Temporal trends in out-of-hospital cardiac arrest survival outcomes between two metropolitan communities: Seoul-Osaka resuscitation study

Abstract

ObjectivesThe objective of this study was to compare the temporal trends in survival after out-of-hospital cardiac arrest (OHCA) between two large metropolitan communities in Asia and evaluate the factors affecting survival after OHCA.DesignA population-based prospective observational study.SettingThe Cardiovascular Disease Surveillance (CAVAS) project in Seoul and the Utstein Osaka Project in Osaka.ParticipantsA total of 36 292 resuscitation-attempted OHCAs with cardiac aetiology from 2006 to 2011 in Seoul and Osaka (11 082 in Seoul and 25 210 in Osaka).Primary outcome measuresThe primary outcome was neurologically favourable survival. Trend analysis and multivariable Poisson regression models were conducted to evaluate the temporal trends in survival of two communities.ResultsDuring the study period, the overall neurologically favourable survival was 2.6% in Seoul and 4.6% in Osaka (p<0.01). In both communities, bystander cardiopulmonary resuscitation (CPR) rates increased significantly from 2006 to 2011 (from 0.1% to 13.1% in Seoul and from 33.3% to 41.7% in Osaka). OHCAs that occurred in public places increased in Seoul (12.5% to 20.1%, p for trend <0.01) and decreased in Osaka (13.5% to 10.5%, p for trend <0.01). The proportion of OHCAs defibrillated by emergency medical service (EMS) providers was only 0.4% in 2006 but increased to 17.5% in 2011 in Seoul, whereas the proportion in Osaka decreased from 17.7% to 13.7% (both p for trend <0.01). Age-adjusted and gender-adjusted rates of neurologically favourable survival increased significantly in Seoul from 1.4% in 2006 to 4.3% in 2011 (adjusted rate ratio per year, 1.17; p for trend <0.01), whereas no significant improvement was observed in Osaka (3.6% in 2006 and 5.1% in 2011; adjusted rate ratio per year, 1.03; p for trend=0.08).ConclusionsSurvivals after OHCA were increased in Seoul while remained constant in Osaka, which may have been affected by the differences and improvements of patient, community, and EMS system factors.

Analysis of the Performance for Bystanders’ Cardiopulmonary Resuscitation in Geriatric and Out-of-Hospital Cardiac Arrested Patients

“…This change in performance rates is consistent with statistics on cardiac arrest patients of all ages in Seoul, including elderly patients 24,27) . The number of lay people educated about CPR for each 100,000 Seoul citizens rose each year, from 2,143 in 2010, while the number of people registered as citizens performing CPR on cardiac arrest patients with good faith (CPR supporters) reached 26,000 24) .…”

Relationship Between the Duration of Cardiopulmonary Resuscitation and Favorable Neurological Outcomes After Out‐of‐Hospital Cardiac Arrest: A Prospective, Nationwide, Population‐Based Cohort Study

“…In recent years, the survival rate from out‐of‐hospital cardiac arrest (OHCA) in industrialized countries has increased because of major advances in cardiopulmonary resuscitation (CPR) . However, the mortality rate remains high, and the survival to hospital discharge rate among OHCA patients is between 7.2% and 11% . Studies have shown that the survival rate declines rapidly when the duration of CPR surpasses 10 minutes and even more rapidly if it exceeds 30 minutes .…”

“…[1][2][3][4] However, the mortality rate remains high, and the survival to hospital discharge rate among OHCA patients is between 7.2% and 11%. [1][2][3][4] Studies have shown that the survival rate declines rapidly when the duration of CPR surpasses 10 minutes and even more rapidly if it exceeds 30 minutes. 5,6 In some studies, 7-9 refractory cardiac arrest is thought to be present if, in the absence of preexisting hypothermia, return of spontaneous circulation (ROSC) is not achieved despite more than 30 minutes of appropriate CPR.…”

“…The objectives of this study were (1) to determine the relationship between duration of prehospital CPR conducted by EMS providers and survival with favorable neurological outcomes after OHCA, and (2) to determine, according to the initial rhythm in OHCA, the critical prehospital CPR duration that would achieve prehospital ROSC and produce a cumulative proportion >99% of survivors and survivors with favorable neurological outcomes.…”

Manual Versus Semiautomatic Rhythm Analysis and Defibrillation for Out-of-Hospital Cardiac Arrest

“…12 Internationally, EMS systems are utilizing SAED as either a stand-alone defibrillation strategy or in combination with manual defibrillation mode. [13][14][15] Although SAED results in faster times to defibrillation and higher cardioversion rates compared with manual defibrillation, 10,11 there are no studies that have translated these differences into better survival outcomes from OHCA. 16 Although previous studies have been limited by sample size, there is also some concern that SAEDs could increase pauses in chest compressions, and this could lead to poorer outcomes for OHCA patients, particularly in patients with initial nonshockable rhythms.…”