Performance of an established system of first responder out-of-hospital defibrillation. The results of the second year of the Heartstart Scotland Project in the ‘Utstein Style’

doi:10.1016/0300-9572(93)90166-N

Resuscitation

Volume 26, Issue 1, August 1993, Pages 75-88

https://doi.org/10.1016/0300-9572(93)90166-N Get rights and content

Abstract

The Heartstart Scotland project for out-of-hospital defibrillation covers the whole of Scotland, a population of approximately 5 102 400 (14.9% > 65 years, 48.3% male). All 395 ambulances in Scotland have been equipped with an automated external defibrillator and crews are trained in basic cardiopulmonary resuscitation and defibrillator use (EMT-D). Between 1 May 1990 and 30 April 1991 a total of 1700 cardiac arrests was reported by the ambulance service. Of the 1676 arrests which we could trace, 63% were witnessed. A total of 1383 (83%) of all patients were declared dead on arrival at hospital or in the emergency department, 119 (7%) died in hospital and 174 (10%) were discharged alive. Of the 174 survivors, 87% were conscious and normal at discharge, 9% had moderate residual disability and 2% severe disability. Survival of patients discharged alive from hospital was 85% at 1 year. Defibrillation was undertaken in 71% of the reported cardiac arrests. Survival of bystander witnessed arrests was increased from 7 to 15% with bystander CPR (P < 0.005). If the cardiac arrest was witnessed by the ambulance crew and required defibrillation, survival to discharge was 39%. Of bystander witnessed arrests reached while still in VF (n = 643), 11% were discharged alive. Patients who were defibrillated within 4 min of arrest had a 43% survival rate to hospital discharge.

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The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.
This was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.
Data on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.
The results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.
EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events.
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One RCT (LOE 1)197, four prospective controlled cohort studies (LOE 2)357–360, one study using historical controls (LOE 3)361, nine observational studies (LOE 4)226,227,362–368, and one mathematical modeling study (LOE 5)369 showed that AED programs are safe and feasible and significantly increase survival of out-of-hospital ventricular fibrillation (VF) cardiac arrest if the emergency response plan is effectively implemented and sustained. For EMS programs, 10 studies (LOE 1370; LOE 2358; LOE 3224,371,372; LOE 4373–377) supported AED use; 11 studies (LOE 2378,379; LOE 3380–383; LOE 4384–388) were neutral, and two meta-analyses359,389 suggested benefit. For first-responder use, two studies (LOE 2390; LOE 3391) supported use of AEDs by fire or police first responders, but six studies (LOE 1392; LOE 2393; LOE 3394–396; LOE 4397) were neutral.
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A few studies have reported demographic trends and survival in patients who arrested after arrival as their primary objective.7–14 Additionally, other studies have reported data on patients who arrested after arrival secondary to other purposes.15–27 Like our study, most of these papers reported around 10% of all cardiac arrests occurred after arrival of EMS, though proportions varied from less than 5% in Ketchikan, Alaska20 and Alachua County, Florida,25 to over 30% on San Juan Island, Washington.15
Many of the factors that affect survival from out-of-hospital cardiac arrest are not relevant in patients who arrest after arrival of emergency medical services (EMS). Because all arrests that occur after arrival of EMS are witnessed and care is immediate, one might expect survival to be very high. Several studies have described communities’ experiences of arrest after arrival but few have compared survival rates stratified by rhythm and witness status. The purpose of this paper was to describe the characteristics of patients who arrested after arrival of EMS and to compare survival in this population to those who had witnessed and unwitnessed arrests before EMS arrival.
We conducted a retrospective cohort study in King County, WA, USA. Descriptive statistics were calculated in patients whose arrests were not witnessed, in patients whose arrests were witnessed by citizens, and in those whose arrests were witnessed by EMS personnel.
The majority of bystander- and EMS-witnessed arrests were initially in ventricular fibrillation (VF), but EMS-witnessed arrests were more likely to initially have been in pulseless electrical activity (PEA) than bystander-witnessed events. Patients whose arrests were witnessed by EMS had the greatest likelihood of survival compared to patients whose arrests were not witnessed or were witnessed by bystanders. Patients whose arrests were witnessed by EMS and were initially in VF had the highest rates of survival (59%).
Patients whose arrests were witnessed by EMS were more likely to have survived their cardiac arrests than those who arrested before EMS arrived. We suggest that survival rates from VF arrests that occur after EMS arrival should be widely reported in order to measure overall EMS performance since many factors such as response times, bystander actions, and witness status are equalized in this subset of patients.
Evaluation of the Outcome of Out-of-Hospital Cardiac Arrest Resuscitation Efforts in Denizli, Turkey
2008, Journal of Emergency Medicine
Citation Excerpt :
In the literature, overall revival rates for patients who suffered OHCA have been reported to vary between 1.4% and 23% (10,13). Only a minority of patients (4–35%) after OHCA are discharged alive from the hospital (8,22–25). When we compared several studies reported from other countries with similar EMS systems to ours it was observed that, in a study of 266 patients with treated OHCA, return of spontaneous circulation was achieved in 83 (31%) patients, 31 (12%) were discharged alive (26).
The objective of this study was to evaluate the outcomes and associated factors for short-term success and long-term survival rates of resuscitated non-traumatic out-of-hospital cardiac arrest (OHCAs) in Denizli, Turkey. All non-traumatic OHCA patients from the Emergency Departments of the Pamukkale University and City Hospitals between the dates of January 1, 2004 and March 1, 2005 were included in this study. A successful outcome was defined as the return of spontaneous circulation or breathing, or evidence of a palpable pulse or a measurable blood pressure. Information on post-resuscitation long-term survival up to 9 months also was obtained by telephone. A total of 222 adults experiencing OHCAs were resuscitated. The number of successful outcomes was 85 (38.3%); 25 (11.2%) were discharged alive; and 21 (9.4%) were alive at the 9-month follow-up. The predicted mean arrest time was 11.7 min (95% confidence interval 10.27–13.2). Type of transportation to the Emergency Department (ambulance, 32.1% vs. private vehicle, 44.5%; p = 0.057), place of arrest (home, 32.6% vs. other, 44.0%; p = 0.08), first rhythm at the scene (asystole, 22.9% vs. ventricular fibrillation-pulseless ventricular tachycardia, 48.0%, vs. pulseless electrical activity, 12.5%; p = 0.056), and advanced cardiac life support starting time (the first 8 min, 46.8% vs. later than 8 min, 32.0%; p = 0.025) had an effect on outcome. Intensive public education for diagnosis and appropriate reporting of OHCA, the importance of bystander cardiopulmonary resuscitation, and the use of automated external defibrillators have an impact on the potential to increase the number of survivors.
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Citation Excerpt :
In a population-based report from Maastricht, the incidence of sudden out-of-hospital cardiac arrest was 97/100,000 per year in the age range of 20–75 years. The incidence of cardiopulmonary resuscitation (CPR) attempts range from 33 to 100 per year/100,000 population.2,3 In this study, all the 605 NPSD cases were local residents of Macau.
To understand the epidemiology of non-traumatic prehospital sudden death (NPSD) in Macau, and to discuss potential diseases related to NPSD.
We analysed the epidemiological characteristics of 605 NPSD cases occurred between January 1, 2003 and December 31, 2005 in Macau. Four hundred NPSD victims’ medical records were reviewed to collect information regarding associated diseases.
NPSD was more common in males than females (56.5% versus 43.5%). Male patients were 7.9 years younger than female patients (68.8 ± 17.7 versus 76.7 ± 16.7, p = 0.000). NPSD had a higher incidence in the months December to March. There were 21.8 NPSD cases per month on an average during this period. NPSD occurred more frequently during daylight hours. The following diagnoses were frequently found in the patients’ medical records: hypertension (39.5%), cerebral vascular accident (18.5%), type 2 diabetes mellitus (17.8%), congestive heart failure (13.3%), chronic renal failure (11.3%), and chronic obstructive pulmonary disease (11%). Coronary artery disease was diagnosed in only 9.2% in all NPSD cases.
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Performance of an established system of first responder out-of-hospital defibrillation. The results of the second year of the Heartstart Scotland Project in the ‘Utstein Style’

Abstract

Am Heart J

Resuscitation

Resuscitation

J Am Coll Cardiol

Ann Emerg Med

Improving survival from sudden cardiac arrest: the “chain of survival” concept

Circulation

Treatment of outof-hospital cardiac arrests with rapid defibrillation by emergency medical technicians

New Engl J Med

Improved neurological recovery and survival after early defibrillation

Circulation

Automatic external defibrillators used by emergency medical technicians

J Am Med Assoc

Efficacy of an automated external defibrillator in the management of out of hospital cardiac arrest: validation of the diagnostic algorithm and initial experience in a rural environment

Circulation

Recommended guidelines for uniform reporting of out-of-hospital cardiac arrest: the Utstein style

Circulation