Successful treatment of out-of-hospital cardiac arrest is still based on quick activation of the chain of survival

Abstract

Background and goal of studyCardiopulmonary resuscitation (CPR) in prehospital care is a major reason for emergency medical service (EMS) dispatches. CPR outcome depends on various factors, such as bystander CPR and initial heart rhythm. Our aim was to investigate whether short-term outcomes such as the return of spontaneous circulation (ROSC) and hospital admission with spontaneous circulation differ depending on the location of the out-of-hospital cardiac arrest (OHCA). In addition, we assessed further aspects of CPR performance.Materials and methodsIn this monocentric retrospective study, protocols of a prehospital physician-staffed EMS located in Munich, Germany, were evaluated using the Mann–Whitney U-test, chi-square test, and a multifactor logistic regression model.Results and discussionOf the 12,073 cases between 1 January 2014 and 31 December 2017, 723 EMS responses with OHCA were analyzed. In 393 of these cases, CPR was performed. The incidence of ROSC did not differ between public and non-public spaces (p = 0.4), but patients with OHCA in public spaces were more often admitted to the hospital with spontaneous circulation (p = 0.011). Shockable initial rhythm was not different between locations (p = 0.2), but defibrillation was performed significantly more often in public places (p < 0.001). Multivariate analyses showed that hospital admission with spontaneous circulation was more likely in patients with shockable initial heart rhythm (p < 0.001) and if CPR was started by an emergency physician (p = 0.006).ConclusionThe location of OHCA did not seem to affect the incidence of ROSC, although patients in public spaces had a higher chance to be admitted to the hospital with spontaneous circulation. Shockable initial heart rhythm, defibrillation, and the start of resuscitative efforts by an emergency physician were associated with higher chances of hospital admission with spontaneous circulation. Bystander CPR and bystander use of automated external defibrillators were low overall, emphasizing the importance of bystander education and training in order to enhance the chain of survival.

Predictors, Prevalence, and Clinical Outcomes of Out-of-Hospital Cardiac Arrests in Croatia: A Nationwide Study

“…This trend seems consistent with the findings from the North American population where, out of 12,930 evaluated OHCAs, 9564 occurred at home [27]. Interestingly, Borgstedt et al (2023) found that the incidence of return of spontaneous circulation (ROSC) did not vary significantly between public and non-public locations (p = 0.4). However, patients experiencing OHCA in public spaces were more frequently admitted to the hospital with spontaneous circulation (p = 0.011) [28].…”

“…One study reported that between 2014 and 2017, out of 12,073 cases, 723 EMS responses related to OHCA were analyzed. Shockable initial heart rhythm, defibrillation, and resuscitative efforts initiated by an emergency physician were found to significantly enhance the chances of a patient's successful admission to a hospital with spontaneous circulation [28]. This underlines the necessity for early recognition and intervention in OHCA cases.…”

“…Interestingly, Borgstedt et al (2023) found that the incidence of return of spontaneous circulation (ROSC) did not vary significantly between public and non-public locations (p = 0.4). However, patients experiencing OHCA in public spaces were more frequently admitted to the hospital with spontaneous circulation (p = 0.011) [28]. The probability of successful ROSC to hospital significantly increasing is also shown in our study by initial heart rate (relative to asystole as reference value) PEA with OR = 2.41 (95% CI: 1.88-3.10; p < 0.001), ventricular fibrillation with OR = 5.81 (95% CI: 4.67-7.23; p < 0.001), and ventricular tachycardia with OR = 5.74 (95% CI: 3.59-9.17; p < 0.001).…”

Características del paro cardiaco extrahospitalario atendido por operadores de ambulancias en Medellín. Estudio de cohorte retrospectivo de base poblacional

“…The median time between activation and EMS arrival was 13 minutes. It is important to work on decreasing the response time of the AO for OHCA assistance, given that the condition under study is time-dependent; that is, the more timely the assistance and specific interventions, the higher the probability of ROSC and hence of improved survival, since after this time range the metabolic changes become incompatible with life (13,17,24,25).…”