Abstract
Background
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.
Methods
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).
Results
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).
Conclusion
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.
Keywords
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Article info
Publication history
Published online: January 22, 2015
Accepted:
January 16,
2015
Received in revised form:
December 24,
2014
Received:
November 18,
2014
Footnotes
☆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.
Identification
Copyright
© 2015 Published by Elsevier Inc. All rights reserved.
