A Utstein-style analysis of prognostic factors related to survival in out-of-hospital cardiac arrests in Akita-City, Japan

Prehospital Cardiac Arrest in a Paramedic First-responder System Using the Utstein Style

OBJECTIVES

To describe the characteristics of patients found to have cardiac arrest and to evaluate the characteristics predictive of survival after cardiac arrest in a paramedic first-responder model.

METHODS

All patients who suffered out-of-hospital cardiac arrest in the city of Reading, Ohio, from January 1998 to December 2003 were recorded in the Utstein style. The number and incidence rate of witnessed arrests, initial rhythms, rate of bystander cardiopulmonary resuscitation (CPR), and 30-day mortality rate were retrospectively collected. Demographics, time to hospital, and response times were evaluated as predictors of survival.

RESULTS

Of those patients initially found to be in cardiac arrest, 14.3% were discharged alive. Witnessed arrests were more likely to result in live discharge of the patient. Whether bystander CPR was performed was not found to affect survival, nor was initial rhythm, although no patients initially found in asystole were discharged alive. No demographic characteristics or response times were predictive of survival.

CONCLUSION

The rates of survival in this paramedic first-response system are favorable compared with basic emergency medical technician first-response systems. Further study using direct comparison methodology is warranted to confirm these findings.

Frequency of ventricular fibrillation as predictor of one-year survival from out-of-hospital cardiac arrests

This study determined whether electrocardiographic analysis of ventricular fibrillation (VF) can predict 1-year survival from bystander-witnessed, out-of-hospital cardiac arrests of cardiac origin. VF was analyzed using fast-Fourier transformation in a community in which emergency medical technicians delivered shock with an automated external defibrillator before arrival to the hospital. The frequency of VF can predict survival 1 year after hospital discharge from shock-delivered, bystander-witnessed cardiac arrests of cardiac etiology.

Emergency system prospective performance evaluation for cardiac arrest in Lombardia, an Italian region

BACKGROUND

The aim of this research is to evaluate quality of out-of-hospital medical services in our country, using performance indicators and a new computerised database.

METHODS

(a)

EXPERIMENTAL DESIGN

Data were collected prospectively in three emergency dispatch centres for 90 days. Follow-up was evaluated at 1 day and 1 month after the event. This paper presents data on the cardiac arrest cohort only. (b)

SETTING

Three emergency dispatch centres in Lombardia. (c)

PATIENTS

One hundred and seventy-eight patients in non-traumatic cardiac arrest were enrolled. (d)

INTERVENTIONS

None. The study was observational only.

RESULTS

Mean interval between phone call and arrival on scene was 8.5+/-3.5 min. BLS manoeuvres were carried out from bystanders only in 15% of the cohort; this was associated with significant mortality reduction (85.7 versus 95.8%, chi(2) P<0.05). One hundred and thirty-three patients (75%) received assistance from BLS crews while only 45 patients (25%) were assisted by ALS medical personel, with a significant mortality reduction (ALS deaths 86.7%, BLS deaths 97%). Total 24 h survival was 9% and survival at 1 month declined to 6.17%.

CONCLUSIONS

Quality monitoring produces objective information on interventions and outcomes. Only with this information, is it possible to implement improvement programmes that are planned according to the data presented.

Resuscitation for patients with out-of-hospital cardiac arrest: Singapore

AIM

To evaluate characteristics and outcome of out-of-hospital cardiac arrest (OHCA) patients presenting to the Emergency Department (ED), and to examine factors that could be used to determine to prolong or abort resuscitation for these patients.

METHOD

All OHCA patients presenting to the ED were studied over a three-month period from November 2001 through January 2002. Patient with traumatic cardiac arrest were excluded. Data were collected from the ambulance case records, ED resuscitation charts, and the ED Very High Frequency (VHF) radio case-log sheet. Information collected included the patient's demographic characteristics, timings (time from call to ambulance arrival on scene, time from arrival at scene to departure from scene, time from scene to arrival in the ED) recorded in the pre-hospital setting, the outcome of the resuscitation, and the final outcome for patients who survived ED resuscitation.

RESULTS

Ninety-three non-traumatic patients with an OHCA were studied during the three-month period. Of the 93 patients, 15 (16.1%) survived ED resuscitation, and one survived to hospital discharge. There were no statistically significant differences for age, race, or gender with regards to the outcome of the resuscitation. The initial cardiac rhythms were asystole (65), pulseless electrical activity (21), and ventricular fibrillation (7). Fourteen (15%) received bystander cardiopulmonary resuscitation (CPR). All seven patients with return of spontaneous circulation (ROSC) on arrival in the ED survived ED resuscitation. The ambulance took an average of 11.80 +/- 3.36 minutes for the survivors and 11.8 +/- 4.22 minutes for the non-survivors from the time of call to get to these patients. The average of the scene times was 12.5 +/- 4.61 minutes for the survivors and 12.0 +/- 4.02 minutes for the non-survivors. Transport time from the scene to the ED took an average of 39.1 +/- 8.32 minutes for the survivors and 37.2 +/- 9.00 minutes for the non-survivors.

CONCLUSION

The survival rate for patients with OHCA after ED resuscitation is similar to the results from other studies. There is a need to increase the awareness and delivery of basic life support by public education. Automatic External Defibrillators (AED) should be available widely to ensure that the chance of early defibrillation is increased. Prolonged resuscitation efforts appear to be futile for OHCA patients if the time from cardiac arrest until arrival in the ED is > or = 30 minutes coupled with no ROSC, and if continuous asystole has been documented for > 10 minutes.