Out-of-hospital cardiac arrest in Cork, Ireland

Background Out-of-hospital cardiac arrest (OHCA) in Ireland accounts for approximately 5000 deaths annually. Little published evidence exists on survival from OHCA in this country to date. We aimed to characterise and describe ‘presumed cardiac’ OHCA in Cork City and County attended by the Ambulance Service. Methods Dispatch records, ambulance patient records and hospital records for a 1-year period were examined for patient demographics, OHCA characteristics, interventions and patient outcomes. Results There were 231 ‘presumed cardiac’ OHCAs attended over the study period; 130 (56%) were in urban locations and 101 (44%) in rural. OHCAs were lay-witnessed in 20% (n=46), and 22% (n=50) received bystander CPR. Shockable rhythm was present in 36 cases (16%) on initial assessment, and there was no difference in presence of shockable rhythm between urban and rural OHCAs (18% vs 13%, p=0.31). Resuscitation was attempted in 176 cases (77.5%), of whom 27 (15%) achieved return of spontaneous circulation and 13 (7.4%) survived to leave hospital. Survival when the initial rhythm was shockable was 16.7% (6 of 36 patients). Despite longer response times for rural compared with urban OHCAs (median (IQR) 16.5 (11.0–23.5) vs 9 (7–12) min, p<0.001), survival to leave hospital alive where resuscitation was attempted was similar (7.4% vs 7.4%, p=0.99, respectively). Conclusion A survival rate of 16.7% in shockable rhythms indicates scope for improvement which would influence the overall survival rate which was found to be 7.4%. Real-time feedback of performance and quality of the continuum of patient care through a clinical-quality cardiac arrest registry would monitor and incentivise such initiatives.

[1]  R. Berg,et al.  Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. , 2010, Resuscitation.

[2]  R. Wolfe,et al.  Cardiac arrest outcomes before and after the 2005 resuscitation guidelines implementation: evidence of improvement? , 2010, Resuscitation.

[3]  J. Soar,et al.  Cardiac arrest centres make sense. , 2010, Resuscitation.

[4]  Robert Swor,et al.  CPR training and CPR performance: do CPR-trained bystanders perform CPR? , 2006, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[5]  Comilla Sasson,et al.  Out-of-hospital cardiac arrest surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. , 2011, Morbidity and mortality weekly report. Surveillance summaries.

[6]  M. Shuster,et al.  Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update and simplification of the Utstein templates for resuscitation registries , 2004 .

[7]  M. Castrén,et al.  In patients with out-of-hospital cardiac arrest, does the provision of dispatch cardiopulmonary resuscitation instructions as opposed to no instructions improve outcome: a systematic review of the literature. , 2011, Resuscitation.

[8]  Foss Mv MANAGEMENT OF VIRUS HEPATITIS. , 1964 .

[9]  J. McNeil,et al.  Clinical‐quality registries: their role in quality improvement , 2010, The Medical journal of Australia.

[10]  C. Callaway,et al.  Regional variation in out-of-hospital cardiac arrest incidence and outcome. , 2008, JAMA.

[11]  D. Davis,et al.  Cardiac arrest survival did not increase in the Resuscitation Outcomes Consortium after implementation of the 2005 AHA CPR and ECC guidelines. , 2011, Resuscitation.

[12]  S M Cobbe,et al.  Surviving out of hospital cardiac arrest at home: a postcode lottery? , 2004, Emergency Medicine Journal.

[13]  R. Bhopal,et al.  Out-of-hospital cardiac arrest in South Asian and white populations in London: database evaluation of characteristics and outcome , 2009, Heart.

[14]  A. Handley,et al.  Utstein-style audit of Protocol C: a non-standard resuscitation protocol for healthcare professionals. , 2011, Resuscitation.

[15]  B Jennett,et al.  Assessment of outcome after severe brain damage. , 1975, Lancet.

[16]  R O Cummins,et al.  Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. Task Force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. , 1991, Annals of emergency medicine.

[17]  P. Cameron,et al.  Out‐of‐hospital cardiac arrest in Victoria: rural and urban outcomes , 2006, The Medical journal of Australia.

[18]  Stephen Joel Coons,et al.  Performing bystander CPR for sudden cardiac arrest: behavioral intentions among the general adult population in Arizona. , 2009, Resuscitation.

[19]  D. Stub,et al.  Hospital characteristics are associated with patient outcomes following out-of-hospital cardiac arrest , 2011, Heart.

[20]  G. Ewy Do modifications of the American Heart Association guidelines improve survival of patients with out-of-hospital cardiac arrest? , 2009, Circulation.

[21]  M. Lelonek,et al.  S-100B protein: An early prognostic marker after cardiac arrest. , 2010, Cardiology journal.

[22]  Frank Archer,et al.  Sensitivity and Specificity of the Medical Priority Dispatch System in Detecting Cardiac Arrest Emergency Calls in Melbourne , 2006, Prehospital and Disaster Medicine.

[23]  P. Steen,et al.  Quality of cardiopulmonary resuscitation before and during transport in out-of-hospital cardiac arrest. , 2008, Resuscitation.

[24]  M. Eisenberg Improving survival from out-of-hospital cardiac arrest: back to the basics. , 2007, Annals of emergency medicine.

[25]  U Ravens,et al.  Task Force on Sudden Cardiac Death of the European Society of Cardiology. , 2001, European heart journal.

[26]  M. Sayre Cardiac arrest survival rates are mutable. , 2011, Resuscitation.

[27]  Vinay Nadkarni,et al.  Reducing Barriers for Implementation of Bystander–Initiated Cardiopulmonary Resuscitation: A Scientific Statement From the American Heart Association for Healthcare Providers, Policymakers, and Community Leaders Regarding the Effectiveness of Cardiopulmonary Resuscitation , 2008, Circulation.

[28]  I. Stiell,et al.  Health-Related Quality of Life Is Better for Cardiac Arrest Survivors Who Received Citizen Cardiopulmonary Resuscitation , 2003, Circulation.

[29]  B. Jennett,et al.  ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical Scale , 1975, The Lancet.

[30]  T. Rea,et al.  Improving bystander cardiopulmonary resuscitation , 2011, Current opinion in critical care.

[31]  Karen Smith,et al.  Changing EMS dispatcher CPR instructions to 400 compressions before mouth-to-mouth improved bystander CPR rates. , 2011, Resuscitation.

[32]  John E Billi,et al.  Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European , 2004, Circulation.