Outcomes of out of hospital cardiac arrest in First Nations and non-First Nations patients in Saskatoon.

INTRODUCTION: One in nine (11.7%) people in Saskatchewan identify as First Nations. It is known that First Nations people have a higher burden of cardiovascular disease, but not whether outcomes of out of hospital cardiac arrest are different. METHODS/METHODOLOGY: We reviewed pre-hospital and inpatient records of patients with out of hospital cardiac arrest between January 1st, 2015 and December 31st, 2017. The population consisted of patients aged 18 years or older with out of hospital cardiac arrest of presumed cardiac origin occurring in the catchment area of Saskatoon's emergency medical services (EMS). Variables of interest included age, gender, First Nations status, EMS response times, bystander cardiopulmonary resuscitation (CPR), and shockable rhythm. Outcomes of interest included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge. RESULTS: In all, 372 patients sustained out of hospital cardiac arrest, of which 27 were status First Nations. There were no differences between First Nations and non-First Nations patients in terms of shockable rhythms (24% vs 26%; p = 0.80), ROSC (42% vs 41%; p = 0.87), survival to hospital admission (27% vs 33%; p = 0.53), and survival to hospital discharge (15% vs 12%; p = 0.54). First Nations patients with out of hospital cardiac arrest were significantly younger (mean age 46 vs. 65 years; p < 0.0001) and had shorter EMS response times (median times 5.3 vs. 6.2 min; p = 0.01) when compared to non-First Nations patients. CONCLUSIONS: In Saskatoon, First Nations patients with out of hospital cardiac arrest appear to have similar survival rates when compared with non-First Nations patients. However, First Nations patients sustaining out of hospital cardiac arrest were significantly younger than their non-First Nations counterparts. This highlights a significant public health issue.

RéSUMé: INTRODUCTION: Une personne sur neuf (11,7 %) en Saskatchewan s'identifie comme membre des Premières Nations. On sait que le fardeau des maladies cardiovasculaires est plus lourd pour les membres des Premières Nations, mais on ne sait pas si les résultats d'un arrêt cardiaque en dehors de l'hôpital sont différents. MéTHODES/MéTHODOLOGIE: Nous avons examiné les dossiers pré-hospitaliers et les dossiers des patients hospitalisés ayant subi un arrêt cardiaque hors hôpital entre le 1er janvier 2015 et le 31 décembre 2017. La population était composée de patients âgés de 18 ans ou plus ayant subi un arrêt cardiaque hors de l'hôpital d'origine cardiaque présumée survenu dans la Territoire des services médicaux d'urgence (SMU) de Saskatoon. Les variables d'intérêt comprenaient l'âge, le sexe, le statut des Premières Nations, les temps de réponse des SMU, la réanimation cardiorespiratoire (RCR) des témoins et le rythme choquant. Les résultats d'intérêt comprenaient le retour de la circulation spontanée (RCS), la survie à l'admission à l'hôpital et la survie la sortie de l'hôpital. RéSULTATS : Au total, 372 patients ont subi un arrêt cardiaque hors de l'hôpital, dont 27 étaient des Premières Nations inscrites. Il n'y avait aucune différence entre les patients des Premières Nations et les patients non membres des Premières Nations en termes de rythmes choquants (24 % contre 26 %; p = 0.80), RCS (42% contre 41% ; p = 0.87), survie à l'admission à l'hôpital ( 27% contre 33%; p = 0.53) et la survie à la sortie de l'hôpital (15 % contre 12%; p = 0.54). Les patients des Premières Nations ayant subi un arrêt cardiaque hors hôpital étaient significativement plus jeunes (âge moyen 46 ans contre 65 ans ; p < 0.0001)) et avaient des temps de réponse plus courts aux SMU (temps médian 5,3 contre 6,2 minutes ; p = 0.01) par rapport aux patients des autres nations. CONCLUSIONS: À Saskatoon, les patients des Premières Nations ayant subi un arrêt cardiaque hors de l'hôpital semblent avoir des taux de survie similaires à ceux des patients non autochtones. Cependant, les patients des Premières Nations qui ont subi un arrêt cardiaque hors de l'hôpital étaient beaucoup plus jeunes que leurs homologues des autres nations. Cela met en évidence un problème de santé publique important.

Impact of Pit-Crew Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest in Saskatoon.

BACKGROUND: In the prehospital setting, pit-crew models of cardiopulmonary resuscitation (CPR) have shown improvements in survival after out-of-hospital cardiac arrest (OHCA). Certain districts in North America have adopted this model, including Saskatoon, Saskatchewan, Canada. OBJECTIVES: Our objectives were to determine whether pit-crew CPR has an impact on survival to discharge after OHCA in Saskatoon, Canada. METHODS: This was a retrospective pre- and postintervention study. All adult patients who had an OHCA between January 1, 2011 and December 31, 2017 of presumed cardiac origin, in which the resuscitation attempt included CPR by trained prehospital responders, were considered for analysis. Our primary outcome was survival to discharge. Survival to admission and return of spontaneous circulation were secondary outcomes. RESULTS: There were 860 OHCAs considered for our study. After 46 exclusions there were 442 in the non-pit-crew group (average age 63.7 years; 64.5% male) and 372 in the pit-crew group (average age 63.5 years; 67.5% male). Survival to discharge after an OHCA was 10.4% (95% confidence interval 7.7-13.6%) in the non-pit-crew group and 12.4% (95% CI 9.2-16.2%) in the pit-crew group, which did not meet statistical significance. Return of spontaneous circulation and survival to admission were 48.4% and 31.3%, respectively, in the non-pit-crew group and 46.7% and 32.3%, respectively, in the pit-crew group. CONCLUSIONS: In our study, implementation of a pit-crew CPR model was not associated with an improvement in survival to discharge after OHCA.