Localization of out-of-hospital cardiac arrest in Göteborg 1994–2002 and implications for public access defibrillation☆
Introduction
Despite large efforts and decades of focusing on the problem of out-of-hospital cardiac arrest (OHCA), the chances for survival remain bleak. Successful treatment of OHCA is very much dependent on a short interval from collapse, or recognition of the medical emergency, to the initiation of treatment. So far, the only interventions that have been shown to improve survival to hospital discharge are cardiopulmonary resuscitation (CPR) [1], [2] and transthoracic defibrillation [3], the latter only useful in patients presenting with ventricular fibrillation (VF) or ventricular tachycardia (VT). No drug or other prehospital intervention apart from CPR and defibrillation has demonstrated benefit in terms of survival to hospital discharge [4]. In most emergency medical services (EMS), especially in rural areas and large metropolitan cities, the intervals from collapse to defibrillation are too long to offer a reasonable chance of survival. Several different approaches have been suggested to shorten prehospital intervals, and one of them is early defibrillation by others than the EMS, termed public access defibrillation (PAD). In some specific and delimited settings, this approach has been very successful. However, the general benefit from PAD in communities is not yet fully known. Furthermore, the benefit of PAD is limited to the fraction of patients presenting with VF or VT. There are several indications that this fraction is decreasing during the last one or two decades [5], [6], [7], [8].
The purpose of this survey was to classify and analyze the locations of OHCA in Göteborg and to identify the locations, if any, that are suitable for PAD.
Section snippets
Methods
The Göteborg EMS has been described elsewhere [6]. In summary, Göteborg has approximately 450,000 inhabitants. The EMS is a two-tiered system, i.e. one standard ambulance and one mobile coronary care unit (MCCU) are dispatched simultaneously when a cardiac arrest is suspected. All ambulances are dispatched by one ambulance centre. The median time from collapse to first defibrillation was 6 min. Cardiac arrest is treated according to guidelines issued by the American Heart Association and the
Results
During the study period 1994–2002, there were 2197 out-of-hospital cardiac arrests in which the EMS initiated a resuscitation attempt. Data on location was not available in three cases.
Discussion
The proportion of patients found in VF among patients with OHCA is seemingly linearly and inversely dependent on the time interval from collapse to first ECG recording [10], [11] and a shortening of this interval will increase the proportion of patients found in VF and so improve survival. The median interval from collapse to first defibrillation is 6 min in our EMS system [6]. Only 17% of the patients in this survey collapsed in locations generally suitable for PAD and only 2.5% collapsed in
Conclusion
Among patients suffering from out-of-hospital cardiac arrest in Göteborg in whom resuscitation efforts were attempted, 17% of all cardiac arrests were regarded as generally suitable for PAD. Only 2.5% of the arrests were in high-incidence sites i.e. locations with more than one cardiac arrest in five years. Sixty-five percent of cardiac arrests occurred in the patient's home. Several sites that would benefit from PAD availability were identified.
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A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at 10.1016/j.resuscitation.2004.08.006.