Outcome of out-of-hospital cardiac arrest over a period of 15 years in comparison to the RACA score in a physician staffed urban emergency medical service in Germany |
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| Institution: | 1. Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Street 25, 53105 Bonn, Germany;2. Emergency Medical System Oberbergischer Kreis, Department of Emergency Medicine, Lockenfeld 12, 51709 Marienheide, Germany;3. Department of Anaesthesiology and Intensive Care, Klinik am Eichert, ALB FILS Kliniken, Eichertstraße 3, 73035 Göppingen, Germany;1. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium;2. Department of Cardiovascular and Thoracic Surgery, Cardiovascular Anaesthesia and Intensive Care, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy;1. Department of Emergency Medicine, Samsung Medical Center, Republic of Korea;2. Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea;3. Department of Social and Preventive Medicine, Inha University School of Medicine, 7-206, 3-ga, Shinheung-dong, Jung-gu, Incheon, 400-712, Republic of Korea;1. Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea;2. Department of Emergency Medicine, KEPCO Medical Center, Seoul, Republic of Korea;3. Department of Emergency Medicine, Ewha Womans University, Seoul, Republic of Korea;4. Department of Emergency Medicine, Chonnam National University, Gwangju, Republic of Korea;5. Department of Emergency Medicine, College of Medicine Chungbuk National University, Cheongju-si, Republic of Korea;6. Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;7. Departments of Emergency Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea;1. Cardiothoracic Intensive Care Unit, Intensive Care Directorate – St. Georges Healthcare NHS Trust, London SW17 0QT, United Kingdom;2. Department of Cardiothoracic Surgery, Oxford Heart Centre, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom;3. Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia;4. Department of Intensive Care Medicine, CHUV-Lausanne University Medical Center, CH-1011 Lausanne, Switzerland;5. Anaesthesia and Critical Care St. George''s Hospital and Medical School, London SW17 0QT, United Kingdom;1. Université de Montréal, Montréal, Québec, Canada;2. Hôpital du Sacré-C?ur de Montréal, Montréal, Québec, Canada;3. Institut de Cardiologie de Montréal, Montréal, Québec, Canada;4. Corporation d’Urgences-santé, Montréal, Québec, Canada;5. Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada;6. Université McGill, Montréal, Québec, Canada;7. Centre Universitaire de Santé McGill, Montréal, Québec, Canada;8. Hôpital général juif de Montréal, Montréal, Québec, Canada |
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| Abstract: | BackgroundPatient outcome after out of hospital cardiac arrest (OHCA) depends on the cardiopulmonary resuscitation (CPR) performance and might also be influenced by organisation of the emergency medical service (EMS) and implementation of guidelines.AimTo assess the rate of return of spontaneous circulation (ROSC) after cardiac arrest to the predicted rate by the ROSC after cardiac arrest (RACA) score over a 15-year period reflecting three different implemented ALS-guidelines in a physician-staffed EMS.MethodsAll adult patients with non-traumatic OHCA in the EMS of Bonn from 1996 to 2011 were included. Utstein data from three 5-years time periods (1996–2001, 2001–2006, 2006–2011) representing different ALS-guideline implementations were collected. Group comparisons were made in terms of incidence, epidemiology and short-term outcome of CPR with emphasis on changes over time and factors of importance. In each group observed ROSC rate were compared to the predicted ROSC rates (the RACA score).ResultsCPR by the ALS unit was attempted in a total of 1989 patients (735, 666, and 588 patients in the first, second and third period, respectively). Average crude incidence of CPR per 100,000 person-years decreased over time (61.3; 55.5; 49.0/100,000/years) while patients treated were significantly older (65.5 ± 16.5; 67.9 ± 15; 68.9 ± 15.7 (p < 0.001)). Observed ROSC rates were higher than predicted by the RACA score in all time periods, however, admittance to ICU decreased significantly from 50% in the first five-year period to 38% last five-year period (p < 0.001). From first to third period the proportion of arrests with first observed rhythm of VT/VF arrests did not change (29% vs. 27%, p = 0.323) nor there were changes in bystander CPR rates (17% vs. 17%, p = 0.520).ConclusionsIn a 15-years period and in the setting of a physician-staffed EMS the ROSC rates remain higher than predicted by the RACA score but the admittance to the ICU after OHCA declined significantly. This finding was accompanied by a decrease in CPR incidence and an increase in age of patients. |
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| Keywords: | Cardiac arrest EMS Outcome CPR OHCA resuscitation RACA |
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