title: A model of survival from out-of-hospital cardiac arrest using the Boston EMS arrest registry.
abstract: OBJECTIVE
  To characterize the survival rate for out-of-hospital arrests of cardiac aetiology and predictor variables associated with survival in Boston, MA, and to develop a composite multivariate logistic regression model for projecting survival rates.
  
  
  METHODS
  This is a retrospective analysis of all arrests of presumed cardiac aetiology (from January 1, 2004 to December 31, 2007) where resuscitation was attempted (n=1156) by 911 emergency responders.
  
  
  RESULTS
  The survival-at-hospital discharge rate was 11% (vs. 1-10% often reported). The coefficients and odds ratios in the first equation of the model show that joint presence of presenting rhythm of ventricular fibrillation/tachycardia (VF/VT) and return of spontaneous circulation in the pre-hospital setting (ROSC) is a substantial direct predictor of survival (e.g., 54% of such cases survive). Response time, public location, witnessed, and age are significant but less sizable direct predictors of survival. A second equation shows that these four variables make an additional indirect contribution to survival by affecting the probability of joint presence of VF/VT and ROSC; bystander CPR also makes such an indirect contribution but no significant direct one as shown in the first equation. The projected survival rate if cases had always experienced bystander CPR and rapid response time of less than four minutes is 21%.
  
  
  CONCLUSIONS
  The unique model describes the major contribution of VF/VT and ROSC, and key relationships among predictors of survival. These connections may have otherwise gone underreported using standard approaches and should be considered when allocating scarce resources to impact cardiac arrest survival.
authors.affiliation: University of Texas of the Permian Basin, Department of Social Science, Mesa Building 4244, Odessa, TX 79762, United States. abrams_h@utpb.edu
authors.forename: Harold C
authors.initials: HC
authors.lastname: Abrams
authors.forename: Peter H
authors.initials: PH
authors.lastname: Moyer
authors.forename: K Sophia
authors.initials: KS
authors.lastname: Dyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate