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Original article
Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest
  1. Ed B G Barnard1,2,
  2. Daniel D Sandbach1,
  3. Tracy L Nicholls3,
  4. Alastair W Wilson1,
  5. Ari Ercole1,4
  1. 1 Research and Clinical Innovation, East Anglian Air Ambulance, Norwich, UK
  2. 2 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Clinical Innovation), Birmingham, UK
  3. 3 Clinical Quality and Improvement, East of England Ambulance Service NHS Trust, Melbourn, UK
  4. 4 Division of Anaesthesia, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Ed B G Barnard, East Anglian Air Ambulance, Norwich, UK; edward.barnard{at}eaaa.org.uk

Abstract

Background Out-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement.

Methods An analysis of 9109 OHCA attended in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for non-traumatic cardiac arrest (NTCA) and traumatic cardiac arrest (TCA). Two Utstein outcome variables were used: survival to hospital admission and hospital discharge.

Results The incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95% CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95% CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.

Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander CPR was dependent on geographical socioeconomic status. An air ambulance was associated with increased survival to both hospital admission and discharge in NTCA, but only with survival to admission in TCA.

Conclusion NTCA and TCA are clinically distinct entities with different predictors for outcome—future OHCA reports should aim to separate arrest aetiologies. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

  • cardiac arrest
  • doctors in PHC
  • prehospital care
  • prehospital care, clinical management
  • trauma, major trauma management

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/emermed-2018-208165

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    Footnotes

    • Contributors The study was conceived by EB, AE and AW. Data were supplied by TLN. Data analyses were undertaken by AE and DDS, with input from EB, AW and TLN. The manuscript was drafted by EB, DDS and AE, with critical review by TLN and AW. All authors have reviewed and agreed to the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval Institutional approval was granted by EEAST as a service evaluation (EEAST/1819/0019) in order to access, analyse and publish these anonymised data, and therefore specific ethical review was waived.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.