title: The association between diabetes status and survival following an out-of-hospital cardiac arrest: A retrospective cohort study.
abstract: Sudden cardiac arrest (SCA), confirmed absence of cardiac mechanical activity, is the leading cause of heart-related death in the US. Almost 85% of SCA occur out-of-hospital (OHCA), with very poor rates of return of spontaneous circulation (ROSC) and survival to hospital discharge. We sought to determine if diabetes status was associated with survival or ROSC following an OHCA.
  
  
  
  We completed a retrospective cohort study using data from the Toronto Regional RescuNet Epistry dataset, based upon data definitions defined by the Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac Arrest and the Strategies for Post Arrest Resuscitation Care (SPARC) network datasets. Adults ≥18years of age who experienced an OHCA, had data on diabetes status, and were treated by Emergency Medical Services (EMS) between 2012-2014 were included in the analysis (n=10,097). We used bivariate analyses to examine relationships between diabetes status, Utstein elements and outcomes, and logistic regression to determine predictors of survival.
  
  
  
  Diabetes prevalence was 27.8% (95% CI: 27.0-28.7). A larger proportion of those with diabetes had a non-shockable initial rhythm (28.8% vs. 25.1%; p<0.01) and did not survive to hospital discharge (92.1% vs. 89.2%, p<0.001). Diabetes status is associated with a decrease in survival, independent from a number of Utstein elements (adjusted OR=0.76; 95% CI: 0.64-0.91, p=0.003).
  
  
  
  This is the first Canadian study to examine the association between diabetes status and OHCA outcomes. Our findings suggest that diabetes status prior to arrest is associated with decreased survival. The growing prevalence of diabetes globally suggests a future burden related to OHCAs.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. Electronic address: monica.parry@utoronto.ca.
authors.forename: Monica
authors.initials: M
authors.lastname: Parry
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
authors.forename: Kyle
authors.initials: K
authors.lastname: Danielson
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Brennenstuhl
authors.affiliation: Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Drennan
authors.affiliation: Robert and Dorothy Pitts Chair in Acute Care and Emergency Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D013223:Statistics as Topic
keywords: Diabetes; Out-of-hospital cardiac arrest; Return of spontaneous circulation; Survival