Regional variation and outcome of out-of-hospital cardiac arrest (ohca) in Finland – the Finnresusci study

Abstract

BackgroundDespite the efforts of the modern Emergency Medical Service Systems (EMS), survival rates for sudden out-of-hospital cardiac arrest (OHCA) have been poor as approximately 10% of OHCA patients survive hospital discharge. Many aspects of OHCA have been studied, but few previous reports on OHCA have documented the variation between different sizes of study areas on a regional scale. The aim of this study was to report the incidence, outcomes and regional variation of OHCA in the Finnish population.MethodsFrom March 1st to August 31st, 2010, data on all OHCA patients in the southern, central and eastern parts of Finland was collected. Data collection was initiated via dispatch centres whenever there was a suspected OHCA case or if a patient developed OHCA before arriving at the hospital. The study area includes 49% of the Finnish population; they are served by eight dispatch centres, two university hospitals and six central hospitals.ResultsThe study period included 1042 cases of OHCA. Resuscitation was attempted on 671 patients (64.4%), an incidence of 51/100,000 inhabitants/year. The initial rhythm was shockable for 211 patients (31.4%). The survival rate at one-year post-OHCA was 13.4%. Of the witnessed OHCA events with a shockable rhythm of presumed cardiac origin (n=140), 64 patients (45.7%) were alive at hospital discharge and 47 (33.6%) were still living one year hence. Surviving until hospital admission was more likely if the OHCA occurred in an urban municipality (41.5%, p=0.001).ConclusionsThe results of this comprehensive regional study of OHCA in Finland seem comparable to those previously reported in other countries. The survival of witnessed OHCA events with shockable initial rhythms has improved in urban Finland in recent decades.

Results of Out-of-Hospital Cardiopulmonary Arrest Cases with Intervention by Lay Rescuers and Emergency Health Workers

“…We believe that this is because the population of elderly people is dense and that they do not receive adequate health care in these areas. The most frequently detected conditions preceding cardiac arrest, such as cerebrovascular events chest pain and breathing difficulty, were the same as those found in other studies (8)(9)(10). These results support the theory that cardiopulmonary and cerebrovascular events are one of the leading causes of sudden death in elderly patients.…”

“…A significant part of these interventions were performed by EMT (n=97, 47.3%) and by paramedics (n=75, 36.6%) ( Table 1). The mean experience of the EHP who performed the interventions was 5.72±3.81 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) years. The ratios of the last in-service training of the EMS personnel are given in Table 1.…”

“…The explanation for why 4/5 of our cases were witnessed by someone is that most of the OHCA cases occurred in the family environment. In related studies (8)(9)(10)(11)(12)(13), the ratio of witnessed OHCA cases varies from 33%-65%. Those studies have reported that people tend to live alone as the socio-cultural and economical levels rise; one indication of this is the decreasing rate of witnessed cardiac arrest cases at homes.…”

“…Considering this finding, the family members of patients with a high risk of sudden death might be educated on BLS to increase the awareness of the importance of early interventions in OHCA cases. This education would be valuable because most of the OHCA cases occur at home (8,14).…”

Epidemiology of out-of-hospital cardiac arrest in the Bielsko-Biala district: a 12-month analysis

“…Comparing the data with literature, a significant discrepancy can be noted, especially with the countries of Western Europe where the numbers are two or three times lower [2]. On the basis of international data, the standard OHCA incidence rate ranges from 34/100,000 (Denmark) [5], through 51/100,000 (Finland) [6], 52/100,000 (Sweden) [7], and 88/100,000 (Ireland), [8] to 206/100,000 (Austria) [9]. These detectable differences can be explained by two major facts: on the one hand, it is related to the characteristics of patients and circumstances of the incident, and on the other hand, to the system of reporting results.…”