Cardiac arrest outside and inside hospital from a 30 year perspective in the Municipality of Gothenburg
Year: 2011
Type: dissertation
Study design: Observational Study
Abstract: Aims: 1:To describe the epidemiology of both out-of-hospital cardiac arrest\n(OHCA) and in-hospital cardiac arrest (IHCA) in the Municipality of\nGothenburg. 2:To describe the differences and similarities in cardiac arrest\ninside and outside hospital. 3:To describe the eventual change in outcome\nfollowing the implementation of mechanical chest compression in the\nemergency medical service.\nMethod: Consecutive OHCA cases in the Municipality of Gothenburg\nbetween 1980 and 2009 to which the emergency medical service responded\nwere followed up to hospital discharge and at 1-month after the event for\nsurvival and neurological outcome according to the Utstein guidelines.\nConsecutive IHCA cases at Sahlgrenska university hospital between 1994\nand 2006 to which the rescue team was called were followed up to discharge\nand at one month after the event for survival and neurological outcome\naccording to the Utstein guidelines. We used the Swedish Cardiac Arrest\nRegister for comparison.\nResults: In the time period 1980 - 1999 there were 5270 resuscitation\nattempts in relation to OHCA of which 3871 were regarded as being of\ncardiac aetiology. The delay to defibrillation was short (8 minutes median)\nand 27 percent of the witnessed OHCAs and 12 percent of the unwitnessed\nOHCAs received bystander-CPR. In all, 8.8% survived to discharge. In the\nUtstein ”golden standard” (bystander-witnessed cardiac arrest of cardiac\naetiology found in ventricular fibrillation), 20 % were discharged from\nhospital. In the time period 1994 – 2002, the rescue team at Sahlgrenska\nUniversity hospital was called 1570 times. In 71% of the cases, the patient\nhad suffered a cardiac arrest. If the patients found in ventricular fibrillation\nwere defibrillated within three minutes, survival to discharge was 63% if the\nIHCA occurred on a ward with ECG-monitoring capacity and 72% if the\nIHCA occurred on a ward without ECG-monitoring capacity. Of IHCAs\nbetween 1994 and 2001 (n=833) 37 per cent survived to hospital discharge,\nand 86 percent of them were alive one year later. The survival after IHCA\nwas three times higher compared with OHCA for shockable rhythms and\nseven times higher for non-shockable rhythms. Between 1992 and 2009,\ncurve for the survival after OHCA had a U shape, with the highest survival at\nthe beginning and at the end. During the last decade, there was an increase in\nsurvival which was associated in terms of time with an increase in the use of\nmechanical chest compression. However, other factors of importance for\nsurvival, such as bystander CPR and post-resuscitation care, also changed.\nConclusion: If patients with ventricular fibrillation are defibrillated within\nthree minutes after collapse, the majority will survive. There are changes in\nsurvival after OHCA in Gothenburg over time with improvement and\ndeterioration. The mechanisms behind these changes are not entirely\nunderstood, but a delay to start of treatment and post-resuscitation care are\nmost probably important. Survival after IHCA is much higher than after\nOHCA, but this is not solely explained by a short time to the delivery of\ntreatment.
Author: Martin Fredriksson
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1529743365