Outcome of out-of-hospital cardiorespiratory arrest in South Glamorgan
Introduction
Effective prompt treatment of pre-hospital cardiac arrest can lead to the prevention of sudden cardiac death and long-term survival 1, 2. This has been recognised by the American Heart Association who have popularised the `chain of survival' concept—early access to the emergency medical services (EMS), early cardiopulmonary resuscitation (CPR), early defibrillation and early advanced cardiac care [3]. In the UK the EMS systems vary from doctor-manned mobile coronary care units [2], ambulance crews equipped with semi-automatic advisory or manually-operated defibrillators 4, 5and paramedic personnel capable of endotracheal intubation, arrhythmia monitoring, defibrillation and drug administration [6].
The most impressive results for resuscitation from prehosptial cardiac arrest have been reported from a paramedic EMS in Washington State, USA, with a 49% survival rate amongst the select group of patients whose arrests were witnessed, where the initial rhythm on arrival of the ambulance service was ventricular fibrillation (VF), where bystanders initiated CPR within 4 min and where definitive advanced life support was available within 8 min [7]. More recently however, two studies from large urban communities have reported survival rates for this optimal group of patients of less than 20%, and an overall survival rate of as little as 1.4% 8, 9. Comparing rates of resuscitation from out-of-hospital cardiac arrest is difficult because the use of different case definitions leads to different numerators and denominators [7]. The Utstein style of reporting of data has been introduced in order to allow more appropriate comparisons [10].
We report our experience of pre-hospital cardiac arrest management provided by South Glamorgan Ambulance Service from 11 July 1989 to 13 April 1992 (but excluding a 6 week period in February and March 1990 when circumstances precluded accurate data collection). We believe that our method of data collection, including interview with attending ambulance personnel, has resulted in a comprehensive dataset. We utilise the Utstein template to enable comparison with other EMS.
Section snippets
Population served
South Glamorgan is an urban and semi-rural county of 484 km2. In 1991 the resident population was an estimated 407 300 (48.5% male); 19.3% were aged 65 years or more. Only 4.8% were from ethnic minorities. 55.6% are in social classes I, II or IIIn. In 1991 the total number of deaths was 4511 (rate 1107.5 per 100 000 population per year), 25.7% of these were due to ischaemic heart disease, 641 male deaths and 520 female deaths. In the 55–64 year age range there were 101 male deaths (529 per
Results
A total of 954 attempted resuscitations were reported during the 138 weeks; 883 per million population per year (Table 1). The cause of the arrest was cardiac in 712 (75%), non-cardiac in 231 (24%), unknown in four cases, and in seven the necessary documents could not be found. Of these 954, primary respiratory arrest accounted for 48 resuscitation attempts (14 judged to be of cardiac cause [15]) and the remaining 906 patients had cardiac and respiratory arrest. Details of age and sex
Discussion
We have utilised univariate analysis and the Utstein template to report our experience of the management of out-of-hospital cardiac arrest by South Glamorgan EMS. The rate of attempted resuscitation (883 per million population per year, 658 for cardiac aetiology) is higher than other British studies 17, 18. It is likely that our methodology, involving a dedicated researcher prospectively analysing ambulance dispatch records and interviewing ambulance crew, has resulted in fuller reporting of
Acknowledgements
This work was funded by a Welsh Office Operational Research Grant and by the Prophit-Rosser Scholarship of the Royal College of Physicians of London. We acknowledge the encouragement and support of Dr Michael Stephens, who was responsible for the early development of South Glamorgan EMS, Dr Peter Donnelly and Carolyn Lester of the Centre for Applied Public Health and their team at `Heartstart Cardiff and the Vale'.
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