Elsevier

Resuscitation

Volume 36, Issue 3, March 1998, Pages 153-159
Resuscitation

Epidemiology and survival rate of out-of-hospital cardiac arrest in north-east Italy: The F.A.C.S. study

https://doi.org/10.1016/S0300-9572(98)00022-7Get rights and content

Abstract

The results of the first epidemiological, prospective, multicentric study on cardiac arrest in a geographical Italian region are reported. On 708 consecutive cardiac arrests, 438 underwent cardiopulmonary resuscitation (CPR). Of these, 344 were identified of cardiac aetiology. The underlying initial rhythm was: 166 asystole (48.3%), 104 ventricular fibrillation (30.2%), 74 pulseless electrical activity (21.5%). The best outcome occurred in patients whose cardiac arrest was witnessed by the EMS (49% return of spontaneous circulation (ROSC), 21% hospital discharge). When cardiac arrest was witnessed by lay people, 20.5% had ROSC and 4.4% were discharged alive from the hospital. When it was unwitnessed ROSC and hospital discharge were 8.6 and 1.7%, respectively. Ventricular fibrillation was highly predictive of outcome. Both ROSC and hospital discharge correlated inversely with the delay of the first defibrillation. Overall, the highest probability of survival was achieved when CPR interventions were started within the first minutes after collapse. Basic Life Support (BLS) manoeuvres began after 9 min of untreated cardiac arrest were still followed by a ROSC, but none of these patients survived. The incidence of prehospital cardiac arrest in our population was estimated to be in proportion of 0.95/1000 per year with a survival rate of 6.7%.

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

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