Acute cardiac care & resuscitationCohort study
Emergency medical services agency-level variation in non-initiation of resuscitation and termination of resuscitation in out-of-hospital cardiac arrest
- retrospective cohort study
Authors' conclusion
Even after adjustment for measured patient and agency characteristics, we observed substantial between-agency variation in non-initiation of resuscitation and TOR. Findings highlight the need for further evaluation of prehospital decision-making processes and opportunities to identify and reduce unwarranted variation and improve consistency, equity, and quality of prehospital care.
Study context
- Population
- Patients with non-traumatic OHCA, 2018–2024 ESO Data Collaborativeencounters, 309,048 eligible for the Universal termination of resuscitation (TOR) rule
- Participants
- 560,240 patients
- Exposure
- Agency-level variation in non-initiation of resuscitation and TOR, quantified by the median odds ratio (MOR) comparing similar encounters treated by two randomly selected emergency medical services (EMS) agencies
Main finding
As reported in the abstract
Resuscitation not initiated (of 560,240 encounters)
76,859 (13.7%)
Median agency-specific rate after adjustment for encounter-level factors
13.6% (IQR, 11.0%-16.7%)
MOR
2.30 (95% CI 2.21-2.38)
Observational data: associations, not effects.
Further findings
TOR among encounters eligible for the Universal TOR rule
- Underwent TOR (of 309,048 eligible encounters)
- 175,826 (56.9%)
- Median agency-specific rate after adjustment for encounter-level factors
- 54.3% (IQR, 35.5%-67.4%)
- MOR
- 4.13 (95% CI 3.87-4.26)
- mixed-effects models incorporating demographic, arrest, scene, agency, and EMS care variables
Original publication
Summarised from the published abstract; every number is checked against it