Emergency medical service treated out-of-hospital cardiac arrest: Identification of weak links in the chain-of-survival through an epidemiological study. (August 2016)

• Record Type: Journal Article
• Authors: Sanson, Gianfranco; Verduno, Jessica; Zambon, Marco; Trevi, Roberto; Caggegi, Giuseppe D; Di Bartolomeo, Stefano; Antonaglia, Vittorio
• Is Part Of: European journal of cardiovascular nursing. Volume 15:Number 5(2016)
• Page Start: 328
• Page End: 336
• Publication Date: 2016-08
• Subjects: Cardiac arrest -- out-of-hospital -- emergency medical service -- outcome -- dispatch; Cardiovascular system -- Diseases -- Nursing -- Periodicals; Cardiovascular Diseases -- nursing -- Periodicals; Cardiology -- Periodicals; Nursing -- Periodicals; Vascular Diseases -- Periodicals; 610.7369105
• DOI: 10.1177/1474515115573365
• Languages: English
• ISSNs: 1474-5151

Abstract

Background: In-depth analysis of emergency medical services (EMSs) performances in out-of-hospital cardiac arrest (OHCA) promotes quality improvement. Aims: The purpose of this study was to identify the improvable factors of the EMS response to OHCA through the description and analysis of OHCA incidence, characteristics, management and outcome. Methods: This was a retrospective cohort study on all OHCA patients treated by the EMSs of the district of Trieste, Italy (236, 556 inhabitants) in 2011. Results: A total of 678 OHCAs occurred and 142 (20.1%) underwent cardiopulmonary resuscitation (CPR), with a respective incidence of 287/100, 000/year and 60/100, 000/year. The incidence of shockable rhythms in the CPR group was 13/100, 000. OHCAs occurred mainly during daytime, though the proportion of patients receiving CPR was significantly higher by night-time ( p =0.01). Thirty-four CPR patients (23.9%) restored spontaneous circulation on scene; 12 (8.5%) survived to hospital discharge (11 with good neurological recovery). Survival was not correlated with age, while was significantly higher for patients with shockable rhythms (32.3%; p <0.001). Mean response time was 8 min. Direct intervention of physician-staffed units did not improve the outcome when compared with two-tiered activation. Patients immediately identified as OHCA by dispatch nurses and those undergoing therapeutic hypothermia showed a non-significant trend towards improved survival ( p =0.09 and 0.07, respectively). Conclusions: OHCA identification by dispatch nurses and reduction of response time were the factors most susceptible to improvement.