Clinical paperMajor differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest☆
Introduction
Among patients who suffer an out-of-hospital cardiac arrest, overall survival to discharge or at one month is low.1 To improve outcome, the “chain of survival” concept has emerged. It includes (1) early recognition and call for the emergency medical service (EMS); (2) early cardiopulmonary resuscitation (CPR); (3) early defibrillation; (4) early advanced cardiac life support (ALS).
In recent years, evidence indicates that we should introduce a fifth link into the chain of survival, i.e. post-resuscitation care. Until now, there are no clear recommendations about how survivors should be treated in the initial phase after cardiac arrest. Therefore the level of treatment may vary between hospitals and affect the outcome.
This survey aims to explore differences in survival between various hospitals in Sweden among patients who were brought to hospital alive after having suffered an out-of-hospital cardiac arrest.
Section snippets
Patients
Patients suffering a cardiac arrest for whom the ambulance was called were included in the registry. Cases of arrest witnessed by the ambulance crew and patients in whom CPR was inappropriate or who had obviously been dead for a long time, and were not taken to hospital, were excluded. For the others, the standardised form was completed by the ambulance crew.
Registry
This study is based on material collected by the Swedish Cardiac Arrest Registry, which is a joint venture between the Federation of
Statistical methods
Ambulance organisations that brought at least 50 patients to hospital with a palpable pulse on hospital admission were included in the analysis. Each ambulance organisation brought these patients to a single hospital, with the exception of the two largest communities (Stockholm and Göteborg), where the ambulances brought the patients to seven and two hospitals respectively. In the analysis, the seven and two hospitals were counted as one each, as we had no detailed information for each of the
Results
Thirty one thousand one hundred and twenty seven patients suffered an out-of-hospital cardiac arrest in whom CPR was attempted and which were not witnessed by the ambulance crew. Of these, 4667 were brought to hospital with a palpable pulse on hospital admission. Since only hospitals with an ambulance organisation from which at least 50 patients were admitted to hospital alive have been included, this means that hospitals to which patients were brought alive by 21 different ambulance
Discussion
In this survey comprising hospitals corresponding to 21 ambulance organisations in Sweden participating in the Swedish Cardiac Arrest Registry, we describe the variation in survival to 1 month among patients who were brought to hospital alive after having suffered an out-of-hospital cardiac arrest. The survival rate varied between 14% and 42%, i.e. there was a three-fold increase in survival in the most successful hospitals compared with the least successful. There are a variety of possible
Conclusion
In a Swedish survey of initial survivors of out-of-hospital cardiac arrest, the percentage of patients who survived to 1 month varied between 14% and 42%. This could be explained to some extent by a difference in patient characteristics and factors at resuscitation. However, differences in post-resuscitation care between hospitals cannot be ruled out as a contributory factor.
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A Spanish translated version of the summary of this article appears as Appendix in the online version at 10.1016/j.resuscitation.2006.01.014.