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DIFFERENCES IN INCIDENCE, RESPONSE, AND OUTCOMES OF OUT-OF-HOSPITAL CARDIAC ARREST IN PORTLAND, OREGON

Abstract

Cardiac arrest is a serious medical event with a poor prognosis for survival. Several studies have investigated OHCA and its sequelae. Cardiac arrest databases have provided evidence-based findings to develop EMS policies for treatment. PURPOSE: This study was completed to describe the cardiac arrest incidence, response, and treatment characteristics of the EMS provider American Medical Response in Portland, OR for three metropolitan counties. METHODS: Data was taken from the AMR MEDS database. Variables included sex, age, witnessed event, CPR, defibrillation, epinephrine, ROSC, and patient survives to hospital admission. Additional variables were EMS time to scene in minutes, time spent on scene in minutes, and transport time to ED in minutes. ANOVA’s were completed on all ratio data while odds ratios were calculated for nominal data. The nominal variables of sex, bystander witnessed OHCA, CPR performed, defibrillation performed, and epinephrine use was examined using bivariate tests of association. The odds ratios and 95% confidence intervals were calculated against the two outcome measures of ROSC and SHA. All statistical testing used p<0.05 for significance. RESULTS: Between January 1, 2013 and December 31, 2014, AMR responded to 2,029 OHCA events. 55% of these cases were treated by paramedics. The OHCA incidence rate for the AMR service area in Portland, OR was 6.36 per 10,000 population in 2013 and 6.16 per 10,000 population in 2014. Average age was 65.00 (SD=17.19) and 63.1% of the patients were male. There were significant differences in the response, treatment, and transport times between the three counties. There were no significant differences in the outcomes of ROSC or SHA between the three counties. Odds ratios discovered a large effect of CPR on ROSC and SHA. Not receiving CPR in Clackamas County had an OR of 15.70 (CI=2.00-123.00) of not achieving ROSC and an OR of 6.26 (CI=0.71-55.1) of not surviving. The OR in Multnomah County was 4.00 (CI=1.5-10.66) for not achieving ROSC without CPR and an OR of 0.92 (CI-0.30-2.78) for surviving without CPR. In Clark County, the odds of ROSC without CPR were 6.12 (CI=2.87-13.0) and were 3.72 (CI=0.84-4.09) for SHA. Clark County had no cases of SHA without ROSC. Clackamas County had an OR of 25.43 (CI=9.62-67.23) of not surviving to admission if ROSC is not achieved. Multnomah County had an OR of 26.47 (CI=14.29-49.0) against survival if ROSC is not achieved. CONCLUSION: One noteworthy finding was the effect CPR had on both ROSC and SHA. This study also reiterated ROSC was highly associated with SHA and added to the knowledge base of current OHCA registries.

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