Out-of-hospital resuscitation: room for improvement

Survival after out-of-hospital cardiac arrests in Katowice (Poland): outcome report according to the “Utstein style”

The purpose of this study was to evaluate the outcome of out-of-hospital cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) in the city of Katowice, Poland, during a period of 1 year prior to the planned reorganization of the national emergency system. Data were collected prospectively according to a modified Utstein style. To ensure accurate data collection, a special method of reporting resuscitation events with the use of a tape-recorder was introduced. Patients were followed for a 1-year period. Between 1 July 2001 and 30 June 2002, out-of-hospital cardiac arrest was confirmed in 1153 patients. Cardiopulmonary resuscitation was attempted in 188 patients. Cardiac arrest of presumed cardiac aetiology (147) was bystander witnessed in 105 (71%) cases and lay-bystander basic life support was performed in 35 (24%). In the group of bystander witnessed arrest ventricular fibrillation (VF) or tachycardia was documented in 59, asystole in 40 and other non-perfusing rhythms in six patients. Of 147 patients with cardiac aetiology, return of spontaneous circulation (ROSC) was achieved in 64 (44%) patients, 15 (10%) were discharged alive and 9 (6%) were alive 1 year later. Most of these patients had a good neurological outcome. Time to first defibrillatory shock was significantly shorter for survivors (median 7 min) compared to non-survivors (median 10 min). The most important resuscitation and patient characteristics associated with survival were VF as initial rhythm, arrest witnessed, and lay-bystander CPR.