Localization of out-of-hospital cardiac arrest in Göteborg 1994–2002 and implications for public access defibrillation

Abstract

Purpose:

The purpose of this study was to report the locality of out-of-hospital cardiac arrest (OHCA) in the city of Göteborg and to identify implications for public access defibrillation (PAD).

Methods:

Ambulance run reports for the years 1994–2002 were studied retrospectively and manually to establish the location of the cardiac arrest.

Results:

The location could be identified in 2194 of 2197 patients (99.9%). One thousand four hundred and twenty-nine (65%) of the arrests took place in the victims’ homes. Two hundred eighty-five (13%) were outdoors and 57 (3%) in cars. Fifty-one (2%) took place en route in ambulances. These arrests were regarded not to be generally suitable for PAD. One hundred thirty-five (6%) of the arrests happened in a public building. Eighteen of these 135 were in 15 different general practitioners’ offices. A ferry terminal had 11 cardiac arrests. One hundred fifty (7%) of the arrests took place in different care facilities. Twenty-one (1%) patients had their cardiac arrest in public transport locations. Twenty-two (1%) patients arrested at work in 20 different sites. In total, 17% of the cardiac arrests were regarded as generally suitable for PAD. Several sites with more than one cardiac arrest in five years could be identified and 54 patients (2.5%) had their cardiac arrest in these high-incidence sites.

Conclusion:

Among patients suffering from out-of-hospital cardiac arrest in Göteborg in whom resuscitation efforts were attempted 17% of all cardiac arrests were regarded as generally suitable for PAD. According to previous suggestions, the indication for public access defibrillation is in a place with a reasonable probability of use of one AED in 5 years. Several high-incidence sites that probably would benefit from defibrillator availability could be identified, and 54 patients (2.5%) arrested in these sites.

Introduction

Despite large efforts and decades of focusing on the problem of out-of-hospital cardiac arrest (OHCA), the chances for survival remain bleak. Successful treatment of OHCA is very much dependent on a short interval from collapse, or recognition of the medical emergency, to the initiation of treatment. So far, the only interventions that have been shown to improve survival to hospital discharge are cardiopulmonary resuscitation (CPR) [1], [2] and transthoracic defibrillation [3], the latter only useful in patients presenting with ventricular fibrillation (VF) or ventricular tachycardia (VT). No drug or other prehospital intervention apart from CPR and defibrillation has demonstrated benefit in terms of survival to hospital discharge [4]. In most emergency medical services (EMS), especially in rural areas and large metropolitan cities, the intervals from collapse to defibrillation are too long to offer a reasonable chance of survival. Several different approaches have been suggested to shorten prehospital intervals, and one of them is early defibrillation by others than the EMS, termed public access defibrillation (PAD). In some specific and delimited settings, this approach has been very successful. However, the general benefit from PAD in communities is not yet fully known. Furthermore, the benefit of PAD is limited to the fraction of patients presenting with VF or VT. There are several indications that this fraction is decreasing during the last one or two decades [5], [6], [7], [8].

The purpose of this survey was to classify and analyze the locations of OHCA in Göteborg and to identify the locations, if any, that are suitable for PAD.