Vol. 149 No. 3132 (2019)
Outcome after out-of-hospital ventricular fibrillation or pulseless ventricular tachycardia: comparison of before and after the implementation of the 2010 Guidelines in a single centre
- Thomas von Hösslin
- Paul Imboden
- Corina Kaufmann
- Thomas Schnider
- Miodrag Filipovic
AIMS OF THE STUDY
Improvements to guidelines and efforts to train and equip laypersons and medical professionals are expected to result in improvements in the outcomes of patients experiencing out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate changes in the survival and neurological outcomes of patients before and after the implementation of the 2010 guidelines.
In a retrospective chart review, we analysed the outcomes of 182 patients who suffered bystander-witnessed, out-of-hospital ventricular fibrillation or pulseless ventricular tachycardia of cardiac aetiology. These definitions were based on the Utstein style. Survival at hospital discharge (study period 2006 to 2015), 1-year survival (study period 2011 to 2015), neurological outcome (cerebral performance category [CPC] score) and the corresponding changes over time were evaluated. In addition, the results were compared with results obtained from a systematic review of the literature.
Of 1423 confirmed OHCAs, 182 fulfilled our inclusion criteria. 91 were treated between 2006 and 2010, and 91 from 2011 to 2015. Thirty-one (34%) survived until hospital discharge in the first time period, 44 (48%) in the second time period (p = 0.071); 26/31 (83%) and 40/44 (91%) respectively had a CPC score of 1–2. Between 2011 and 2015, the 1-year survival rate of the patients discharged from hospital was 36/44 (82%). All of these 36 patients (100%) had a favourable neurological outcome (CPC 1–2). These results were well within the range reported in the literature, although this range is wide (11 to 52% for survival at discharge and 6 to 47% for survival at 1 year).
Survival was found to be at the upper range of the results retrieved by the systematic literature review. However, we found no significant improvements over time. The neurological outcomes of the survivors were favourable. The generalisability of this study is limited by its small sample size. To further improve outcomes, more public health measures, such as a functioning chain of survival, are required (e.g. an effective first responder network).
- Chan PS, McNally B, Tang F, Kellermann A ; CARES Surveillance Group. Recent trends in survival from out-of-hospital cardiac arrest in the United States. Circulation. 2014;130(21):1876–82. doi:.https://doi.org/10.1161/CIRCULATIONAHA.114.009711
- Hollenberg J, Herlitz J, Lindqvist J, Riva G, Bohm K, Rosenqvist M, et al. 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(4):389–96. doi:.https://doi.org/10.1161/CIRCULATIONAHA.107.734137
- Blom MT, Beesems SG, Homma PCM, Zijlstra JA, Hulleman M, van Hoeijen DA, et al. Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators. Circulation. 2014;130(21):1868–75. doi:.https://doi.org/10.1161/CIRCULATIONAHA.114.010905
- Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, de Caen AR, et al. Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122(16, Suppl 2):S250–75. doi:.https://doi.org/10.1161/CIRCULATIONAHA.110.970897
- Hazinski MF, Nolan JP, Aickin R, Bhanji F, Billi JE, Callaway CW, et al. Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2015;132(16, Suppl 1):S2–39. doi:.https://doi.org/10.1161/CIR.0000000000000270
- Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18, Suppl 2):S444–64. doi:.https://doi.org/10.1161/CIR.0000000000000261
- Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18, Suppl 3):S729–67. doi:.https://doi.org/10.1161/CIRCULATIONAHA.110.970988
- Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, et al.; ERC Guidelines Writing Group. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation. 2010;81(10):1219–76. doi:.https://doi.org/10.1016/j.resuscitation.2010.08.021
- Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al.; ERC Guidelines 2015 Writing Group. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015;95:1–80. doi:.https://doi.org/10.1016/j.resuscitation.2015.07.038
- National Heart. Lung and Blood Institute [Internet]. Sudden Cardiac Arrest [cited 2018 Aug 25]. Available from: https://www.nhlbi.nih.gov/health/health-topics/topics/scda
- Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al.; 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 Councils of Southern Africa; ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. 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. Circulation. 2004;110(21):3385–97. doi:.https://doi.org/10.1161/01.CIR.0000147236.85306.15
- Moher D, Liberati A, Tetzlaff J, Altman DG ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:.https://doi.org/10.1371/journal.pmed.1000097
- Mauri R, Burkart R, Benvenuti C, Caputo ML, Moccetti T, Del Bufalo A, et al. Better management of out-of-hospital cardiac arrest increases survival rate and improves neurological outcome in the Swiss Canton Ticino. Europace. 2016;18(3):398–404. doi:.https://doi.org/10.1093/europace/euv218
- McNally B, Robb R, Mehta M, Vellano K, Valderrama AL, Yoon PW, et al.; Centers for Disease Control and Prevention. Out-of-hospital cardiac arrest surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. MMWR Surveill Summ. 2011;60(8):1–19.
- Wissenberg M, Lippert FK, Folke F, Weeke P, Hansen CM, Christensen EF, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA. 2013;310(13):1377–84. doi:.https://doi.org/10.1001/jama.2013.278483
- Debaty G, Labarere J, Frascone RJ, Wayne MA, Swor RA, Mahoney BD, et al. Long-Term Prognostic Value of Gasping During Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol. 2017;70(12):1467–76. doi:.https://doi.org/10.1016/j.jacc.2017.07.782
- Nürnberger A, Sterz F, Malzer R, Warenits A, Girsa M, Stöckl M, et al. Out of hospital cardiac arrest in Vienna: incidence and outcome. Resuscitation. 2013;84(1):42–7. doi:.https://doi.org/10.1016/j.resuscitation.2012.07.002
- Phelps R, Dumas F, Maynard C, Silver J, Rea T. Cerebral Performance Category and long-term prognosis following out-of-hospital cardiac arrest. Crit Care Med. 2013;41(5):1252–7. doi:.https://doi.org/10.1097/CCM.0b013e31827ca975
- Lindner TW, Søreide E, Nilsen OB, Torunn MW, Lossius HM. Good outcome in every fourth resuscitation attempt is achievable--an Utstein template report from the Stavanger region. Resuscitation. 2011;82(12):1508–13. doi:.https://doi.org/10.1016/j.resuscitation.2011.06.016
- Berdowski J, Berg RA, Tijssen JGP, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010;81(11):1479–87. doi:.https://doi.org/10.1016/j.resuscitation.2010.08.006
- Capucci A, Aschieri D, Guerra F, Pelizzoni V, Nani S, Villani GQ, et al. Community-based automated external defibrillator only resuscitation for out-of-hospital cardiac arrest patients. Am Heart J. 2016;172:192–200. doi:.https://doi.org/10.1016/j.ahj.2015.10.018
- Nordberg P, Hollenberg J, Rosenqvist M, Herlitz J, Jonsson M, Järnbert-Petterson H, et al. The implementation of a dual dispatch system in out-of-hospital cardiac arrest is associated with improved short and long term survival. Eur Heart J Acute Cardiovasc Care. 2014;3(4):293–303. doi:.https://doi.org/10.1177/2048872614532415
- Lick CJ, Aufderheide TP, Niskanen RA, Steinkamp JE, Davis SP, Nygaard SD, et al. Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest. Crit Care Med. 2011;39(1):26–33. doi:.https://doi.org/10.1097/CCM.0b013e3181fa7ce4
- Rettung St. Gallen [Internet]. First Responder [cited 2018 Aug 25]. Teil der Notfallversorgung [about 1 screen]. Available from: http://www.rettung-sg.ch/index.php?id=22