Large urban center improves out-of-hospital cardiac arrest survival.

Abstract

Large cities pose unique challenges that limit the effectiveness of system improvement interventions. Successful implementation of integrated cardiac resuscitation systems of care can serve as a model for other urban centers. This was a retrospective analysis of prospectively collected data of adult cases of non-traumatic cardiac arrest who received treatment by Chicago Fire Department EMS from September 1, 2013 through December 31, 2016. We measured temporal OHCA outcomes during implementation of system-wide initiatives including telephone-assisted and community CPR training programs; high performance CPR and team based simulation training; new post resuscitation care and destination protocols; and case review for EMS providers. Outcomes measured included bystander CPR rates, return of spontaneous circulation (ROSC), hospital admission and survival, and favorable neurologic outcomes (CPC 1-2). Relative risk was determined by logistic regression model where observed group-specific outcomes are expressed as odds ratios (OR). We included 6103 adult OHCA cases occurring outside of health care facilities from September 1, 2013 through December 31, 2016. Significantly improved outcomes (p < 0.05) were observed between 2013 and 2016 for bystander CPR (11.6% vs 19.4%), ROSC (28.6% vs 36.9%), hospital admission (22.5% vs 29.4%), survival (7.3% vs 9.9%), and CPC 1-2 (4.3% vs 6.4%). Utstein survival increased from 16.3%-35.4% and CPC 1-2 survival from 11.6%-29.1% (p < 0.05). After adjustment for OHCA characteristics, survival with CPC 1-2 increased over time (OR 1.15, p = 0.0277). Densely populated cities with low survival rates can overcome systematic challenges and improve OHCA survival.