VACAR Annual Report 2011/12 - Ambulance Victoria
VACAR Annual Report 2011/12 - Ambulance Victoria VACAR Annual Report 2011/12 - Ambulance Victoria
SURVIVAL OUTCOMES Risk-adjusted odds of adult survival by year Risk-adjusted odds of survival provide a balanced method for measuring trends in resuscitation performance across years. Figure 49 shows the odds of survival to hospital discharge for adult patients by year, and is adjusted for known predictors of survival including age, response time, gender, public location, shockable rhythm on arrival, bystander witnessed and bystander CPR. The risk-adjusted odds of survival to hospital discharge have improved significantly over the last 10 years. In fact, the probability of survival to hospital discharge is 2.5 times higher in 2011/12 than when compared to cases in 2002/03 (95% CI 1.9-3.3, p < 0.0001). This finding is similar to what has been observed over the last three years. Risk-adjusted odds of survival to discharge for adult patients presenting in a shockable rhythm has also observed significant increases over 10 years. In 2011/12, the risk-adjusted odds of survival for a patient presenting in VF/VT was 3.7 (95% CI 2.7-5.3, p < 0.0001) when compared with survival in 2002-03. Figure 49: Trends in the risk-adjusted odds of survival to hospital discharge for adult patients. 1 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 0.5 1.0 2.0 4.0 Adjusted odds ratios (95% CI) 1. Adults > 15 years or missing age, who received EMS attempted resuscitation. Excludes EMS witnessed events. Adjusted odds ratios are adjusted for age, response time, gender, public location, shockable rhythm on arrival, bystander witnessed and bystander CPR. VACAR Annual Report 2011/12 Page 46
SURVIVAL OUTCOMES Risk-adjusted odds of adult survival by region Regional differences in cardiac arrest outcomes have been described across continents, cities, and population densities. Earlier work by VACAR (Jennings et al. MJA. 2006) demonstrated a significant disparity in survival outcomes across urban and regional areas of Victoria. Despite significant improvements to this trend over the last five years, VACAR continues to monitor regional disparity in resuscitation outcomes. Risk-adjusted odds of adult survival to hospital discharge across Department of Health regions of Victoria for the 2011/12 year are presented in Figure 50. Odds-ratios shown are adjusted for known predictors of survival including age, response time, gender, public location, shockable rhythm on arrival, bystander witnessed and bystander CPR. In the metropolitan regions, no significant difference in survival to hospital discharge can be observed for adult patients. Furthermore, although a trend of decreasing odds of survival can be observed across rural regions, these trends were not statistically significant. It is worth noting that in some rural regions the number of cases which receive an attempt at resuscitation by paramedics may be small. This may lead to an increase in the 95% confidence interval and the degree of uncertainty in the results presented. Figure 50: Riskadjusted odds ratios of survival to hospital discharge for adult patients across DH regions of Victoria, 2011/12. 1 North & West Metropolitan Eastern Metropolitan Southern Metropolitan Barwon South West Grampians Loddon Mallee Hume Gippsland 0.1 1.0 10.0 Adjusted odds ratios (95% CI) 1. Adults > 15 years or missing age, who received EMS attempted resuscitation. Excludes EMS witnessed events. Adjusted odds ratios are adjusted for age, response time, gender, public location, shockable rhythm on arrival, bystander witnessed and bystander CPR. VACAR Annual Report 2011/12 Page 47
- Page 1 and 2: [Cover Page] VACAR Annual Report 20
- Page 3 and 4: Victorian Ambulance Cardiac Arrest
- Page 5 and 6: This document has been prepared by
- Page 7 and 8: Contents List of tables Page 9 List
- Page 9 and 10: List of tables Table 1: VACAR inclu
- Page 11 and 12: Figure 27: Direction of first bysta
- Page 13 and 14: Victorian Ambulance Cardiac Arrest
- Page 15 and 16: About this report While cardiovascu
- Page 17 and 18: Data capture Ambulance Victoria’s
- Page 19 and 20: Executive summary 1. There were 5,1
- Page 21 and 22: VACAR Annual Report 2011/12 Page 21
- Page 23 and 24: Frequency INCIDENCE Incidence of ad
- Page 25 and 26: Age Category (Years) DEMOGRAPHICS D
- Page 27 and 28: Age Category DEMOGRAPHICS Demograph
- Page 29 and 30: PRECIPITATING EVENTS Paediatric pre
- Page 31 and 32: Proportion LOCATION OF ARREST Arres
- Page 33 and 34: VACAR Annual Report 2011/12 Page 33
- Page 35 and 36: Time (Minutes) EARLY ACCESS Emergen
- Page 37 and 38: Time (Minutes) Survival EARLY DEFIB
- Page 39 and 40: [This page is blank] VACAR Annual R
- Page 41 and 42: VACAR Annual Report 2011/12 Page 41
- Page 43 and 44: Proportion SCENE OUTCOMES Return of
- Page 45: Proportion Survival SURVIVAL OUTCOM
- Page 49 and 50: QUALITY OF LIFE Discharge direction
- Page 51 and 52: Glossary of terms Table 6: Glossary
- Page 53 and 54: The VACAR group Table 8: Members of
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SURVIVAL OUTCOMES<br />
Risk-adjusted odds of adult survival by region<br />
Regional differences in cardiac arrest outcomes have been described across continents, cities,<br />
and population densities. Earlier work by <strong>VACAR</strong> (Jennings et al. MJA. 2006) demonstrated a<br />
significant disparity in survival outcomes across urban and regional areas of <strong>Victoria</strong>. Despite<br />
significant improvements to this trend over the last five years, <strong>VACAR</strong> continues to monitor<br />
regional disparity in resuscitation outcomes.<br />
Risk-adjusted odds of adult survival to hospital discharge across Department of Health regions<br />
of <strong>Victoria</strong> for the <strong>2011</strong>/<strong>12</strong> year are presented in Figure 50. Odds-ratios shown are adjusted for<br />
known predictors of survival including age, response time, gender, public location, shockable<br />
rhythm on arrival, bystander witnessed and bystander CPR. In the metropolitan regions, no<br />
significant difference in survival to hospital discharge can be observed for adult patients.<br />
Furthermore, although a trend of decreasing odds of survival can be observed across rural<br />
regions, these trends were not statistically significant.<br />
It is worth noting that in some rural regions the number of cases which receive an attempt at<br />
resuscitation by paramedics may be small. This may lead to an increase in the 95% confidence<br />
interval and the degree of uncertainty in the results presented.<br />
Figure 50: Riskadjusted<br />
odds ratios of<br />
survival to hospital<br />
discharge for adult<br />
patients across DH<br />
regions of <strong>Victoria</strong>,<br />
<strong>2011</strong>/<strong>12</strong>. 1<br />
North & West<br />
Metropolitan<br />
Eastern<br />
Metropolitan<br />
Southern<br />
Metropolitan<br />
Barwon<br />
South West<br />
Grampians<br />
Loddon Mallee<br />
Hume<br />
Gippsland<br />
0.1 1.0 10.0<br />
Adjusted odds ratios (95% CI)<br />
1. Adults > 15 years or missing age, who received EMS attempted resuscitation. Excludes EMS witnessed events. Adjusted odds<br />
ratios are adjusted for age, response time, gender, public location, shockable rhythm on arrival, bystander witnessed and<br />
bystander CPR.<br />
<strong>VACAR</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2011</strong>/<strong>12</strong> Page 47
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