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