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| Utstein style | |
|---|---|
| Name | Utstein style |
| Caption | Utstein Abbey, site of the 1991 consensus meeting |
| Discipline | Resuscitation science |
| Developed by | International liaison committee on resuscitation |
| First published | 1991 |
| Latest revision | 2004 |
Utstein style is a standardized template for reporting data from cardiac arrest and resuscitation research. It originated from a consensus meeting to harmonize outcomes reporting and has been adopted across clinical trials, registries, and guideline statements to improve comparability and meta-analysis. The framework influenced clinical protocols, registry design, and policy recommendations by international organizations and has been cited in numerous studies and guideline updates.
The Utstein process began at a 1991 meeting held at Utstein Abbey that convened representatives from the International Liaison Committee on Resuscitation, American Heart Association, European Resuscitation Council, Heart and Stroke Foundation of Canada, and researchers from institutions such as Harvard Medical School, University of Oslo, University of Copenhagen, University of Toronto, and Karolinska Institutet. Participants included experts affiliated with organizations like World Health Organization, National Institutes of Health, Centers for Disease Control and Prevention, and professional societies such as the American College of Cardiology and Royal College of Physicians. Subsequent consensus revisions involved committees from European Society of Cardiology, Society of Critical Care Medicine, International Federation for Emergency Medicine, and national registries including Resuscitation Council UK and Australian Resuscitation Council. Major updates were published following meetings linked to conferences like European Resuscitation Congress, American Heart Association Scientific Sessions, and forums at institutions including Mayo Clinic, Cleveland Clinic, and Johns Hopkins Hospital.
The Utstein template established core principles emphasizing standardized definitions, time-stamped event chronology, and hierarchical outcome reporting endorsed by bodies such as World Medical Association, International Committee of the Red Cross, and European Resuscitation Council. It prescribes categories for location and witness status aligning with datasets used by registries at King's College London, University College London, University of Melbourne, and University of Washington. The structure includes sections for patient demographics, arrest circumstances, interventions (e.g., by teams from St. Thomas' Hospital or Royal Brompton Hospital), and outcomes measured at intervals influenced by trial designs from Oxford University Clinical Research Unit and Vanderbilt University Medical Center.
Researchers applied the Utstein template in randomized trials run at centers like Stanford University School of Medicine, Yale School of Medicine, University of Pennsylvania, and multicenter networks such as European Cardiac Arrest Registry and Resuscitation Outcomes Consortium. Registries at Karolinska University Hospital, Mount Sinai Hospital, and Royal Melbourne Hospital adopted Utstein-style elements to compare prehospital care by services including London Ambulance Service, New York City EMS, Los Angeles County Fire Department, and Tokyo Fire Department. Guideline committees from American Heart Association, European Resuscitation Council, and International Liaison Committee on Resuscitation used Utstein metrics to assess interventions like targeted temperature management practiced at Massachusetts General Hospital and post-arrest coronary angiography protocols from Cleveland Clinic Foundation.
The template defines core data elements including arrest location (examples: home, public place, nursing home), witness status (witnessed by bystander, EMS personnel, physician), initial rhythm categories such as ventricular fibrillation, pulseless ventricular tachycardia, asystole, and pulseless electrical activity, and response intervals (collapse-to-CPR, collapse-to-defibrillation) standardized across studies from Johns Hopkins University, Duke University Medical Center, and University of California, San Francisco. It specifies outcome measures such as return of spontaneous circulation, survival to hospital admission, survival to hospital discharge, and neurologic outcome scales like Cerebral Performance Category and functional measures utilized in cohorts from University of Pittsburgh Medical Center and Brigham and Women's Hospital.
Implementation guidance recommends use of Utstein definitions in registry design by institutions like European Registry of Cardiac Arrest and protocol harmonization in trials led by Resuscitation Outcomes Consortium and International Liaison Committee on Resuscitation. Reporting checklists parallel initiatives from Consolidated Standards of Reporting Trials and align with data standards from Observational Medical Outcomes Partnership and Health Level Seven International where applicable. Training for data collection has been provided by academic centers including University of Oxford, McGill University, and Seoul National University Hospital and through collaborations with emergency services such as Sydney Ambulance Service and Toronto Paramedic Services.
Adoption of the Utstein template enabled pooled analyses and meta-analyses by groups at Cochrane Collaboration, Institute for Health Metrics and Evaluation, and academic consortia, improving evidence synthesis for interventions evaluated at Vanderbilt Medical Center, Beth Israel Deaconess Medical Center, and Northwestern Memorial Hospital. Standardized reporting contributed to benchmarking efforts in systems of care across regions including Scandinavia, North America, Europe, and Asia-Pacific and informed policy changes promoted by World Health Organization initiatives and national health agencies like Public Health England and Canadian Institute for Health Research.
Critics from centers including University of Toronto, University of Sydney, and University of Cape Town have pointed to limitations such as potential insensitivity to regional EMS differences (e.g., practices in Japan, Brazil, South Africa), challenges in capturing long-term neurological outcomes tracked by centers like University of Bern and Charité – Universitätsmedizin Berlin, and the administrative burden noted by municipal services such as Chicago Fire Department and Los Angeles County EMS. Authors affiliated with BMJ, The Lancet, and New England Journal of Medicine have debated the need for expanded variables to reflect precision medicine approaches championed at Broad Institute and Sanger Institute.
Category:Resuscitation