: 72.39 per 100 000 [95% CI 71.35-73.45]; very remote: 87.01 per 100 000 [95% CI 78.03-95.98]). There was an inverse association between incidence of OHCA events and socio-economic status (SEIFA 1 and 2: 81.34 per 100 000 [95% CI 79.28-83.40]; SEIFA 9 and 10: 61.57 per 100 000 [95% CI 59.67-63.46]). Conclusion: Rural-specific strategies should be continued. Prevention and management strategies for OHCA targeting lower socio-economic groups require focus.
Antecedents to cardiac arrests in a hospital equipped with a medical emergency team
Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2011
Studies conducted before the conception of medical emergency teams (METs) revealed that cardiac arrests were often preceded by deranged vital signs. METs have been implemented in hospitals to review ward patients whose conditions are deteriorating in order to prevent adverse events, including cardiac arrest. Antecedents to cardiac arrests in a MET-equipped hospital have not been assessed. To determine what proportion of patients who had cardiac arrests had documented MET criteria before the arrest, and what proportion had a premorbid status suggesting they were unsuitable resuscitation candidates. Prospective observational study of cardiac arrests at the Austin Hospital, Melbourne, Australia, 1 April - 30 September 2010. Data were obtained from the patients' records and electronic "respond blue" database. Patients' premorbid medical condition and functional status; prior "not-for-resuscitation" (NFR) order; presence or absence of a MET call before cardiac...
Objective: To describe temporal trends in incidence of pre-hospital outcomes from adult out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology attended by Queensland Ambulance Service (QAS) paramedics between 2002 and 2014, by age, gender, geographical remoteness and socio-economic status. Methods: Cases included in this retrospective cohort study were identified from the QAS OHCA Registry. Included cases were linked with Queensland Hospital Admitted Patient Data Collection and Queensland Death Registry. Population data were obtained from the Australian Bureau of Statistics to calculate incidence rates for each year. Analyses were undertaken by four mutually exclusive pre-hospital outcomes: (i) no resuscitation (No-Resus); (ii) resuscitation, no pre-hospital return of spontaneous circulation (No-ROSC); (iii) resuscitation, prehospital return of spontaneous circulation not sustained to hospital (Unsustained-ROSC); and (iv) resuscitation, pre-hospital return of spontaneous circulation sustained to hospital (Sustained-ROSC). Trends over time were analysed for crude and specific rates for total OHCA events and for each outcome. Results: Between 2002 and 2014, there were 30 560 OHCA cases. Crude incidence significantly increased over time for No-Resus and Sustained-ROSC, and significantly decreased for No-ROSC. These trends were reflected in major cities, inner and outer regional areas. There was a significant increase in Sustained-ROSC in remote areas, and no significant trends in very remote areas. Conclusion: Incidence of withholding resuscitation and ROSC sustained to hospital have independently increased over time. Factors of middle age, more rural location and lower socio-economic status should all be targeted in the development and implementation of future strategies.
Critical Care Medicine, 2010
To determine the long-term impact of a medical emergency team on survival and to assess the utility of administrative data to monitor outcomes. Design: Prospective study of cardiac arrests and survival. Retrospective study of administrative data. Setting: University affiliated tertiary referral hospital in Melbourne, Australia. Patients: All patients admitted to hospital in three 6-month periods between 2002-2007 (prospective) and 1993-2007 (retrospective). Intervention: Implementation of a medical emergency team in November 2002. Measurements and Main Results: In the prospective analysis, rates of unexpected cardiac arrest and hospital mortality (referenced to 1000 patient-care days) were measured before (
2021
Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (...
Resuscitation, 2016
Resuscitation guidelines often recommend ongoing cardiopulmonary resuscitation (CPR) efforts to hospital for out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical service (EMS) personnel. In this study, we examine the relationship between EMS CPR duration and survival to hospital discharge in EMS witnessed OHCA patients. Between January 2003 and December 2011, 1035 adult EMS witnessed arrests of presumed cardiac aetiology were included from the Victorian Ambulance Cardiac Arrest Registry. CPR duration was defined as the total sum of prehospital CPR time in minutes. Adjusted logistic regression analyses were used to assess the impact of EMS CPR duration on survival to hospital discharge. 382 (37.3%) patients were discharged alive. The median CPR duration was 12min (95% CI: 11-13) overall, but was higher in non-survivors compared to survivors (24min vs. 2min, p<0.001). The 99th percentile CPR duration in patients surviving to hospital discharge differed by the initi...
PloS one, 2015
Out-of-hospital cardiac arrest (OHCA) remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia. We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0), we linked the location of the arrest using the dispatch coordinates (longitude and latitude) to Victorian Local Government Areas (LGAs). We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates. Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1%) cases were of presumed cardiac etiology. Significant...