Editor’s Choice-Progress in the chain of survival and its impact on outcomes of patients admitted to a specialized high-volume cardiac arrest center during the past two decades
Restricted accessResearch articleFirst published online November, 2016
Editor’s Choice-Progress in the chain of survival and its impact on outcomes of patients admitted to a specialized high-volume cardiac arrest center during the past two decades
Cardiac arrest (CA) is still associated with high mortality and morbidity. Data on the changes in management and outcomes over a long period of time are limited. Using data from a single emergency department (ED), we assessed changes over two decades.
Methods:
In this single-center observational study, we prospectively included 4133 patients receiving cardiopulmonary resuscitation and being admitted to the ED of a tertiary care hospital between January 1992 and December 2012.
Results:
There was a significant improvement in both 6-month survival rates (+10.8%; p < 0.001) and favorable neurological outcome (+4.7%; p < 0.001). While the number of witnessed CA cases decreased (-4.7%; p < 0.001) the proportion of patients receiving bystander basic life support increased (+8.3%; p < 0.001). The proportion of patients with initially shockable ECG rhythms remained unchanged, but cardiovascular causes of CA decreased (-9.6%; p < 0.001). Interestingly, the time from CA until ED admission increased (+0.1 hours; p = 0.024). The use of percutaneous coronary intervention and therapeutic hypothermia were significantly associated with survival.
Conclusions:
Outcomes of patients with CA treated at a specialized ED have improved significantly within the last 20 years. Improvements in every link in the chain of survival were noted.
BerdowskiJBergRATijssenJG. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation2010; 81: 1479–1487.
2.
GräsnerJTHerlitzJKosterRW. Quality management in resuscitation – towards a European cardiac arrest registry (EuReCa). Resuscitation2011; 82: 989–994.
3.
SchoberASterzFHerknerH. Post-resuscitation care at the emergency department with critical care facilities – a length-of-stay analysis. Resuscitation2011; 82: 853–858.
4.
HazinskiMFNolanJPBilliJE. Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation2010; 122: S250–S275.
5.
NolanJPSoarJZidemanDA. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation2010; 81: 1219–1276.
6.
YeungJMoulaertV. Focus on the brain of the cardiac arrest survivor. Resuscitation2015; 88: A5–A6.
7.
JennettBBondM. Assessment of outcome after severe brain damage. Lancet1975; 1: 480–484.
8.
HolzerMBernardSAHachimi-IdrissiS. Hypothermia for neuroprotection after cardiac arrest: Systematic review and individual patient data meta-analysis. Crit Care Med2005; 33: 414–418.
9.
LeckyFBrydenDLittleR. Emergency intubation for acutely ill and injured patients. Cochrane Database Syst Rev2008; CD001429.
10.
CabriniLBeccariaPLandoniG. Impact of impedance threshold devices on cardiopulmonary resuscitation: A systematic review and meta-analysis of randomized controlled studies. Crit Care Med2008; 36: 1625–1632.
11.
SannaTLa TorreGde WaureC. Cardiopulmonary resuscitation alone vs. cardiopulmonary resuscitation plus automated external defibrillator use by non-healthcare professionals: a meta-analysis on 1583 cases of out-of-hospital cardiac arrest. Resuscitation2008; 76: 226–232.
12.
JohnsonNJAckerMHsuCH. Extracorporeal life support as rescue strategy for out-of-hospital and emergency department cardiac arrest. Resuscitation2014; 85: 1527–1532
13.
Biondi-ZoccaiGGAbbateAParisiQ. Vasopressin superior to adrenaline or placebo in the management of cardiac arrest? A meta-analysis. Resuscitation2003; 59: 221–224.
14.
NürnbergerASterzFMalzerR. Out of hospital cardiac arrest in Vienna: Incidence and outcome. Resuscitation2013; 84: 42–47.
15.
PerkinsGDJacobsIGNadkarniVM. Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest. Resuscitation2015; 96: 328–340.
16.
StegPGJamesSKAtarD. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J2012; 33: 2569–2619.
17.
Van de WerfF1BaxJBetriuA. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J2008; 29: 2909–2945.
18.
Van de WerfFArdissinoDBetriuA. Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J2003; 24: 28–66.
19.
[No authors listed]. Acute myocardial infarction: pre-hospital and in-hospital management. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 1996; 17: 43–63.
20.
KliegelAScheineckerWEisenburgerP. Hurrah – we are still alive! A different dimension in post-resuscitative care: The annual gathering of cardiac arrest survivors at a typical Viennese wine tavern. Resuscitation2002; 52: 301–304.
21.
European Resuscitation Council Working Party. Adult advanced cardiac life support: The European Resuscitation Council guidelines 1992 (abridged). BMJ1993; 306(6892): 1589–1593.
22.
Advanced Life Support Working Group of the European Resuscitation Council. The 1998 European Resuscitation Council guidelines for adult advanced life support. BMJ1998; 316: 1863–1869.
23.
de LatorreFNolanJRobertsonC. A statement from the Advanced Life Support Working Group(1) and approved by the Executive Committee of the European Resuscitation Council. Resuscitation2001; 48: 211–221.
24.
NolanJPDeakinCDSoarJ. European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation2005; 67 Suppl1: S39–S86.
25.
DeakinCDNolanJPSoarJ. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation2010; 81: 1305–1352.
26.
StrömsöeASvenssonLAxelssonAB. Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival. Eur Heart J2015; 36: 863–871.
27.
ValenzuelaTDRoeDJNicholG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med2000; 343: 1206–1209.
28.
BlomMTBeesemsSGHommaPC. Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators. Circulation2014; 130: 1868–1875.
29.
HollenbergJHerlitzJLindqvistJ. Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew – witnessed cases and bystander cardiopulmonary resuscitation. Circulation2008; 118: 389–396.
30.
AdielssonAHollenbergJKarlssonT. Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: Bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective. Heart2011; 97: 1391–1396.
31.
WissenbergMLippertFKFolkeF. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA2013; 310: 1377–1384.
32.
BernardSAGrayTWBuistMD. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med2002; 346: 557–563.
33.
LindnerTWLangørgenJSundeK. Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU. Crit Care2013; 17: R147.
34.
FothergillRTWatsonLRVirdiGK. Survival of resuscitated cardiac arrest patients with ST-elevation myocardial infarction (STEMI) conveyed directly to a Heart Attack Centre by ambulance clinicians. Resuscitation2014; 85: 96–98.
35.
KocjancicSTJazbecANocM. Impact of intensified postresuscitation treatment on outcome of comatose survivors of out-of-hospital cardiac arrest according to initial rhythm. Resuscitation2014; 85: 1364–1369.
36.
WnentJSeewaldSHeringlakeM. Choice of hospital after out-of-hospital cardiac arrest – a decision with far-reaching consequences: A study in a large German city. Crit Care2012; 16: R164.
37.
ShinSDSuhGJAhnKO. Cardiopulmonary resuscitation outcome of out-of-hospital cardiac arrest in low-volume versus high-volume emergency departments: An observational study and propensity score matching analysis. Resuscitation2011; 82: 32–39.
38.
SchoberAHolzerMHochrieserH. Effect of intensive care after cardiac arrest on patient outcome: a database analysis. Crit Care2014; 18: R84.
39.
SøholmHWachtellKNielsenSL. Tertiary centres have improved survival compared to other hospitals in the Copenhagen area after out-of-hospital cardiac arrest. Resuscitation2013; 84: 162–167.
