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Prehospital Emergency Care Volume 26, 2022 - Issue 2
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Focus on Cardiac Arrest

Community Variations in Out-of-Hospital Cardiac Arrest Care and Outcomes in Texas

Ryan HuebingerDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).Correspondence[email protected]
ORCID Iconhttps://orcid.org/0000-0002-9448-5744
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Jeff JarvisDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
, MD,
Kevin SchulzDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
, MD,
David PersseDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
, MD,
Hei Kit ChanDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
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David MiramontesDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
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Veer VithalaniDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
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Gerad TroutmanDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
, MD, MBA,
Robert GreenbergDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
, MD,
Rabab Al-ArajiDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
, MPH,
Normandy VillaDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
, MPH,
Micah PanczykDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
, MS,
Henry WangDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
, MD, MS &
Bentley BobrowDepartment of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas (RH, KS, DP, NV, MP, HW, BB); Baylor Scott & White Health/Texas A&M University College of Medicine, Temple, Texas (JJ, RG); Williamson County EMS, Georgetown, Texas (JJ); Houston Fire Department Emergency Medical Services, Houston, Texas (KS, DP); Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas (HKC); University of Texas Health Science Center at San Antonio, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas (DM); MedStar Mobile Healthcare, Fort Worth, Texas (VV); Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas (VV); Division of Emergency Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas (GT); Emory University Rollins School of Public Health, Atlanta, Georgia (RA-A).
, MD show all
Pages 204-211 | Received 13 Jan 2021, Accepted 17 Mar 2021, Published online: 13 Apr 2021
 
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Abstract

Background: Large and unacceptable variation exists in cardiac resuscitation care and outcomes across communities. Texas is the second most populous state in the US with wide variation in community and emergency response infrastructure. We utilized the Texas-CARES registry to perform the first Texas state analysis of out-of-hospital cardiac arrest (OHCA) in Texas, evaluating for variations in incidence, care, and outcomes.

Methods: We analyzed the Texas-CARES registry, including all adult, non-traumatic OHCAs from 1/1/2014 through 12/31/2018. We analyzed the incidence and characteristics of OHCA care and outcome, overall and stratified by community. Utilizing mixed models accounting for clustering by community, we characterized variations in bystander CPR, bystander AED in public locations, and survival to hospital discharge across communities, adjusting for age, gender, race, location of arrest, and rate of witnessed arrest (bystander and 911 responder witnessed).

Results: There were a total of 26,847 (5,369 per year) OHCAs from 13 communities; median 2,762 per community (IQR 444-2,767, min 136, max 9161). Texas care and outcome characteristics were: bystander CPR (43.3%), bystander AED use (9.1%), survival to discharge (9.1%), and survival with good neurological outcomes (4.0%). Bystander CPR rate ranged from 19.2% to 55.0%, and there were five communities above and five below the adjusted 95% confidence interval. Bystander AED use ranged from 0% to 19.5%, and there was one community below the adjusted 95% confidence interval. Survival to hospital discharge ranged from 6.7% to 14.0%, and there were three communities above and two below the adjusted 95% confidence interval.

Conclusion: While overall OHCA care and outcomes were similar in Texas compared to national averages, bystander CPR, bystander AED use, and survival varied widely across communities in Texas. These variations signal opportunities to improve OHCA care and outcomes in Texas.

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