PULS - Austrian Cardiac Arrest Awareness Association: An overview of a multi-tiered and multi-facetted regional initiative to save lives

Resuscitation of out-of-hospital cardiac arrest victims in Austria's largest helicopter emergency medical service: A retrospective cohort study

Background

Helicopter emergency medical services (HEMS) play a fundamental role in prehospital care. However, the impact of HEMS on survival of patients with out-of-hospital cardiac arrest (OHCA) is widely unknown. Therefore, the purpose of this study was to assess demographics, treatment, and outcome of patients with OHCA attended by physician-staffed helicopters.

Methods

Retrospective cohort study enrolling OHCA patients treated by HEMS during a ten-year period (2010-2019) in Austria. Patients were identified using electronic mission records of 13 HEMS bases run by the Austrian Automobile, Motorcycle and Touring Club (OEAMTC), and subsequently matched with the national register of deaths to determine 30-day and one-year survival rates. Results are reported according to the 2015 Utstein Style. Multivariable logistic regression analysis was used to identify factors associated with patient outcome.

Results

In total, 9344 presumed OHCA missions were identified. Cardiopulmonary resuscitation was attempted or continued by HEMS in 3889 cases. Approximately 32.2% of patients achieved return of spontaneous circulation (ROSC) and 22.5% sustained ROSC until arrival at the emergency department. Thirty-day and one-year survival rates were 14.0% and 12.4% respectively. HEMS response time, on-scene time, age, pathogenesis, arrest location, witness-status, first monitored rhythm, bystander automated external defibrillator (AED) use, airway type and administration of adrenaline were independent predictors of 30-day survival.

Conclusions

This study provides an extensive insight into the management of OHCA in an almost nationwide HEMS sample. Thirty-day and one-year survival rates are high, indicating high-quality care and systematic selection of patients with favorable prognosis.

[Layperson basic life support education in Austria: An overview]

Early interventions of laypersons can improve the survival and neurological outcome in patients with out-of-hospital cardiac arrest. There are several organizations in Austria which train lay people in basic life support and raise awareness for sudden cardiac death. To obtain an overview of the various initiatives, a questionnaire was sent to 26 organizations, and 15 of the organizations (58%) replied. The geographical distribution of the organizations between rural and urban areas was illustrated in a map. Most of them are situated in a university city, resulting in accessibility disparities for individuals in urban and rural settings. Layperson resuscitation education in Austria is largely dependent on the individual commitments of volunteers. The time spent practicing chest compressions in resuscitation courses ranges from 25% to 90% of the total course time. Furthermore, reasons for a lack of scientific endeavours could be identified, and solutions are suggested. Through better networking between organizations and initiatives, more laypersons could be trained in the future, which would lead to improved survival chances for persons suffering from out-of-hospital cardiac arrest in Austria. Appropriate support by political bodies and public authorities is and will remain a key element.