Elsevier

Resuscitation

Volume 84, Issue 1, January 2013, Pages 42-47
Resuscitation

Clinical paper
Out of hospital cardiac arrest in Vienna: Incidence and outcome

https://doi.org/10.1016/j.resuscitation.2012.07.002Get rights and content

Abstract

Aim of the study

To determine the incidence of out-of-hospital cardiac arrest and the survival rate of those patients who received CPR in the city of Vienna.

Methods

A cohort of patients with out-of-hospital cardiac arrests and who were treated by the Vienna Ambulance Service between January 1, 2009, and December 31, 2010, were followed up until either death or hospital discharge. The associations of survival and neurological outcome with their potential predictors were analysed using simple logistic regression models. Odds ratios were estimated for each factor.

Results

During the observation period, a total of 7030 (206.8/100,000 inhabitants/year) patients without signs of circulation were assessed by teams of the Vienna Ambulance Service, and 1448 adult patients were resuscitated by emergency medical service personnel. A sustained return of spontaneous circulation was reported in 361 (24.9%) of the treated patients, and in all 479 (33.0%) of the patients were taken to the emergency department. A total of 164 (11.3%) of the patients were discharged from the hospital alive, and 126 (8.7%) of the patients showed cerebral performance categories of 1 or 2 at the time of discharge. Younger age, an arrest in a public area, a witnessed arrest and a shockable rhythm were associated with a higher probability of survival to hospital discharge.

Conclusion

Survival rates for out-of-hospital cardiac arrests remain low. Efforts should be focused on rapidly initiating basic life support, early defibrillation, and high-quality CPR by emergency medical services and state-of-the art post-resuscitation care.

Introduction

Assessing and treating patients who suffer an out-of-hospital cardiac arrest is a major challenge for both emergency medical services and emergency departments. The reported survival rate after an out-of-hospital cardiac arrest varies significantly, ranging from 1.8% to 21.5% in different communities.1, 2, 3 Although sudden cardiac arrest incidences and local emergency response systems differ greatly, earlier studies have emphasised the effects of rapidly initiating basic and advanced life support and the quality of CPR on survival.4, 5 Therefore, survival after an out-of-hospital cardiac arrest may directly reflect the quality of a community's chain of survival. Furthermore, a detailed analysis of incidence and outcomes should identify the weak links in this chain and should provide suggestions for improving them. The last large-scale evaluation of out-of-hospital cardiac arrest survival in the city of Vienna, Austria was performed almost 20 years ago – before early defibrillation, evidence-based CPR guidelines, new curricula for intermediate and advanced emergency medical technicians and comprehensive post-resuscitation care strategies, such as therapeutic hypothermia, became common.6 For these reasons, we expected an increase in both the incidence of treated out-of-hospital cardiac arrests and their survival rate.

Section snippets

Methods

The aims of this cohort study were to determine the incidence and outcomes of adult out-of-hospital cardiac arrests and, if possible, to identify the weak links in the local chain of survival. The investigation complied with the Declaration of Helsinki's principles for physicians engaged in biomedical research involving human subjects and was approved by the appropriate ethics committee; the subjects provided informed consent to participate when it was appropriate.

All out-of-hospital cardiac

Results

The core data of our study are presented in Fig. 1. During the study period, a total of 7030 (206.8/100,000 inhabitants/year) patients without signs of circulation were assessed by teams from the Vienna Ambulance Service. In 5582 cases (79%), no resuscitative efforts were initiated either because confirmed signs of death were detected or because any resuscitation attempt was judged to be futile by the attending physician. The Vienna Ambulance Service teams ultimately treated 1448 (42.6/100,000

Discussion

The incidence of treated out-of-hospital cardiac arrests described in this study (43.5/100,000 inhabitants per year) is comparable to the findings of previous studies, but the incidence of emergency medical services-assessed out-of-hospital cardiac arrest is significantly higher (206.8/100,000) than those cited in the literature (75.9–159.3/100,000).1, 2, 3

In Vienna, declarations of death outside of a hospital setting must be made by emergency physicians, who are therefore dispatched on every

Conclusion

This study examined the incidence of out of hospital cardiac arrest in Vienna from 2009 to 2010. The survival rate remained relatively unchanged within the last 20 years. We identified lower patient's age, a witnessed cardiac arrest, an initially shockable rhythm and a cardiac arrest in a public location as favourable contributing factors for survival.

Conflict of interest statement

All of the authors were also involved with the Circulation Improving Resuscitation Care (CIRC) trial, and the majority received funds from the Zoll Medical Corporation for their participation. Nevertheless, there was no direct support for this study, and the Zoll Medical Corporation had no influence on its design.

Acknowledgements

We are indebted to the emergency medical technicians and physicians of the Vienna Ambulance Service for their enthusiasm and to the staff of all of the participating hospitals for their support and indulgence. We also wish to thank Zoll Medical Corporation, whose Circulation Improving Resuscitation Care (CIRC) trial was the catalyst for this study.

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.07.002.

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