Disparities in Emergency Medical Services Termination of Resuscitation Practices for Patients with Out-of-Hospital Cardiac Arrest.

Abstract

Objectives: There are well-described racial, ethnic, and gender-based inequities following out-of-hospital cardiac arrest (OHCA). Few studies have analyzed disparities in emergency medical services (EMS) termination of resuscitation (TOR) practices. This purpose of this study was to identify inequities in duration of prehospital resuscitation prior to TOR.

Methods: A retrospective cohort of adult (≥18 years-old), non-traumatic OHCA events in a single metropolitan, fire-based EMS system was evaluated. Duration of resuscitation prior to prehospital TOR was separately evaluated among racial/ethnic (Black, Hispanic, and White) and gender (Female and Male) groups using a multivariable linear regression model. Variables in the model included bystander cardiopulmonary resuscitation (CPR) provision, arrest witnessed status, initial rhythm (shockable versus non-shockable), and patient age. Multiple imputation was used to account for missing data entries where duration of resuscitation was not documented. Incidence of hospital transport between racial/ethnic and gender groups was also assessed.

Results: Between February 1, 2020 and February 28, 2023, 3700 patients met inclusion criteria, of which 1895 (51.2%) had field TOR and 1328/1895 had a documented time of TOR. When controlling for arrest witnessed status, bystander CPR provision, initial shockable rhythm, and subject age, Black race (24.1 minutes (95% confidence interval 21.2-27.0, p < 0.001)) and Hispanic ethnicity (23.7 minutes (95% CI 20.0-27.5, p = 0.03)) were associated with shorter duration of resuscitation compared to White race (25.8 minutes (95% CI 23.9-27.7)). These racial inequities persisted when using multiple imputation modeling. There was no difference in duration of resuscitation between female (24.3 minutes (95% CI 22.4-26.2)) and male gender (24.7 minutes (95%CI 21.8-27.5), p = 0.46). There were no differences in incidence of hospital transport.

Conclusions: This study identified inequities in prehospital termination of resuscitation practices following OHCA. Black and Hispanic patients, as compared to White patients, received approximately 2-minute-shorter prehospital resuscitative efforts prior to TOR despite controlling for bystander CPR, witnessed status, initial rhythm, and patient age. There were no gender-based differences in prehospital duration of resuscitation.