Racial differences in cardiac arrest survival: insights from Minnesota metro data and the University of Minnesota extracorporeal cardiopulmonary resuscitation cohort

Aims The study explores the association between race, survival and neurological outcomes among out-of-hospital cardiac arrest (OHCA) patients listed in Minnesota metro and the University of Minnesota Extracorporeal Cardiopulmonary Resuscitation (UMN-ECPR) program. Methods This retrospective study included OHCA patients with initial shockable rhythm from two distinct cohorts: the Minnesota metro CARES cohort, treated with conventional CPR and the UMN-ECPR database (2016–2023). Race was categorized as white or non-white. Good neurological outcome was defined as a Cerebral-Performance-Category score of 1–2. Logistic regression analyses examined survival by race, with primary models adjusted for age and gender and exploratory models further adjusted for witnessed status, location, bystander CPR, return-of-spontaneous-circulation, CPR duration. Results Of 2,700 OHCA patients in the CARES cohort, primarily treated with conventional CPR, 16.5 % were non-white. Compared to white patients, non-whites were younger (mean age 54.0 vs. 64.4 years), more often female (32.8 % vs. 23.6 %), and less likely to receive bystander CPR (52.2 % vs. 60 %). Non-white patients had lower age- and gender-adjusted odds of survival to discharge (OR: 0.64; 95 % CI, 0.5–0.82; p < 0.001) and favorable neurological outcome (OR: 0.48; 95 % CI, 0.35–0.64; p < 0.001). Among 414 ECPR patients (22.7 % non-white), non-white patients were younger (mean age 51 vs. 58.8 years) with lower bystander CPR rates (65.2 % vs. 74.8 %). There were no significant differences in age- and gender-adjusted survival (OR: 1.17; 95 % CI, 0.69–2; p = 0.554) or neurological outcome (OR: 1.07; 95 % CI, 0.61–1.88; p = 0.818). Conclusion Non-white race was linked to worse outcomes in the conventional CPR cohort but not in the ECPR cohort.