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Variations in Out-of-Hospital Cardiac Arrest Resuscitation Performance and Outcomes in Ohio
Michelle M J Nassal1, Henry E Wang1, Jonathan R Powell1
1The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.
The Western Journal of Emergency Medicine
|June 25, 2025
Summary
Top-performing emergency medical service (EMS) agencies in Ohio showed variations in out-of-hospital cardiac arrest (OHCA) care, utilizing less mechanical CPR and achieving greater success in advanced airway placement. These findings highlight opportunities for improving OHCA survival rates across the state.
Area of Science:
- Emergency Medicine
- Cardiology
- Public Health
Background:
- Understanding variations in emergency medical service (EMS) and hospital performance is crucial for enhancing out-of-hospital cardiac arrest (OHCA) care.
- This study investigated EMS and hospital-level differences in OHCA outcomes within Ohio.
Purpose of the Study:
- To compare variations in OHCA performance and outcomes between EMS agencies and hospitals in Ohio.
- To identify characteristics of top-performing EMS agencies in OHCA resuscitation.
Main Methods:
- Analysis of adult OHCA data from the 2019 Ohio Cardiac Arrest Registry to Enhance Survival (Ohio CARES).
- Inclusion criteria: EMS agencies and hospitals with ≥10 OHCA episodes.
- Primary outcomes: return of spontaneous circulation (ROSC) and survival to hospital discharge.
- Statistical comparison using linear mixed models and chi-squared tests, adjusting for Utstein variables.
Main Results:
- Significant variations in ROSC (15.8%–51.0%) and survival to discharge (8.1%–19.0%) were observed across EMS agencies and hospitals.
- Top-performing EMS agencies tended to treat younger patients and patients in public areas.
- Key differences in practice: top agencies used less mechanical CPR and had higher success rates in advanced airway placement.
Conclusions:
- Substantial variability exists in OHCA care and outcomes across Ohio's EMS agencies and hospitals.
- Top-performing EMS agencies demonstrate distinct characteristics and employ specific resuscitation techniques.
- Identifying these variations offers critical insights for systemic improvements in OHCA management and survival.
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