Identification of Predictors for Survival in Out-of-Hospital, Cardiac Arrest—Analysis of Prehospital Resuscitations in the Rescue Service of Dachau over Three Consecutive Years (original) (raw)
Related papers
Paramedics, technicians, and survival from out of hospital cardiac arrest
Emergency Medicine Journal, 1997
Objective-To test the hypothesis that limited paramedic advanced life support skills afford no advantage in survival from cardiac arrest when compared with nonparamedic ambulance crews equipped with defibrillators in an urban environment; and to investigate whether separate response units delayed on scene times. Methods-A prospective, observational study was conducted over 17 consecutive months on all adult patients brought to the accident and emergency (A&E) department of Glasgow Royal Infirmary having suffered an out of hospital cardiac arrest of cardiac aetiology. The main interventions were bystander cardiopulmonary resuscitation (CPR) and limited advance life support skills. Main outcome measures-Return of spontaneous circulation, survival to admission, and discharge. Results-Of 240 patients brought to the A&E department, 19 had no clear record of whether a paramedic was or was not involved and so were excluded. There was no difference in survival between the two groups, although a trend to admission favoured non-paramedics. Paramedics spent much longer at the scene (P < 0.0001). Witnessed arrests (P = 0.01), early bystander CPR (P = 0.12), shockable rhythms (P = 0.003), and defibrillation (P < 0.0001) were associated with better survival. Intubation and at scene times were not associated with better survival. Delayed second response units did not prolong at scene times. Conclusions-The interventions of greatest benefit in out of hospital cardiac arrest are basic life support and defibrillation.
Resuscitation, 1997
Outcome after prehospital cardiac arrest was examined in the EMS system of Bonn, a midsized urban community, and presented according to the Utstein style. The data were collected from January lst, 1989 to December 31st. 1992 by the Bonn-north ALS unit, which serves 240 000 residents. Fifty-six patients suffered from cardiac arrest of non-cardiac aetiology and were excluded; 464 patients were resuscitated after cardiac arrest of presumed cardiac aetiology (incidence of CPR attempts: 48.33 per year,'100000 population). The collapse was unwitnessed, bystander witnessed or EMS personnel witnessed in 178, 214 or 72 patients, respectively. In these subgroups discharge rates and l-year survival accounted for 7.3% (4.5%). 22.9% (15.9%) and 16.7% (Il. 1%). respectively. Thirty-four patients were discharged without neurological deficits (cerebral performance category 1: CPC I), 22 and nine patients scored CPC 2 or CPC 3, respectively. Nine patients were comatose (CPC 4) when they were discharged and remained in this state until they died. Of the 50 l-year survivors 35 lived without neurological deficit, eight demonstrated mild (CPC 2) and five severe (CPC 3) cerebral disability at l-year after resuscitation. and. finally, two patients remained comatose for more than 1 year. The Utstein template recommends the selection of patients who were found in VF after bystander witnessed collapse. In our cohort 118 patients met these criteria. Of them 41 (35%) could be discharged from hospital and 28 (24%) lived more than 1 year. The comparison of our data with those from double-response EMS systems of other communities revealed that. in midsized urban and suburban communities the highest discharging rates could be achieved. Our study demonstrated that survival depends crucially on short response intervals and life support which will be performed by well-trained emergency technicians. paramedics and physicians. Copyright 0 1997 Elsevier Science Ireland Ltd.
Revista Latino-Americana de Enfermagem, 2014
OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%), "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%), "only the carry out of basic life support" (OR=0.142; p<0.05; CI95...
Eurasian Journal of Emergency Medicine, 2016
Aim: In this study, all interventions made by lay rescuers and health professionals and the shortcomings for cardiopulmonary arrest management outside the hospital were examined. Materials and Methods: The study was conducted between December 2012 and May 2014 in the Emergency Department of Gaziantep University. To ensure orderly and standardized records, a study form was prepared that consisted of 31 questions. The time and location of the cardiac arrest, information regarding the lay rescuers and professional health workers, and the practices followed during transport and at the emergency service were examined. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) for Windows software version 22.0, and p<0.05 was accepted as statistically significant. Results: Of the 205 cardiac arrests, 69.8% were male and 30.2% were female. The mean age in all of the cases was 58.34±19.1 years. The cardiac arrests mostly occurred in the home environment (62.4%) and happened between 13.00 and 20.00 hours (43.4%). The most frequent conditions that caused a worsening of the cases were syncope (unresponsiveness) (35.6%). The people who identified the cardiac arrest case and called for help by informing emergency health personnel (EHP) were mostly family members (50.7%). The activation time was 14.27±20.30 min. The time to arrive at the scene was 8.4±6.4 (1-35) min. Lay rescuers performed resuscitation in 19.5% of cases. The most frequent rhythms on the arrival of the EHP were asystole (74.1%). EHP evaluated the glaskow coma scale (GCS) of 88.3% of the cases as ≤7 at the scene. EHP performed basic life support (BLS) on all cases (100%) and endo-tracheal intubation (ETI) on 29.3% of the cases at the scene. The on-scene time and transport time to ED were 8.09±8.82 and 9.02±7.92 (1-50) min, respectively. The average duration of CPR at ED was 35.15±16.9 min. Of all the cases, 7.8% were discharged from intensive care unit (ICU) to homes. Of all the cases, 77.6% died at the ED, and 14.6% died in ICU. Conclusion: The intervention rate by lay rescuers was far less than the international rates. The survival rates were generally below the internationally reported rates. There is no adequate public awareness in our area for identifying cardiac arrest in patients and for initiating early chest compressions.
Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors
Heart, 1998
Objective-To study the circumstances and medical profile of out-of-hospital sudden cardiac arrest (SCA) patients in whom resuscitation was attempted by the ambulance service, and to identify causes of SCA in survivors and factors that influence resuscitation success rate. Methods-During a five year period (1991-95) all cases of out-of-hospital SCA between the ages of 20 and 75 years and living in the Maastricht area in the Netherlands were studied. Information was gathered about the circumstances of SCA, as well as medical history for all patients in whom resuscitation was attempted by the ambulance personnel. Causes of SCA in survivors were studied and logistic regression analysis was performed to identify factors associated with survival. Results-Of 288 SCA patients in whom cardiopulmonary resuscitation (CPR) and advanced life support were applied, 47 (16%) were discharged alive from the hospital. Their mean (SD) age was 58 (11) years, 37 (79%) were men, and 24 (51%) had a history of cardiac disease. Acute myocardial infarction was diagnosed in 24 (51%) of the survivors; seven with and 17 without a history of cardiac disease. Ventricular fibrillation (VF) or ventricular tachycardia (VT) as the first documented rhythm was significantly positively associated with survival (odds ratio (OR) 5.7, 95% confidence interval (CI) 2.1 to 15.9). A time interval of less than four minutes between the moment of collapse and the start of resuscitation, and an ambulance delay time of less than eight minutes were significantly positively associated with survival (OR 3.3, 95% CI 1.3 to 8.6, and OR, 3.6, 95% CI 1.3 to 10.5, respectively). A history of cardiac disease was negatively associated with survival (OR 0.46, 95% CI 0.21 to 0.98). Conclusions-Acute myocardial infarction was the underlying mechanism of SCA in most of the survivors, especially in those without a history of cardiac disease. CPR within four minutes, an ambulance delay time less than eight minutes, and VT or VF diagnosed by the paramedics were positively associated with success.
Resuscitation, 2017
Most survival outcomes in out-of-hospital cardiac arrest (OHCA) are provided by emergency medical services (EMS) without a doctor on board. Our objective was to determine such outcomes in a whole country with public physician-led EMS. We analyzed data from a nationwide prospective registry of OHCA cases attended by 19 public EMS in Spain, covering the period from 1-October 2013 to 30-October 2014. Advanced life support (ALS) was initiated in 9347 cases (incidence 18.6 cases/10(5) inhabitants per year). Resuscitation was considered futile in 558 cases (5.9%), and ALS was continued in 8789 cases (94.1%); mean age 63.5±17 years, 72.1% men. Initial rhythm was shockable in 22.1% of cases. Basic life support (BLS) was provided by bystanders in 1602 (24%) cases (635 of them with telephone assistance from the dispatch center). Of 8789 patients receiving ALS, 72.1% men, 2669 (30.4%) patients had return of spontaneous circulation on hospital arrival, 50.6% when the initial rhythm was shockabl...
Resuscitation, 1996
Objective: to provide researchers with a description of the method of dealing with out-of-hospital cardiac arrests, and the results thereof, using the Utstein style. Design: a series of out-of-hospital cardiac arrests between 1 October 1991 and 3 I September 1992. Setting: a French 'departement (administrative subdivision). Population: 570 000 inhabitants; area: 2600 km?; emergency medical system consisting of two levels of response: the Emergency and Resuscitation Mobile Unit and the Fire Service. Patients: a sample of 380 patients found to have neither palpable pulse nor independent respiration. Results: of the 234 (61%) patients in whom resuscitation was attempted, 41 (17%) were hospitalised and 12 (5%) discharged were still alive at 1 year follow-up. Of the patients who showed signs of cardiac arrest of cardiac aetiology, classified as having initial ventricular fibrillation (VF) rhythms: 62% of the cases (5/Q were alive at 1 year if the cardiac arrest occurred in the presence of emergency medical personnel: 6% of the cases (2:'31) were alive at I year if the cardiac arrest occurred in the presence of non-specialised bystander-
2020
Background Variation in the incidence, survival rate and factors associated with survival after cardiac arrest in Europe is reported. Some studies have tried to fill the knowledge gap regarding the epidemiology of out-of-hospital cardiac arrest in Europe but were unable to identify reasons for the reported differences. Therefore, the purpose of this study was to describe European Emergency Medical Systems, particularly from the perspective of country and ambulance service characteristics, cardiac arrest identification, dispatch, treatment, and monitoring. Methods An online questionnaire with 51 questions about ambulance and dispatch characteristics, on-scene management of cardiac arrest and the availability and dataset in cardiac arrest registries, was sent to all national coordinators who participated in the European Registry of Cardiac Arrest studies. In addition, individual invitations were sent to the remaining European countries. Results Participants from 28 European countries ...