Clinical paperSurvival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study
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,
References (30)
- et al.
EuReCa ONE; 27 Nations, ONE Europe, ONE Registry
Resuscitation
(2016) Good outcome in every fourth resuscitation attempt is achievable–an Utstein template report from the Stavanger region
Resuscitation
(2011)Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden
Am Heart J
(2005)Prevention of deterioration of ventricular fibrillation by basic life support during out-of-hospital cardiac arrest
Resuscitation
(2002)Resuscitation in Europe: a tale of five European regions
Resuscitation
(1999)Quality management in resuscitation–towards a European cardiac arrest registry (EuReCa)
Resuscitation
(2011)Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation
Resuscitation
(2015)Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: results from the Aus-ROC Epistry
Resuscitation
(2018)A survey of key opinion leaders on ethical resuscitation practices in 31 European Countries
Resuscitation
(2016)International variation in survival after out-of-hospital cardiac arrest: a validation study of the Utstein template
Resuscitation
(2019)
Causes for the declining proportion of ventricular fibrillation in out-of-hospital cardiac arrest
Resuscitation
Survival after public access defibrillation in Stockholm, Sweden–A striking success
Resuscitation
Therapeutic hypothermia after cardiac arrest: a systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature
Resuscitation
Cardiac catheterization is associated with superior outcomes for survivors of out of hospital cardiac arrest: review and meta-analysis
Resuscitation
Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators
Circulation
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Both authors contributed equally.