Trends in out-of-hospital cardiac arrest across the world: additional data from the CanROC and RéAC national registries.

We read with interest the second report of the International Liaison Committee on Resuscitation (ILCOR) by Nishiyama et al.1Nishiyama C. Kiguchi T. Okubo M. et al.Three-year trends in out-of-hospital cardiac arrest across the world: second report from the International Liaison Committee on Resuscitation (ILCOR).Resuscitation. 2023; 187: 1-2Google Scholar This work reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) drawn from a total of 15 national (n = 11) and regional (n = 4) population-based registries in North America, Europe, Asia and Oceania, which covered all emergency medical service (EMS)-treated OHCA in each area from 2015 through 2017. Results showed that population coverage, data collection, registry structures, patient and EMS variables, and outcomes, were heterogeneous. Although the report noted most registries demonstrated an increase of bystander cardiopulmonary resuscitation (CPR), less than half showed favourable temporal trends in survival for all EMS-treated and bystander-witnessed shockable OHCAs. Inter-registries discrepancies in structure and data collection may explain in part this variability, which also probably results from complex and intricate factors related to population education, societal and cultural expectations, geographics and socio-economics, as well as EMS system organizations and practices. It is noteworthy that, in the ILCOR report, over 98% of EMS-assessed OHCA cases received EMS resuscitation attempts in Asia during the study period, while this rate was far less on other continents (40.1–66.9%). Understanding the determinants of this variability is facilitated by international, collaborative OHCA registries such as the ones included in this ILCOR report (AUS-ROC, PAROS). Two national registries in Europe and North America (CanROC [Canada] and RéAC [France]), not included in this report, have formed an international collaboration. The CanROC registry contains OHCA data from 2005 onward.2Morrison L.J. Nichol G. Rea T.D. et al.Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry—Cardiac Arrest.Resuscitation. 2008; 78: 161-169Abstract Full Text Full Text PDF PubMed Scopus (225) Google Scholar Its current population base is 20 million people, it is expanding to include all provinces in Canada, and comprises a total of around 180,000 cases. RéAC was created in 2011, covers around 90% of France’s 70-million population, includes a total of 150,000 OHCA cases, and takes part in pan-European EURECA studies.3Hubert H. Tazarourte K. Wiel E. et al.Rationale, Methodology, Implementation, and First Results of the French Out-of-hospital Cardiac Arrest Registry.Prehosp Emerg Care. 2014; 18: 511-519Crossref PubMed Scopus (56) Google Scholar CanROC and RéAC have engaged in mutual efforts since 2020 to further explore hidden components of variability in OHCA outcomes through the creation of a research network and common registry, named ReACanROC.4Heidet M. Fraticelli L. Grunau B. et al.ReACanROC: Towards the creation of a France-Canada research network for out-of-hospital cardiac arrest.Resuscitation. 2020; 152: 133-140Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar We used the ReACanROC’s aligned, homogeneous dataset to describe temporal trends in both countries from 2015 to 2017. Similarly to the results by Nishiyama et al., Table 1 shows that bystander-attempted CPR rates increased in both countries, but no clear trend emerged regarding outcomes on a national level (2015 vs. 2017 survival rates: 11.2% vs. 10.0% in Canada, and 6.0% vs. 6.4% in France). Nevertheless, nation-wide results may raise further research questions, such as temporal trends of socio-geographic disparities or variation in accessibility to prehospital care. For example, the ReACanROC research network recently showed associations between low on-scene socioeconomic status, altered on-foot accessibility to public external defibrillators, and poorer outcomes of OHCA.5Heidet M. Freyssenge J. Claustre C. et al.Association between location of out-of-hospital cardiac arrest, on-scene socioeconomic status, and accessibility to public automated defibrillators in two large metropolitan areas in Canada and France.Resuscitation. 2022; 181: 97-109Abstract Full Text Full Text PDF PubMed Scopus (2) Google ScholarTable 1Temporal trends of estimated incidence, bystander CPR in EMS-treated cases, survival, and favourable neurological outcomes in France and Canada (2015–2017).201520162017CanadaFranceCanadaFranceCanadaFranceIncidence, per 100,000 population°In France, EMS-assessed (Canada, 2015: n = 5,331; 2016: n = 2,768; 2017: n = 3,411; France, 2015: n = 8,533; 2016: n = 8,130; 2017: n = 8,251). All cases89.552.178.851.993.351.5 Adult, non-traumatic, EMS-treated50.641.147.041.755.041.7Bystander CPR, n (%)*In all cases recorded.2,401 (45.0)3,923 (46.0)1,469 (53.1)3,954 (48.6)1,812 (53.1)4,224 (51.2)Outcomes*In all cases recorded. Survival, n (%)598 (11.2)515 (6.0)333 (12.0)540 (6.6)341 (10.0)528 (6.4) Favourable neurological status, n (%)NA393 (76.3)NA417 (77.2)NA396 (75.0)OutcomesaIn non-traumatic, non-EMS witnessed, bystander-witnessed, shockable initial rhythms, EMS-treated cases: (Canada, 2015: n = 773; 2016: n = 415; 2017: n = 472; France, 2015: n = 1,204; 2016: n = 1,326; 2017: n = 1,337). Survival, n (%)262 (33.9)226 (18.8)163 (39.3)266 (20.1)165 (35.0)279 (20.9) Favourable neurological status, n (%)NA177 (78.3)NA208 (78.2)NA220 (72.2)NA: not applicable.* In all cases recorded.° In France, EMS-assessed (Canada, 2015: n = 5,331; 2016: n = 2,768; 2017: n = 3,411; France, 2015: n = 8,533; 2016: n = 8,130; 2017: n = 8,251).a In non-traumatic, non-EMS witnessed, bystander-witnessed, shockable initial rhythms, EMS-treated cases: (Canada, 2015: n = 773; 2016: n = 415; 2017: n = 472; France, 2015: n = 1,204; 2016: n = 1,326; 2017: n = 1,337). Open table in a new tab NA: not applicable. Common, homogenized, international OHCA registries facilitate the conduction of large research projects aiming at identifying hidden predictors of multi-level variability. As others, CanROC, RéAC, and ReACanROC look forward to international collaborations aimed at increasing discovery to improve outcomes of OHCA. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. We acknowledge with gratitude the funding agencies that made the collection of these data possible (Canada: US National Institutes of Health (2015 data only), Canadian Institutes of Health Research, and the Heart and Stroke Foundation of Canada; France: the French Society of Emergency Medicine (“Société Française de Médecine d’Urgence, SFMU), the French Federation of Cardiology (“Fédération Française de Cardiologie”, FFC), the Mutual of National Education (“Mutuelle de l’Éducation Nationale”, MGEN), Lille University, the French northern region (“Hauts-de-France”), and the European community). We would like to thank the research staff and clinicians of all participating sites and investigators of both registries (Gr-ReAC and CanROC). We also wish to express gratitude to people involved in the data management in France and Canada, including Courtney Truong, Audra Stitt, Kosma Wysocki, and to the research assistants and administrative personnel involved in this project in each team (Magali Bischoff, Sylvie Besnier, Manya Charrette, Lauren Tierney, Helen Connolly, Sarah Pennington). We thank Julie Freyssenge and Clément Claustre from the Urg’ARA network for their constant help on this project. We are immensely grateful to Pr Hervé Hubert (Lille), Dr Carlos El Khoury (Lyon), Pr Jim Christenson (Vancouver), Pr Sheldon Cheskes (Toronto) for the critical role they played in the creation of the ReACanROC network. Finally we sincerely thank the EMS agencies and the prehospital responders for their commitment to excellent care and high quality data collection.