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Sudden Cardiac Arrest articles added 12/28/00
Skyaid comment: response time is vitally important
Ann Emerg Med 1996 Jun;27(6):700-10
Effectiveness of emergency medical services for victims of out-of-hospital cardiac arrest: a metaanalysis.
Nichol G, Detsky AS, Stiell IG, O'Rourke K, Wells G, Laupacis A
Clinical Epidemiology Unit, Loeb Medical Research Institute, Ottawa Civic Hospital, Ontario, Canada.
STUDY OBJECTIVE: To determine the relative effectiveness of differences in response time interval, proportion of bystander CPR, and type and tier of emergency medical services (EMS) system on survival after out of hospital cardiac arrest. METHODS: We performed a comprehensive literature search, excluding EMS systems other than those of interest (systems of interest were those comprising one tier with providers of basic life support [BLS] or advanced life support [ALS] and those comprising two tiers with providers of BLS or BLS-defibrillation followed by ALS), patient population of fewer than 100 cardiac arrests, studies in which we could not determine the total number of arrests of presumed cardiac origin, and studies lacking data on survival to hospital discharge. Metaanalysis using generalized linear model with dispersion estimation for random effects was then performed. RESULTS: Increased survival to hospital discharge was significantly associated with tier (P < .01), response time interval (P < .01), and bystander CPR (P = .04). A significant interaction was detected between response time interval and bystander CPR (P = .02). For the studies analyzed, survival was 5.2% in a one-tier EMS system or 10.5% in a two-tier EMS system. A 1-minute decrease in mean response time interval was associated with absolute increases in survival rates of .4% and .7% in a one-tier and two-tier EMS systems, respectively. CONCLUSION: Increased survival to hospital discharge may be associated with decreased response time interval and with the use of a two-tier EMS system as opposed to a one-tier system. The data available for this analysis were suboptimal. Policymakers need more methodologically rigorous research to have more reliable and valid estimates of the effectiveness of different EMS systems.
Resuscitation 1999 Jan;40(1):3-9
Out-of-hospital cardiac arrests in an urban/rural area during 1991 and 1996: have emergency medical service changes improved outcome?
Absalom AR, Bradley P, Soar J
University Department of Anaesthesia, Glasgow Royal Infirmary, UK.
Survival after out-of-hospital cardiac arrest is influenced by pre-hospital emergency medical care. This study compares outcome of cardiac arrest victims presenting to an emergency department serving a mixed urban/rural area (Norfolk, UK) in 1991 with 1996. Between these years the regional emergency medical service (EMS) was extensively re-organized. We identified 113 such cases of out-of-hospital cardiac arrest in 1991 and 147 in 1996. The age distribution, proportion of witnessed arrests, and initial rhythms were similar for the 2 years. In 1996 EMS response time was significantly slower and the proportion of cases where the EMS arrived before arrest was significantly lower. Fewer patients who had a witnessed arrest received immediate bystander CPR in 1996. The number of patients discharged home decreased from 15 in 1991 to 11 in 1996, but this difference did not reach statistical significance. The majority of survivors had restoration of spontaneous circulation prior to arrival in the emergency department (14 in 1991 and ten in 1996). Survival was greatest in those arresting in the presence of the EMS (ten in 1991 and nine in 1996). In conclusion changes in EMS provision have resulted in an increase in the response time. This was associated with a decrease in the number of survivors although this was not statistically significant.