Response by Girotra and Chan to Letter Regarding Article, “Regional Variation in Out-of-Hospital Cardiac Arrest Survival in the United States”
Year: 2016
Type: article
Abstract: We appreciate the interest of Bougouin et al in our study and agree that, although bystander cardiopulmonary resuscitation is an important link in the chain of survival, other factors such as timeliness of the emergency response, quality of resuscitation, therapeutic interventions, and organized post-resuscitation care are important and likely account for the unexplained variation in cardiac arrest survival in our study.1,2 However, our ability to examine the relative impact of these factors on survival variation across communities was limited by lack of granular data.In response to the suggestion by Bougouin et al, we partitioned overall survival into survival-to-hospital admission (ie, following return of spontaneous circulation) and in-hospital survival (ie, survival to discharge among patients who were admitted to a hospital after return of spontaneous circulation).We calculated risk-adjusted rates of overall survival, survival to hospital admission, and in-hospital survival for each county with a hierarchical model that adjusted for patient age, sex, location of arrest, witnessed arrest, rhythm, bystander cardiopulmonary resuscitation, bystander automated external defibrillator, and calendar year.In contrast to the findings reported in their study, 3 we found that overall survival was strongly correlated with both outcomes: survival-to-hospital admission (ρ= 0.76; P<0.0001) and in-hospital survival (ρ=0.65;P<0.0001).However, risk-adjusted in-hospital survival varied across counties (median: 36.5%;range: 28.4%-44.7%),and county-level rates of survival-to-hospital admission and in-hospital survival were not correlated with each other (ρ=0.08;P=0.36).Collectively, these data suggest that county-level variation in survival outcomes is partly due to variation in hospital treatments and support a comprehensive strategy that targets both prehospital and hospital factors to improve survival, especially in communities with low cardiac arrest survival rates.
Source: Circulation
Authors: Saket Girotra, Paul S. Chan
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2554551665