Introducing the Crimean out-of-hospital cardiac arrest and resuscitation registry (COHCARR): Rationale, design and 6-month baseline data

Introduction: There is an urgent unmet need for establishing out-of-hospital cardiac arrest (OHCA) registries in the former Soviet Union countries. This article aims to provide a rationale and describe methodology of the Crimean out-of-hospital cardiac arrest and resuscitation registry (COHCARR), and report baseline information on OHCA epidemiology and emergency medical service (EMS) performance in the Republic of Crimea. Methods: COHCARR is designed to be a prospective population-based registry of all EMS-attended OHCA cases with resuscitation attempts, occurring in the Republic of Crimea. The population coverage is 1.91 million (100% inhabitants of the republic). The baseline descriptive analysis of OHCA with attempted resuscitation (January 01-June 30, 2018) has been performed following the Utstein methodology to provide a snapshot of OHCA problem in the region. Results: During the period, a total of 6,391 OHCA were attended by EMS. With that, resuscitation was attempted only in 196 cases (3.1%; median age 65 years, male 56%, shockable 16%). Most (95%) were witnessed by EMS or a bystander. Out of the bystander-witnessed cases (24%, n=47), bystander resuscitation was attempted in 19% (n=9). Return of spontaneous circulation (ROSC) was achieved in 6.6% patients, and 5.6% survived to hospital admission. Conclusions: The low rates of attempted resuscitation, ROSC and survival to hospital admission imply an opportunity to improve outcomes from OHCA in the Crimea. The registry will help to target reasonable cost-effective interventions and assess their effectiveness in the region. COHCARR may serve as a basic model for developing OHCA registries in other post-Soviet territories.