Clinical Investigation
Acute Ischemic Heart Disease
Cardiac arrest outside and inside hospital in a community: Mechanisms behind the differences in outcome and outcome in relation to time of arrest

https://doi.org/10.1016/j.ahj.2010.01.015Get rights and content

Background

The aim was to compare characteristics and outcome after cardiac arrest where cardiopulmonary resuscitation was attempted outside and inside hospital over 12 years.

Methods

All out-of-hospital cardiac arrests (OHCAs) in Göteborg between 1994 and 2006 and all in-hospital cardiac arrests (IHCAs) in 1 of the city's 2 hospitals for whom the rescue team was called between 1994 and 2006 were included in the survey.

Results

The study included 2,984 cases of OHCA and 1,478 cases of IHCA. Patients with OHCA differed from those with an IHCA; they were younger, included fewer women, were less frequently found in ventricular fibrillation, and were treated later.

If patients were found in a shockable rhythm, survival to 1 month/discharge was 18% after OHCA and 61% after IHCA (P < .0001). Corresponding values for a nonshockable rhythm were 3% and 21% (P < .0001). Survival was higher on daytime and weekdays as compared with nighttime and weekends after IHCA but not after OHCA.

Among patients found in a shockable rhythm, a multivariate analysis considering age, gender, witnessed status, delay to defibrillation, time of day, day of week, and location showed that IHCA was associated with increased survival compared with OHCA (adjusted odds ratio 3.18, 95% CI 2.07-4.88).

Conclusion

Compared with OHCA, the survival of patients with IHCA increased 3-fold for shockable rhythm and 7-fold for nonshockable rhythm in our practice setting. If patients were found in a shockable rhythm, the higher survival after IHCA was only partly explained by a shorter treatment delay. The time and day of CA were associated with survival in IHCA but not OHCA.

Section snippets

Out-of-hospital cardiac arrest

All consecutive cases of cardiac arrest in Göteborg to which the Emergency Medical Service (EMS) system attempted resuscitation between January 1, 1994, and December 31, 2006, were followed up for 1 year. We collected background data from the EMS logbook. We gathered data from the ambulance trip sheet, hospital records, and death certificates. The data were transferred to a database following a formal protocol.

Study area and OHCA population

Göteborg is a city with an area of 455 km2. The resident population is around

Results

In total, 2,984 cases of OHCA and 1,478 cases of IHCA were included in the survey.

In all, 8.2% of patients survived the OHCA to 1 month, whereas 39.7% survived an IHCA to hospital discharge. Information on survival was missing in 22 and 6 cases, respectively. Because the catchment populations were 500,000 and 250,000, respectively, this indicated that 4 persons per 100,000 inhabitants and year were resuscitated after an OHCA and 17 after an IHCA. Therefore, a total of 21 persons per 100,000

Discussion

This study is unique in that it describes the characteristics of and outcome among patients suffering from IHCA and OHCA within the same community over a 12-year period. Results indicate that, in our practice settings, overall survival is about 5 times higher when cardiac arrest occurs in-hospital compared with outside hospital. They further suggest that about 17 patients per 100,000 inhabitants and year can survive an IHCA versus 4 patients per 100,000 inhabitants and year in the case of an

Conclusions

Compared with outside hospital, patients who suffer a cardiac arrest inside a hospital have a greater probability of survival (3 times as high in a shockable rhythm and 7 times as high if found with a nonshockable rhythm) in our practice setting.

The rescue team's response time appears to be inversely related to survival both in and outside hospital when patients are found in a shockable rhythm.

The increased survival after IHCA was only partly explained by more rapid treatment among patients

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