Elsevier

Resuscitation

Volume 67, Issue 1, October 2005, Pages 75-80
Resuscitation

Incidence of EMS-treated out-of-hospital cardiac arrest in Europe

https://doi.org/10.1016/j.resuscitation.2005.03.021Get rights and content

Abstract

Background:

The potential impact of efforts in Europe to improve survival from out-of-hospital cardiac arrest is unclear, in part, because estimates of incidence and survival are uncertain. The aim of the investigation was to determine a representative European incidence and survival from cardiac arrest in all-rhythms and in ventricular fibrillation treated by the emergency medical services (EMS).

Methods and results:

We used Medline to identify peer-reviewed articles published between 1 January 1980 and 30 June 2004 that reported a European community's EMS cardiac arrest experience. Inclusion criteria required the study to include at least 25 cases, report of the total number of all-rhythm and/or ventricular fibrillation arrests, and information about population size and study duration. The incidence was computed by dividing the total number of events by the product of the community's population and the study duration.

Reports from 37 communities met the inclusion criteria. A total of 18,105 all-rhythm EMS-treated cardiac arrests occurred during 48 million person-years of observation, resulting in an overall incidence for all-rhythm arrests of 37.72 per 100,000 person-years. Incidence of ventricular fibrillation arrest was 16.84 per 100,000 person-years. Survival was 10.7% for all-rhythm and 21.2% for ventricular fibrillation cardiac arrest. Applying these results to the European population, approximately, 275,000 persons would experience, all-rhythm cardiac arrest treated by the EMS with 29,000 persons surviving to hospital discharge.

Conclusion:

The results provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of 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.

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