Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.
All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.
Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p
AIMS: To assess the impact of therapeutic hypothermia on cognitive function and quality of life in comatose survivors of out of Hospital Cardiac arrest (OHCA). METHODS: We prospectively studied comatose survivors of OHCA consecutively admitted in a 4-year period. Therapeutic hypothermia was implemented in the last 2-year period, intervention period (n=79), and this group was compared to patients admitted the 2 previous years, control period (n=77). We assessed Cerebral Performance Category (CPC), survival, Mini Mental State Examination (MMSE) and self-rated quality of life (SF-36) 6 months after OHCA in the subgroup with VF/VT as initial rhythm. RESULTS: CPC in patients alive at hospital discharge was significantly better in the intervention period with a CPC of 1-2 in 97% vs. 71% in the control period, p=0.003, corresponding to an adjusted odds ratio of a favourable cerebral outcome of 17, p=0.01. No significant differences were found in long-term survival (57% vs. 56% alive at 30 months), MMSE, or SF-36. Therapeutic hypothermia (hazard ratio: 0.15, p=0.007) and bystander CPR (hazard ratio 0.19, p=0.002) were significantly related to survival in the intervention period. CONCLUSION: CPC at discharge from hospital was significantly improved following implementation of therapeutic hypothermia in comatose patients resuscitated from OCHA with VF/VT. However, significant improvement in survival, cognitive status or quality of life could not be detected at long-term follow-up.
Internationally, survival among patients suffering in-hospital cardiac arrest is relatively low and unchanged at about 15%. Our experience at Sahlgrenska Hospital in Göteborg indicates a higher rate. We found survival to be related to the type of arrhythmia initially encountered, the highest rate having been observed among patients in ventricular fibrillation. We also found survival among patients suffering cardiac arrest to be higher in monitored as opposed to non-monitored wards. Whether the improved survival rate observed at Sahlgrenska as compared with international observations among patients suffering cardiac arrest is due to improvements in the organization or to patient selection is not clear. In order to achieve a higher survival rate after in-hospital cardiac arrest an efficient organization in which health care providers are given regular training and feed back is most likely of the utmost importance.
Helsinki, a city of 500,000 inhabitants, is served by a two-tiered emergency medical system with basic emergency medical technicians in ordinary ambulances and one physician-staffed prehospital emergency care unit. All 266 patients with prehospital cardiopulmonary resuscitation during 1987 were studied. Two hundred twelve patients with presumed heart disease and a witnessed arrest were analyzed further. Their response times for basic life support and advanced life support were 5.5 and 10.7 minutes, respectively. The initial cardiac rhythm in 144 patients (68%) was ventricular fibrillation. In 79 of these patients, cardiopulmonary resuscitation was successful, and 39 patients (27%) were discharged from hospital. The patients who survived had shorter response times for basic life support and their arrest locations was more often outside home, compared with the nonsurvivors. The results seem comparable with emergency medical systems in the United States, but a need to reduce response times is identified.
In Europe, 40% of all deaths of individuals who are 25-74 years of age are caused by cardiovascular disease. Cardiac disease is the underlying cause in two-thirds of out-of-hospital sudden deaths. The 28-day case fatality rate for the combined population of out-of-hospital coronary artery disease deaths and hospitalized acute myocardial infarction patients is approximately 50% in 29 of the regions included in the World Health Organization (WHO) Monitoring Trends and Determinants in Cardiovascular Disease registry. Of 14,065 patients included in the Swedish Cardiac Arrest Registry, resuscitation procedures were started in 10,966 patients. The remaining 3,099 were considered definitely dead; 70% were witnessed, cardiac arrests and 32.3% had been given bystander cardiopulmonary resuscitation (CPR). The incidence of ventricular tachycardia (VT)/ventricular fibrillation (VF) in all patients was 43%, in witnessed cases 54%, and in nonwitnessed cases, 31%. The initial incidence of VT/VF was calculated to be approximately 60% in the whole population and 80-85% in those with probable cardiac disease. Survival to 1 month was 5.0% in the total population, 9.5% for those with VT/VF on the first electrocardiogram compared with 1.6% for those not in VT/VF. Survival rate was also calculated in relation to delay time to first defibrillation. Survival was 50% when defibrillation was performed immediately and decreased gradually to 0% for those with a delay time of 20 minutes. The survival rate after bystander CPR was 2.6-fold higher than the rate for those where no treatment was given until the ambulance arrived.
There has recently been an increased attention focused on the importance of reducing time without blood flow from chest compressions (no flow time, NFT) during cardiopulmonary resuscitation (CPR). In this study we have analyzed and quantified the NFTs during external automatic defibrillation in 105 cardiac arrest patients. We found that for around half of the time (about 10 min), these patients were not perfused. We have proposed methods to reduce NFT in connection with analyses and shocks. The key factors were rhythm analysis during ongoing CPR, capacitor charging during analysis, 1 min of CPR immediately after a shock (with rhythm analysis during CPR at the end of the 1 min), and distinguishing between asystole and organized rhythm in analyses to skip pulse check if asystole. The potential reduction in NFT using these methods was calculated theoretically and we found a reduction in the total NFT of about 4.5 and 1 min, respectively, in the subgroups of patients having at least one shock and patients having received no shocks. In the present study, the median NFT ratio could theoretically be reduced from 51% to 34% or 49% to 39% depending on if the patient would have a shockable rhythm or not. By introducing the proposed methods into an AED, the NFT would be significantly reduced, hopefully increasing the survival.
In a region with a population of 250,000 people, all emergency calls for cardiac arrest were prospectively registered during a period of 6 years. Timing of events were carefully registered as were treatment and the participation of 3 ambulances equipped with defibrillators. When time until initial treatment of cardiac arrest was below 5 min, 12% could be resuscitated and discharged alive. This figure decreased to 2% in the period between 5 and 10 min and was zero to above 10 min. Similarly, a reasonable 12% of patients experiencing ventricular fibrillation at a public place could be resuscitated and discharged alive whereas only 5% of ventricular fibrillation occurring at the patients home could be successfully resuscitated. Asystolia was rarely treated successfully. Faster treatment improved results much and 63% of patients having ventricular fibrillation in the emergency room left hospital alive. Results of cardioversion in ambulances did not depend on time from initiation of cardiac arrest, but all patients receiving cardioversion later than 10 min died without regaining consciousness. The results were compared with other more effective programs. The study region apparently had much fewer cardiac arrest than a similar region in Seattle, U.S.A. In those cases where treatment could be initiated within 5 min, results were comparable.