International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template

Kylie Dyson, Siobhan P. Brown, Susanne May, Karen Smith, Rudolph W. Koster, Stefanie G. Beesems, Markku Kuisma, Ari Salo, Judith Finn, Fritz Sterz, Alexander Nürnberger, Laurie J. Morrison, Theresa M. Olasveengen, Clifton W. Callaway, Sang Do Shin, Jan Thorsten Gräsner, Mohamud Daya, Matthew Huei Ming Ma, Johan Herlitz, Anneli StrömsöeTom P. Aufderheide, Siobhán Masterson, Henry Wang, Jim Christenson, Ian Stiell, Gary M. Vilke, Ahamed Idris, Chika Nishiyama, Taku Iwami, Graham Nichol

Research output: Contribution to journalArticlepeer-review

80 Scopus citations


Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232). Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85–0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. Conclusions: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.

Original languageEnglish (US)
Pages (from-to)168-181
Number of pages14
StatePublished - May 2019


  • Emergency Medical Services
  • Out-of-hospital cardiac arrest
  • Outcomes
  • Survival
  • Utstein

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


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