This study compared cardiac arrest outcomes between Detroit, Michigan (DEMCA) and Genesee County, Michigan (GCMCA) from 2017-2021. DEMCA had significantly higher rates of poverty, unemployment, and African American patients compared to GCMCA. While bystander witnessed arrests and CPR rates were higher in DEMCA, survival rates were significantly lower - only 1.9% survived with good neurological outcomes in DEMCA compared to 5.5% in GCMCA. Socioeconomic factors likely contributed to the differences in outcomes between the two regions. Further work is needed to improve cardiac arrest survival, especially in communities with higher poverty and unemployment.

1. Tale of Two Cities: Cardiac Arrest Outcomes
in Flint and Detroit, Michigan
Ryan Reece, MD

2. Disclosures
• None

3. Collaborators
Ryan Reece, MD – Assistant Professor, University of Michigan
James A. Cranford, PhD – Associate Research Scientist, University of Michigan
Robert Dunne, MD – Professor, Wayne State University
Ryan Silvagi, EMT-P – Research Assistant, Wayne State University
Damon Gorelick, EMT-P/IC – Director of Operations, Detroit East Medical
Control Authority
Erin Brennan, MD – Clinical Assistant Professor, Wayne State University
Stefanie Wise, MD – Clinical Assistant Professor, Wayne State University
Howard A. Klausner, MD – Clinical Associate Professor, Wayne State
University

4. Introduction
• Out-of-hospital cardiac arrest (OHCA) remains a major public health
problem despite the advances and research into improving outcomes.
• Previous research indicates that areas with lower socioeconomic status
(SES) have lower bystander CPR and AED application rates.
• Two regions in Michigan (Detroit and Genesee County) are characterized
by relatively poor OHCA outcomes.
• Detroit scores lower than Genesee County on indicators of SES.

5. Hypothesis
OHCA characteristics and patient outcomes would be worse
in the Detroit area when compared to Genesee County.

6. Methods
• IRB reviewed and exempt project
– Approvals from EMS agencies and MCAs
• Review of Cardiac Arrest Registry to Enhance Survival
(CARES) Data
• Genesee County and Detroit East Medical Control
Authorities; GCMCA & DEMCA
• Year 2017 – 2021
• Demographics, Socioeconomic Status/Census Tract
Data, Resuscitation Data, Outcome Data

7. Methods
Between-region differences (DEMCA vs. GCMCA) in were
analyzed with independent-samples t-tests, chi-squared tests,
and quantile regression for medians.

8. Results/Demographics
• DEMCA
– 7381 Cardiac Arrests
– Mean Age 60.7
– Male 56.6%
– Black/AA 82.5%
– White 13.2%
• GCMCA
– 821 Cardiac Arrests
– Mean Age 61.8
– Male 58.3%
– Black/AA 25%
– White 61.8%
• Arrests <30% Poverty
– DEMCA 61%
– GCMCA 32.2%
• P<.001
• Unemployment
– DEMCA 15.3%
– GCMCA 6.8%
• P<.001

9. Demographic Differences: DMCA vs. GCMCA
61.0%
15.3%
82.5%
32.2%
6.8%
25.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Very High Poverty (≥30% below
FPL)
Median Unemployment Rate Percent African-American
DEMCA
GCMCA
p<.001
p<.001
p<.001

10. 32.9%
37.9%
14.7%
24.5%
34.8%
30.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Bystander Witnessed Arrest Bystander CPR Sustained ROSC
DEMCA
GCMCA
p<.001
p=.01
p<.001
Outcome Differences: DMCA vs. GCMCA

11. 18.2%
4.9%
1.9%
25.2%
8.3%
5.5%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Survival to Hospital Admission Survival to Hospital Discharge Survival with CPC 1 or 2
DEMCA
GCMCA
p<.001
p<.001
p<.001
Survival Differences: DMCA vs. GCMCA

12. 1.9%
5.5%
6.7%
7.8%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
DEMCA GCMCA Michigan USA
Survival with CPC 1 or 2

13. Conclusion
• The DEMCA system had worse cardiac arrest
outcomes when compared to GCMCA.
• However, the DEMCA system was more likely to
witness and perform bystander CPR.
• Socioeconomic status may play a larger role.
• Additional work is needed to improve the chain
of survival in these communities.

14. References
• Berdowski, Jocelyn, Robert A. Berg, Jan G. P. Tijssen, and Rudolph W. Koster. 2010. “Global Incidences of out-of-Hospital Cardiac Arrest and Survival
Rates: Systematic Review of 67 Prospective Studies.” Resuscitation 81 (11): 1479–87.
• Berger, David A., Nai-Wei Chen, Joseph B. Miller, Robert D. Welch, Joshua C. Reynolds, James M. Pribble, Robert A. Swor DO, and CARES Surveillance
Group. 2021. “Substantial Variation Exists in Post-Cardiac Arrest Outcomes across Michigan Hospitals.” Resuscitation 159 (February): 97–104.
• Cummins, R. O., D. A. Chamberlain, N. S. Abramson, M. Allen, P. J. Baskett, L. Becker, L. Bossaert, H. H. Delooz, W. F. Dick, and M. S. Eisenberg. 1991.
“Recommended Guidelines for Uniform Reporting of Data from out-of-Hospital Cardiac Arrest: The Utstein Style. A Statement for Health
Professionals from a Task Force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada,
and the Australian Resuscitation Council.” Circulation 84 (2): 960–75.
• Hallstrom, A. P., J. P. Ornato, M. Weisfeldt, A. Travers, J. Christenson, M. A. McBurnie, R. Zalenski, et al. 2004. “Public-Access Defibrillation and
Survival after out-of-Hospital Cardiac Arrest.” The New England Journal of Medicine 351 (7): 637–46.
• Lerner, E. Brooke, Thomas D. Rea, Bentley J. Bobrow, Joe E. Acker 3rd, Robert A. Berg, Steven C. Brooks, David C. Cone, et al. 2012. “Emergency
Medical Service Dispatch Cardiopulmonary Resuscitation Prearrival Instructions to Improve Survival from out-of-Hospital Cardiac Arrest: A Scientific
Statement from the American Heart Association.” Circulation 125 (4): 648–55.
• McNally, Bryan, Allen Stokes, Allison Crouch, Arthur L. Kellermann, and CARES Surveillance Group. 2009. “CARES: Cardiac Arrest Registry to Enhance
Survival.” Annals of Emergency Medicine 54 (5): 674–83.e2.
• Meaney, Peter A., Bentley J. Bobrow, Mary E. Mancini, Jim Christenson, Allan R. de Caen, Farhan Bhanji, Benjamin S. Abella, et al. 2013.
“Cardiopulmonary Resuscitation Quality: [corrected] Improving Cardiac Resuscitation Outcomes Both inside and Outside the Hospital: A Consensus
Statement from the American Heart Association.” Circulation 128 (4): 417–35.
• Nakamura, Fumiaki, Yasuaki Hayashino, Tatsuya Nishiuchi, Naoki Kakudate, Misa Takegami, Yosuke Yamamoto, Shin Yamazaki, and Shunichi
Fukuhara. 2013. “Contribution of out-of-Hospital Factors to a Reduction in Cardiac Arrest Mortality after Witnessed Ventricular Fibrillation or
Tachycardia.” Resuscitation 84 (6): 747–51.
• Wallace, Sarah K., Benjamin S. Abella, and Lance B. Becker. 2013. “Quantifying the Effect of Cardiopulmonary Resuscitation Quality on Cardiac Arrest
Outcome.” Circulation. Cardiovascular Quality and Outcomes 6 (2): 148–56.
• Wik, Lars, Jo Kramer-Johansen, Helge Myklebust, Hallstein Sørebø, Leif Svensson, Bob Fellows, and Petter Andreas Steen. 2005. “Quality of
Cardiopulmonary Resuscitation during out-of-Hospital Cardiac Arrest.” JAMA: The Journal of the American Medical Association 293 (3): 299–304.