[Out-of-hospital cardiac arrest in an experimental model of the management of cardiologic emergencies in a metropolitan area]

Abstract

Since March 1992, an emergency medical system--EMS--(Servizio Emergenze Cardiologiche Territoriale, SECT) operates in the metropolitan area of Turin (130, 16 Km2), for a population of 964,000 inhabitants. SECT is based on a mobile intensive care unit, staffed with a physician and a nurse, trained in advanced cardiopulmonary resuscitation (CPR) and equipped to treat all cardiac emergencies. According to the "Utstein Style" we report the demographic and clinical features of the patients (pts) suffering Cardiac Arrest (CA) and the impact of SECT on out-of-hospital CA. During 26 months of activity, SECT performed 3,648 missions (most important among these: 457 acute myocardial infarction, 723 angina, 523 arrhythmias, 270 acute heart failure, 154 cardiac arrest), and managed 207 confirmed CA (154 calls for CA, 53 CA occurred after team arrival because of other symptoms). Resuscitation was attempted in 135 pts, in 72 pts medical personnel accerted an irreversible death state. 86% of CA occurred at home. In all cases a cardiac etiology was presumed. All CA were witnessed: 53 by EMS personnel, 82 by lay bystander. In 53 EMS witnessed CA, ventricular tachycardia (VT) or ventricular fibrillation (VF) was showed in 47.2%, asystole in 43.4%, other rhythms (Oth) in 9.4%. Return of spontaneous circulation (ROSC) was obtained in 52.8% pts, 76% in VT/VF Group. 43.4% were admitted alive to intensive care unit (ICU), 68% in VT/VF Group. 37.7% were discharged alive, 64% in VT/VF Group. In 82 lay witnessed CA initial rhythm was VT/VF in 31.7%, asystole in 59.7%, Oth. In 8.6%. CPR was attempted by lay bystander in 28% of cases. ROSC was obtained in 18.3%. CPR was attempted by lay bystander in 28% of cases. ROSC was obtained in 18.3% pts, 42.3% in VT/VF Group. 15.8% were admitted alive to ICU, 34.6% in VT/VF Group. 9.7% pts were discharged alive, 23% in VT/VF Group. Discharged alive rate in lay attempted CPR cases was 17.4%. The collapse-EMS CPR interval was 16 +/- 6.13 min (range 4-29), with a collapse-call receipt interval of 8.57 +/- 5.75 min (range 1-23) and a call receipt-EMS CPR interval of 8.06 +/- 3.56 min (range 2-19). The same intervals are significantly longer in not attempted CPR cases: respectively 26.53 +/- 10.73 min (range 10-65) -p < 0.001-, 19.29 +/- 11.3 min (range 5-60) -p < 0.001- and 8.26 +/- 3.96 (range 3-25) -p = NS-. Although far from the international effectiveness standards, SECT seemed to improve the out-of-hospital CA prognosis. High rate of CA occurred at home, time delay in early access link, better trend in survival in lay bystander attempted CPR cases and lack in early defibrillation lead to strategies for system improvement through targeted CPR training as well as semiautomatic external defibrillators introduction.