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. 2016 Mar;18(3):398-404.
doi: 10.1093/europace/euv218. Epub 2015 Sep 7.

Better management of out-of-hospital cardiac arrest increases survival rate and improves neurological outcome in the Swiss Canton Ticino

Romano Mauri  1 , Roman Burkart  2 , Claudio Benvenuti  2 , Maria Luce Caputo  3 , Tiziano Moccetti  3 , Alessandro Del Bufalo  3 , Augusto Gallino  4 , Carlo Casso  5 , Luciano Anselmi  5 , Tiziano Cassina  6 , Catherine Klersy  7 , Angelo Auricchio  8
Affiliations

Better management of out-of-hospital cardiac arrest increases survival rate and improves neurological outcome in the Swiss Canton Ticino

Romano Mauri et al. Europace. 2016 Mar.

Abstract

Aim: To determine the incidence of out-of-hospital cardiac arrest (OHCA) fulfilling Utstein criteria in the Canton Ticino, Switzerland, the survival rate of OHCA patients and their neurological outcome.

Methods and results: All OHCAs treated in Canton Ticino between 1 January 2005 and 31 December 2014 were followed until either death or hospital discharge. The survival and neurological outcome of those OHCA fulfilling Utstein criteria are reported. A total of 3367 OHCAs occurred in the Canton Ticino over a 10-year period. Resuscitation was attempted in 2298 patients; of those 1492 (65%) were of presumed cardiac origin, 454 fulfilling the Utstein comparator criteria. About 69% [95% confidence interval (CI), 66.6-71.4%] of the patients had a bystander-witnessed arrest; a dispatched cardiopulmonary resuscitation (CPR) steadily and significantly increased from 2005 to 2014. Out-of-hospital cardiac arrest occurred prevalently home (67%), in men (71%) of a mean age of 71 ± 13 years. There were no statistically significant differences either in demographic characteristics of OHCA victims over these years or in presenting rhythm. There was a progressive increase in the survival at discharge from 15% in 2005 to 55% in 2014; overall 96% (95% CI, 93.3-99.9%) of the survivors had a good neurological outcome.

Conclusion: The significant increase in Utstein comparator survival rates and improved neurological outcome in OHCA victims in Canton Ticino are the result of an effective OHCA management programme which includes large-scale public education, a coordinated fast EMS response, high density of external defibrillators, and advances in clinical interventions for OHCAs.

Keywords: Bystander resuscitation; Neurological outcome; Out-of hospital cardiac arrest; Survival.

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Figures

Figure 1
Figure 1
Flowchart of patients' inclusion.
Figure 2
Figure 2
Pre-hospital resuscitation activities (first responders on scene, bystander-performed CPR, and AED use) and survival rate at hospital discharge (dotted line). Data for bystander-performed CPR have been collected starting in 2009; data on the use of AED have been collected starting in 2008.
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