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Heart 1998;79:356-361; doi:10.1136/hrt.79.4.356
Copyright © 1998 BMJ Publishing Group Ltd & British Cardiovascular Society

Heart 1998;79:356-361 ( April )

Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors

J J M de Vreede-Swagemakers,a A P M Gorgels,a W I Dubois-Arbouw,a J Dalstra,a M J A P Daemen,b J W van Ree,c R E Stijns,d H J J Wellensa

a Department of Cardiology, University hospital of Maastricht, PO Box 5800, 6202 AZ Maastricht, Netherlands, b Department of Pathology, University Hospital of Maastricht, c Department of General Practice, University of Maastricht, d District Medical and Social Health Service of Southern Limburg, Maastricht, Netherlands.

Correspondence to: Dr de Vreede-Swagemakers.

Accepted for publication 5 January 1998

Objective---To study the circumstances and medical profile of out-of-hospital sudden cardiac arrest (SCA) patients in whom resuscitation was attempted by the ambulance service, and to identify causes of SCA in survivors and factors that influence resuscitation success rate.
Methods---During a five year period (1991-95) all cases of out-of-hospital SCA between the ages of 20 and 75 years and living in the Maastricht area in the Netherlands were studied. Information was gathered about the circumstances of SCA, as well as medical history for all patients in whom resuscitation was attempted by the ambulance personnel. Causes of SCA in survivors were studied and logistic regression analysis was performed to identify factors associated with survival.
Results---Of 288 SCA patients in whom cardiopulmonary resuscitation (CPR) and advanced life support were applied, 47 (16%) were discharged alive from the hospital. Their mean (SD) age was 58 (11) years, 37 (79%) were men, and 24 (51%) had a history of cardiac disease. Acute myocardial infarction was diagnosed in 24 (51%) of the survivors; seven with and 17 without a history of cardiac disease. Ventricular fibrillation (VF) or ventricular tachycardia (VT) as the first documented rhythm was significantly positively associated with survival (odds ratio (OR) 5.7, 95% confidence interval (CI) 2.1 to 15.9). A time interval of less than four minutes between the moment of collapse and the start of resuscitation, and an ambulance delay time of less than eight minutes were significantly positively associated with survival (OR 3.3, 95% CI 1.3 to 8.6, and OR, 3.6, 95% CI 1.3 to 10.5, respectively). A history of cardiac disease was negatively associated with survival (OR 0.46, 95% CI 0.21 to 0.98).
Conclusions---Acute myocardial infarction was the underlying mechanism of SCA in most of the survivors, especially in those without a history of cardiac disease. CPR within four minutes, an ambulance delay time less than eight minutes, and VT or VF diagnosed by the paramedics were positively associated with success.

Keywords: cardiac arrest;  sudden death;  cardiopulmonary resuscitation;  paramedics

© 1998 by Heart
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