Epidemiology and outcomes of out-of-hospital cardiac arrests treated by an anaesthetist-staffed emergency medical service: a 3-year registry analysis in The Friuli-Venezia-Giulia region

Abstract

Objectives: Out-of-hospital cardiac arrest (OHCA) presents significant regional variations in incidence, management, and survival rates. The Friuli-Venezia-Giulia (FVG) region in northeastern Italy has established a cardiac arrest registry to evaluate epidemiological trends and the effectiveness of its emergency medical service (EMS) interventions. This study analyses EMS-treated OHCAs over a three-year period, focusing on patient characteristics, resuscitation practices, and survival outcomes.

Methods: A retrospective cohort study was conducted using prospectively collected data from the FVG-OHCA registry between January 2021-December 2023. All adult OHCAs where resuscitation was attempted by EMS were included. Demographics, OHCA characteristics, bystander interventions, EMS response and treatments, and outcomes were analysed. Logistic regression was used to identify factors associated with survival to hospital admission, six-month survival, and good neurological recovery (Cerebral Performance Category (CPC) 1-2).

Results: A total of 4,089 OHCA cases were recorded, with an incidence of 113/100,000 inhabitants/year. Although bystander CPR rate was 67%, public AED use was low (4.3%). Resuscitation was attempted by EMS in 48% of cases, and an advanced airway was placed in 75% of patients. Survival to hospital admission was 22.9%, while six-month survival was 9.7%, and 7.6% of patients had a CPC 1-2. Younger age, male gender, shockable rhythm, and public location were associated with long-term survival. High-quality bystander CPR, use of mechanical CPR, and advanced airway placement during CPR were associated only with survival to hospital admission.

Conclusions: This study provides comprehensive insights into OHCA epidemiology and outcomes in the FVG region and emphasises the importance of early intervention, high-quality bystander CPR, and specialised prehospital care.

Keywords: Cardiopulmonary resuscitation; Out-of-hospital cardiac arrest; Outcome; Registry; Survival.

Fig. 1

Demographic data and emergency medical system vehicles distribution and availability in Friuli-Venezia-Giulia Region. In the embedded table, characteristics of out-of-hospital cardiac arrests (OHCAs) with cardiopulmonary resuscitation (CPR) attempted by emergency medical system (EMS) are detailed. BLS, basic life support; ALS, advanced life support. Data in the table are reported as n (%) or median [IQR]. §p < 0.05 and §§p < 0.01 vs. province 2; #p < 0.05, ##p < 0.01 vs. province 3; °p < 0.05 and °° p < 0.01 vs. province 4. Some cardiac arrest location was recorded as “other” or “unknown/not recorded” in the registry, which accounts for the missing percentage in the total.

Fig. 2

Flow-chart with numbers of out-of-hospital cardiac arrest (OHCA) in Friuli-Venezia-Giulia Region. CPR, cardiopulmonary resuscitation; EMS, emergency medical system; ER, emergency room; ROSC, return of spontaneous circulation.

Fig. 3

Impact of no-flow and cardiopulmonary resuscitation (CPR) duration on survival to hospital admission, 6-month survival, and good neurological recovery (cerebral performance category 1–2), in the emergency medical system-treated out-of-hospital cardiac arrest in Friuli-Venezia-Giulia Region. No-flow time in unwitnessed cardiac arrests was defined as the estimated time from presumed collapse (or last seen well) to initiation of CPR.