Evaluation of outcome following cardiac arrest in patients presenting to two Scottish emergency departments
Abstract
Objectives: To compare and contrast outcomes following cardiac arrest managed in two Accident and Emergency departments, and to identify factors which might account for such differences. Design: Prospective 1-year evaluation of patients sustaining an out-of-hospital cardiac arrest. Setting: The Accident and Emergency departments of the Edinburgh (ERI) and Glasgow (GRI) Royal Infirmaries which serve two large urban municipalities. Patients: All patients sustaining a prehospital cardiac arrest and brought to ERI or GRI were included. Children (<13 years), those declared dead on arrival at the scene, and events related to poisoning, near drowning, trauma and pregnancy were excluded. Measurements and main results: There were 297 prehospital arrests from ERI, and 158 from GRI. Eighty-two (27.6%) were admitted as ‘in-patients’ to ERI and 23 (14.6%) to GRI (P < 0.01). Thirty-nine (13.1%) survived to hospital discharge from ERI; 13 (8.2%) survived to discharge from GRI (NS). The proportion of :Asystole observed was significantly different between the two centres — 162:98 from ERI, 54:73 from GRI (P < 0.001). Significantly more prehospital arrests were witnessed and received bystander CPR in those brought to ERI (P < 0.02). For the combined VF/VT/Asystole groups the ERI ambulance response times were significantly shorter (P < 0.01). However, there was no significant difference in the collapse to EMS arrival at the scene times between ERI and GRI. Two survivors from ERI had asystole as their initial observed rhythm. From GRI, one survivor had asystole, one had electromechanical dissociation and in another the initial rhythm was unknown. No survivor to discharge had severe neurological disability. Conclusions: Patients suffering out-of-hospital cardiac arrests in Edinburgh have a significantly better chance of being admitted to a ward. There is a trend favouring better survival to discharge in Edinburgh, but with the numbers investigated this does not achieve statistical significance. Amongst those factors which contribute to survival there are fewer witnessed arrests, less bystander CPR and slower ambulance response times in those brought to GRI. There is a need to investigate the environment in which patients collapse, to train the public in CPR, and to review the efficiency and resourcing of the ambulance service.
References (13)
- ML Sedgwick et al.
Performance of an established system of first responder out-of-hospital defibrillation. The results of the Heartstart Scotland Project in the ‘Utstein Style’
Resuscitation
(1993) - KA Hossmann
Ischaemia-related neuronal injury
Resuscitation
(1993) - CE Robertson et al.
Cardiorespiratory resuscitation in the accident and emergency department
Arch Emerg Med
(1984) Guidelines for basic life support
BMJ
(1993)- DW Hamer et al.
Survival from cardiac arrest in an accident and emergency department: the impact of out of hospital advisory defibrillation
Resuscitation
(1993) - S Cusack et al.
Flying squad response to out-of-hospital arrest — a decade of experience
Arch Emerg Med
(1992)
Cited by (24)
Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies
2010, ResuscitationThe aim of this investigation was to estimate and contrast the global incidence and outcome of out-of-hospital cardiac arrest (OHCA) to provide a better understanding of the variability in risk and survival of OHCA.
We conducted a review of published English-language articles about incidence of OHCA, available through MEDLINE and EmBase. For studies including adult patients and both adult and paediatric patients, we used Utstein data reporting guidelines to calculate, summarize and compare incidences per 100,000 person-years of attended OHCAs, treated OHCAs, treated OHCAs with a cardiac cause, treated OHCA with ventricular fibrillation (VF), and survival-to-hospital discharge rates following OHCA.
Sixty-seven studies from Europe, North America, Asia or Australia met inclusion criteria. The weighted incidence estimate was significantly higher in studies including adults than in those including adults and paediatrics for treated OHCAs (62.3 vs 34.7; P < 0.001); and for treated OHCAs with a cardiac cause (54.6 vs 40.8; P = 0.004). Neither survival to discharge rates nor VF survival to discharge rates differed statistically significant among studies. The incidence of treated OHCAs was higher in North America (54.6) than in Europe (35.0), Asia (28.3), and Australia (44.0) (P < 0.001). In Asia, the percentage of VF and survival to discharge rates were lower (11% and 2%, respectively) than those in Europe (35% and 9%, respectively), North America (28% and 6%, respectively), or Australia (40% and 11%, respectively) (P < 0.001, P < 0.001).
OHCA incidence and outcome varies greatly around the globe. A better understanding of the variability is fundamental to improving OHCA prevention and resuscitation.
Incidence of EMS-treated out-of-hospital cardiac arrest in Europe
2005, ResuscitationThe potential impact of efforts in Europe to improve survival from out-of-hospital cardiac arrest is unclear, in part, because estimates of incidence and survival are uncertain. The aim of the investigation was to determine a representative European incidence and survival from cardiac arrest in all-rhythms and in ventricular fibrillation treated by the emergency medical services (EMS).
We used Medline to identify peer-reviewed articles published between 1 January 1980 and 30 June 2004 that reported a European community's EMS cardiac arrest experience. Inclusion criteria required the study to include at least 25 cases, report of the total number of all-rhythm and/or ventricular fibrillation arrests, and information about population size and study duration. The incidence was computed by dividing the total number of events by the product of the community's population and the study duration.
Reports from 37 communities met the inclusion criteria. A total of 18,105 all-rhythm EMS-treated cardiac arrests occurred during 48 million person-years of observation, resulting in an overall incidence for all-rhythm arrests of 37.72 per 100,000 person-years. Incidence of ventricular fibrillation arrest was 16.84 per 100,000 person-years. Survival was 10.7% for all-rhythm and 21.2% for ventricular fibrillation cardiac arrest. Applying these results to the European population, approximately, 275,000 persons would experience, all-rhythm cardiac arrest treated by the EMS with 29,000 persons surviving to hospital discharge.
The results provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of cardiac arrest in Europe.
Emergency system prospective performance evaluation for cardiac arrest in Lombardia, an Italian region
2002, ResuscitationBackground: The aim of this research is to evaluate quality of out-of-hospital medical services in our country, using performance indicators and a new computerised database. Methods: (a) Experimental design: Data were collected prospectively in three emergency dispatch centres for 90 days. Follow-up was evaluated at 1 day and 1 month after the event. This paper presents data on the cardiac arrest cohort only. (b) Setting: Three emergency dispatch centres in Lombardia. (c) Patients: One hundred and seventy-eight patients in non-traumatic cardiac arrest were enrolled. (d) Interventions: None. The study was observational only. Results: Mean interval between phone call and arrival on scene was 8.5±3.5 min. BLS manoeuvres were carried out from bystanders only in 15% of the cohort; this was associated with significant mortality reduction (85.7 versus 95.8%, χ2 P<0.05). One hundred and thirty-three patients (75%) received assistance from BLS crews while only 45 patients (25%) were assisted by ALS medical personel, with a significant mortality reduction (ALS deaths 86.7%, BLS deaths 97%). Total 24 h survival was 9% and survival at 1 month declined to 6.17%. Conclusions: Quality monitoring produces objective information on interventions and outcomes. Only with this information, is it possible to implement improvement programmes that are planned according to the data presented.
Contexto: Poucos dados estão disponı́veis, no nosso paı́s, relativos á qualidade dos sistemas de emergência. O objectivo deste estudo é avaliar a qualidade dos serviços médicos extra-hospitalares utilizando indicadores de desempenho e uma nova base de dados computadorizada. Métodos: (a) Desenho experimental: Os dados foram coligidos prospectivamente em três centros de orientação de emergência durante 90 dias. A evolução foi avaliada um dia e 1 mês após o evento. Este artigo apresenta apenas os dados do coorte com paragem cardı́aca. (b) Local: Três centros de orientação de emergência na Lombardia. (c) Doentes: Foram envolvidos 178 doentes com paragem cardı́aca não associada a trauma. (d) Intervenções: Nenhuma. O estudo foi apenas observacional. Resultados: O intervalo médio entre a chamada telefónica e a chegada ao local foi de 8.5±3.5 min. Estavam a ser prestadas manobras de SBV pelas testemunhas em apenas 15 % do coorte; este dado associou-se a uma redução significativa da mortalidade (85.7 versus 95.8%, χ2 P<0.05). Cento e trinta e três doentes (75%) receberam assistência por equipes de SBV enquanto 45 doentes (25%) foram assistidos por pessoal médico com qualificação em SAV, com uma redução significativa da mortalidade (mortes com SAV 86.7%, mortes com SBV 97%). A sobrevivência total às 24h foi de 9% e diminuiu para 6.17% ao fim de 30 dias. Conclusões: a monitorização da qualidade produz informação objectiva sobre as intervenções e resultados. Apenas com esta informação é possı́vel implementar programas de melhoria que são planeados de acordo com os dados apresentados.
Antecedentes: En nuestro paı́s existen pocos datos disponibles acerca de la calidad de los sistemas de emergencia. El objetivo de esta investigación es evaluar la calidad de los servicios médicos prehospitalarios, usando indicadores de desempeño y una nueva base de datos computarizada. Métodos: (a) Diseño experimental: Se recolectaron prospectivamente los datos en tres centros de despacho durante 90 dı́as. Se realizó una evaluación de seguimiento al dı́a y al mes después del evento. Este artı́culo presenta datos en cohorte de paro cardı́aco solamente. (b) escenario: Tres centros de despacho de emergencias en Lombardı́a. (c) Pacientes: Se enrolaron 178 pacientes en paro cardı́aco no traumático. (d) Intervenciones:Ninguna. El estudio fue solamente observacional. Resultados: El intervalo promedio entre llamada telefónica y llegada a la escena fue 8.5±3.5 min. Se realizaron maniobras de soporte vital básico por testigos solamente en un 15% de la cohorte; esto se asoció con reducción significativa de la mortalidad (85.7 versus 95.8%, χ2 P<0.05). Ciento treinta y tres pacientes (75%) recibieron asistencia de equipos de soporte vital básico (BLS), mientras que solo 45 pacientes (25%) fueron asistidos por personal de salud de soporte vital avanzado (ALS), con una reducción significativa de la mortalidad (ALS 86.7% muertes, BLS 97% muertes). La sobrevida total a las 24 horas fue de 9% y declino hasta 6.17 al mes. Conclusiones: El monitoreo de la calidad produce información objetiva acerca de las intervenciones y los resultados. Solo con esta información, es posible implementar programas de mejorı́a planificados de acuerdo a los datos presentados.
The chain of survival
2001, Annals of Emergency MedicineAminophylline in the treatment of atropine-resistant bradyasystole
2000, ResuscitationAim: To describe patient characteristics, hospital investigations and interventions and early mortality among patients being hospitalized after out-of-hospital cardiac arrest in two hospitals. Setting: Municipality of Göteborg, Sweden. Patients: All patients suffering an out-of-hospital cardiac arrest who were successfully resuscitated and admitted to hospital between 1 October 1980 and 31 December 1996. All patients were resuscitated by the same Emergency Medical Service and admitted alive to one of the two city hospitals in Göteborg. Results: Of 579 patients admitted to Sahlgrenska Hospital, 253 (44%) were discharged alive and of 459 patients admitted to Östra Hospital, 152 (33%) were discharged alive (P<0.001). More patients in Sahlgrenska Hospital were still receiving cardiopulmonary resuscitation (CPR) treatment (P=0.03), but patients in Östra had a lower systolic blood pressure and higher heart rate on admission. A larger percentage of patients admitted to Sahlgrenska Hospital underwent coronary angiography (P<0.001), electrophysiological testing (P<0.001), Holter recording (P<0.001), echocardiography (P=0.004), Percutaneous Transluminal Coronary Angioplasty (PTCA, P=0.009), implantation of Automatic Implantable Cardioverter Defibrillator (AICD, P=0.03) and exercise stress tests (P=0.003). Inhabitants in the catchment area of Östra hospital had a less favourable socio-economic profile. Conclusion: Survival after out-of-hospital cardiac arrest may be affected by the course of hospital management. Other variables that might influence survival are socio-economic factors and cardiorespiratory status on admission to hospital. Further investigation is called for as more patients are being hospitalised alive after out-of-hospital cardiac arrest.