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Pre-hospital predictors of long-term survival from out-of-hospital cardiac arrest

  • Katherine Pemberton
    Affiliations
    College of Public Health, Medical and Veterinary Sciences, James Cook University, Angus Park Drive, Douglas 4811, Queensland, Australia

    Queensland Ambulance Service, GPO Box 1425, Brisbane 4001, Queensland, Australia
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  • Richard C. Franklin
    Affiliations
    College of Public Health, Medical and Veterinary Sciences, James Cook University, Angus Park Drive, Douglas 4811, Queensland, Australia
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  • Emma Bosley
    Affiliations
    Queensland Ambulance Service, GPO Box 1425, Brisbane 4001, Queensland, Australia

    School of Clinical Sciences, Queensland University of Technology, Victoria Park Rd, Kelvin Grove 4059, Queensland, Australia
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  • Kerrianne Watt
    Correspondence
    Correspondence to: Queensland Ambulance Service Education Centre, GPO Box 683, Brisbane 4001, Australia.
    Affiliations
    College of Public Health, Medical and Veterinary Sciences, James Cook University, Angus Park Drive, Douglas 4811, Queensland, Australia

    Queensland Ambulance Service, GPO Box 1425, Brisbane 4001, Queensland, Australia
    Search for articles by this author
Published:November 24, 2022DOI:https://doi.org/10.1016/j.auec.2022.10.006

      Abstract

      Objective

      To identify predictors of longer-term outcomes from adult out-of-hospital cardiac arrest of presumed cardiac aetiology.

      Methods

      In this retrospective cohort study, three large routinely collected databases were linked: 1)QAS Out-of-Hospital Cardiac (OHCA) Registry; 2)Queensland Hospital Admitted Patient Data Collection; and 3)Queensland Registrar General Death Registry. Participants were adult (18years+) residents of Queensland, who suffered an OHCA of presumed cardiac aetiology and had resuscitation attempted by QAS paramedics between 2002 and 2014. Four mutually exclusive outcomes were analysed: 1) No pre-hospital return of spontaneous circulation (ROSC) sustained to the Emergency Department (ED) or ROSC in ED; 2) Survival< 30 days (Pre-hospital ROSC sustained to ED or ROSC in ED but death within 30 days; 3) survival between 30 and 364 days; and 4) survival to 365 + days. Multinomial logistic regression was used to calculate odds ratios and 95 % confidence intervals.

      Results

      Variables significantly predictive of survival to 365 + days after adjusting for all measured confounders are: an initial shockable rhythm; bystander witnessed events with bystander CPR; paramedic witnessed events; intubation placement; time of day (midday-2.59 pm); and attendance by Critical Care Paramedic (CCP).

      Conclusion

      From a service provision perspective, attendance of a CCP at an OHCA may be an important factor to achieve preferred long-term outcomes. Enhanced experience, exposure and expertise, together with extended clinical practice, may explain this finding.

      Keywords

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