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Trends in survival from out-of-hospital cardiac arrest with a shockable rhythm and its association with bystander resuscitation: a retrospective study
  1. Vivien Hong Tuan Ha1,
  2. Daniel Jost1,2,
  3. Wulfran Bougouin2,3,
  4. Guillaume Joly1,
  5. Romain Jouffroy1,4,
  6. Patricia Jabre2,5,
  7. Frankie Beganton2,
  8. Clément Derkenne1,
  9. Sabine Lemoine1,
  10. Lemoine Frédéric1,
  11. Lionel Lamhaut2,5,
  12. Thomas Loeb6,
  13. François Revaux7,
  14. Florence Dumas2,3,
  15. Julie Trichereau1,
  16. Olivier Stibbe1,
  17. Nicolas Deye8,9,
  18. Eloi Marijon3,
  19. Alain Cariou3,
  20. Xavier Jouven3,
  21. Stephane Travers1
  1. 1 Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
  2. 2 Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
  3. 3 Paris Descartes-Sorbonne Cité University, Paris, France
  4. 4 Service de médecine intensive et réanimation, Hôpital Universitaire Ambroise Paré, Assistance Publique—Hopitaux de Paris, Paris, France
  5. 5 SAMU de Paris, Necker Hospital, Paris, France
  6. 6 SAMU 92 - Prehospital Emergency Department, Hôpital Raymond-Poincare, Garches, France
  7. 7 SAMU 94, Assistance Publique—Hopitaux de Paris, Créteil, France
  8. 8 Intensive Care Unit, Lariboisière Hospital, Paris, France
  9. 9 Inserm U942, Sorbonne Paris Nord University, Paris, France
  1. Correspondence to Dr Daniel Jost, Medical Emergency Department, Paris Fire Brigade, Paris 75009, France; daniel.jost{at}


Objective Over 300 000 cases of out-of-hospital cardiac arrests (OHCAs) occur each year in the USA and Europe. Despite decades of investment and research, survival remains disappointingly low. We report the trends in survival after a ventricular fibrillation/pulseless ventricular tachycardia OHCA, over a 13-year period, in a French urban region, and describe the simultaneous evolution of the rescue system.

Methods We investigated four 18-month periods between 2005 and 2018. The first period was considered baseline and included patients from the randomised controlled trial ‘DEFI 2005’. The three following periods were based on the Paris Sudden Death Expertise Center Registry (France). Inclusion criteria were non-traumatic cardiac arrests treated with at least one external electric shock with an automated external defibrillator from the basic life support team and resuscitated by a physician-staffed ALS team. Primary outcome was survival at hospital discharge with a good neurological outcome.

Results Of 21 781 patients under consideration, 3476 (16%) met the inclusion criteria. Over all study periods, survival at hospital discharge increased from 12% in 2005 to 25% in 2018 (p<0.001), and return of spontaneous circulation at hospital admission increased from 43% to 58% (p=0.004).

Lay-rescuer cardiopulmonary resuscitation (CPR) and telephone CPR (T-CPR) rates increased significantly, but public defibrillator use remained limited.

Conclusion In a two-tiered rescue system, survival from OHCA at hospital discharge doubled over a 13-year study period. Concomitantly, the system implemented an OHCA patient registry and increased T-CPR frequency, despite a consistently low rate of public defibrillator use.

  • chain of survival
  • pre-hospital care
  • resuscitation

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • VHTH and DJ are joint first authors.

  • XJ and ST are joint senior authors.

  • Handling editor Edward Carlton

  • Contributors Concept and design: VHTH, DJ, WB, GJ. Acquisition, analysis or interpretation of data: FB, RJ, WB, CD, SL, LF, PJ, LL, TL, FR, FD, OS, ND, EM. Statistical analysis: JT, VHTH, DJ. Supervision: EM, AC, XJ, ST. Guarantor: DJ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.