• Resuscitation · Jul 2023

    The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand.

    • Stuart Howell, Karen Smith, Judith Finn, Peter Cameron, Stephen Ball, Emma Bosley, Tan Doan, Bridget Dicker, Steven Faddy, Ziad Nehme, Andy Swain, Melanie Thorrowgood, Andrew Thomas, Samuel Perillo, Mike McDermott, Tony Smith, Janet Bray, and Aus-ROC OHCA Epistry Management Committee.
    • School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
    • Resuscitation. 2023 Jul 1; 188: 109847109847.

    IntroductionThe aim of this study was to develop a risk adjustment strategy, including effect modifiers, for benchmarking emergency medical service (EMS) performance for out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand.MethodUsing 2017-2019 data from the Australasian Resuscitation Outcomes Consortium (Aus-ROC) OHCA Epistry, we included adults who received an EMS attempted resuscitation for a presumed medical OHCA. Logistic regression was applied to develop risk adjustment models for event survival (return of spontaneous circulation at hospital handover) and survival to hospital discharge/30 days. We examined potential effect modifiers, and assessed model discrimination and validity.ResultsBoth OHCA survival outcome models included EMS agency and the Utstein variables (age, sex, location of arrest, witnessed arrest, initial rhythm, bystander cardiopulmonary resuscitation, defibrillation prior to EMS arrival, and EMS response time). The model for event survival had good discrimination according to the concordance statistic (0.77) and explained 28% of the variation in survival. The corresponding figures for survival to hospital discharge/30 days were 0.87 and 49%. The addition of effect modifiers did little to improve the performance of either model.ConclusionThe development of risk adjustment models with good discrimination is an important step in benchmarking EMS performance for OHCA. The Utstein variables are important in risk-adjustment, but only explain a small proportion of the variation in survival. Further research is required to understand what factors contribute to the variation in survival between EMS.Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

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