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Ethnic differences in sudden cardiac arrest resuscitation
  1. Joanna Ghobrial1,2,
  2. Susan R Heckbert3,
  3. Traci M Bartz4,
  4. Gina Lovasi5,
  5. Erin Wallace6,
  6. Rozenn N Lemaitre1,
  7. April F Mohanty7,
  8. Thomas D Rea8,
  9. David S Siscovick9,
  10. Jean Yee1,
  11. M Sue Lentz1,
  12. Nona Sotoodehnia10
  1. 1Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA
  2. 2Department of Cardiology, University of California, Los Angeles, California, USA
  3. 3Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, Washington, USA
  4. 4Cardiovascular Health Research Unit and Department of Biostatistics, University of Washington, Seattle, Washington, USA
  5. 5Columbia University, New York, New York, USA
  6. 6Seattle Children's Research Institute, Seattle, Washington, USA
  7. 7Salt Lake City Veteran's Affairs, Salt Lake City, Utah, USA
  8. 8University of Washington, Seattle, Washington, USA
  9. 9New York Academy of Medicine, New York, New York, USA
  10. 10Cardiovascular Health Research Unit, Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Joanna Ghobrial, Department of Cardiology, University of California, Los Angeles, CA, 90024, USA; joannaghobrial{at}gmail.com

Abstract

Objective Ethnic differences in sudden cardiac arrest resuscitation have not been fully explored and studies have yielded inconsistent results. We examined the association of ethnicity with factors affecting sudden cardiac arrest outcomes.

Methods Retrospective cohort study of 3551 white, 440 black and 297 Asian sudden cardiac arrest cases in Seattle and King County, Washington, USA.

Results Compared with whites, blacks and Asians were younger, had lower socioeconomic status and were more likely to have diabetes, hypertension and end-stage renal disease (all p<0.001). Blacks and Asians were less likely to have a witnessed arrest (whites 57.6%, blacks 52.1%, Asians 46.1%, p<0.001) or receive bystander cardiopulmonary resuscitation (whites 50.9%, blacks 41.4%, Asians 47.1%, p=0.001), but had shorter average emergency medical services response time (mean in minutes: whites 5.18, blacks 4.75, Asians 4.85, p<0.001). Compared with whites, blacks were more likely to be found in pulseless electrical activity (blacks 20.9% vs whites 16.6%, p<0.001), and Asians were more likely to be found in asystole (Asians 41.1% vs whites 30.0%, p<0.001). One of the strongest predictors of resuscitation outcomes was initial cardiac rhythm with 25% of ventricular fibrillation, 4% of patients with pulseless electrical activity and 1% of patients with asystole surviving to hospital discharge (adjusted OR of resuscitation in pulseless electrical activity compared with ventricular fibrillation: 0.30, 95% CI 0.24 to 0.34, p<0.001, adjusted OR of resuscitation in asystole relative to ventricular fibrillation 0.21, 95% CI 0.17 to 0.26, p<0.001). Survival to hospital discharge was similar across all three ethnicities.

Conclusions While there were differences in some prognostic characteristics between blacks, whites and Asians, we did not detect a significant difference in survival following sudden cardiac arrest between the three ethnic groups. There was, however, an ethnic difference in presenting rhythm, with pulseless electrical activity more prevalent in blacks and asystole more prevalent in Asians.

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