Outcomes from out-of-hospital cardiac arrest in Detroit

Department of Emergency Medicine, Wayne State University, Detroit, Michigan, United States
Resuscitation (Impact Factor: 4.17). 02/2007; 72(1):59-65. DOI: 10.1016/j.resuscitation.2006.04.017
Source: PubMed


To determine the out-of-hospital cardiac arrest survival rate, and prevalence of modifiable factors associated with survival, in Detroit, Michigan, over a 6-month period of time in 2002.
A retrospective review of all out-of-hospital cardiac arrests responded to by the Detroit Fire Department, Division of Emergency Medical Services. All elements of the EMS runsheet were transcribed to a database for analysis. Patient hospital records were reviewed to determine survival to hospital admission. All survivors to hospital admission were surveyed later in the Michigan Department of Vital Records death registry search.
During this study timeframe, there were 538 confirmed out-of-hospital cardiac arrests within the City of Detroit, of which 67 were excluded for being dead on scene [51 (12.5%)] or having no available hospital records [16 (3.0%)]. Of the remaining 471 patients, 443 (94.1%) died before hospital admission. Only 44 (9.9%) of the 471 patients had a first recorded rhythm of ventricular fibrillation (VF), and 339 (76.5%) were asystolic. Of the 28 patients who survived to hospital admission, only 2 (7.1%) were noted to have a first rhythm of VF, and 15 (53.6%) were asystolic. Only one patient survived to hospital discharge.
In this urban setting, out-of-hospital cardiac arrest is an almost uniformly fatal event.

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Available from: Robert D Welch, Feb 11, 2014
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    • "In the United States, more than 166,000 patients experience an OHCA annually [15] and approximately 60% are treated by emergency medical services. OHCA survival to hospital discharge range from 0.3% in Detroit [16] to 20.4% in Slovenia [17].Five clinical criteria to predict survival from OHCA [18] have recently been reported. They are: cardiac arrest witnessed by a bystander, arrest witnessed by emergency medical personnel, provision of bystander CPR, shockable cardiac rhythm, and return of spontaneous circulation (ROSC) in the field. "
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    • "Despite major attempts to improve the chain of survival, survival rates for OHCA remain the same at 7.6% for over 30 years [4]. Average rates of survival to hospital discharge are as low as 0.3% in some communities [5,6] and depend strongly not only on the time to initiation of chest compressions but also on the time until defibrillation and the underlying rhythm [3]. While the first two factors can be influenced, they cannot be performed simultaneously. "
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    ABSTRACT: Current 2005 guidelines for advanced cardiac life support strongly recommend immediate defibrillation for out-of-hospital cardiac arrest. However, findings from experimental and clinical studies have indicated a potential advantage of pretreatment with chest compression-only cardiopulmonary resuscitation (CPR) prior to defibrillation in improving outcomes. The aim of this meta-analysis is to evaluate the beneficial effect of chest compression-first versus defibrillation-first on survival in patients with out-of-hospital cardiac arrest. Main outcome measures were survival to hospital discharge (primary endpoint), return of spontaneous circulation (ROSC), neurologic outcome and long-term survival. Randomized, controlled clinical trials that were published between January 1, 1950, and June 19, 2010, were identified by a computerized search using SCOPUS, MEDLINE, BIOS, EMBASE, the Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts database, and Web of Science and supplemented by conference proceedings. Random effects models were used to calculate pooled odds ratios (ORs). A subgroup analysis was conducted to explore the effects of response interval greater than 5 min on outcomes. A total of four trials enrolling 1503 subjects were integrated into this analysis. No difference was found between chest compression-first versus defibrillation-first in the rate of return of spontaneous circulation (OR 1.01 [0.82-1.26]; P = 0.979), survival to hospital discharge (OR 1.10 [0.70-1.70]; P = 0.686) or favorable neurologic outcomes (OR 1.02 [0.31-3.38]; P = 0.979). For 1-year survival, however, the OR point estimates favored chest compression first (OR 1.38 [0.95-2.02]; P = 0.092) but the 95% CI crossed 1.0, suggesting insufficient estimate precision. Similarly, for cases with prolonged response times (> 5 min) point estimates pointed toward superiority of chest compression first (OR 1.45 [0.66-3.20]; P = 0.353), but the 95% CI again crossed 1.0. Current evidence does not support the notion that chest compression first prior to defibrillation improves the outcome of patients in out-of-hospital cardiac arrest. It appears that both treatments are equivalent. However, subgroup analyses indicate that chest compression first may be beneficial for cardiac arrests with a prolonged response time.
    BMC Medicine 09/2010; 8(1):52. DOI:10.1186/1741-7015-8-52 · 7.25 Impact Factor
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    ABSTRACT: Sudden cardiac arrest is the leading cause of death among adults, yet it need not be fatal. Though survival in most communities is very poor, a few communities achieve rates as high as 50%. Why are some communities so successful in snatching life from the jaws of death? "Resuscitate " describes the steps any EMS system can take to improve cardiac arrest survival. It is written for the medical directors, administrative directors, fire chiefs, dispatch directors, and program supervisor who direct and run EMS systems all across the country, and for the EMTs, paramedics, and dispatchers who provide frontline care.This second edition of "Resuscitate " provides fifteen concrete steps to improve survival. Four steps will lead to rapid improvements at the local level and are relatively easy to implement. Six additional steps are more difficult to implement but also likely to improve survival. The remaining steps recommend changes at the national level."Resuscitate " is the official textbook for the Resuscitation Academy, held twice a year in Seattle. Cosponsored by Seattle Medic One, King County EMS, and the Medic One Foundation, the Academy draws attendees from throughout the world for two intensive days of classes, demonstrations, and workshops to acquire the knowledge and tools to improve survival in their own communities. This new edition includes lessons learned from attendees of the Academy as well as from the faculty's evolving thoughts on how to measure performance and improve survival, one community at a time. It also includes an addendum on the Resuscitation Academy ( For more than thirty years, Mickey S. Eisenberg M.D., Ph.D., has played a leading role in developing King County, Washington's emergency response to cases of sudden cardiac arrest, a system recognized as among the very best in the nation. He is a professor of medicine at the University of Washington and serves as the medical director of King County Emergency Medical Services."If you care about sudden cardiac arrest in your community and how emergency medical services respond to this critical emergency, I can think of no more important book than this."-from the Foreword by Roger D. White, M.D., Mayo Clinic"Eisenberg has done a remarkable job in articulating the steps to be taken for communities to improve survival from sudden cardiac arrest. "Resuscitate " is a 'best in class' and one of a kind guide that provides inspiration as well as direction in translating resuscitatioin science into practice. It is essential for all those who seek to establish strategies to improve survival and quality of life for cardiac arrest victims whose hearts are 'too young to die.'" -David B. Hiltz, EMT-P Resuscitation Academy Alumni"This book was transformative to me and to the EMS system in Durham, North Carolina. I read it cover to cover and attended the Resuscitation Academy. Eisenberg and his colleagues gave me the knowledge, the tools, and the inspiration to improve resuscitation in Durham. Step by step we are getting better and more lives are being saved." -Captain David Jacobs, Durham County Fire Department.
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