Elsevier

Resuscitation

Volume 148, 1 March 2020, Pages 218-226
Resuscitation

Clinical paper
Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study

https://doi.org/10.1016/j.resuscitation.2019.12.042Get rights and content

Abstract

Background

The epidemiology and outcome after out-of-hospital cardiac arrest (OHCA) varies across Europe. Following on from EuReCa ONE, the aim of this study was to further explore the incidence of and outcomes from OHCA in Europe and to improve understanding of the role of the bystander.

Methods

This prospective, multicentre study involved the collection of registry-based data over a three-month period (1st October 2017 to 31st December 2017). The core study dataset complied with the Utstein-style. Primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital admission. Secondary outcome was survival to hospital discharge.

Results

All 28 countries provided data, covering a total population of 178,879,118. A total of 37,054 OHCA were confirmed, with CPR being started in 25,171 cases. The bystander cardiopulmonary resuscitation (CPR) rate ranged from 13% to 82% between countries (average: 58%). In one third of cases (33%) ROSC was achieved and 8% of patients were discharged from hospital alive. Survival to hospital discharge was higher in patients when a bystander performed CPR with ventilations, compared to compression-only CPR (14% vs. 8% respectively).

Conclusion

In addition to increasing our understanding of the role of bystander CPR within Europe, EuReCa TWO has confirmed large variation in OHCA incidence, characteristics and outcome, and highlighted the extent to which OHCA is a public health burden across Europe. Unexplained variation remains and the EuReCa network has a continuing role to play in improving the quality management of resuscitation.

Introduction

Sudden out of hospital cardiac arrest (OHCA) is the third leading cause of death in Europe.1 The first European Registry of Cardiac Arrest project (EuReCa ONE) collected and analysed data across Europe on resuscitation events during October 2014. This revealed that more than half of patients with OHCA who are assessed by the Emergency Medical Services (EMS) received cardio-pulmonary resuscitation (CPR) either before or on arrival of the EMS.1 Among such cases, survival to 30 days reached approximately 10%.1 However, in previous studies covering European areas high survival rates are reported.2, 3

There are a number of well-known factors that influence outcome after OHCA.4 The majority of these studies have shown that early initiation of CPR, and increased use of Automated External Defibrillators (AEDs) is associated with an improved chance of survival.3, 5, 6, 7, 8, 9 While previous studies have tried to fill the knowledge gap regarding the OHCA epidemiology of cardiac arrest in Europe,1, 10, 11 EuReCa ONE was the first attempt to study OHCA epidemiology on a European scale, but data collection was limited to one month. The aim of EuReCa TWO is to further explore the epidemiology of OHCA by tripling the observation period (to three months), expanding the reach of the EuReCA network by involving more countries, and gaining a better understanding of the role of the bystander in a cohort of the population in 28 European countries.

Section snippets

Material and methods

EuReCa TWO was an international, prospective, multi-centre study, for which data were collected from 1st October 2017 to 31st December 2017. Patients with OHCA were eligible for inclusion if they were attended by EMS regardless of performance or non-performance of a resuscitation attempt, arrest aetiology, initial arrest rhythm, age, or gender. The core study dataset complied with the Utstein definitions.12 In addition to the EuReCa ONE dataset, the following study questions were added: age and

Results

In the 28 participating European countries, data from regions covering 178,879,118 inhabitants were reported (Supplemental Table S3). Four countries reported data for the whole country while others covered from 3% to 94% of the total population. There were 38,585 suspected cardiac arrests reported of which 37,054 were confirmed. In 25,171 patients, resuscitation was started by a bystander or by the EMS. The proportion of cases where resuscitation was commenced or continued by the EMS was 62.6%,

Discussion

The EuReCa TWO study prospectively describes the epidemiology of OHCA and the effects of CPR before EMS arrival in 28 countries in Europe. By increasing the number of participating countries and the duration of data collection, this study has further confirmed large variation in European estimates of OHCA incidence and outcome. EuReCa TWO has also demonstrated the potential of 28 countries to collect OHCA data covering almost 180 million inhabitants, fulfilling a central aim of the EuReCa

Conclusion

EuReCa TWO has reinforced the large public health burden of OHCA in Europe, while highlighting the variability in incidence and survival. In addition, EuReCa TWO has added findings in relation to the performance of bystander CPR in Europe. It highlights the need for further work on the definition of this important predictor of outcome. Between-country variation remained an incompletely understood feature of our results. Continued collaboration across the EuReCa network will help to elucidate

Acknowledgments

The authors like to thank all contributors from local and regional EMS. Austria: Michael Baubin, Adolf Schinnerl, Gerhard Prause, Thomas Tschoellitsch, Helmut Trimmel, Rene Belz, Wolfgang Fleischmann; Belgium: Magali Bartiaux, Koenraad Monsieurs, Stephan Wilmin, Mathias Faniel, Marie Vanhove, Pascale Lievens, Dominique Biarent, Marc Van Nuffelen, Ives Hubloue, Jean-Marie Jacques, Michèle Yerna, Robert Leach, Mathieu Jeanmaire, Paule Denoël, Frank Van Trimpont, Francis Desmet, Louise Delhaye,

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Both authors contributed equally.

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