Out-of-hospital cardiac arrest (OHCA) patients from minoritized communities have lower rates of initial shockable rhythm, which is linked to favorable outcomes. We sought to evaluate the importance of initial shockable rhythm on OHCA outcomes and factors that mediate differences in initial shockable rhythm. We performed a retrospective study of the 2013–2022 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES). Using census tract data, we stratified OHCAs into majority race/ethnicity communities: >50% White, >50% Black, and >50% Hispanic/Latino. We compared logistic regression models between community race/ethnicity and OHCA outcome: (1) unadjusted, (2) adjusting for bystander CPR (bCPR), and (3) adjusting for initial rhythm. Using structural equation modeling, we performed mediation analyses between community race/ethnicity, OHCA characteristics, and initial shockable rhythm. We included 22,730 OHCAs from majority White (21.1% initial shockable rhythm), 4,749 from majority Black (15.3% shockable), and 16,054 majority Hispanic/Latino (16.1% shockable) communities. Odds of favorable neurologic outcome were lower for majority Black (0.4 [0.3–0.5]) and Hispanic/Latino (0.6 [0.6–0.7]). While adjusting for bCPR minimally changed outcome odds, adjusting for shockable rhythm increased odds for Black (0.5 [0.4–0.5]) and Hispanic/Latino (0.7 [0.6–0.8]) communities. On mediation analysis for majority Black, the top mediators of initial shockable rhythm were public location (14.6%), bystander witnessed OHCA (11.6%), and female gender (5.7%). The top mediators for majority Hispanic/Latino were bystander-witnessed OHCA (10.2%), public location (3.52%), and bystander CPR (3.49%), Bystander-witnessed OHCA and public location were the largest mediators of shockable rhythm for OHCAs from minoritized communities.

中文翻译：

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德克萨斯州院外心脏骤停初始可电击节律的社区种族和种族差异的调节因素


来自少数群体的院外心脏骤停 (OHCA) 患者的初始可电击节律率较低，这与良好的预后相关。我们试图评估初始可电击心律对 OHCA 结果的重要性以及介导初始可电击心律差异的因素。我们对 2013-2022 年德克萨斯州心脏骤停登记处以提高生存率 (TX-CARES) 进行了回顾性研究。使用人口普查区数据，我们将 OHCA 按多数种族/族裔社区进行分层：>50% 白人、>50% 黑人和 >50% 西班牙裔/拉丁裔。我们比较了社区种族/族裔与 OHCA 结果之间的逻辑回归模型：(1) 未经调整，(2) 根据旁观者心肺复苏 (bCPR) 进行调整，以及 (3) 根据初始心律进行调整。使用结构方程模型，我们在社区种族/民族、OHCA 特征和初始可电击节律之间进行了中介分析。我们纳入了来自多数白人（21.1% 初始可电击节律）的 22,730 名 OHCA，来自多数黑人（15.3% 可电击）的 4,749 名 OHCA，以及 16,054 名多数西班牙裔/拉丁裔（16.1% 可电击）社区。大多数黑人（0.4 [0.3–0.5]）和西班牙裔/拉丁裔（0.6 [0.6–0.7]）获得良好神经系统结果的几率较低。虽然调整 bCPR 的结果发生率变化最小，但调整可电击节律增加了黑人 (0.5 [0.4–0.5]) 和西班牙裔/拉丁裔 (0.7 [0.6–0.8]) 社区的赔率。在对大多数黑人的中介分析中，初始可电击节律的首要中介是公共场所（14.6%）、目睹 OHCA 的旁观者（11.6%）和女性（5.7%）。对于大多数西班牙裔/拉丁裔来说，最主要的调解员是旁观者见证的 OHCA (10.2%)、公共场所 (3.52%) 和旁观者心肺复苏 (3.52%)。49%），旁观者见证的 OHCA 和公共场所是少数群体社区 OHCA 令人震惊的节奏的最大中介者。