High survival rate of 43% in out-of-hospital cardiac arrest patients in an optimised chain of survival
L W Boyce, T P M Vliet Vlieland, J Bosch, R Wolterbeek, G Volker, H J van Exel, C Heringhaus, M J Schalij, P H Goossens, L W Boyce, T P M Vliet Vlieland, J Bosch, R Wolterbeek, G Volker, H J van Exel, C Heringhaus, M J Schalij, P H Goossens
Abstract
Aims: Survival to hospital discharge after out-of-hospital cardiac arrest (OHCA) varies widely. This study describes short-term survival after OHCA in a region with an extensive care path and a follow-up of 1 year.
Methods: Consecutive patients ≥16 years admitted to the emergency department between April 2011 and December 2012 were included. In July 2014 a follow-up took place. Socio-demographic data, characteristics of the OHCA and interventions were described and associations with survival were determined.
Results: Two hundred forty-two patients were included (73 % male, median age 65 years). In 76 % the cardiac arrest was of cardiac origin and 52 % had a shockable rhythm. In 74 % the cardiac arrest was witnessed, 76 % received bystander cardiopulmonary resuscitation and in 39 % an automatic external defibrillator (AED) was used. Of the 168 hospitalised patients, 144 underwent therapeutic procedures. A total of 105 patients survived until hospital discharge. Younger age, cardiac arrest in public area, witnessed cardiac arrest, cardiac origin with a shockable rhythm, the use of an AED, shorter time until return of spontaneous circulation, Glasgow Coma Scale (GCS) ≥13 during transport and longer length of hospital stay were associated with survival. Of the 105 survivors 72 survived for at least 1 year after cardiac arrest and 6 patients died.
Conclusion: A survival rate of 43 % after OHCA is achievable. Witnessed cardiac arrest, cardiac cause of arrest, initial cardiac rhythm and GCS ≥13 were associated with higher survival.
Figures
References
- Berdowski J, Berg R, Tijssen JGP, et al. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81(11):1479–87. doi: 10.1016/j.resuscitation.2010.08.006.
- Hulleman M, Berdowski J, de Groot, et al. Implantable cardioverter-defibrillators have reduced the incidence of resuscitation for out-of-hospital cardiac arrest caused by lethal arrhythmias. Circulation. 2012;126(7):815–21. doi: 10.1161/CIRCULATIONAHA.111.089425.
- Waalewijn R, de Vos R, Koster RW. Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in “Utstein” style. Resuscitation. 1998;38(3):157–67. doi: 10.1016/S0300-9572(98)00102-6.
- Sasson C, Rogers MAM, Dahl J, et al. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3(1):63–81. doi: 10.1161/CIRCOUTCOMES.109.889576.
- Stub D, Smith K, Bray JE, et al. Hospital characteristics are associated with patient outcomes following out-of-hospital cardiac arrest. Heart. 2011;97(18):1489–94. doi: 10.1136/hrt.2011.226431.
- Johnson NJ, Salhi RA, Abella BS, et al. Emergency department factors associated with survival after sudden cardiac arrest. Resuscitation. 2012;84(3):292–7. doi: 10.1016/j.resuscitation.2012.10.013.
- Six AJ, Backus BE, Kingma A, et al. Consumption of diagnostic procedures and other cardiology care in chest pain patients after presentation at the emergency department. Neth Heart J. 2012;20(12):499–504. doi: 10.1007/s12471-012-0322-6.
- Arawwawala D, Brett SJ. Clinical review: beyond immediate survival from resuscitation-long-term outcome considerations after cardiac arrest. Crit Care. 2007;11(6):235. doi: 10.1186/cc6139.
- Weisfeldt ML, Sitlani CM, Ornato, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol. 2010;55(16):1713–20. doi: 10.1016/j.jacc.2009.11.077.
- Berdowski J, Blom MT, Bardai A, et al. Impact of onsite or dispatched automated external defibrillator use on survival after out-of-hospital cardiac arrest. Circulation. 2011;124(20):2225–32. doi: 10.1161/CIRCULATIONAHA.110.015545.
- Van Engen-Verheul M, de Vries H, Kemps H, et al. Cardiac rehabilitation uptake and its determinants in the Netherlands. Eur J Prev Cardiol. 2013;20(2):349–56. doi: 10.1177/2047487312439497.
Source: PubMed