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

Abstract

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)

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

“…The critical time appears to be 4 min, which is comparable with previous reports. 5,[11][12][13][14][15] The interval from scene to hospital was, however, not significantly associated with survival. These findings indicate the importance of quick arrival of an ambulance at the scene and early life support interventions, irrespective of the interval to hospital.…”

The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

“…19 However, the assisting physicians were not dispatched by EMS but happened to witness the OHCA in a public place. Olasveengen et al compared physician and ALS-paramedic staffed ambulances for OHCA, both with median response times of 9 minutes, and found no difference in survival to hospital discharge (OR 1.35; 95% CI 0.71 -2.60).…”

“…14 A systematic review by Botker from 2009 examined the effect of physician-delivered pre-hospital critical care on OHCA outcomes and found a benefit, 'based on limited evidence'. 15 Small sample size, 16 comparison of pre-hospital critical care with very limited basic life support 17 and study designs which did not control for significant confounding factors [17][18][19][20] make the application and generalisation of these findings problematic.…”

Pre‐hospital cardiac arrest and induction of mild hypothermia: studies on epidemiology and feasibility

“…Included were arrests of cardiac aetiology in which EMS personnel attempted resuscitation. Overall survival rates ranged from 5.6 to 19.6 % (Bottiger et al 1999;Giraud et al 1996;Hanche-Olsen and Nielsen 2002;Hassan et al 1996;Hoeven et al 1994;Schneider et al 1994;Skogvoll et al 1999;Soo et al 1999;Tadel et al 1998;Weston et al 1997). As discussed by Atwood et al in their review evaluating these results, the differences in survival rates may be due to differences in layperson or EMS response to cardiac arrest as well as due to treatment related factors .…”