Out-of-hospital resuscitation in East Sussex: 1981 to 1989.

Lewis, Susan J.; Holmberg, Stig; Quinn, Elizabeth; Baker, Katie; Grainger, Robert M.; Vincent, R; Chamberlain, Douglas

doi:10.1136/hrt.70.6.568

Cited by 16 publications

(5 citation statements)

References 24 publications

(2 reference statements)

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“…In Helsinki (population 516 000) cardiac arrests witnessed by paramedical staff were not reported on,13 and about 7 lives per 100 000 were saved by resuscitation compared with 1.5 per 100 000 in our report when we excluded cardiac arrests witnessed by paramedical staff. Moreover, in Brighton during the 1980s about 8 lives per 100 000 were saved 17. Had these results been replicated over the two years in our three health districts at least three times as many lives as the 55 which we recorded might have been saved.…”

Section: Discussionsupporting

confidence: 49%

Fatality outside hospital from acute coronary events in three British health districts, 1994-5

1998

BMJ

132

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Objectives: To provide a contemporary account of the treatment and outcomes of acute coronary attacks in England and Wales and to identify strategies that might improve the outcome. Design: Two year community and hospital based study in three British health districts. Setting: Health districts of Brighton (population 282 000), South Glamorgan (408 000), and York (264 000). Subjects: 3523 men and women under 75 years of age who died outside hospital from acute coronary causes, who were admitted to hospital with acute myocardial infarction, or who developed acute infarction or died unexpectedly from acute coronary causes while they were already in hospital. Interventions: Attempted resuscitation in people having a cardiac arrest outside hospital. Main outcome measures: Total case fatality, case fatality outside and inside hospital, and the effect of resuscitation on case fatality outside hospital. Results: 1589 patients died within 30 days of the acute event. Case fatality was 45% (95% confidence interval 43% to 47%), rising from 27% (160/595) (23% to 31%) at age <55 years to 53% (1019/1916) (51% to 55%) at 65-74 years. Overall, 74% (1172/1589) (72% to 76%) of fatal events happened outside hospital, and there was a negative age gradient (P<0.001) such that 91% (145/160) (87% to 95%) of fatalities occurred outside hospital at age <55 compared with 70% (710/1019) (67% to 73%) at 65-74 years. Without successful resuscitation of 55 patients outside hospital, total case fatality at 30 days would have risen from 45% to 46.7%. Conclusion: Opportunities for reducing fatality from acute coronary attacks lie mainly outside hospital. These results and others imply that survival from cardiac arrest outside hospital might be trebled by improved ambulance and patient response. Proper application of secondary preventive measures for patients with coronary disease could have an even larger impact. Key messages In three health districts during 1994-5 total case fatality for people under 75 years of age was 45% and 74% of fatal events happened outside hospital The likelihood of a fatal event occurring outside hospital was greater for people under 55 years of age (91%) than for those aged 65-74 years (70%) Total fatality was reduced appreciably (by 1.7%) by resuscitation outside hospital, but this proportion might possibly be trebled by further upgrading of ambulance services Because 46% of people who died were already known to have coronary heart disease, improved secondary prevention may have a major part in further reducing mortality

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Section: Discussionsupporting

confidence: 49%

Fatality outside hospital from acute coronary events in three British health districts, 1994-5

1998

BMJ

132

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“…Our overall rate of survival to hospital discharge of 6.1% for all cardiac arrhythmias and 11.7% for ventricular fibrillation is similar to other ambulance services in the United Kingdom,1 9 10 but much less than that of 28.9% in Seattle, USA 11. Paramedic skills of ambulance staff have been shown by Lewis et al to increase the likelihood of successful resuscitation12, but from the perspective of accident and emergency department based research, paramedics did not have a major impact on survival, as Guly has reported in Edinburgh 3…”

Section: Discussionmentioning

confidence: 96%

Resuscitation from out-of-hospital cardiac arrest: is survival dependent on who is available at the scene?

Soo

Gray

Young

et al. 1999

Heart

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Objective-To determine whether survival from out-of-hospital cardiac arrest is influenced by the on-scene availability of different grades of ambulance personnel and other health professionals. Design-Population based, retrospective, observational study. Setting-County of Nottinghamshire with a population of one million. Subjects-All 2094 patients who had resuscitation attempted by Nottinghamshire Ambulance Service crew from 1991 to 1994; study of 1547 patients whose arrest were of cardiac aetiology. Main outcome measures-Survival to hospital admission and survival to hospital discharge. Results-Overall survival from out-ofhospital cardiac arrest remains poor: 221 patients (14.3%) survived to reach hospital alive and only 94 (6.1%) survived to be discharged from hospital. Multivariate logistic regression analysis showed that the chances of those resuscitated by technician crew reaching hospital alive were poor but were greater when paramedic crew were either called to assist technicians or dealt with the arrest themselves (odds ratio 6.9 (95% confidence interval 3.92 to 26.61)). Compared to technician crew, survival to hospital discharge was only significantly improved with paramedic crew (3.55 (1.62 to 7.79)) and further improved when paramedics were assisted by either a health professional (9.91 (3.12 to 26.61)) or a medical practitioner (20.88 (6.72 to 64.94)). Conclusions-Survivalfrom out-ofhospital cardiac arrest remains poor despite attendance at the scene of the arrest by ambulance crew and other health professionals. Patients resuscitated by a paramedic from out-of-hospital cardiac arrest caused by cardiac disease were more likely to survive to hospital discharge than when resuscitation was provided by an ambulance technician. Resuscitation by a paramedic assisted by a medical practitioner oVers a patient the best chances of surviving the event. (Heart 1999;81:47-52)

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“…Assuming similar success rates, there would be about 640 survivors in the UK annually, but we previously calculated 12 that there would be three times as many (1920) if success rates would be improved to match those in the most successful overseas centres 8 9 or those in one UK centre during the 1980s. 15 To what extent public access defibrillation will improve matters is controversial, 6 16 but other population based studies 17 18 agree with ours that it can be applicable only to about 20% of out of hospital arrests (although slightly more for younger victims) (table 1) and it depends on what proportion of arrests occur in places where a defibrillator is available. 19 At the time of writing, nearly all of the 700 defibrillators that have been provided under the UK national defibrillator scheme are at main line railway stations and airports.…”

Section: Discussionmentioning

confidence: 60%

Coronary-cameral fistula

Ho¹

2005

Heart

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Objectives: To discover the circumstances of out of hospital cardiac death irrespective of resuscitation attempts. Design: Prospective community study over the two years 1994 and 1995. Setting: The health districts of Brighton, South Glamorgan, and York, UK. Subjects: 1290 victims of sudden death or cardiac arrest caused by coronary heart disease who were under 76 years of age. Interventions: Basic and advanced life support for witnessed cardiac arrests. Main outcome measures: Survival to reach hospital and for 30 days after the arrest. Results: 35 (35%) of 101 patients (mean age 64) whose arrest was witnessed by a doctor or paramedic survived for 30 days compared with 9 of 464 (2%) whose arrest was witnessed by a relative or bystander at home (mean age 66) and 15 of 200 (8%) whose arrest was witnessed in a public place (mean age 61). None of the 525 victims of an unwitnessed arrest survived but the majority of those whose arrest was witnessed had complained of new symptoms before the arrest. Victims who were given basic life support by relatives or bystanders had better survival (14 of 183 (8%)) than those who were not (10 of 481 (2%), p , 0.001). Of the 20% of arrests that occurred in public places, few were in places where public access defibrillators would now be available. Conclusions: The burden of out of hospital cardiac arrest is mainly in the home but most victims have premonitory symptoms. Public education to seek help urgently for new or prolonged chest pain seems the most promising method to address the problem.

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Out-of-hospital resuscitation in East Sussex: 1981 to 1989.

Abstract: Extended training for ambulance staff increases the likelihood of successful resuscitation from out-of-hospital cardiopulmonary arrest. Though instruction in defibrillation must have the highest priority, full paramedical training can bring appreciable additional benefits.

Cited by 16 publications

References 24 publications

Fatality outside hospital from acute coronary events in three British health districts, 1994-5

Fatality outside hospital from acute coronary events in three British health districts, 1994-5

Resuscitation from out-of-hospital cardiac arrest: is survival dependent on who is available at the scene?

Coronary-cameral fistula

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