BACKGROUND: A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role of treatment with adrenaline in these patients remains to be determined. AIM: To describe the proportion of patients with witnessed out-of-hospital cardiac arrest found in ventricular fibrillation who survived and were discharged from hospital in relation to whether they were treated with adrenaline prior to hospital admission. PATIENTS AND TREATMENT: All the patients with out-of-hospital cardiac arrest found in ventricular fibrillation in Göteborg between 1981 and 1992 in whom cardiopulmonary resuscitation (CPR) was initiated by our emergency medical service (EMS). During the observation period, some of the EMS staff were authorized to give medication and some were not. RESULTS: In all, 1360 patients were found in ventricular fibrillation and detailed information was available in 1203 cases (88%). Adrenaline was given in 417 cases (35%). Among patients with sustained ventricular fibrillation, those who received adrenaline experienced the return of spontaneous circulation more frequently (P
AIM: To describe the occurrence, characteristics and outcome among patients with out-of-hospital cardiac arrest who required continuation of cardiopulmonary resuscitation (CPR) on admission to the emergency department. PATIENTS: all patients in the municipality of Göteborg who suffered out-of-hospital cardiac arrest, were reached by the emergency medical service (EMS) system and in whom CPR was initiated. Period for inclusion in study: 1 Oct. 1980-31 Dec. 1992. RESULTS: of 334 out-of-hospital cardiac arrests, 2,319 (68%) were receiving on-going CPR at the time of admission to hospital. Of these, 137 patients (6%) were hospitalized alive and 28 (1.2%) could be discharged from hospital. Of these patients, 39% had a cerebral performance categories (CPC) score of 1 (no cerebral deficiency), 18% had a CPC score of 2 (moderate cerebral deficiency), 36% had a CPC score of 3 (severe cerebral deficiency) and 7% had a CPC score of 4 (coma) at discharge. Among patients discharged. 76% were alive after 1 year. CONCLUSION: among consecutive patients with out-of-hospital cardiac arrest, CPR was ongoing in 68% of them on admission to hospital. Among these patients, 6% were hospitalized alive and 1.2% were discharged from hospital. Thus, among patients with ongoing CPR on admission to hospital, survivors can be found but they are few in numbers and extensive cerebral damage is frequently present.
For one year (1 September 1975-31 August 1976) an analysis was made of all deaths occurring outside hospital in the Gothenburg area (population 480 000). The total number of deaths was 1309. It was found that 675 (52%) of these deaths were caused by ischaemic heart disease (IHD), while 54 (4%) were caused by other heart diseases. The circumstances preceding death were analyzed in 363 cases representing all autopsied subjects under 75 years of age who died from IHD (autopsy rate 95%). Of these, 68% died at home, 4% during transport to hospital, and 4% at work. 214 (59%) of the deaths were witnessed, and in 189 (52%) cases, an ambulance had been called. 111 (52% died within 1 min of the onset of symptoms. 23 subject were in ventricular fibrillation on arrival at hospital. 11 of them were resuscitated, but only 3 were discharged alive. Additionally 12 of the non-autopsied subjects who died from IHD and 11 who died from other heart diseases had been witnessed and an ambulance had been called. In summary, 212 subjects who died outside hospital from heart disease in one year in Gothenburg died witnessed, and an ambulance was called. This should be the maximum annual number of cases of cardiac arrest outside hospital which it is possible to reach with a mobile coronary care organization within the time limit for effective resuscitation attempts.
During 1989-1991, the mobile coronary care unit (MCCU) in Gothenburg answered 10,908 calls. The most frequent cause of alarm calls was chest pain (21 per cent), whereas cardiac arrest accounted for 9 and surgical cases for 15 per cent. Severe pain was most frequent among patients with chest or abdominal pain. Despite the high frequency of chest pain, only a third of the myocardial infarction cases were attended by the MCCU. Of all cases of out-of-hospital cardiac arrest where resuscitation was attempted, 26 per cent were alive at admission to hospital, and 10 per cent at discharge, as compared with 48 and 22 per cent, respectively, among the subgroup with bystander-witnessed cardiac arrest and ventricular fibrillation as an initial finding.
OBJECTIVE--To describe the proportion of patients who were discharged from hospital after witnessed cardiac arrest outside hospital in relation to whether a bystander initiated cardiopulmonary resuscitation. PATIENTS--All patients with witnessed cardiac arrest outside hospital before arrival of the ambulance and in whom cardiopulmonary resuscitation was attempted by the emergency medical service in Gothenburg during 1980-92. RESULTS--Cardiopulmonary resuscitation was initiated by a bystander in 18% (303) of 1,660 cases. In this group 69% had ventricular fibrillation at first recording compared with 51% in the remaining patients (P
In order to reduce the delay times from onset of symptoms to arrival in hospital, and increase the use of ambulance in patients with suspected acute myocardial infarction (AMI), a media campaign was initiated in an urban area. An initial 3-week intense campaign was followed by a maintenance phase of 1 year. Delay times and ambulance use during the campaign were compared with the previous 21 months. Among patients admitted to a coronary care unit (CCU) due to suspected AMI, the median delay time was reduced from 3 h to 2 h 40 min and the mean delay time was reduced from 11 h 33 min to 7 h 42 min (P less than 0.001). Among patients with confirmed AMI the median delay time was reduced from 3 h to 2 h 20 min and the mean delay time from 10 h to 6 h 27 min (P less than 0.001). We conclude that a 1-year media campaign can reduce delay times in suspected AMI, and that this effect appears to continue at 1 year, but ambulance use seems to be more difficult to influence.
