Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry—Cardiac Arrest

doi:10.1016/j.resuscitation.2008.02.020

Resuscitation

Volume 78, Issue 2, August 2008, Pages 161-169

https://doi.org/10.1016/j.resuscitation.2008.02.020 Get rights and content

Summary

Objective

To describe the development, design and consequent scientific implications of the Resuscitation Outcomes Consortium (ROC) population-based registry; ROC Epistry—Cardiac Arrest.

Methods

The ROC Epistry—Cardiac Arrest is designed as a prospective population-based registry of all Emergency Medical Services (EMSs)-attended 9-1-1 calls for patients with out-of-hospital cardiac arrest occurring in the geographical area described by the eight US and three Canadian regions. The dataset was derived by an North American interdisciplinary steering committee. Enrolled cases include individuals of all ages who experience cardiac arrest outside the hospital, with evaluation by organized EMS personnel and: (a) attempts at external defibrillation (by lay responders or emergency personnel), or chest compressions by organized EMS personnel; (b) were pulseless but did not receive attempts to defibrillate or CPR by EMS personnel. Selected data items are categorized as mandatory or optional and undergo revisions approximately every 12 months. Where possible all definitions are referenced to existing literature. Where a common definition did not exist one was developed. Optional items include standardized CPR process data elements. It is anticipated the ROC Epistry—Cardiac Arrest will enroll between approximately 9000 and 13,500 treated all rhythm arrests and 4000 and 5000 ventricular fibrillation arrests annually and approximately 8000 EMS-attended but untreated arrests.

Conclusion

We describe the rationale, development, design and future implications of the ROC Epistry—Cardiac Arrest. This paper will serve as the reference for subsequent ROC manuscripts and for the common data elements captured in both ROC Epistry—Cardiac Arrest and the ROC trials.

Introduction

Out-of-hospital cardiac arrest is a large public health problem that accounts for hundreds of thousands of deaths annually in North America. Patient and care characteristics can predict favourable outcome and this understanding has been incorporated in efforts to improve resuscitation.1, 2, 3, 4 EMS-treated out-of-hospital cardiac arrest survival figures across communities varies approximately 12-fold for both all-rhythms arrests (1.8–21.5%) and arrests presenting with ventricular fibrillation (3.3–40.5%).2, 5, 6, 7, 8

Understanding this heterogeneity provides the foundation for improving the care and outcome for cardiac arrest and in turn may impact this public health challenge.

A population-based registry of out-of-hospital cardiac arrest enables assessment of how evidence-based resuscitation is implemented in community-based practice. In other disease states registries have provided invaluable resources to establish novel prognostic measures that may serve to further the understanding of the pathophysiology or guide patient care.1, 3, 5, 6, 9

To date, no single North American population-based registry from multiple communities exists for out-of-hospital cardiac arrest. The Resuscitation Outcomes Consortium (ROC) is supported to conduct randomized clinical trials evaluating promising treatment interventions for out-of-hospital cardiac arrest and life-threatening trauma.¹⁰ The objective of this paper is to describe the development, design and consequent scientific implications of the Resuscitation Outcomes Consortium cardiac arrest population-based registry referred to as the ROC Epistry—Cardiac Arrest.

Section snippets

Literature review

A comprehensive review of the world literature was conducted to identify existing out-of-hospital registries and population-based datasets. This search strategy included all English literature published from 1996 to 2004 and tracked in MEDLINE, EMBASE CINAHL, or Health Star. The search strategy used the terms pre-hospital or prehospital, ambulance(s), paramedic(s), or Emergency Medical Technician(s), Emergency Medical Services (E), data collection, Medical Records Systems, computerized or

Design

ROC Epistry—Cardiac Arrest was designed as a prospective population-based cohort study.

Setting

The ROC Epistry—Cardiac Arrest data included all EMS-attended 9-1-1 calls for patients with out-of-hospital cardiac arrest occurring in eight US regions (Alabama, Dallas, Iowa, Milwaukee, Pittsburgh, Portland, San Diego, and Seattle/King County), and three Canadian regions (Ottawa, Toronto, and British Columbia) with one data coordinating center (University of Washington) (Figure 1). Approximately 23.7

Variables

Selected data items were categorized as mandatory (Table 3) or optional and the online Appendix 2 lists their definitions and reference source.

Discussion

The ROC Epistry—Cardiac Arrest dataset was derived through an North American interdisciplinary collaboration of ROC investigators, EMS liaisons and study staff. The data variables and definitions were based from the literature and when possible included established data definitions and collection processes. Throughout the process of design and implementation, the ROC Epistry—Cardiac Arrest working group strove to balance scientific merit with the ability to obtain reliable and meaningful

Conclusion

We describe the rationale, development, design and potential usefulness of ROC Epistry—Cardiac Arrest. This paper will serve as the reference for subsequent ROC manuscripts both descriptive and inferential and for the common data elements captured in both ROC Epistry—Cardiac Arrest and the ROC randomized controlled trials when applicable. The design and implementation was an iterative, collaborative process that served as a basis to address important epidemiologic and clinical questions

Conflict of interest

None.

Acknowledgments

We would like to acknowledge and thank the development committee for ROC Epistry which, in addition to the authors, was comprised of the following individuals: Tom Terndrup and Carolyn Williams (Alabama); Ray Fowler and Joe Minei (Dallas); Judy Powell, Gena Sears* (University of Washington); Michael Hartley and Melanie A. Kenney (Iowa); Chris Von Briesen (Milwaukee); Lisa Nesbit and Ian Stiell (Ottawa); Sara Pennington, Dan Bishop and Dug Andrusiek (British Columbia); Lori Kelly (Pittsburgh);

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What cardiac arrest registries can tell us about health differences and disparities
2024, Resuscitation Plus
Cardiac arrest is common and associated with significant mortality and morbidity among survivors. To better understand the epidemiology and outcomes of cardiac arrest, many countries and regions have developed cardiac arrest registries. In the United States, with the diversity of its population, these registries have illuminated differences and disparities in the care and outcomes of cardiac arrest patients based on their race, ethnicity, and sex. These findings raise concerns as traditionally vulnerable patient groups have lower survival rates for cardiac arrest—a condition for which overall survival is already low. Although leveraging registries to raise awareness of disparities in cardiac arrest outcomes is an important first step, further research is needed to understand the sources of these differences, narrow observed disparities and improve overall outcomes.
Epidemiology and outcomes of out of hospital cardiac arrest in Saudi Arabia: Findings from the Saudi Out of Hospital cardiac Arrest Registry (SOHAR)
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The Saudi Out-of-Hospital Cardiac Arrest Registry (SOHAR) is the first out-of-hospital cardiac arrest (OHCA) registry in Saudi Arabia. This study aimed to describe the epidemiology and outcomes of OHCA in Saudi Arabia.
The SOHAR is a prospective data collection system. Data were collected monthly from defined regions, and registry measured variables were adopted from the Utstein recommendations.
During the period from 01/01/2019 to 31/12/2022, 3671 patients were included in the registry. The mean age was 62 years, and 6.5% (240) of patients were under the age of 18 years. The most common cause of OHCA was medical 3439 (93.6%). A total of 641 (17.4%) and 129 (3.9%) had presumed cardiac and respiratory causes. Additionally, most OHCA in Saudi Arabia (3034, 82.6%) occurred at home. Prehospital Return Of Spontaneous Circulation (ROSC) was achieved in 275 (7.4%) cases, and 491 (13.3%) patients were pronounced dead upon arrival at the hospital. Survival to hospital discharge was achieved in 107 (2.9%) of the cases, and good neurological outcomes, defined as a Cerebral Performance Category (CPC) of 1–3, occurred in < 0.5% of patients.
The Saudi out-of-hospital ROSC was 7.4%. The survival to hospital discharge rate was 2.9%, and less than 1% of patients were discharged with good neurological outcomes. Further research and the continuation of registry data collection is highly recommended. Additionally, a national-level out-of-hospital cardiac arrest system is recommended to ensure the standardization of medical care provided to patients with OHCA.
Improving survival and outcome in those suffering an out-of-hospital cardiac arrest in the post-COVID-19 era
2024, American Journal of Emergency Medicine
Predicting survival post-cardiac arrest: An observational cohort study
2023, Resuscitation Plus
Over 400,000 out-of-hospital cardiac arrest (OHCA) occur each year in Canada and the United States with less than 10% survival to hospital discharge. Cardiac arrest is a heterogenous condition and patient outcomes are impacted by a multitude of factors. Prognostication is recommended at 72 hours after return of spontaneous circulation (ROSC), however there may be other factors that could predict patient outcome earlier in the post-arrest period. The objective of our study was to develop and internally validate a novel clinical prediction rule to risk stratify patients early in the post-cardiac arrest period.
We performed a retrospective cohort study of adult (≥18 years) post-cardiac arrest patients between 2010 and 2015 from the Epistry Cardiac Arrest database in Toronto. Our primary analysis used ordinal logistic regression to examine neurologic outcome at discharge using the modified Rankin Scale (mRS). Our secondary analysis used logistic regression for neurologic outcome and survival to hospital discharge. Models were internally validated using bootstrap validation.
A total of 3432 patients met our inclusion criteria. Our clinical prediction model was able to predict neurologic outcome on an ordinal scale using our predefined variables with an AUC of 0.89 after internal validation. The predictive performance was maintained when examining neurologic outcome as a binary variable and survival to hospital discharge.
We were able to develop a model to accurately risk stratify adult cardiac arrest patients early in the post-cardiac arrest period. Future steps are needed to externally validate this model in other healthcare settings.
Trends in out-of-hospital cardiac arrest across the world: Additional data from the CanROC and RéAC national registries
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Clinical outcomes following out-of-hospital cardiac arrest: The minute-by-minute impact of bystander cardiopulmonary resuscitation
2023, Resuscitation
The time-dependent prognostic role of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients has not been described with great precision, especially for neurologic outcomes. Our objective was to assess the association between bystander CPR, emergency medical service (EMS) response time, and OHCA patients’ outcomes.
This cohort study used the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registries. Bystander-witnessed adult OHCA treated by EMS were included. The primary outcome was survival to hospital discharge and secondary outcome was survival with a good neurologic outcome (modified Rankin scale 0–2). Multivariable logistic regression models were used to assess the associations and interactions between bystander CPR, EMS response time and clinical outcomes.
Out of 229,637 patients, 41,012 were included (18,867 [46.0%] without bystander CPR and 22,145 [54.0%] with bystander CPR). Bystander CPR was independently associated with higher survival (adjusted odds ratio [AOR] = 1.70 [95%CI 1.61–1.80]) and survival with a good neurologic outcome (AOR = 1.87 [95%CI 1.70–2.06]), while longer EMS response times were independently associated with lower survival to hospital discharge (each additional minute of EMS response time: AOR = 0.92 [95%CI 0.91–0.93], p < 0.001) and lower survival with a good neurologic outcome (AOR = 0.88 [95%CI 0.86–0.89], p < 0.001). There was no interaction between bystander CPR and EMS response time’s association with survival (p = 0.12) and neurologic outcomes (p = 0.65).
Although bystander CPR is associated with an immediate increase in odds of survival and of good neurologic outcome for OHCA patients, it does not influence the negative association between longer EMS response time and survival and good neurologic outcome.

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^☆: A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.02.020.

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Clinical paperRationale, development and implementation of the Resuscitation Outcomes Consortium Epistry—Cardiac Arrest☆

Summary

Objective

Methods

Conclusion

Introduction

Section snippets

Literature review

Design

Setting

Variables

Discussion

Conclusion

Conflict of interest

Acknowledgments

Ann Emerg Med

Ann Emerg Med

Resuscitation

Ann Emerg Med

Resuscitation

Resuscitation

Resuscitation

J Am Coll Cardiol

Resuscitation

J Am Coll Cardiol

Ann Emerg Med

Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project

N Engl J Med

Influence of ambulance crew's length of experience on the outcome of out-of-hospital cardiac arrest

Eur Heart J

Temporal patterns in long-term survival after resuscitation from out-of-hospital cardiac arrest

Circulation

Clinical paper
Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry—Cardiac Arrest☆