Temporal Trends of Out-of-Hospital Cardiac Arrests Without Resuscitation Attempt by Emergency Medical Services

Victor Waldmann; Nicole Karam; Bamba Gaye; Wulfran Bougouin; Florence Dumas; Ardalan Sharifzadehgan; Kumar Narayanan; Haoiinda Kassim; Frankie Beganton; Daniel Jost; Lionel Lamhaut; Thomas Loeb; Frédéric Adnet; Jean-Marc Agostinucci; Sandrine Deltour; François Revaux; Bertrand Ludes; Sebastian Voicu; Bruno Megarbane; Patricia Jabre; Alain Cariou; Eloi Marijon; Xavier Jouven; on behalf Paris-SDEC investigators

doi:10.1161/CIRCOUTCOMES.120.006626

Temporal Trends of Out-of-Hospital Cardiac Arrests Without Resuscitation Attempt by Emergency Medical Services

Circ Cardiovasc Qual Outcomes. 2021 Mar;14(3):e006626. doi: 10.1161/CIRCOUTCOMES.120.006626. Epub 2021 Mar 12.

Authors

Victor Waldmann^{1

2

3}, Nicole Karam^{1

2

3}, Bamba Gaye^{2

3}, Wulfran Bougouin^{2

3

4}, Florence Dumas^{2

3

5}, Ardalan Sharifzadehgan^{1

2

3}, Kumar Narayanan^{2

6}, Haoiinda Kassim², Frankie Beganton⁴, Daniel Jost⁷, Lionel Lamhaut⁸, Thomas Loeb⁹, Frédéric Adnet¹⁰, Jean-Marc Agostinucci¹⁰, Sandrine Deltour¹¹, François Revaux¹², Bertrand Ludes^{3

11}, Sebastian Voicu¹³, Bruno Megarbane¹³, Patricia Jabre⁸, Alain Cariou^{2

3

14}, Eloi Marijon^{1

2

3}, Xavier Jouven^{1

2

3}; on behalf Paris-SDEC investigators

Affiliations

¹ European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).
² Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).
³ Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.).
⁴ Ramsay Générale de Santé, Hôpital privé Jacques Cartier, Intensive Care Unit, Massy, France (W.B.).
⁵ Emergency Department, Cochin Hospital, Paris, France (F.D.).
⁶ Cardiology Department, Medicover Hospitals, Hyderabad, India (K.N.).
⁷ Paris Firefighters Brigade, France (D.J.).
⁸ SAMU de Paris, Necker Hospital, France (L.L., P.J.).
⁹ SAMU 92, Garches, France (T.L.).
¹⁰ SAMU 93, Bobigny, France (F.A., J.-M.A.).
¹¹ Cerebrovascular Unit, La Pitié Salpêtrière Hospital, Paris, France (S.D.).
¹² SAMU 94, Créteil, France (F.R.).
¹³ Intensive Care Unit, Lariboisière Hospital, Paris, France (S.V., B.M.).
¹⁴ Intensive Care Unit, Cochin Hospital, Paris, France (A.C.).

PMID: 33706541
DOI: 10.1161/CIRCOUTCOMES.120.006626

Abstract

Background: Significant improvements in survival from out-of-hospital cardiac arrest (OHCA) have been reported; however, these are based only on data from OHCA in whom resuscitation is initiated by emergency medical services (EMS). We aimed to assess the characteristics and temporal trends of OHCA without resuscitation attempt by EMS.

Methods: Prospective population-based study between 2011 and 2016 in the Greater Paris area (6.7 million inhabitants). All cases of OHCA were included in collaboration with EMS units, 48 different hospitals, and forensic units.

Results: Among 15 207 OHCA (mean age 70.7±16.9 years, 61.6% male), 5486 (36.1%) had no resuscitation attempt by EMS. Factors that were independently associated with increase in likelihood of no resuscitation attempt included: age of patients (odds ratio, 1.06 per year [95% CI, 1.05-1.06], P<0.001), female sex (odds ratio, 1.21 [95% CI, 1.10-1.32], P=0.002), OHCA at home location (odds ratio, 3.38 [95%CI, 2.86-4.01], P<0.001), and absence of bystander (odds ratio, 1.94 [95% CI, 1.74-2.16], P<0.001). Overall, the annual number of OHCA increased by 9.1% (from 2923 to 3189, P=0.028). This increase was related to an increase of the annual number of OHCA without resuscitation attempt by EMS by 26.3% (from 993 to 1253, P=0.012), while the annual number of OHCA with resuscitation attempt by EMS did not significantly change (from 1930 to 1936, P=0.416). Considering only cases with resuscitation attempt, survival rate at hospital discharge increased (from 7.3% to 9.5%, P=0.02). However, when considering all OHCA, survival improvement did not reach statistical significance (from 4.8% to 5.7%, P=0.17).

Conclusions: We demonstrated an increase of the total number of OHCA related to an increase of the number of OHCA without resuscitation attempt by EMS. This increasing proportion of OHCA without resuscitation attempt attenuates improvement in survival rates achieved in EMS-treated patients.

Keywords: emergency medical services; out-of-hospital cardiac arrest; population; resuscitation; survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cardiopulmonary Resuscitation
Emergency Medical Services*
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest* / diagnosis
Out-of-Hospital Cardiac Arrest* / epidemiology
Out-of-Hospital Cardiac Arrest* / therapy
Prospective Studies
Survival Rate