Out-of-hospital cardiac arrests in Helsinki: Utstein style reporting.

Abstract

Objective-To determine the epidemiology of out-of-hospital cardiac arrests and survival after resuscitation and to apply the Utstein style of reporting to data collection. Design-Prospective cohort study. Setting-A middle-sized urban city (population 516 000) served by a single emergency medical services system. Patients-Consecutive prehospital cardiac arrests occurring between 1 January and 31 December 1994. Intervention-Advanced cardiac life support according to the recommendations of American Heart Association. Main outcome measures-Survival from cardiac arrest to hospital discharge, and factors associated with survival. Results-Four hundred and twelve patients were considered for resuscitation. The overall incidence of out-ofhospital cardiac arrest was 79-8/100 000 inhabitants/year. Fifty seven patients (16.6%) survived to discharge when resuscitation was attempted. 32-5% survived when cardiac arrest was bystander witnessed and was of cardiac origin with ventricular fibrillation as the initial rhythm. When asystole or pulseless electrical activity was the first rhythm recorded, discharge rates were 6-2 and 2-7% respectively. The cause of cardiac arrest was cardiac in 66-5%, and ventricular fibrillation was the initial rhythm in 65-0% of bystander witnessed cardiac arrests of cardiac origin. 22-1% of patients received bystander initiated cardiopulmonary resuscitation. The mean time intervals from the receipt of the call to the arrival of a first response advanced life support unit and mobile intensive care unit at the patient's side and to the return of spontaneous circulation were 7-0 and 10-3 and 12-6 and 16*7 min respectively. In the logistic regression model bystander witnessed arrest, age, ventricular fibrillation as initial rhythm, and the call-to-arrival interval of the first response unit were independent factors relating to survival. Utstein style reporting with modification of time zero was found to be an appropriate form of data collection in this emergency medical services system.Conclusions-After implementation of major changes in the emergency medical services system during the 1980s survival from out-of-hospital cardiac arrest markedly increased. However, early access, which has turned out to be the weakest link in the chain of survival, should receive major attention in the near future. Utstein style reporting with a modified time zero was found to be appropriate, although laborious, protocol for data collection.

Comparison of the early effects of out-of-hospital resuscitation in selected urban and rural areas in Poland. A preliminary report from the Polish Cardiac Arrest Registry by the Polish Resuscitation Council

“…In our study material, we did not identify any cases of use of an automated external defibrillator by the event witnesses, and thus the time to evaluation of the mechanism of OHCA and any defibrillation attempts was strictly related to the time of ambulance arrival to the scene [19].…”

Memory Impairment in Out-of-Hospital Cardiac Arrest Survivors Is Associated With Global Reduction in Brain Volume, Not Focal Hippocampal Injury

“…[1][2][3] In Edinburgh, Scotland, a 4-fold increase in the rate of survival to discharge was reported after the introduction of semiautomated ambulance defibrillators. 4 Although these and other centers have achieved impressive improvements in mortality figures, comparatively little attention has been focused on the sequelae of the cardiac arrest itself.…”

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

“…It has been estimated that incidence of sudden cardiac death (SCD) is 1 per 1,000 inhabitants annually in USA and Europe (Myerburg et al 1992, Priori et al 2001. The incidence of OHCA in Helsinki is 80/100,000 inhabitants/year (Kuisma et al 1996). Resuscitation is attempted in 50-66/100,000 inhabitants/year (Herlitz et al 1999).…”

“…Based on data from Finland, the annual incidence of resuscitation for out-of-hospital cardiac arrest (OHCA) of cardiac aetiology is 53 per 100,000 population (Kuisma et al 1996). Mortality among these patients admitted to hospital after OHCA remains high.…”