Emergency Medical Service Agency Practices and Cardiac Arrest Survival

JAMA CardiolPublished 1 Aug 2024

Authors' conclusion

In a national registry for OHCA, 7 practices associated with higher rates of favorable neurological survival were identified at EMS agencies.

Study context

Population: US EMS agencies in CARES with ≥10 OHCAs annually, January 2015 to December 2019of 577 eligible agencies
Participants: 470 agencies

Exposure: EMS agency resuscitation practices and risk-standardized favorable neurological survival
Highest quartilen = 118
Lowest quartilen = 118reference
Outcome: Risk-standardized rate of favorable neurological survival for OHCA at each EMS agency, and its association with EMS practices

As reported in the abstract

Association of EMS practices with risk-standardized favorable neurological survival

use simulation to assess CPR competency vs Lowest quartile: β 0.54; P = 0.05
perform frequent reassessment (at least once every 6 months) of CPR competency in new staff: β 0.51; P = 0.04
use full multiperson scenario simulation for ongoing skills training vs Lowest quartile: β 0.48; P = 0.01
perform simulation training at least every 6 months: β 0.63; P < 0.001
conduct training in the use of mechanical CPR devices at least once annually vs Lowest quartile: β 0.43; P = 0.04
use CPR feedback devices vs Lowest quartile: β 0.58; P = 0.007
transport patients to a designated cardiac arrest or ST-segment elevation myocardial infarction receiving center vs Lowest quartile: β 0.57; P = 0.003

Mean (SD) rate of risk-standardized favorable neurological survival: 8.1% (1.8%)

Observational data: associations, not effects.

Adoption of ≥4 of the 7 practices, by survival quartile

P < 0.001

Highest quartile59.3%

Lowest quartile35.6%

Emergency Medical Service Agency Practices and Cardiac Arrest Survival. JAMA Cardiol. Published 1 August 2024. doi:10.1001/jamacardio.2024.1189

Summarised from the published abstract; every number is checked against it