Big Survival Differences in Out-of-Hospital Cardiac Arrest Between EMS Agencies Interview with:

Masashi Okubo, MD. Clinical Instructor of Emergency Medicine Research Fellow Department of Emergency Medicine University of Pittsburgh

Dr. Okubo

Masashi OkuboMD.
Clinical Instructor of Emergency Medicine
Research Fellow
Department of Emergency Medicine
University of Pittsburgh What is the background for this study? What are the main findings? 

Response: Out-of-hospital cardiac arrest (OHCA) is a major public health problem, annually affecting over 350,000 individuals in the US with low survival rate, 11.4% among those who were treated by emergency medical services (EMS). Prior studies showed a 5-fold difference (3.0% to 16.3%)  in survival to hospital discharge between 10 study sites in North America (US and Canada) and 6.5-fold difference (3.4% to 22.0%) between 132 US counties after OHCA.

However, it was unclear how much patient outcome after OHCA differ between EMS agencies which play a critical role in OHCA care. Among 43,656 adults treated for Out-of-hospital cardiac arrest by 112 EMS agencies in North America, we found that survival to hospital discharge differed from 0% to 28.9% between EMS agencies. There was a median difference of 56% in the odds of survival to hospital discharge for patients with similar characteristics between any 2 randomly selected EMS agencies, after adjusting for known measured sources of variability. What should readers take away from your report?

Response: This study suggests that there is a substantial variation in patient outcomes after Out-of-hospital cardiac arrest between EMS agencies in North America, which cannot be explained by captured patient and agency characteristics. What recommendations do you have for future research as a result of this work?

Response: Future research should identify modifiable factors that are contributing to this observed variation in outcomes. It would be important to establish metrics/benchmarks of EMS system performance on .Out-of-hospital cardiac arrest care to improve patient outcomes and quality of care.


Okubo M, Schmicker RH, Wallace DJ, et al. Variation in Survival After Out-of-Hospital Cardiac Arrest Between Emergency Medical Services Agencies. JAMA Cardiol. Published online September 26, 2018. doi:10.1001/jamacardio.2018.3037

Sep 27, 2018 @ 3:50 pm

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