Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience.

Abstract

SUMMARYAll patients with primary cardiac disease presenting with out-of-hospital sudden cardiac death (OH-SCD) to a provincial hospital were reviewed retrospectively over a 5-year period from 1985 to 1989. This coincided with the introduction of out-of-hospital defibrillation (OH-DEFIB) by ambulance officers. Of 215 patients, 17 (9%) survived to leave hospital alive, 15 of whom underwent OH-DEFIB. There was an increase in survivors from 4%, prior to OH-DEFIB, to 9% of all cardiac arrests, but this was not statistically significant (P = 0.3). However, long term survival amongst immediate survivors was associated with a statistically significant improvement following the introduction of OH-DEFIB (15 of 30 (50%) vs. 2 of 19 (10.5%), P<0.01).Mean call-out, at-scene and transfer times did not significantly vary between survivors and non-survivors. A total of 155 (72%) had a known cardiac history, with the majority (74%) of arrests occurring at home. Of 134 witfessed arrests, only 46 (34%) underwent bystander-initiated cardioplumonary resuscitation (CPR).A programme in CPR aimed at relatives of known cardiac patients, and the adoption of a paramedic protocol which improves oxygenation at the time of arrest are recommended.

Outcome from prehospital cardiac arrest in Melbourne, Australia

“…In Australia, the outcome from prehospital cardiac arrest has been reported for the New South Wales intensive care ambulance system and for the cities of Perth, Ipswich and Geelong 3–6 .…”

“…In 1992, Scott and Fitzgerald reported the outcomes of patients with prehospital cardiac arrest in Ipswich, Queensland 5 . Over a five year period, 215 patients were treated, 48 before and 167 after the introduction of prehospital defibrillation by ambulance officers.…”

“…Patient survival is dependent upon prompt treatment. Although outcomes have been extensively studied in North America and Europe there have been relatively tew reports from Australia 2–7 . This study was undertaken to establish the incidence and outcome of prehospital cardiac arrest in Melbourne, Australia.…”

Out‐of‐hospital cardiac arrest in Victoria: rural and urban outcomes

“…Many deaths from heart disease occur outside the hospital and present as sudden cardiac arrest (SCA). The reported survival rates for out-of-hospital SCA in Australia vary from 3% to 71%, [4][5][6][7][8][9][10][11][12][13] but few studies have specifically examined whether there are differences in outcomes between urban and rural cardiac arrests.…”

Prehospital defibrillation in Geelong

“…Reviews of emergency systems that employ a CPR/defibrillation‐only protocol (EMT‐D), have revealed survival rates of 1–26%. This variation has prompted wide interest and research internationally 2–11 . There are few published reports in Australia in this field 7–9 .…”