Incidence of EMS-treated out-of-hospital cardiac arrest in Europe☆
Introduction
Out-of-hospital sudden cardiac arrest is a leading cause of death in Europe and the United States. To improve outcome from sudden cardiac arrest, measures are needed to strengthen the “chain of survival” that includes quick activation of emergency services, prompt bystander cardiopulmonary resuscitation, early defibrillation, and timely advanced cardiac life support [1]. The public health implications of improvements in the chain of survival depend, in part, on the extent and effectiveness of current emergency medical services (EMS) care for sudden cardiac arrest. In a systematic assessment of communities in the United States, the incidence of EMS-treated sudden cardiac arrest was, approximately, 55 per 100,000 person-years for all-rhythm arrests and 21 per 100,000 person-years for ventricular fibrillation arrests with survival estimates of 8% for all-rhythm arrests and 17% among ventricular fibrillation arrests [2].
No such population-based estimates are available for Europe. Health behaviours and preventative care that influence the risk of sudden cardiac arrest can differ between Europe and the United States [3]. Moreover, cultural differences between the US and Europe may influence community activation and EMS involvement in the chain of survival [4]. Finally, care of the cardiac arrest patient may vary, for example many European EMS-systems are staffed by physicians, while most in the US systems consist of emergency medical technicians and/or paramedics. The aim of this investigation was to determine a representative European incidence and survival of EMS-treated all-rhythm and ventricular fibrillation sudden cardiac arrest.
Section snippets
Study design and population
The study was a systematic review of peer-reviewed European community reports of EMS-treated sudden cardiac arrest due to heart-disease. The estimates of incidence included only persons where the EMS attempted resuscitation and not those where EMS was summoned but did not initiate resuscitation or those where EMS was not summoned. Inclusion criteria required that the study contain at least 25 cases, report the total number of all-rhythm arrests and/or ventricular fibrillation arrests for the
Results
A total of 37 communities, described in 32 studies, met inclusion criteria [5], [6], [7], [8], [9], [10], [11], [12], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37]. The communities had a variety of EMS-systems that included single-tier and two-tier systems that were staffed by paramedics, nurses, physicians, or some combination of these. Community populations ranged from 34,500 persons in Bodo,
Discussion
In this systematic assessment of cardiac arrest treated by the EMS in European communities, the summary incidence estimates were 38 per 100,000 person years for all-rhythm cardiac arrest and 17 per 100,000 person years for ventricular fibrillation cardiac arrest. These estimates would translate to 275,000 all-rhythm and 123,000 ventricular fibrillation cardiac arrests treated by the EMS annually in Europe. Summary estimates of survival were 10.7% for all-rhythm arrests and 21.2% for ventricular
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A Spanish translated version of the Abstract of this article appears as Appendix at 10.1016/j.resuscitation.2005.03.021.