Outcome differences between PARAMEDIC2 and the German Resuscitation Registry: a secondary analysis of a randomized controlled trial compared with registry data.

BACKGROUND AND IMPORTANCE There has been much discussion of the results of the PARAMEDIC2 trial, as resuscitation outcome rates are considerably lower in this trial than in country-level registries on out-of-hospital cardiac arrest (OHCA). Here, we developed a statistical framework to investigate this gap and to examine possible sources for observed discrepancies in outcome rates. DESIGN Summary data from the PARAMEDIC2 trial were used as available in the publication of this study. We developed a modelling framework based on logistic regression to compare data from this randomized controlled trial and registry data from the German Resuscitation Registry (GRR), where we considered 26 019 patients treated with epinephrine for OHCA in the GRR. To account and adjust for differences in patient characteristics and baseline variables predictive for outcomes after OHCA between the GRR cohort and the PARAMEDIC2 study sample, we included all available variables determined at the arrival of EMS personnel in the modelling framework: age, sex, initial cardiac rhythm, cause of cardiac arrest, witness of cardiac arrest, CPR performed by a bystander, and the interval between emergency call and arrival of the ambulance at the scene (baseline model). In order to find possible explanations for the discrepancies in outcome between PARAMEDIC2 and GRR, in a second (baseline plus treatment) model, we additionally included all available variables related to the interventions of the EMS personnel (type of airway management, type of vascular access, and time to administration of epinephrine). MAIN RESULTS A patient cohort with baseline variables as in the PARAMEDIC2 trial would have survived to hospital discharge in 7.7% and survived with favourable neurological outcome in 5.0% in an EMS and health care system as in Germany, compared with 3.2 and 2.2%, respectively, in the Epinephrine group of the trial. Adding treatment-related variables to our logistic regression model, the rate of survival to discharge would decrease from 7.7 (for baseline variables only) to 5.6% and the rate of survival with favourable neurological outcome from 5.0 to 3.4%. CONCLUSION Our framework helps in the medical interpretation of the PARAMEDIC2 trial and the transferability of the trial's results for other EMS systems. Significantly higher rates of survival and favourable neurological outcome than reported in this trial could be possible in other EMS and health care systems

Das SCATTER-Projekt: Computerbasierte Simulation zur Unterstützung bei der strategischen Verlegung von Intensivpatienten [The SCATTER project: computer-based simulation in the strategic transfer of intensive care patients]

Hintergrund: Der Bedarf für ein Konzept für die bundesweite strategische Verlegung von Intensivpatienten wurde durch die COVID-19-Pandemie („coronavirus disease 2019“: Coronavirus-Krankheit-2019; ausgelöst durch eine Infektion mit dem Virus SARS-CoV-2) deutlich. Trotz des eigens hierfür entwickelten Kleeblattkonzeptes stellt die Verlegung einer großen Anzahl von Intensivpatienten eine große Herausforderung dar. Mithilfe einer Computersimulation werden in dem Projekt SCATTER (StrategisChe PATienTenvERlegung) Verlegungsstrategien für die Krisenbewältigung am Beispiel eines fiktiven Szenarios getestet und Empfehlungen entwickelt. Methode: Nach sorgfältiger Erhebung von Prozess- und Strukturdaten für innerdeutsche Intensivtransporte erfolgte die Programmierung der Computersimulation. Hier können auf diverse Parameter Einfluss genommen und unterschiedlichste Verlegungsszenarien erprobt werden. In einem fiktiven Übungsszenario wurden von Schleswig-Holstein ausgehend bundesweite Verlegungen simuliert und anhand verschiedener Kriterien beurteilt. Ergebnisse: Bei den bodengebundenen Verlegungen zeigte sich aufgrund der eingeschränkten Reichweite und in Abhängigkeit der gewählten Zielregion, dass meist nicht alle Patienten verlegt werden können. Luftgebunden lässt sich zwar eine höhere Anzahl von Patienten verlegen, dies ist jedoch oft mit zusätzlichen Umlagerungen verbunden, die ein potenzielles Risiko für die Patienten darstellen. Eine distanzabhängige luft- oder bodengebundene Transportstrategie führte in dem Übungsszenario zu identischen Ergebnissen wie der rein luftgebundene Transport, da aufgrund der großen Distanz stets der luftgebundene Transport gewählt wurde. Diskussion: Aus der Computersimulation können wichtige Erkenntnisse über verschiedene Verlegungsstrategien und Rückschlüsse auf die Realität gezogen und Empfehlungen entwickelt werden

European Registry of Cardiac Arrest – Study-THREE (EuReCa THREE) – an international, prospective, multi-centre, three-month survey of epidemiology, treatment and outcome of patients with out-of-hospital cardiac arrest in Europe – the study protocol

Background The aim of the European Registry of Cardiac Arrest (EuReCa) network is to provide high quality evidence on epidemiology of out-of-hospital cardiac arrest (OHCA) in Europe by supporting and developing cardiac arrest registries and performing European-wide studies. To date, the EuReCa ONE and EuReCa TWO studies have involved around 28 countries, with population covered increasing from the first to the second study. The aim of the EuReCa THREE study is to build on previous work and to support the promotion of quality data collection on OHCA throughout Europe. Methods/design EuReCa THREE will be the third prospective cohort study on epidemiology of OHCA and will involve around 30 European countries. The study will be conducted between 1st September and 30th November 2022. Data will be collected on cardiac arrest cases attended, resuscitation attempted, patient and cardiac arrest event characteristics and outcomes (including return of spontaneous circulation, status on hospital arrival and discharge). A particular focus for EuReCa THREE will be to describe key time intervals in OHCA management; time from call to EMS arrival on scene, time from cardiac arrest to start CPR, time from EMS arrival to delivery of patient to hospital. EuReCa THREE was registered with the German Registry of Clinical Trials Registration Number: DRKS00028591 searchable via WHO meta-registry (https://apps.who.int/trialsearch/). Discussion The EuReCa THREE study will increase our knowledge on longitudinal OHCA epidemiology and provide new knowledge on crucial time intervals in OHCA management in Europe. However, the primary aim of building a network to support quality data on OHCA, remains the central tenant of the EuReCa project

International variation in survival after out-of-hospital cardiac arrest : A validation study of the Utstein template

Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232). Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8%(range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. Conclusions: The Utstein factors explained 51%. of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.Peer reviewe