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Incidence of EMS-treated out-of-hospital cardiac arrest in the United States

      Abstract

      Background: The potential impact of efforts to improve the chain of survival for out-of-hospital sudden cardiac arrest (SCA) is unclear in part because estimates of the incidence of treatable cases of SCA are uncertain. The aim of the investigation was to determine a representative national incidence of emergency medical services (EMS)-treated all-rhythm and ventricular fibrillation (VF) SCA as well as survival. Methods: We used Medline to identify peer-reviewed articles published between 1 January 1980 and 31 March 2003 that reported a US community’s EMS SCA experience. Inclusion criteria required the study to include at least 25 cases, report the total number of all-rhythm and/or ventricular fibrillation arrests, and provide information about population size and study duration. Incidence was computed by dividing the total number of SCA events by the product of the community’s population and the study duration. Results: Reports from 35 communities met the inclusion criteria. A total of 35,801 all-rhythm EMS-treated cardiac arrests occurred during 62.11 million person-years of observation resulting in an overall incidence of 54.99 per 100,000 person-years. The incidence of ventricular fibrillation-rhythm SCA was 21.32 per 100,000 person-years. Sensitivity analyses generally produced similar results. Applying these results to the US population, 155,000 persons would experience EMS-treated all-rhythm SCA and 60,000 persons would experience EMS-treated ventricular fibrillation-rhythm SCA annually in the US. Survival was 8.4% for all-rhythm and 17.7% for ventricular fibrillation SCA. Conclusion: The results provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of SCA.

      Sumàrio

      Introdução:O impacto potencial dos esforços para melhorar a cadeia de sobrevivência para as paragens cardı́acas súbitas (SCA) pré-hospitalares é desconhecido, em parte porque as estimativas da incidência de casos tratáveis de SCA são imprecisas. O objectivo da investigação foi determinar uma incidência nacional representativa das SCA tratadas pelos Serviços de Emergência Médica (EMS) em todos os ritmos e em fibrilhação ventricular (VF), assim como a sobrevida.
      Métodos: Usamos a Medline para identificar artigos revistos por peritos e publicados entre 1 de Janeiro de 1980 e 31 de Março de 2003, apresentando experiências de SCA tratadas pelos EMS em comunidades americanas. Os critérios de inclusão obrigaram a que o estudo incluı́sse pelo menos 25 casos, registos do número total de paragens em todos os ritmos e/ou fibrilhação ventricular e informação sobre o tamanho da população e a duração do estudo. A incidência foi calculada pela razão entre o número total de eventos de SCA e o produto da população pela duração do estudo.
      Resultados:Resultados de 35 comunidades cumpriram os critérios de inclusão. Ocorreram 35.801 paragens cardı́acas em todos os ritmos, tratadas pelos EMS, em 62,11 milhões de pessoas/ano de observação, o que resultou numa incidência global de 54,99 por 100.000 pessoas/ano. A incidência de SCA com ritmo de fibrilhação ventricular foi de 21,32 por 100.000 pessoas/ano. As análises de sensibilidade obtiveram resultados similares. Aplicando estes resultados à população dos Estados Unidos, anualmente 155.000 pessoas sofrem SCA em todos os ritmos e 60.000 pessoas sofrem SCA em ritmo de fibrilhação ventricular, tratadas pelos EMS. A sobrevida foi de 8,4% para SCA em todos os ritmos e de 17,7% em fibrilhação ventricular.
      Conclusão:Os resultados fornecem uma base para avaliar as limitações e oportunidades dos cuidados dos EMS em relação ao peso das SCA na saúde pública.

      Resumen

      Antecedentes: El impacto potencial de los esfuerzos para mejorar la cadena de sobrevida para paro cardiaco súbito(SCA) extrahospitalario no es claro en parte porque las estimaciones de la incidencia de casos tratables de SCA es incierta. El objetivo de esta investigación es determinar una incidencia nacional representativa SCA tratados por los servicios de emergencia médicas por todos los ritmos y por fibrilación ventricular(VF) al igual que la sobrevida.
      Métodos: Usamos Medline para identificar artı́culos de revisión publicados entre Enero 1 1980 y Marzo 31 2003 que reportara la experiencia de SCA tratado por EMD en la comunidad de EEUU. Los criterios de inclusión del estudio requirieron que el estudio fuera de al menos 25 casos, que reportara el numero total de SCA por todos los ritmos y / o por VF, y que proporcionara información acerca del tamaño de la población y duración del estudio. La incidencia fue computada dividiendo el número total de eventos SCA por el producto de la población de la comunidad y la duración del estudio.
      Resultados: Reportes de 35 comunidades alcanzaron los criterios de inclusión. Ocurrieron un total de 35801 SCA por todos los ritmos, tratados por EMS ocurrieron durante 62.11 millones de persona-años de observación resultando en una incidencia global de 54.99 por 100000persona-año. La incidencia de SCA por VF fue de 21.32 por 100000 persona-año.Los análisis de sensibilidad generalmente produjeron resultados similares. Al aplicar los resultados a la población de EEUU, 155000 personas experimentarı́an SCA por todos los ritmos tratado por EMS y 60000 personas experimentarı́an SCA en VF tratado por EMS anualmente en los EEUU. La sobrevida fue 8.4% para SCA por todos los ritmos y 17.7% para SCA porVF.
      Conclusión: El resultado proporciona un medio para evaluar oportunidades y limitaciones de los cuidados de EMS con relación a los marcos de salud pública del SCA.

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