title: Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC).
abstract: BACKGROUND
  Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death and a 2010 meta-analysis concluded that outcomes have not improved over several decades. However, guidelines have changed to emphasize CPR quality, minimization of interruptions, and standardized post-resuscitation care. We sought to evaluate whether OHCA outcomes have improved over time among agencies participating in the Resuscitation Outcomes Consortium (ROC) cardiac arrest registry (Epistry) and randomized clinical trials (RCTs).
  
  
  METHODS
  Observational cohort study of 47,148 EMS-treated OHCA cases in Epistry from 139 EMS agencies at 10 ROC sites that participated in at least one RCT between 1/1/2006 and 12/31/2010. We reviewed patient, scene, event characteristics, and outcomes of EMS-treated OHCA over time, including subgroups with initial rhythm of pulseless ventricular tachycardia or ventricular fibrillation (VT/VF).
  
  
  RESULTS
  Mean response interval, median age and male proportion remained similar over time. Unadjusted survival to discharge increased between 2006 and 2010 for treated OHCA (from 8.2% to 10.4%), as well as for subgroups of VT/VF (21.4% to 29.3%) and bystander witnessed VT/VF (23.5% to 30.3%). Compared with 2006, adjusted survival to discharge was significantly higher in 2010 for treated cases (OR = 1.72; 95% CI 1.53, 1.94), VT/VF cases (OR = 1.69; 95% CI 1.45, 1.98) and bystander witnessed VT/VF cases (OR = 1.65; 95% CI 1.36, 2.00). Tests for trend in each subgroup were significant (p < 0.001).
  
  
  CONCLUSIONS
  ROC-wide survival increased significantly between 2006 and 2010. Additional research efforts are warranted to identify specific factors associated with this improvement.
authors: Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States. Electronic address: dayam@ohsu.edu.
authors: Mohamud R
authors: MR
authors: Daya
authors: University of Washington Clinical Trial Center, Seattle, WA, United States.
authors: Robert H
authors: RH
authors: Schmicker
authors: Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States.
authors: Dana M
authors: DM
authors: Zive
authors: University of Washington, Seattle, WA, United States.
authors: Thomas D
authors: TD
authors: Rea
authors: University of Washington Clinical Trial Center, Seattle, WA, United States; University of Washington, Seattle, WA, United States.
authors: Graham
authors: G
authors: Nichol
authors: University of Toronto, Toronto, ON, Canada.
authors: Jason E
authors: JE
authors: Buick
authors: Queens University, Kingston, ON, Canada.
authors: Steven
authors: S
authors: Brooks
authors: University of British Columbia, Vancouver, BC, Canada.
authors: Jim
authors: J
authors: Christenson
authors: Wilfrid Laurier University, Waterloo, ON, Canada.
authors: Renee
authors: R
authors: MacPhee
authors: University of Toronto, Toronto, ON, Canada.
authors: Alan
authors: A
authors: Craig
authors: University of Pittsburgh, Pittsburgh, PA, United States.
authors: Jon C
authors: JC
authors: Rittenberger
authors: University of California at San Diego, San Diego, CA, United States.
authors: Daniel P
authors: DP
authors: Davis
authors: University of Washington Clinical Trial Center, Seattle, WA, United States.
authors: Susanne
authors: S
authors: May
authors: University of Texas Southwestern, Dallas, TX, United States.
authors: Jane
authors: J
authors: Wigginton
authors: University of Alabama at Birmingham, Birmingham, AL, United States.
authors: Henry
authors: H
authors: Wang
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015331:Cohort Studies; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy; D010351:Patient Discharge; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate
keywords: Emergency Medical Services (EMS); Out-of-hospital cardiac arrest (OHCA); Resucitation