Trends in outcomes after out-of-hospital cardiac arrest: An observational study in Jiading District Shanghai / 中华急诊医学杂志

ABSTRACT

Objective:This study aimed to investigate temporal trends in Event survival after OHCA from 2015 to 2019 in Jiading district Shanghai. And analysis the influencing factors.Methods:This was a population based observational cohort study evaluating the temporal trends in survival after OHCA, we included consecutive patients who experienced an OHCA between January 1,2015 and December 31, 2019, we included all adult patients aged ≥ 18 years who presumed medical cause and were treated by emergency medical services (EMS) in Jiading District. The Data was obtained from Dispatch software system, The emergency case registration system, paper-based treatment records, dispatcher's telephone recording and in-hospital records, This Data organized according to the Utstein template using standard data element definitions. Temporal changes were measured by chi-square trend test. we constructed a multilevel logistic regression model to identify factors independently associated with event survival arrival at hospital and survival to hospital discharge.Results:A total of 1305 patients with OHCA met study inclusion criteria during the study period. Survival to hospital admission was 4.14% increased from 1.87% in 2015 to 7.31% in 2019 for trend ( P=0.009), survival to hospital discharge was 1.23%, increased from 0.37% in 2015 to 3.32% in 2019 ( P=0.003). But there was no evidence of a temporal change in survival to hospital discharge with good neurologic function (0.37 in 2015 to1.33% in 2019, P=0.339 for trend). In the subgroup, the rate of Recognition was increased from 7.49% in 2015 to 19.27% in 2019 ( P< 0.01). The proportion of cases receiving bystander CPR was 17.39%, which increased from 9.36% in 2015 to 25.19% in 2019 ( P= 0.000). The proportion of shockable rhythm was 4.06%, there was no evidence of a temporal change in the proportion of the overall rhythm (3.00%-4.65%, P=0.323 for trend), There were no cases of bystanders using automated external defibrillators (AEDs) in patients with cardiac arrest, The EMS response time (min) were15.45±8.71, which decreased from 15.10±8.12 in 2015 to 13.41±6.47 in 2019 ( P< 0.0001). Multiple regression analysis showed that Male ( OR= 0.315, 95% CI 0.168-0.519, P =0.000), Not Shockable rhythm ( OR= 0.096, 95% CI 0.043-0.012, P=0.000), and public location ( OR=2.411, 95% CI 1.302-4.463, P=0.005) were independent predictor of Factors Associated with survival at hospital admission. Male ( OR= 0.247, 95% CI 0.070-0.866, P=0.029), Not Shockable rhythm ( OR= 0.072, 95% CI 0.016-0.318, P=0.001), and No Epinephrine administration ( OR=5.953, 95% CI1.222-29.012, P=0.005) were independent predictor of Factors Associated with Survival to Hospital Discharge. Conclusions:Survival after OHCA has improved over time. Several targeted initiatives established along the chain of survival of OHCA during the past 5-years may help explain the improvement in survival outcome observed in Jiading District, including improved the rate of Recognition, improved participation rates in bystander CPR and a reduction in EMS response time.In the future, more resources should be improving the quality of CPR training and expanding AEDs coverage and encouraging the public to have the courage to use them.