Ventricular fibrillation in Rochester, Minnesota: Experience over 18 years

Agarwal, Dipti A.; Hess, Erik P.; Atkinson, Elizabeth J.; White, Roger D.

doi:10.1016/j.resuscitation.2009.07.019

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Volume 80, Issue 11 , Pages 1253-1258, November 2009

Ventricular fibrillation in Rochester, Minnesota: Experience over 18 years☆

Dipti A. Agarwal
- Department of Emergency Medicine, Division of Emergency Medicine Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
Erik P. Hess
- Department of Emergency Medicine, Division of Emergency Medicine Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
Elizabeth J. Atkinson
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
Roger D. White
- Department of Anesthesiology and Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
- City of Rochester Early Defibrillation Program, Rochester, MN 55905, USA
- Corresponding author at: Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. Tel.: +1 507 255 1612; fax: +1 507 255 6463.

Received 30 April 2009; received in revised form 29 June 2009; accepted 15 July 2009. published online 28 August 2009.

Abstract

Objective

Survival following out-of-hospital cardiac arrest (OHCA) continues to be disappointingly low world-wide, despite advances in technology and international guidelines for resuscitation. Few cities or emergency medical service (EMS) agencies report patient outcomes after OHCA. Among those who do, survival from witnessed VF ranges from 7.7% to 39.9%, with only a few cities reporting rates higher than this. We report outcomes and incidence of VF OHCA over 18 years in a medium-sized city incorporating an aggressive approach to OHCA.

Methods

The city, which increased in population over the study period from 70,000 to 100,000 persons, utilizes an emergency response system which dispatches defibrillator-equipped police, fire-rescue and ambulance personnel simultaneously. Police and fire-rescue personnel are equipped with automated external defibrillators (AEDs). Advanced life-support is provided as needed by paramedics.

Results

There were 454 arrests during the study period attributed to a cardiac cause. Of 271 bystander-witnessed arrests, 203 (74.9%) were in VF and 94 (46.3%) were discharged. Average time from 9-1-1 call to shock was relatively short: mean 6.5min (S.D. 2.5min). In a multivariable model, the interval from call to shock was strongly associated with neurologically intact survival (OR 0.72, 95% CI: 0.61–0.84 for each additional minute). The age- and sex-adjusted incidence of EMS-treated VF OHCA significantly (p<0.001) declined over the study period: 1991–1999: 37.9/100,000 (95% CI: 31.8–44.0), 2000–2008: 17.8/100,000 (95% CI: 14.4–21.2).

Conclusions

High survival from witnessed VF OHCA (46.3%) was achieved during the study period. Rapid response, and therefore rapid defibrillation, was the major contributor to survival.

Keywords: Automated external defibrillator (AED), Defibrillation, Cardiac arrest, Cardiopulmonary resuscitation (CPR), Return of spontaneous circulation, Resuscitation, Emergency medical services

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☆ A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.07.019.

PII: S0300-9572(09)00417-1

doi:10.1016/j.resuscitation.2009.07.019

« Previous Next »Resuscitation
Volume 80, Issue 11 , Pages 1253-1258, November 2009

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