From the Guidelines
The Utstein guideline for resuscitation performance is a standardized framework for reporting out-of-hospital cardiac arrest (OHCA) data, which includes core elements such as system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes, as well as supplemental elements that may be applicable to research-oriented systems or special resuscitation circumstances 1.
Key Components of the Utstein Guideline
- The Utstein template provides a framework for combining core elements of resuscitation performance for OHCA, including community response, EMS treatments, and hospital systems of care 1.
- The template follows the natural flow of the patient through community, out-of-hospital, and in-hospital systems of care, and encompasses core system structure, process, and outcome of care, as well as performance measures 1.
- Outcomes are defined at 4 levels: any ROSC, survived event, survived to discharge, and favorable neurological outcome at discharge if known, with the option to report survival to 30 days as an alternative to survival to discharge 1.
- The template allows reporting of the bystander-witnessed cardiac arrest who had a first recorded rhythm that was shockable, which is recommended as the Utstein comparator of system efficacy, and all EMS-treated cardiac arrests are recommended for system effectiveness comparisons 1.
Implementation and Challenges
- Implementation of the Utstein template has improved transparency and comparability of reports, but challenges lie ahead, particularly in the balance of feasibility versus desirability of data elements 1.
- Recognition and focus on a core outcome comparator, such as bystander-witnessed, shockable cardiac arrest, may offer a universal comparator for all systems, as a tracer methodology for efficacy in all systems 1.
- Increased implementation of the updated consensus definitions and reporting templates will inform and improve future formulas for survival and enable meta-analysis and inclusion of larger numbers of patients in studies of cardiac arrest where appropriate 1.
History and Development
- The Utstein template was first developed in 1990 and has undergone several updates, including a revision in 2004 that broadened the focus to include all EMS-treated cardiac arrests irrespective of first monitored rhythm and whether or not the arrests were witnessed 1.
- The 2015 update of the Utstein template reflects consensus on the need to account for EMS system factors, increasing availability of automated external defibrillators, variability in the data collection process, trends in epidemiology, and emerging field treatments, among other factors 1.
From the Research
Utstein Template Guideline
The Utstein template is a standardized reporting framework for cardiac arrest and cardiopulmonary resuscitation outcome reports. The guideline was first introduced in 1991 and has undergone several updates, with the most recent update being in 2024 2. The template provides a structured framework for comparing systems of care for cardiac arrest, both in-hospital and out-of-hospital.
Key Components of the Utstein Template
The Utstein template includes core and supplementary data elements, which are grouped into several categories, including:
- Hospital factors
- Patient variables
- Pre-event factors
- Cardiac arrest and postresuscitation processes
- Outcomes These elements are classified as core or supplemental, with core variables being considered essential for quality improvement programs and supplementary variables being useful for research purposes 3.
Updates to the Utstein Template
The Utstein template has undergone several updates, with changes reflecting advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes 2. The updates have also aimed to elevate data collection and reporting transparency by registries and researchers, and to advance international comparisons and collaborations.
Implementation of the Utstein Template
The Utstein template has been implemented in various regions, with studies showing improvements in survival rates and outcomes for patients with out-of-hospital cardiac arrest 4. The template has also been used to identify factors linked to improved survival, such as bystander cardiopulmonary resuscitation and the use of shockable rhythms.
Benefits of the Utstein Template
The Utstein template provides a standardized framework for reporting cardiac arrest and cardiopulmonary resuscitation outcomes, allowing for comparisons between systems of care and identification of areas for improvement. The template has been shown to be effective in improving outcomes for patients with out-of-hospital cardiac arrest, with one study finding that good outcome is achievable in every fourth resuscitation attempt 4. The Utstein template has also been recognized as a key component of resuscitation science, implementation, and outcomes, with a sustained and far-reaching impact on the field 5.