Resuscitation in Europe: a tale of five European regions

doi:10.1016/S0300-9572(99)00045-3

Resuscitation

Volume 41, Issue 2, July 1999, Pages 121-131

https://doi.org/10.1016/S0300-9572(99)00045-3 Get rights and content

Abstract

Aim: To describe cardiac arrest data from five emergency medical services (EMS) systems in Europe with regard to survival from an out-of-hospital cardiac arrest. Methods: Based on recommendations from various countries in Europe EMS systems were approached with regard to survival from out-of-hospital cardiac arrest. Five EMS systems were asked to report their cardiac arrest data according to the Utstein style. Results: The five selected EMS systems were: Bonn (Germany), Göttingen (Germany), Helsinki (Finland), Reykjavik (Iceland) and Stavanger (Norway). For patients with a bystander witnessed arrest of cardiac aetiology the percentage of patients being discharged alive from hospital in these regions were: 21, 33, 23, 23 and 35. The corresponding percentages for patients fulfilling criteria as above and being found in ventricular fibrillation were: 32, 42, 32, 27 and 55. Conclusions: Many EMS systems in Europe show extremely good results in terms of survival after an out-of-hospital cardiac arrest. Some of the results should be interpreted with caution since they were based on relatively small sample sizes. Furthermore, the results from one of the regions (Stavanger) was unit based and not community based.

Introduction

Over the past decades there has been a heightened awareness of the importance of sudden cardiac death and appreciation of the therapeutic implications. This has been one reason for the development of out-of-hospital emergency medical service(s) (EMS) [1].

Although originally introduced by Pantridge in Northern Ireland [2] this development took place most rapidly in Seattle, King County, USA [3]. During the last two decades various regions in Europe have reported success in terms of improved survival after an out-of-hospital cardiac arrest [4], [5], [6]. The present survey describes resuscitation in five centres in Europe and was initiated by an invitation lecture by the organizing committee of the 4th Congress of the European Resuscitation Council (ERC) with the title ‘Resuscitation in Europe at its best: A tale of five European regions’.

Section snippets

Methods

Based on recommendations from the secretary of the organizing committee of the 4th Congress of the European Resuscitation Council persons in the following countries were approached: Norway, Sweden, Denmark, Finland, Iceland, Scotland, England, Germany, The Netherlands, Belgium, France, Switzerland, Italy, Spain, Austria and Slovenia regarding their EMS systems.

Based on their response, key persons in the following EMS systems were contacted: Stavanger, Oslo, Trondheim and Fredrikstad (Norway);

Initial survey

The overall survival rate varied from 23% in Stavanger to 6% in Ljubljana. The corresponding figures for patients having suffered a bystander witnessed cardiac arrest of a cardiac aetiology varied from 35 to 6%. Seven EMS systems reported a survival rate of more than 20% for this group (Stavanger (35%), Göttingen (33%), Mainz (31%), Varkaus (28%), Reykjavik (23%), Helsinki (23%) and Bonn (21%) (Table 1).

Among patients having suffered a bystander witnessed cardiac arrest of a cardiac aetiology

Discussion

The aim of this study was to describe resuscitation in five different regions in Europe.

It must be emphasized that some of the information is based on a small sample size and consequently the data have to be interpreted with caution. The data from Stavanger are not population based, but merely unit based.

It is possible that there are other regions in Europe in which EMS systems operate with similar results in terms of survival from an out-of-hospital cardiac arrest. Furthermore, EMS systems

Limitation

The aim of this manuscript is to give examples of resuscitation in Europe. The results in Table 1 should be used as background information and not as a comparison of the effectiveness between various organisations. Such a comparison could only be made if data were collected uniformly in a common data base. In this survey data were gathered during different time periods.

Factors other than medical performance or organisation may explain the differences between rescue organisations in terms of

Conclusion

This survey demonstrated the type of results that can be achieved for resuscitation after out-of-hospital cardiac arrest in Europe. There are links in the chain of survival which can be further improved even in the best of EMS systems. Future research will clarify whether some of the data, which were based on a relatively small sample size can be confirmed in a larger patient population. Whether survival after an out-of-hospital cardiac arrest can be further improved remains to be determined.

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An Utstein-based model score to predict survival to hospital admission: The UB-ROSC score
2020, International Journal of Cardiology
To develop and validate a multi-parametric practical score to predict the probability of survival to hospital admission of an out-of-hospital cardiac arrest (OHCA) victim by using Utstein Style-based variables.
All consecutive OHCA cases occurring from 2015 to 2017 in two regions, Pavia Province (Italy) and Canton Ticino (Switzerland) were included. We used random effect logistic regression to model survival to hospital admission after an OHCA. We computed the model area under the ROC curve (AUC ROC) for discrimination and we performed both internal and external validation by considering all OHCAs occurring in the aforementioned regions in 2018. The Utstein-Based ROSC (UB-ROSC) score was derived by using the coefficients estimated in the regression model. The score value was obtained adding the pertinent score components calculated for each variable. The score was then plotted against the probability of survival to hospital admission.
1962 OHCAs were included (62% male, mean age 73 ± 16 years). Age, aetiology, location, witnessed OHCA, bystander CPR, EMS arrival time and shockable rhythm were independently associated with survival to hospital admission. The model showed excellent discrimination (AUC 0.83, 95%CI 0.81–0.85) for predicting survival to hospital admission, also at internal cross-validation (AUC 0.82, 95%CI 0.80–0.84). The model maintained good discrimination after external validation by using the 2018 OHCA cohort (AUC 0.77, 95%CI 0.74–0.80).
UB-ROSC score is a novel score that predicts the probability of survival to hospital admission of an OHCA victim. UB-ROSC shall help in setting realistic expectations about sustained ROSC achievement during resuscitation manoeuvres.
Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study
2020, Resuscitation
The epidemiology and outcome after out-of-hospital cardiac arrest (OHCA) varies across Europe. Following on from EuReCa ONE, the aim of this study was to further explore the incidence of and outcomes from OHCA in Europe and to improve understanding of the role of the bystander.
This prospective, multicentre study involved the collection of registry-based data over a three-month period (1st October 2017 to 31st December 2017). The core study dataset complied with the Utstein-style. Primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital admission. Secondary outcome was survival to hospital discharge.
All 28 countries provided data, covering a total population of 178,879,118. A total of 37,054 OHCA were confirmed, with CPR being started in 25,171 cases. The bystander cardiopulmonary resuscitation (CPR) rate ranged from 13% to 82% between countries (average: 58%). In one third of cases (33%) ROSC was achieved and 8% of patients were discharged from hospital alive. Survival to hospital discharge was higher in patients when a bystander performed CPR with ventilations, compared to compression-only CPR (14% vs. 8% respectively).
In addition to increasing our understanding of the role of bystander CPR within Europe, EuReCa TWO has confirmed large variation in OHCA incidence, characteristics and outcome, and highlighted the extent to which OHCA is a public health burden across Europe. Unexplained variation remains and the EuReCa network has a continuing role to play in improving the quality management of resuscitation.
Out-of-hospital cardiac arrest (OHCA) attended by mobile emergency teams with a physician on board. Results of the Spanish OHCA Registry (OSHCAR)
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Citation Excerpt :
Based on out-of-hospital emergency medical services (EMS) data, OHCA affects more than 275,000 people a year in Europe,1 with an incidence of 38 cases per 100,000 people per year. These data vary greatly between different European countries,2,3 and even between different regions of the same country.4 Apart from specific initiatives,5 one must consult regional and national registries to obtain real figures in clinical practice.
Most survival outcomes in out-of-hospital cardiac arrest (OHCA) are provided by emergency medical services (EMS) without a doctor on board. Our objective was to determine such outcomes in a whole country with public physician-led EMS.
We analyzed data from a nationwide prospective registry of OHCA cases attended by 19 public EMS in Spain, covering the period from 1-October 2013 to 30-October 2014.
Advanced life support (ALS) was initiated in 9347 cases (incidence 18.6 cases/10⁵ inhabitants per year). Resuscitation was considered futile in 558 cases (5.9%), and ALS was continued in 8789 cases (94.1%); mean age 63.5 ± 17 years, 72.1% men. Initial rhythm was shockable in 22.1% of cases. Basic life support (BLS) was provided by bystanders in 1602 (24%) cases (635 of them with telephone assistance from the dispatch center). Of 8789 patients receiving ALS, 72.1% men, 2669 (30.4%) patients had return of spontaneous circulation on hospital arrival, 50.6% when the initial rhythm was shockable. Hospital discharge with good neurological status (CPC_1–2) was found in 11.1% of the study population and in 27.6% when considering the Utstein comparator group of patients. A total of 216 (2.5%) patients arrived at the hospital with ongoing resuscitation, of whom only one survived with CPC_1–2, and 165 (1.9%) patients were included in non-heart-beating donation programs.
In Spain with physician-led EMS, OHCA survival with CPC_1-2 reached a reasonable percentage despite only a modest contribution of bystander BLS. Ongoing resuscitation strategy seems to be futile except when considering non-heart beating donation programs.
EuReCa ONE—27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe
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The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.
This was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.
Data on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.
The results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.
EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events.
Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses
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Out-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity in Europe. We aim to investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest compression during CPR.
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Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chest compression (compressions with correct pressure point, correct depth, and sufficient decompression), which are, respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6 mm); and compression rate (129.4 vs 110.2 vs 101.5 vs 103.5 min^− 1).
During the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectiveness compression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirm the results in clinical practice.
Outcome of out-of-hospital cardiac arrest over a period of 15 years in comparison to the RACA score in a physician staffed urban emergency medical service in Germany
2015, Resuscitation
Patient outcome after out of hospital cardiac arrest (OHCA) depends on the cardiopulmonary resuscitation (CPR) performance and might also be influenced by organisation of the emergency medical service (EMS) and implementation of guidelines.
To assess the rate of return of spontaneous circulation (ROSC) after cardiac arrest to the predicted rate by the ROSC after cardiac arrest (RACA) score over a 15-year period reflecting three different implemented ALS-guidelines in a physician-staffed EMS.
All adult patients with non-traumatic OHCA in the EMS of Bonn from 1996 to 2011 were included. Utstein data from three 5-years time periods (1996–2001, 2001–2006, 2006–2011) representing different ALS-guideline implementations were collected. Group comparisons were made in terms of incidence, epidemiology and short-term outcome of CPR with emphasis on changes over time and factors of importance. In each group observed ROSC rate were compared to the predicted ROSC rates (the RACA score).
CPR by the ALS unit was attempted in a total of 1989 patients (735, 666, and 588 patients in the first, second and third period, respectively). Average crude incidence of CPR per 100,000 person-years decreased over time (61.3; 55.5; 49.0/100,000/years) while patients treated were significantly older (65.5 ± 16.5; 67.9 ± 15; 68.9 ± 15.7 (p < 0.001)). Observed ROSC rates were higher than predicted by the RACA score in all time periods, however, admittance to ICU decreased significantly from 50% in the first five-year period to 38% last five-year period (p < 0.001). From first to third period the proportion of arrests with first observed rhythm of VT/VF arrests did not change (29% vs. 27%, p = 0.323) nor there were changes in bystander CPR rates (17% vs. 17%, p = 0.520).
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Resuscitation in Europe: a tale of five European regions

Abstract

Introduction

Section snippets

Methods

Initial survey

Discussion

Limitation

Conclusion

Lancet

Resuscitation

Resuscitation

Resuscitation

Ann Emerg Med

Resuscitation

Resuscitation

Resuscitation

Br J Anaesth

Ann Emerg Med

Ann Emerg Med

Chest

Resuscitation

Sudden cardiac death: I. A decade’s experience with out-of-hospital resuscitation

Mod Concepts Cardiovasc Dis

Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation

Am J Public Health

Out-of-hospital cardiac arrests in Helsinki: Utstein style reporting

Heart

Circulation

Prehospital cardiopulmonary resuscitation: is it effective?

J Am Med Assoc