Clinical paperOut of hospital cardiac arrest in Vienna: Incidence and outcome☆
Introduction
Assessing and treating patients who suffer an out-of-hospital cardiac arrest is a major challenge for both emergency medical services and emergency departments. The reported survival rate after an out-of-hospital cardiac arrest varies significantly, ranging from 1.8% to 21.5% in different communities.1, 2, 3 Although sudden cardiac arrest incidences and local emergency response systems differ greatly, earlier studies have emphasised the effects of rapidly initiating basic and advanced life support and the quality of CPR on survival.4, 5 Therefore, survival after an out-of-hospital cardiac arrest may directly reflect the quality of a community's chain of survival. Furthermore, a detailed analysis of incidence and outcomes should identify the weak links in this chain and should provide suggestions for improving them. The last large-scale evaluation of out-of-hospital cardiac arrest survival in the city of Vienna, Austria was performed almost 20 years ago – before early defibrillation, evidence-based CPR guidelines, new curricula for intermediate and advanced emergency medical technicians and comprehensive post-resuscitation care strategies, such as therapeutic hypothermia, became common.6 For these reasons, we expected an increase in both the incidence of treated out-of-hospital cardiac arrests and their survival rate.
Section snippets
Methods
The aims of this cohort study were to determine the incidence and outcomes of adult out-of-hospital cardiac arrests and, if possible, to identify the weak links in the local chain of survival. The investigation complied with the Declaration of Helsinki's principles for physicians engaged in biomedical research involving human subjects and was approved by the appropriate ethics committee; the subjects provided informed consent to participate when it was appropriate.
All out-of-hospital cardiac
Results
The core data of our study are presented in Fig. 1. During the study period, a total of 7030 (206.8/100,000 inhabitants/year) patients without signs of circulation were assessed by teams from the Vienna Ambulance Service. In 5582 cases (79%), no resuscitative efforts were initiated either because confirmed signs of death were detected or because any resuscitation attempt was judged to be futile by the attending physician. The Vienna Ambulance Service teams ultimately treated 1448 (42.6/100,000
Discussion
The incidence of treated out-of-hospital cardiac arrests described in this study (43.5/100,000 inhabitants per year) is comparable to the findings of previous studies, but the incidence of emergency medical services-assessed out-of-hospital cardiac arrest is significantly higher (206.8/100,000) than those cited in the literature (75.9–159.3/100,000).1, 2, 3
In Vienna, declarations of death outside of a hospital setting must be made by emergency physicians, who are therefore dispatched on every
Conclusion
This study examined the incidence of out of hospital cardiac arrest in Vienna from 2009 to 2010. The survival rate remained relatively unchanged within the last 20 years. We identified lower patient's age, a witnessed cardiac arrest, an initially shockable rhythm and a cardiac arrest in a public location as favourable contributing factors for survival.
Conflict of interest statement
All of the authors were also involved with the Circulation Improving Resuscitation Care (CIRC) trial, and the majority received funds from the Zoll Medical Corporation for their participation. Nevertheless, there was no direct support for this study, and the Zoll Medical Corporation had no influence on its design.
Acknowledgements
We are indebted to the emergency medical technicians and physicians of the Vienna Ambulance Service for their enthusiasm and to the staff of all of the participating hospitals for their support and indulgence. We also wish to thank Zoll Medical Corporation, whose Circulation Improving Resuscitation Care (CIRC) trial was the catalyst for this study.
References (15)
- et al.
Incidence of EMS-treated out-of-hospital cardiac arrest in Europe
Resuscitation
(2005) - et al.
Incidence of EMS-treated out-of-hospital cardiac arrest in the United States
Resuscitation
(2004) Survival from prehospital cardiac arrest is critically dependent upon response time
Resuscitation
(2006)- et al.
Improving outcome after out-of-hospital cardiac arrest by strengthening weak links of the local chain of survival; quality of advanced life support and post-resuscitation care
Resuscitation
(2010) - et al.
Prediction of survival after out-of-hospital cardiac arrest: results of a community-based study in Vienna
Resuscitation
(1996) - et al.
Design of the circulation improving resuscitation care (CIRC) trial: a new state of the art design for out-of-hospital cardiac arrest research
Resuscitation
(2011) - et al.
Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa)
Resuscitation
(2004)
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.07.002.