Aim

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.

Methods

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.

Results

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.

Conclusion

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.

中文翻译：

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2015-2019 年美国 EMS 参与的院外心脏骤停存活率趋势

目标

每天，近 1000 名美国成年人经历院外心脏骤停 (OHCA)。出院后的存活率因许多因素而异，包括社会人口统计学、逮捕地点以及是否提供旁观者干预。目前的研究使用一组向心脏骤停登记处提供数据以提高生存率的紧急医疗服务 (EMS) 机构，按逮捕地点检查 OHCA 生存率的最新趋势。

方法

2015 年 CARES 队列（N = 122,613）包括 EMS 机构在 2015-2019 年连续五年提供数据。我们按逮捕地点（公共、住宅、疗养院）评估了 2015 年 CARES 队列的 EMS 参与的 OHCA 生存趋势。使用 18-65 岁病例的 3 级分层逻辑回归模型估计未调整和调整的百分比。

结果

总体而言，EMS 参与的 OHCA 的存活率从 2015 年的 12.5% 显着增加至 2019 年的 13.8%（p = 0.001）。旁观者目击逮捕的存活率也从 2015 年的 17.8% 显着增加至 2019 年的 19.7%（p = 0.004）。总体而言，生存趋势有所增加，旁观者目睹了在公共场所和疗养院发生的 OHCA。

结论

在整体组和旁观者见证组中观察到 EMS 参与的 OHCA 存活率增加的趋势。在最有可能获得理想结果的组中，OHCA 的生存趋势没有变化——旁观者目睹，节奏令人震惊，并接受旁观者干预。OHCA 的报告和监测可能是改善结果的重要第一步。可能需要针对旁观者 CPR 和 AED 使用的其他社区干预措施。