Epidemiology and survival rate of out-of-hospital cardiac arrest in north-east Italy: The F.A.C.S. study
Introduction
It has been widely emphasised that successful resuscitation after cardiac arrest in the clinical setting is most likely when the collapse is witnessed, and if a bystander promptly begins cardiopulmonary resuscitation (CPR) manoeuvres, if the initial rhythm is ventricular fibrillation (VF), and when VF is defibrillated as soon as possible [1]. These factors represent three of the four links of the well known chain-of-survival [2]. Efforts have been made continually to increase the strength of the chain and there is clear evidence that outcome is improved when these links are enhanced 3, 4, 5, 6, 7, 8.
In our country epidemiological data on cardiac arrest and the effects of CPR manoeuvres have been reported in metropolitan areas 9, 10, 11, 12, 13. To provide further information on cardiac arrest in large areas, we decided to investigate the occurrence of out-of-hospital cardiac arrest in a whole region involving several towns and more than one EMS.
The goals of the study were: (a) the evaluation of the efficacy of CPR manoeuvres in relation to the return of spontaneous circulation (ROSC); (b) the proportion of cases with ventricular fibrillation as presenting rhythm; (c) the neurological assessment at 24 and 48 h after ROSC; (d) the evaluation of hospital discharge in relationship to witnessed arrest, bystander CPR, intervention time, CPR duration, cardiac rhythm, age, and sex; (e) estimation of the 1 year survival rate; (f) analysis of the incidence of cardiac arrest and the survival rate.
Section snippets
Method
The FACS (Friuli Venezia Giulia Cardiac Arrest Cooperative Study) study was conducted in the Friuli Venezia Giulia region, located in the north-east part of the country. The region has an area of 7844 km2 and a population of 1.2 million. There are four operative dispatch centres (OCs) each one located in one main town (Trieste, Udine, Gorizia, Pordenone). The emergency calls reach the OCs by dialling the unique emergency number 1–1–8. A network of ambulances and one helicopter activated by the
Results
The number of cardiac arrests and the development of the template according to Utstein style is depicted in Fig. 1.
Of the total of 708 cardiac arrests, there were 438 patients whose condition was considered treatable and underwent CPR. Of these, 344 were of cardiac aetiology while 94 had a non-cardiac aetiology. In the cardiac arrests due to cardiac aetiology, asystole, as the initial rhythm, was documented in 166 patients (48.3%), ventricular fibrillation (VF) in 104 (30.2%), and pulseless
Discussion
The lack of large epidemiological data on out-of-hospital cardiac arrest in our country was the initial issue which prompted us to start this study.
In patients with cardiac arrest due to presumed cardiac aetiology, we were surprised to observe that ventricular fibrillation was documented in only 30% of the cases. This percentage is lower than other investigators have reported in their studies 5, 19, 20, 21. Two possible explanations may account for such differences. The relatively low incidence
Acknowledgements
We gratefully acknowledge the essential work of the tens of people who actively co-operated in the collection and revision of the data. Without them, this study would not have been possible and each one of these should merit co-authorship. Although it is not possible to name them all, we wish to appreciate their work by listing those who were indicated referees for each area and represented an essential link between the study promoters and all operators who contributed to the collection of the
References (34)
- et al.
Survival after cardiac arrest outside hospital over a 12-year period in Gothenburg
Resuscitation
(1994) - et al.
Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest
Resuscitation
(1994) - et al.
Cardiac arrest and pre-hospital resuscitation within a metropolitan emergency medical system in Turin (Italy)
Resuscitation
(1994) - et al.
Out-of-hospital cardiac arrest: response time intervals reflect EMS system function
Resuscitation
(1994) - et al.
Cardiopulmonary resuscitation outcome in Bologna in 1995: urban and suburban area
Resuscitation
(1996) - et al.
Assessment of coma and impaired consciousness: a practical scale
Lancet
(1974) - et al.
Incidence of cardiac arrest: a neglected factor in evaluating survival rates
Ann Emerg Med
(1993) - et al.
Pre-hospital cardiac arrest: room for improvement
Resuscitation
(1995) - et al.
Out-of-hospital cardiac arrest. Evaluation of one year activity in Saint-Etienne's emergency medical system using the Utstein style
Resuscitation
(1996) - et al.
Evaluation of outcome following cardiac arrest in patients presenting to two Scottish emergency departments
Resuscitation
(1995)
Factors influencing survival after out-of-hospital cardiac arrest
J Am Coll Cardiol
Prediction of survival after out-of-hospital cardiac arrest: results of a community-based study in Vienna
Resuscitation
Assessment of neurological prognisis in comatose survivors of cardiac arrest. BRCT I Study Group
Lancet
Cardiac arrest and resuscitation: a tale of 29 cities
Ann Emerg Med
Prehospital resuscitation in Helsinki, Finland
Am J Emerg Med
Improving survival from sudden cardiac arrest: the ‘Chain of Survival’ concept
Circulation
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