Despite immediate resuscitation, survival rates following out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical service (EMS) are reportedly low. We sought to compare survival and 12-month functional recovery outcomes for OHCA occurring before and after EMS arrival.
Between 1st July 2008 and 30th June 2013, we included 8648 adult OHCA cases receiving an EMS attempted resuscitation from the Victorian Ambulance Cardiac Arrest Registry, and categorised them into five groups: bystander witnessed cases ± bystander CPR, unwitnessed cases ± bystander CPR, and EMS witnessed cases. The main outcomes were survival to hospital and survival to hospital discharge. Twelve-month survival with good functional recovery was measured in a sub-group of patients using the Extended Glasgow Outcome Scale (GOSE).
Baseline and arrest characteristics differed significantly across groups. Unadjusted survival outcomes were highest among bystander witnessed cases receiving bystander CPR and EMS witnessed cases, however outcomes differed significantly between these groups: survival to hospital (46.0% vs. 53.4% respectively, p < 0.001); survival to hospital discharge (21.1% vs. 34.9% respectively, p < 0.001). When compared to bystander witnessed cases receiving bystander CPR, EMS witnessed cases were associated with a significant improvement in the risk adjusted odds of survival to hospital (OR 2.02, 95% CI: 1.75–2.35), survival to hospital discharge (OR 6.16, 95% CI: 5.04–7.52) and survival to 12 months with good functional recovery (OR 5.56, 95% CI: 4.18–7.40).
When compared to OHCA occurring prior to EMS arrival, EMS witnessed arrests were associated with significantly higher survival to hospital discharge rates and favourable neurological recovery at 12-month post-arrest.
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- Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81
- The relationship between time to arrival of emergency medical services (EMS) and survival from out-of-hospital ventricular fibrillation cardiac arrest.Resuscitation. 2010; 81: 622-625
- Optimal defibrillation response intervals for maximum out-of-hospital cardiac arrest survival rates.Ann Emerg Med. 2003; 42: 242-250
- Incidence, duration and survival of ventricular fibrillation in out-of hospital cardiac arrest in patients in Sweden.Resuscitation. 2000; 44: 7-17
- Advanced rescuer- versus citizen-witnessed cardiac arrest: is there a difference in outcome?.Prehosp Emerg Care. 2011; 15: 55-60
- Survival after out-of-hospital cardiac arrests in Katowice (Poland): outcome report according to the “Utstein style”.Resuscitation. 2004; 61: 315-325
- One-year survival after out-of-hospital cardiac arrest in Bonn city: outcome report according to the ‘Utstein style’.Resuscitation. 1997; 33: 233-243
- Treatment of out-of-hospital cardiac arrest in Ljubljana: outcome report according to the ‘Utstein’ style.Resuscitation. 1998; 38: 169-176
- Cardiac arrests treated by ambulance paramedics and fire fighters. The Emergency Medical Response Program.Med J Aust. 2002; 177: 305-309
- Public access defibrillation – results from the Victorian Ambulance Cardiac Arrest Registry.Resuscitation. 2014; 85: 1739-1744
- 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 Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa).Resuscitation. 2004; 63: 233-249
- The development of a data-matching algorithm to define the ‘case patient’.Aust Health Rev. 2013; 37: 54-59
- Quality of life and functional outcomes 12-months after out-of-hospital cardiac arrest.Circulation. 2015; 131: 174-181
- Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use.J Neurotrauma. 1998; 15: 573-585
- Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew – witnessed cases and bystander cardiopulmonary resuscitation.Circulation. 2008; 118: 389-396
- Increased survival after EMS witnessed cardiac arrest. Observations from the Resuscitation Outcomes Consortium (ROC) Epistry – cardiac arrest.Resuscitation. 2010; 81: 826-830
- A comprehensive investigation of cardiac arrest before and after arrival of emergency medical services.Resuscitation. 2010; 81: 769-772
- Outcome after out-of-hospital cardiac arrest witnessed by EMS: changes over time and factors of importance for outcome in Sweden.Resuscitation. 2012; 83: 1253-1258
- Cardiac arrest witnessed by emergency medical services personnel: descriptive epidemiology, prodromal symptoms, and predictors of survival.Ann Emerg Med. 2000; 35: 138-146
- Outcome of CPR in a large metropolitan area – where are the survivors?.Ann Emerg Med. 1991; 20: 355-361
- Cardiac arrests witnessed by EMS personnel in a multitiered system: epidemiology and outcome.Am J Emerg Med. 1998; 16: 12-16
- Survival models for out-of-hospital cardiopulmonary resuscitation from the perspectives of the bystander, the first responder and the paramedic.Resuscitation. 2001; 51: 113-122
- Out-of-hospital cardiac arrest: significance of symptoms in patients collapsing before and after arrival of paramedics.Am J Emerg Med. 1986; 4: 116-120
- The significance of pre-arrest factors in out-of-hospital cardiac arrests witnessed by emergency medical services: a report from the Victorian Ambulance Cardiac Arrest Registry.Resuscitation. 2015; 88: 35-42
- How sudden is sudden cardiac death?.Circulation. 2006; 114: 1146-1150
- Causes of sudden cardiac death in young Australians.Med J Aust. 2004; 180: 110-112
- Factors associated with pulseless electric activity versus ventricular fibrillation: the Oregon sudden unexpected death study.Circulation. 2010; 122: 2116-2122
- Prearrest signs of shock and respiratory insufficiency in out-of-hospital cardiac arrests witnessed by crew of the emergency medical service.Am J Emerg Med. 2009; 27: 440-448
- Quality of life after cardiac arrest: how and when to assess outcomes after hospital discharge?.Resuscitation. 2014; 85: 1127-1128
Published online: January 22, 2015
Accepted: January 16, 2015
Received in revised form: December 24, 2014
Received: November 18, 2014
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2015.01.012.
© 2015 Published by Elsevier Inc. All rights reserved.