Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival

Strömsöe, Anneli; Svensson, Leif; Axelsson, Åsa; Claesson, Andreas; Göransson, Katarina E.; Nordberg, Per; Herlitz, Johan

doi:10.1093/eurheartj/ehu240

Cited by 142 publications

(118 citation statements)

References 37 publications

(28 reference statements)

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“…In our study, the arrival time was 9 min. This result is comparable to international data [7,9,14,[18][19][20]29].…”

Section: Resultssupporting

confidence: 90%

“…Comparing the data with literature, a significant discrepancy can be noted, especially with the countries of Western Europe where the numbers are two or three times lower [2]. On the basis of international data, the standard OHCA incidence rate ranges from 34/100,000 (Denmark) [5], through 51/100,000 (Finland) [6], 52/100,000 (Sweden) [7], and 88/100,000 (Ireland), [8] to 206/100,000 (Austria) [9]. These detectable differences can be explained by two major facts: on the one hand, it is related to the characteristics of patients and circumstances of the incident, and on the other hand, to the system of reporting results.…”

Section: Resultsmentioning

confidence: 76%

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Epidemiology of out-of-hospital cardiac arrest in the Bielsko-Biala district: a 12-month analysis

2016

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A b s t r a c tBackground: Out-of-hospital cardiac arrest (OHCA) is the sudden, unexpected loss of heart function, which occurs out of specialist healthcare facilities and inevitably leads to death if uninterrupted by effective cardiopulmonary resuscitation (CPR). Aim:To evaluate the circumstances and basic epidemiological indices of OHCA in the population of adult inhabitants of Bielsko-Biala district within 12 months. Methods:On the basis of standard ambulance dispatch cards of the Emergency Medical Services (EMS) teams, a retrospective analysis was made of 272 OHCA cases covering the period from 01.01.2013 to 31.12.2013. We assessed the basic demographic data of the victims, circumstances of the occurrence of OHCA, information on the potential cause and mechanism of the OHCA, and data related to the actions undertaken by witnesses and EMS teams. Results:The overall OHCA incidence was 170/100,000 (243/100,000 in men; 99/100,000 in women). It increased with subjects' age (p < 0.01). The most frequent place of OHCA was the victim's home (82%). OHCA occurred in the presence of witnesses in 60% of cases. CPR was undertaken by a witness in 56% cases. Median CPR duration undertaken by a witness was 10 (IQR 8-14) min. Median time from notification receipt by the EMS to the team arrival was 9 (7-11) min. On the scene, defibrillation rhythm was recognised in 39% of cases. Sixty-seven patients were declared deceased after the arrival of the EMS teams. In the remaining 205 cases, CPR was undertaken, which was ineffective for 141 persons. Median CPR duration undertaken by the EMS team was 30 (20-40) min. The overall prehospital case fatality ratio was 76.5% (75.3% for men; 79.3% for women).Conclusions: OHCA incidence in the Bielsko-Biala population in 2013 was high, increased with age, and was twice as high for men than women. OHCA occurred most often at home, in the presence of a witness; however, CPR was not always undertaken promptly at the scene. CPR was effective for approximately 30% of the victims. The prehospital mortality was high with no differences between genders.

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“…In our study, the arrival time was 9 min. This result is comparable to international data [7,9,14,[18][19][20]29].…”

Section: Resultssupporting

confidence: 90%

Section: Resultsmentioning

confidence: 76%

Epidemiology of out-of-hospital cardiac arrest in the Bielsko-Biala district: a 12-month analysis

2016

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“…These reforms likely led to a more rapidly initiated chain of survival that would have contributed to our documented increase in the percentage of defibrillated patients (Table 2) and earlier CPR. This may have contributed to our overall improved bystander‐witnessed survival, survival to hospital admission, and overall survival, as documented in other studies 17, 18, 19…”

Section: Discussionsupporting

confidence: 67%

Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

May

Zhang

Foley

et al. 2018

JAHA

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BackgroundIn 2002, the out‐of‐hospital cardiac arrest (OHCA) survival rate in Detroit was the lowest in the nation. Concerted efforts sought to improve the city's chain of survival with a focus on emergency medical services (EMS). This study assesses the impact on OHCA survival rates and describe factors associated with survival.Methods and ResultsData for non‐traumatic OHCA cases in Detroit from 2014 to 2016 were extracted from CARES (Cardiac Arrest Registry to Enhance Survival). Chi‐squared tests, non‐parametric tests, and a multivariable logistic regression analysis were employed to examine the associations between overall survival and its covariates. A total of 2359 non‐traumatic OHCA cases were examined. The overall survival rate increased from 3.7% in 2014 to 5.4% in 2015, and 6.4% in 2016 (P<0.01), reflecting a 73% improvement in survival over the 3‐year period. EMS median on‐scene time decreased over the study period, while the rate at which EMS initiated cardiopulmonary resuscitation and applied an automated external defibrillator (AED) greatly increased (P<0.001). The factors significantly associated with survival were female sex (odds ratio=1.70, P<0.05), a public setting (odds ratio=2.31, P<0.01), an EMS witness (odds ratio=6.18, P<0.01), and the presence of an initial shockable rhythm (odds ratio=1.88, P<0.05).ConclusionsFrom 2014 to 2016, the overall survival rate for OHCA patients in Detroit, MI significantly improved. Our results suggest that an improved chain of survival may explain this progress. This study is an example of how OHCA data analysis and EMS improvement can improve end OHCA outcomes in a resource‐limited urban setting.

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“…For comparison, in Sweden, the average response time of the rescue system for patients who survived SCA was 11 min and 15 min in cases of death. The authors of this study also indicated that a higher survival rate was observed in areas where more ambulances are based, and not on the density of population [17]. In one research project conducted in Poland the authors defined that ambulance arrival time was 9 min for patients with ROSC and 11 min for deceased.…”

Section: Discussionmentioning

confidence: 79%

Emergency medical system response time does not affect incidence of return of spontaneous circulation after prehospital resuscitation in one million central European agglomeration residents

Kłosiewicz

Skitek-Adamczak²,

Zieliński³

2017

Kardiol Pol

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A b s t r a c t Background:The survival of out-of-hospital sudden cardiac arrest (OHSCA) in Europe still remains low. The State Medical Rescue System is composed of several elements. The efficacy of each of these elements may have an influence on the victim's survival. Until now, the incidence of return of spontaneous circulation (ROSC) and its correlation with rescue services time in the city of Poznan has not been determined. Aim:The main purpose of this study was to assess incidents of OHSCA and prehospital frequency of ROSC after OHSCA in Poznan city and district. We also wanted to analyse whether ROSC depends on Emergency Medical System (EMS) reaction time. Methods: Retrospective analysis based on medical documentation conducted in 2015 in Poznan EMS.Results: Return of spontaneous circulation was achieved in 68.88% of cases. It was most frequent when OHSCA occurred in public places (p = 0.000, contingency factor = 0.233) and victims were younger (p = 0.042, contingency factor = 0.129). 63.17% of patients were male, but sex did not affect the incidence of ROSC. The median time of system response was 8.53 min, while time from ambulance departure to arrival was 5.42 min. We did not find any statistically significant difference between the number of deaths and those parameters (p = 0.723, p = 0.891). However, longer team response time correlated with the highest mortality (p = 0.042, contingency factor = 0.126). In the group where ROSC was achieved the median time of EMS response was 8.18 min, while among the group of deceased the median was 8.63 min. Conclusions:The incidence of OHSCA in our region is similar to other Polish and European cities. EMS response time does not affect the frequency of ROSC. ROSC was achieved more often if OHSCA occurred in public and the victim was younger.

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Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival

Cited by 142 publications

References 37 publications

Epidemiology of out-of-hospital cardiac arrest in the Bielsko-Biala district: a 12-month analysis

Epidemiology of out-of-hospital cardiac arrest in the Bielsko-Biala district: a 12-month analysis

Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

Emergency medical system response time does not affect incidence of return of spontaneous circulation after prehospital resuscitation in one million central European agglomeration residents

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