Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area

Abstract

Results-Of 330 000 inhabitants, 755 suffered from cardiac arrest covered by the Heidelberg ALS services. In 512 patients, cardiopulmonary resuscitation had been initiated. Of 338 patients with cardiac aetiology, return of spontaneous circulation was achieved in 164 patients (49%), 48 (14%) were discharged alive, and 40 (12%) were alive one year later; most of these patients showed good neurological outcome. Thus, 4.85 patients with cardiac aetiology were saved by the ALS services and discharged alive per 100 000 inhabitants a year. Ventricular fibrillation or tachycardia was detected in 106 patients (31%), other cardiac rhythms in 40 (12%), and asystole in 192 (57%). Hospital discharge rates (and one year survival) in these subgroups were 34.0% (29.2%), 12.5% (7.5%), and 3.6% (3.1%), respectively. Discharge rates increased if cardiac arrest was witnessed (bystander, 20.0%; BLS/ALS personnel, 21.4%; nonwitnessed arrest, 3.3%; p < 0.01), and if the time period between the alarm and the arrival of the ALS unit was four minutes or less (< 4 minutes, 30.6%; 4-8 minutes, 10.4%; > 8 minutes, 8.1%; p < 0.001). In 69 patients with bystander witnessed cardiac arrest with ventricular fibrillation, the discharge rate was 37.7%; 21 patients were alive after one year. Conclusions-A two tier BLS and physician staVed ALS system is associated with good long term outcome of patients suVering from out-of-hospital cardiac arrest of cardiac aetiology in a midsized urban/suburban area. Further studies, however, are required to assess whether having a physician in the ALS unit is an independent determinant for improved long term outcome. (Heart 1999;82:674-679) Keywords: out-of-hospital cardiac arrest; emergency medical services; long term outcome; Utstein style Patient outcome after out-of-hospital cardiac arrest depends on individual, demographic, sociological, and logistic factors.

Out of hospital cardiac arrest resuscitation outcome in North India — CARO study

“…International data suggested that OHCA at residence were less likely to be witnessed and have poorer outcome, [10] likewise in our study too, OHCA at home was associated with poor survival outcome as compared to public place.…”

“…OHCA was more common in males (70%) as compared to females ( =0.003). International studies [4,10] showed that 61.1% to 70.1% were males who experienced OHCA where as Indian study by Rajaram et al showed 66% males. These data do suggest that males are more prone for OHCA than females; but regarding relationship between survival after OHCA and sex of the individual, it was statistically non-signifi cant; further studies with large number of samples in this context are required.…”

Use of hypothermia in the intensive care unit

“…However, fewer than 20% of patients with CA fulfill the inclusion criteria for these studies [171] .…”

Out-of-Hospital Cardiac Arrest and Survival-An Epidemiological Analysis of Emergency Service Reports in a Large City in Japan-

“…4,5,15,[23][24][25][26][27] This low rescue rate might be partly explained by the long interval (approximately 5 min) from emergency call to the ambulance's arrival at the scene. Another plausible explanation is that the proportion of aged people with inherently poor recovery has greatly increased in Japan in recent years.…”