International NotesOut-of-hospital resuscitation in Tartu: Effect of reorganization of Estonian EMS system☆,☆☆,★,★★
Section snippets
Methods
The setting for this study is a two-tiered EMS system in the Tartu urban area of Estonia (size: 38.8 km2, population 100,000). One ambulance dispatch center and the 03 or 112-telephone service serves the area. Until the end of 1999, Estonian ambulance dispatch centers were located only by ambulance stations in which they had to have telephone number 03 service, that was different from the telephone numbers of fire departments and police. In the future, the majority of all emergency calls will
Patients
Data were retrospectively (before July 12, 1994) and prospectively (after July 12, 1994) collected between January 1, 1993 and December 31, 1998 according to an Utstein style.7 Patients with expected death are excluded from analysis.
Statistical methods
Data were entered into a computerized database. Chi-squared analysis for nonparametric data with Yate's correction and Student's t test for parametric data (STATISTICA 5.1/W, StatSoft, Inc) were used to determine significance of differences between groups. A P value < .05 was considered significant.
Results
During the 6-year study period there were 865 confirmed out-of-hospital cardiac arrests considered for resuscitation (Figure 1). Resuscitation was attempted in 368 patients. Of these, 71.3% were men (mean age 55.4 years), 26.3% women (mean age 64.1 years), and 2.3% children younger than the age of 14 years. Mean age (median) of all adult resuscitated patients was 59.8 years (range 18 to 89 years). In this group, the majority of deaths
Discussion
It is known that the incidence rates of out-of-hospital cardiac arrest varied from 35 to 128 per 100,000 inhabitants/year with a mean of 62.10 In Helsinki the number for sudden cardiac arrest of cardiac origin was 53.1/100,000.2 In South Estonia with a population of 400,000 during 1980 to 1996 the incidence of such cardiac arrests was 51.5/100,000 but in men in the age groups from 20 to 39 and from 40 to 84 years it was 19.2/100,000 and 120/100,000 respectively.12 The ischemic heart disease
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Cited by (18)
Impact of prehospital physician-led cardiopulmonary resuscitation on neurologically intact survival after out-of-hospital cardiac arrest: A nationwide population-based observational study
2019, ResuscitationCitation Excerpt :However, EMS systems for OHCA vary in their configurations worldwide.6–17 In many European countries, an EMS physician on board the ambulance is dispatched as a member of the prehospital critical care team and performs advanced life support (ALS) in the field.6–11 In other countries, such as the United States and most parts of Japan, a paramedic EMS team with no physician delivers prehospital advanced care for OHCA.12–17
The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest
2015, ResuscitationCitation Excerpt :After adjusting for this imbalance between the CCT and ALS paramedic groups, the effect of CCT treatment was no longer statistically significant (OR 1.54, 95% CI 0.89–2.67, p = 0.13). Despite a current lack of scientific evidence to support pre-hospital critical care for OHCA, it is the standard of care in many European countries and increasingly common in the UK.11,13,17 While it is intuitive that a higher level of pre-hospital care will improve outcomes, the findings of this and previous studies21 warrant a detailed discussion of how exactly CCTs might benefit patients with OHCA, to guide further research and EMS configurations.
Advanced life support versus basic life support in the pre-hospital setting: A meta-analysis
2011, ResuscitationCitation Excerpt :The 113 articles which remained after the abstract selection were reviewed extensively and 96 articles were excluded (74 articles were not included comparison between ALS and BLS in the pre-hospital setting, 21 articles reporting non controlled trials and 4 articles were duplicated in the 4 different databases). After evaluating these citations and references therein we included 18 trials.21–38 The quality assessment of these studies, based on the recommendations of The Cochrane Collaboration, revealed that inadequate sequence generation provided the largest risk of bias followed by inadequate allocation concealment (Table 1).13
European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support
2010, ResuscitationCitation Excerpt :In adult cardiac arrest, physician presence during resuscitation, compared with paramedics alone, has been reported to increase compliance with guidelines183,184 and physicians in some systems can perform advanced resuscitation procedures more successfully.183,185–188 When compared within individual systems, there are contradictory findings with some studies suggesting improved survival to hospital discharge when physicians are part of the resuscitation team189–192 and other studies suggesting no difference in short- or long-term survival.183,189,191,193–199 in one study, survival of the event was lower when physicians were part of the resuscitation team.199
Part 12: Education, implementation, and teams: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
2010, ResuscitationCitation Excerpt :In adult cardiac arrest, physician presence during resuscitation, compared with paramedics alone, has been reported to increase compliance with guidelines (LOE 2307; LOE 4308) and physicians in some systems can perform advanced resuscitation procedures more successfully (LOE 2307,309; LOE 4310–312). When compared within individual systems, four studies suggested improved survival to hospital discharge when physicians were part of the resuscitation team (LOE 2313,314; LOE 3315,316) and 10 studies suggested no difference in survival of the event (LOE 2)307,313 or survival to hospital discharge (LOE 2)307,315,317–323. One study found lower survival of the event when physicians were part of the resuscitation team (LOE 2)323.
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Returned September 20, 1999.
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Address reprint requests to Aleksander Sipria, MD, PhD, Senior Assistant Professor, Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, Tartu 51014, Estonia. Email: [email protected]
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Am J Emerg Med 2000;18:469-473.
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0735-6757/00/1804-0024$10.00/0