Establishing the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry

Abstract

IntroductionOut-of-hospital cardiac arrest (OHCA) is a global health problem with low survival. Regional variation in survival has heightened interest in combining cardiac arrest registries to understand and improve OHCA outcomes. While individual OHCA registries exist in Australian and New Zealand ambulance services, until recently these registries have not been combined. The aim of this protocol paper is to describe the rationale and methods of the Australian Resuscitation Outcomes Consortium (Aus-ROC) OHCA epidemiological registry (Epistry).Methods and analysisThe Aus-ROC Epistry is designed as a population-based cohort study. Data collection started in 2014. Six ambulance services in Australia (Ambulance Victoria, SA Ambulance Service, St John Ambulance Western Australia and Queensland Ambulance Service) and New Zealand (St John New Zealand and Wellington Free Ambulance) currently contribute data. All OHCA attended by ambulance, regardless of aetiology or patient age, are included in the Epistry. The catchment population is approximately 19.3 million persons, representing 63% of the Australian population and 100% of the New Zealand population. Data are collected using Utstein-style definitions. Information incorporated into the Epistry includes demographics, arrest features, ambulance response times, treatment and patient outcomes. The primary outcome is ‘survival to hospital discharge’, with ‘return of spontaneous circulation’ as a key secondary outcome.Ethics and disseminationEthics approval was independently sought by each of the contributing registries. Overarching ethics for the Epistry was provided by Monash University HREC (Approval No. CF12/3938—2012001888). A population-based OHCA registry capturing the majority of Australia and New Zealand will allow risk-adjusted outcomes to be determined, to enable benchmarking across ambulance providers, facilitate the identification of system-wide strategies associated with survival from OHCA, and allow monitoring of temporal trends in process and outcomes to improve patient care. Findings will be shared with participating ambulance services and the academic community.

Description of the ambulance services participating in the Aus‐ROC Australian and New Zealand out‐of‐hospital cardiac arrest Epistry

“…Some variation in the variables collected by each of the ambulance services has been noted previously, and this has limited the number of core variables included in the Aus‐ROC Epistry. However, the Epistry contains a wide range of data, including demographics, arrest features, ambulance response times, treatment and patient outcomes.…”

“…Differences were observed in the variables that services collect to facilitate defining ‘attempted resuscitation’, criteria for withholding resuscitation attempts, the serviced population, the number of OHCA cases attended, the structure of the workforce and termination of resuscitation guidelines. One of the major objectives of the Aus‐ROC Epistry is to understand ambulance service variations and the impact of this on survival of OHCA . These data are important in identifying differences in the provision of service by ambulance services and can be used to explain a proportion of the regional variation in survival should such a variation be identified in future Aus‐ROC studies.…”

“…For example, the proportion of paramedics with BLS‐only training varied from 1% to 82% between ambulance services. This likely reflects a combination of the proportion of rural regions within ambulance service areas (see appendices 2 and 3 in Beck et al …”

“…Aus‐ROC was established as a National Health and Medical Research Council (NHRMC) Centre of Research Excellence in 2011 to build research capacity aimed at improving OHCA survival and outcomes. One of the major objectives of this consortium was to develop an OHCA Epistry to enhance and inform coordinated outcomes research and evaluation across Australia and New Zealand, as described previously …”

Paramedic resuscitation competency: A survey of Australian and New Zealand emergency medical services

“…The whole population of Australia (23.9 million) and New Zealand (4.6 million) is covered by these EMS agencies. Potential participants were identified via established connections with the Australian Resuscitation Outcomes Consortium (Aus‐ROC) . We targeted education managers to answer the survey on their organisation's behalf; however, participants were encouraged to seek out the most appropriate individual in their organisation to answer each section of the survey.…”