Survival in out-of-hospital cardiac arrest before and after use of advanced postresuscitation care: a survey focusing on incidence, patient characteristics, survival, and estimated cerebral function after postresuscitation care

Am J Emerg Med. 2010 Jun;28(5):543-51. doi: 10.1016/j.ajem.2009.01.042.

Abstract

Background: Knowledge of the epidemiology of postresuscitation care is insufficient. We describe the epidemiology of postresuscitation care in a community from a 26-year perspective, focusing on incidence, patient characteristics, survival, and estimated cerebral function in relation to intensified postresuscitation care and initial arrhythmia.

Methods: The study included patients with out-of-hospital cardiac arrest (OHCA) who were brought alive to a hospital ward in Göteborg, Sweden, between 1980 and 2006. Two periods (1980-2002 and 2003-2006) were compared.

Results: In all, 1603 patients were included. For age, sex, and history, no significant differences between the 2 periods were seen. There was a significant multiple increase in bystander cardiopulmonary resuscitation, the use of coronary angiography, coronary revascularization, and therapeutic hypothermia. The number of patients found in ventricular fibrillation (VF) decreased (P = .011). For all patients, 1-year survival did not change significantly (27% vs 32%; P = .14). Among patients found in VF, an increase in 1-year survival was found (37% vs 57%; P < .0001), whereas no significant change was seen in nonshockable rhythm (10% vs 7%; P = .38). Survivors to discharge displaying low cerebral function (ie, cerebral performance categories score >or=3) decreased from 28% to 6% (P = .0006) among all patients.

Conclusion: After the introduction of a more intensified postresuscitation care, there was no overall improvement in survival but signs of an improved cerebral function among survivors. There was a marked increase in survival among patients found in a shockable rhythm but not among those found in a nonshockable rhythm.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Brain / physiopathology
  • Cardiopulmonary Resuscitation / mortality*
  • Cardiopulmonary Resuscitation / statistics & numerical data
  • Coronary Angiography / mortality
  • Critical Care / methods
  • Critical Care / statistics & numerical data
  • Emergency Medical Services
  • Female
  • Heart Arrest / mortality*
  • Heart Arrest / physiopathology
  • Heart Arrest / therapy
  • Humans
  • Hypothermia, Induced / mortality
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Revascularization / mortality
  • Sex Factors
  • Survival Analysis
  • Sweden
  • Ventricular Fibrillation / mortality