Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study

PAROS Clinical Research Network

Research output: Contribution to journalArticle

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Abstract

Study objective: The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai). Methods: This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community. Results: Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95% CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95% CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95% CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival. Conclusion: In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation.

Original languageEnglish
Pages (from-to)608-617.e15
JournalAnnals of Emergency Medicine
Volume71
Issue number5
DOIs
Publication statusPublished - 2018 May 1

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Out-of-Hospital Cardiac Arrest
Resuscitation
Outcome Assessment (Health Care)
Survival
Cardiopulmonary Resuscitation
Emergency Medical Services
Odds Ratio
Confidence Intervals
Reaction Time
Logistic Models
United Arab Emirates
Republic of Korea
Pediatric Hospitals
Malaysia
Singapore
Thailand
Taiwan
Multicenter Studies
Cluster Analysis
Japan

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

@article{9bc679b063c246778d7fb2136dba9fdd,
title = "Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study",
abstract = "Study objective: The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai). Methods: This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community. Results: Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95{\%} confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95{\%} CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95{\%} CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95{\%} CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival. Conclusion: In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation.",
author = "{PAROS Clinical Research Network} and Hideharu Tanaka and Ong, {Marcus E.H.} and Siddiqui, {Fahad J.} and Ma, {Matthew H.M.} and Hiroshi Kaneko and Lee, {Kyung Won} and Kentaro Kajino and Chih-Hao Lin and Gan, {Han Nee} and Pairoj Khruekarnchana and Omer Alsakaf and Rahman, {Nik H.} and Doctor, {Nausheen E.} and Pryseley Assam and Shin, {Sang Do} and Sarah, {A. K.} and Julina, {M. N.} and Naroo, {G. Y.} and O. Alsakaf and T. Yagdir and N. Khunkhlai and A. Monsomboon and T. Piyasuwankul and T. Nishiuchi and Ko, {P. C.I.} and Kyoung, {J. S.} and Wong, {K. D.} and Mao, {D. R.H.} and Goh, {E. S.} and Tham, {L. P.} and Cheah, {S. O.} and Chia, {M. Y.C.} and L. Tiah and Leong, {B. S.H.} and Ng, {Y. Y.}",
year = "2018",
month = "5",
day = "1",
doi = "10.1016/j.annemergmed.2017.07.484",
language = "English",
volume = "71",
pages = "608--617.e15",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "5",

}

Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study. / PAROS Clinical Research Network.

In: Annals of Emergency Medicine, Vol. 71, No. 5, 01.05.2018, p. 608-617.e15.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study

AU - PAROS Clinical Research Network

AU - Tanaka, Hideharu

AU - Ong, Marcus E.H.

AU - Siddiqui, Fahad J.

AU - Ma, Matthew H.M.

AU - Kaneko, Hiroshi

AU - Lee, Kyung Won

AU - Kajino, Kentaro

AU - Lin, Chih-Hao

AU - Gan, Han Nee

AU - Khruekarnchana, Pairoj

AU - Alsakaf, Omer

AU - Rahman, Nik H.

AU - Doctor, Nausheen E.

AU - Assam, Pryseley

AU - Shin, Sang Do

AU - Sarah, A. K.

AU - Julina, M. N.

AU - Naroo, G. Y.

AU - Alsakaf, O.

AU - Yagdir, T.

AU - Khunkhlai, N.

AU - Monsomboon, A.

AU - Piyasuwankul, T.

AU - Nishiuchi, T.

AU - Ko, P. C.I.

AU - Kyoung, J. S.

AU - Wong, K. D.

AU - Mao, D. R.H.

AU - Goh, E. S.

AU - Tham, L. P.

AU - Cheah, S. O.

AU - Chia, M. Y.C.

AU - Tiah, L.

AU - Leong, B. S.H.

AU - Ng, Y. Y.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Study objective: The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai). Methods: This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community. Results: Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95% CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95% CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95% CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival. Conclusion: In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation.

AB - Study objective: The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai). Methods: This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community. Results: Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95% CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95% CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95% CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival. Conclusion: In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation.

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U2 - 10.1016/j.annemergmed.2017.07.484

DO - 10.1016/j.annemergmed.2017.07.484

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VL - 71

SP - 608-617.e15

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 5

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