• Deepak Kumar Pasupula, Anusha Bhat, Sudeep K Siddappa Malleshappa, Muhammad Bilal Munir, Amr Barakat, Sandeep Jain, Norman C Wang, Samir Saba, and Aditya Bhonsale.
• University of Pittsburgh Medical Center, PA (D.K.P., A.B., S.J., N.C.W., S.S., A.B.).
• Circ Arrhythm Electrophysiol. 2020 Feb 1; 13 (2): e007843.

BackgroundIn October 2010, the American Heart Association/Emergency Cardiovascular Care updated cardiopulmonary resuscitation guidelines. Its impact on the survival rate among out-of-hospital cardiac arrest patients (OHCA) is not well studied. We sought to assess the survival trends in OHCA patients before and after the introduction of the 2010 American Heart Association cardiopulmonary resuscitation guidelines in the United States.MethodsA retrospective observational study from the National Emergency Department (ED) Sample was designed to identify patients presenting to the ED primarily after an OHCA in the United States between January 1, 2006, and December 31, 2015. The main outcome studied was the change in trends of ED survival and survival-to-discharge rates before and after guideline modification.ResultsAmong 1 282 520 patients presenting to the ED after OHCA (mean [SD] age, 65.8 [17.2] years; 62% men), ED survival rate (23%) and survival-to-discharge rate (16%) trends showed significant improvement after implementation of the 2010 American Heart Association cardiopulmonary resuscitation guidelines, 1.25% ([95% CI, 0.72%-1.78%] P=0.001) and 0.89% ([95% CI, 0.35%-1.43%] P=0.006), respectively. Notably, among patients with nonshockable rhythm (change in ED survival rate trend, 1.3% [95% CI, 0.89%-1.74%]; P<0.001 and survival-to-discharge trend, 0.94% [95% CI, 0.42%-1.47%]; P=0.004). Among patients admitted to the presenting hospital (n=145 592), 46% were discharged alive, of which 49% were discharged home. Significant decrease in discharge to home was noted (-1.7% [95% CI, -3.18% to -0.22%]; P=0.03), while a significant increase in neurological complication (0.17% [95% CI, 0.06%-0.28%]; P=0.007) was noted with the guideline modification.ConclusionsThe change in 2010 American Heart Association cardiopulmonary resuscitation guidelines was associated with only slight improvement in ED survival and survival-to-discharge trends among US OHCA patients and only 1 in 6 OHCA patients survival to discharge.

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