Abstract Aim The aim of this investigation was to estimate and contrast the global incidence and outcome of out-of-hospital cardiac arrest (OHCA) to provide a better understanding of the variability ...in risk and survival of OHCA. Methods We conducted a review of published English-language articles about incidence of OHCA, available through MEDLINE and EmBase. For studies including adult patients and both adult and paediatric patients, we used Utstein data reporting guidelines to calculate, summarize and compare incidences per 100,000 person-years of attended OHCAs, treated OHCAs, treated OHCAs with a cardiac cause, treated OHCA with ventricular fibrillation (VF), and survival-to-hospital discharge rates following OHCA. Results Sixty-seven studies from Europe, North America, Asia or Australia met inclusion criteria. The weighted incidence estimate was significantly higher in studies including adults than in those including adults and paediatrics for treated OHCAs (62.3 vs 34.7; P < 0.001); and for treated OHCAs with a cardiac cause (54.6 vs 40.8; P = 0.004). Neither survival to discharge rates nor VF survival to discharge rates differed statistically significant among studies. The incidence of treated OHCAs was higher in North America (54.6) than in Europe (35.0), Asia (28.3), and Australia (44.0) ( P < 0.001). In Asia, the percentage of VF and survival to discharge rates were lower (11% and 2%, respectively) than those in Europe (35% and 9%, respectively), North America (28% and 6%, respectively), or Australia (40% and 11%, respectively) ( P < 0.001, P < 0.001). Conclusions OHCA incidence and outcome varies greatly around the globe. A better understanding of the variability is fundamental to improving OHCA prevention and resuscitation.
In recent years, a wider use of automated external defibrillators (AEDs) to treat out-of-hospital cardiac arrest was advocated in The Netherlands. We aimed to establish whether survival with ...favorable neurologic outcome after out-of-hospital cardiac arrest has significantly increased, and, if so, whether this is attributable to AED use.
We performed a population-based cohort study, including patients with out-of-hospital cardiac arrest from cardiac causes between 2006 and 2012, excluding emergency medical service-witnessed arrests. We determined survival status at each stage (to emergency department, to admission, and to discharge) and examined temporal trends using logistic regression analysis with year of resuscitation as an independent variable. By adding each covariable subsequently to the regression model, we investigated their impact on the odds ratio of year of resuscitation. Analyses were performed according to initial rhythm (shockable versus nonshockable) and AED use. Rates of survival with favorable neurologic outcome after out-of-hospital cardiac arrest increased significantly (N=6133, 16.2% to 19.7%; P for trend=0.021), although solely in patients presenting with a shockable initial rhythm (N=2823; 29.1% to 41.4%; P for trend<0.001). In this group, survival increased at each stage but was strongest in the prehospital phase (odds ratio, 1.11 95% CI, 1.06-1.16). Rates of AED use almost tripled during the study period (21.4% to 59.3%; P for trend <0.001), thereby decreasing time from emergency call to defibrillation-device connection (median, 9.9 to 8.0 minutes; P<0.001). AED use statistically explained increased survival with favorable neurologic outcome by decreasing the odds ratio of year of resuscitation to a nonsignificant 1.04.
Increased AED use is associated with increased survival in patients with a shockable initial rhythm. We recommend continuous efforts to introduce or extend AED programs.
In out-of-hospital cardiac arrest (OHCA), return of spontaneous circulation (ROSC) on scene occurs only in a minority of patients. The optimal duration of resuscitation on scene before transport with ...ongoing cardiopulmonary resuscitation (CPR) is unknown.
To determine the time of resuscitation on scene (‘time on scene’) and survival in patients transported with ongoing CPR in the Netherlands.
Data on OHCA patients (>18 years) without ROSC on scene, where resuscitation was started between January 1, 2012 and December 31, 2016 in the Amsterdam Resuscitation Study (ARREST) database were analyzed. Time on scene was related to 30-day survival.
Of the 5871 OHCA patients where resuscitation was started, 2437 did not achieve ROSC on scene. Of these, 655 patients were transported with ongoing CPR and 606 (93%) had complete rhythm data. At the moment of transport, 199 (33%) patients had a shockable rhythm, 299 (49%) pulseless electrical activity (PEA) and 108 (18%) asystole as rhythm. Twenty-nine patients (4%) were alive at 30 days. Patients who survived 30 days had a higher proportion of a shockable first monitored rhythm (89% vs. 52%, p < 0.001). Survivors had a significantly shorter time on scene (20 min vs. 26 min, p = 0.004), with the highest survival rate (8%) in patients transported within 20 min. In a multivariable model time on scene (OR 0.94; 95%CI 0.89–0.99) was independently associated with 30-day survival.
In OHCA patients transported with ongoing CPR the survival rate significantly declines when time on scene increases.
Mechanical chest compression (CC) during cardiopulmonary resuscitation (CPR) with AutoPulse or LUCAS devices has not improved survival from cardiac arrest. Cohort studies suggest risk of excess ...damage. We studied safety of mechanical CC and determined possible excess damage compared with manual CC.
This is a randomized non-inferiority safety study. Randomization to AutoPulse, LUCAS, or manual CC with corrective depth and rate feedback was performed. We included patients with in-hospital cardiac arrest or with out-of-hospital cardiac arrest arriving with manual CPR at the emergency department. The primary outcome was serious or life-threatening visceral resuscitation-related damage, assessed blind by post-mortem computed tomography scan and/or autopsy or by clinical course until discharge. Non-inferiority hypothesis: mechanical CC compared with manual control does not increase the primary outcome by a risk difference of > 10% upper 95% confidence interval (CI). We included 115 patients treated with AutoPulse, 122 with LUCAS, and 137 patients received manual CC. Safety outcome analysis was possible in 337 of 374 (90.1%) included patients. The primary outcome was observed in 12 of 103 AutoPulse patients (11.6%), 8 of 108 LUCAS patients (7.4%), and 8 of 126 controls (6.4%). Rate difference AutoPulse-control: +5.3% (95% CI - 2.2% to 12.8%), P = 0.15. Rate difference LUCAS-control +1.0% (95% CI - 5.5% to 7.6%), P = 0.75.
LUCAS does not cause significantly more serious or life-threatening visceral damage than manual CC. For AutoPulse, significantly more serious or life-threatening visceral damage than manual CC cannot be excluded.
Automated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home.
In residential areas, 785 AEDs were placed and 5735 volunteer ...responders were recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient. We analysed survival (primary outcome) and neurologically favourable survival to discharge, time to first defibrillation shock, and cardiopulmonary resuscitation (CPR) before Emergency Medical Service (EMS) arrival of patients in residences found with ventricular fibrillation (VF), before and after introduction of this text-message alert system. Survival from OHCAs in residences increased from 26% to 39% {adjusted relative risk (RR) 1.5 95% confidence interval (CI): 1.03-2.0}. RR for neurologically favourable survival was 1.4 (95% CI: 0.99-2.0). No CPR before ambulance arrival decreased from 22% to 9% (RR: 0.5, 95% CI: 0.3-0.7). Text-message-responders with AED administered shocks to 16% of all patients in VF in residences, while defibrillation by EMS decreased from 73% to 39% in residences (P < 0.001). Defibrillation by first responders in residences increased from 22 to 40% (P < 0.001). Use of public AEDs in residences remained unchanged (6% and 5%) (P = 0.81). Time from emergency call to defibrillation decreased from median 11.7 to 9.3 min; mean difference -2.6 (95% CI: -3.5 to -1.6).
Introducing volunteer responders directed to AEDs, dispatched by text-message was associated with significantly reduced time to first defibrillation, increased bystander CPR and increased overall survival for OHCA patients in residences found with VF.
Abstract Aim Public access defibrillation rarely reaches out-of-hospital cardiac arrest (OHCA) patients in residential areas. We developed a text message (TM) alert system, dispatching local lay ...rescuers (TM-responders). We analyzed the functioning of this system, focusing on response times and early defibrillation in relation to other responders. Methods In July 2013, 14 112 TM-responders and 1550 automated external defibrillators (AEDs) were registered in a database residing with the dispatch center of two regions of the Netherlands. TM-responders living <1000 m radius of the patient received a TM to go to the patient directly, or were directed to retrieve an AED first. We analyzed 1536 OHCA patients where a defibrillator was connected from February 2010 until July 2013. Electrocardiograms from all defibrillators were analyzed for connection and defibrillation time. Results Of all OHCAs, the dispatcher activated the TM-alert system 893 times (58.1%). In 850 cases ≥1 TM-responder received a TM-alert and in 738 cases ≥1 AED was available. A TM-responder AED was connected in 184 of all OHCAs (12.0%), corresponding with 23.1% of all connected AEDs. Of all used TM-responder AEDs, 87.5% were used in residential areas, compared to 71.6% of all other defibrillators. TM-responders with AEDs defibrillated mean 2:39 (min:sec) earlier compared to emergency medical services (median interval 8:00 25–75th percentile, 6:35–9:49 vs. 10:39 25–75th percentile, 8:18–13:23, P < 0.001). Of all shocking TM-responder AEDs, 10.5% delivered a shock ≤6 min after call. Conclusion A TM-alert system that includes local lay rescuers and AEDs contributes to earlier defibrillation in OHCA, particularly in residential areas.
People with epilepsy are at increased risk for sudden death. The most prevalent cause of sudden death in the general population is sudden cardiac arrest (SCA) due to ventricular fibrillation (VF). ...SCA may contribute to the increased incidence of sudden death in people with epilepsy. We assessed whether the risk for SCA is increased in epilepsy by determining the risk for SCA among people with active epilepsy in a community-based study.
This investigation was part of the Amsterdam Resuscitation Studies (ARREST) in the Netherlands. It was designed to assess SCA risk in the general population. All SCA cases in the study area were identified and matched to controls (by age, sex, and SCA date). A diagnosis of active epilepsy was ascertained in all cases and controls. Relative risk for SCA was estimated by calculating the adjusted odds ratios using conditional logistic regression (adjustment was made for known risk factors for SCA). We identified 1019 cases of SCA with ECG-documented VF, and matched them to 2834 controls. There were 12 people with active epilepsy among cases and 12 among controls. Epilepsy was associated with a three-fold increased risk for SCA (adjusted OR 2.9 95%CI 1.1-8.0., p=0.034). The risk for SCA in epilepsy was particularly increased in young and females.
Epilepsy in the general population seems to be associated with an increased risk for SCA.
Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has ...undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival.
We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n=232).
Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85–0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival.
The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.
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