A study published in JAMA Cardiology examines two decades of data on out-of-hospital cardiac arrest (OHCA) in King County, Washington, offering valuable insight into long-term trends in incidence and survival outcomes. Researchers analyzed over 25,000 OHCAs with attempted resuscitation between 2001 and 2021, using data from a regional registry linked to EMS and hospital systems. The study aimed to assess whether OHCA incidence changed over time and to identify shifts in survival by clinical subgroup and prehospital or hospital-based care.
The results reveal that while the overall incidence of OHCA remained stable over the 20-year period, survival improved across nearly all subgroups, particularly for patients presenting with shockable rhythms. These outcome gains were closely tied to improvements in community, prehospital, and hospital care, including increased rates of bystander CPR, AED use before EMS arrival, targeted temperature management, and early coronary intervention. These findings highlight the dynamic and evolving nature of OHCA response systems, and underscore how coordinated health services improvements can translate into better survival outcomes.
While this is a large and comprehensive long-term OHCA study, the authors note some limitations. The findings reflect the experience of a single metropolitan region with a highly coordinated EMS and hospital system, which may limit generalizability. Some OHCAs were not included if no resuscitation was attempted, or if the event occurred outside of the EMS system. Additionally, data on CPR quality and timing of withdrawal of care were not consistently available throughout the study period. Finally, while associations between interventions and survival were observed, causality cannot be definitively established. Still, the findings offer compelling support for continued investment in system-wide improvements and can inform future prevention and treatment strategies across communities.
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Source: JAMA