Out-of-hospital cardiac arrest in the department of Maldonado, Uruguay
A five year study
Abstract
Objective: to describe and analyse the presentation, treatment and evolution until hospitalization, of patients treated for out-of-hospital cardiac arrest by an emergency ambulance service in Maldonado, Uruguay.
Method: a descriptive-analytical, retrospective study of all patients who suffered from out-of-hospital cardiac arrest and were treated by an emergency ambulance service from January 2005 through June 2010.
Results: 169 non-traumatic cases of out-of-hospital cardiac arrest in adults were analysed. Average age was 66.9 years old, 70.4% were men. Seventy point four per cent occurred in the patients' domicile. Response time was 6 minutes. Cardiopulmonary resuscitation maneuvers (CRM) were applied to 39.6% of patients prior to their arriving at the hospital. The most frequent heart rate upon arrival was asystole (57.4%), followed by ventricular fibrillation (26.6%). Return to spontaneous circulation was achieved in 30.2% of patients and survival upon hospitalization was 22.5%.
Out of hospital cardiac arrest in non- shockable ryhtms was associated to return to spontaneous circulation (43.5% versus 25.2% p=0,021). Out of hospital cardiac arrest in the streets was associated to greater survival rates upon hospitalization (39.1% versus 19.9%, p=0,04). Combination of out of hospital cardiac arrest in the streets and non-shockable rythms was associated to return to spontaneous circulation (71.4% versus 28.4%, p=0,027) and greater survival upon hospitalization (57.1% versus 21%, p=0.046).
Conclusions: response time of emergency ambulance services was good when compared to international figures. Out-of-hospital cardiac arrest in the street and with non-shockable rythms was associated to better prognosis. Results in terms of return to spontaneous circulation and survival upon hospitalization were comparable to what is internationally reported.
References
(2) Becker LB, Weisfeldt ML, Weil MH, Budinger T, Carrico J, Kern K, et al. The PULSE initiative: scientific priorities and strategic planning for resuscitation research and life saving therapies. Circulation 2002; 105(21):2562-70.
(3) World Health Organization. Health Statistics and Health Information Systems. The global burden of diseases: 2004 update: part 2 causes of death. Disponible en: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf Consulta: 2 de feb de 2013.
(4) Zipes DP, Wellens HJ. Sudden cardiac death. Circulation 1998; 98(21):2334-51.
(5) Engelstein ED, Zipes DP. Sudden cardiac death. En: Alexander RW, Schlant RC, Fuster V, eds. The heart, arteries and veins. New York: McGraw-Hill, 1998:1081-112.
(6) Myerburg RJ, Castellanos A. Cardiac arrest and sudden death. En: Braunwald E, ed. Heart disease: a textbook of cardiovascular medicine. Philadelphia: WB Saunders, 1997: 742-79.
(7) Gutterman DD. Silent myocardial ischemia. Circ J 2009; 73(5):785-97.
(8) Mehra R. Global public health problem of sudden cardiac death. J Electrocardiol 2007; 40(6 Suppl):S118-22.
(9) Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S, Bossaert L; European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005: Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2005; 67(Suppl 1):S7-23.
(10) Patrone LF, Opertti A. Asistencia prehospitalaria del paro cardiorrespiratorio. Paciente Crít (Uruguay) 1988; 1(2):106- 18.
(11) Eckstein M, Stratton SJ, Chan LS. Cardiac Arrest Resuscitation Evaluation in Los Angeles: CARE-LA. Ann Emerg Med 2005; 45(5):504-9.
(12) Pleskot M, Babu A, Kajzr J, Kvasnicka J, Stritecky J, Cermakova E, et al. Characteristics and short-term survival of individuals with out-of-hospital cardiac arrests in the East Bohemian region. Resuscitation 2006; 68(2):209-20.
(13) Robinson S, Swain AH, Hoyle SR, Larsen PD. Survival from out-of-hospital cardiac arrest in New Zealand following the 2005 resuscitation guideline changes. Resuscitation 2010; 81(12):1648-51.
(14) Franek O, Pokorna M, Sukupova P. Pre-hospital cardiac arrest in Prague, Czech Republic-the Utstein-style report. Resuscitation 2010; 81(7):831-5.
(15) Pell JP, Sirel JM, Marsden AK, Ford I, Walker NL, Cobbe SM. Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study. BMJ 2002; 325(7363):515.
(16) Vaillancourt C, Stiell IG; Canadian Cardiovascular Outcomes Research Team. Cardiac arrest care and emergency medical services in Canada. Can J Cardiol 2004; 20(11):1081-90.
(17) Kette F, Pellis T; Pordenone Cardiac Arrest Cooperative Study Group (PACS). Increased survival despite a reduction in out-of-hospital ventricular fibrillation in north-east Italy. Resuscitation 2007; 72(1):52-8.
(18) Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010; 3(1):63-81.
(19) Lim GH, Seow E. Resuscitation for patients with out-of-hospital cardiac arrest: Singapore. Prehosp Disaster Med 2002; 17(2):96-101.
(20) Ley 18360. Desfibriladores externos automáticos. Montevideo, 26 de setiembre de 2008. Disponible en: http://www.parlamento.gub.uy/leyes/AccesoTextoLey.asp?Ley=18360& Anchor Consulta: 2 de feb de 2013.
(21) Decreto Nº 330/009. Obligatoriedad de disponer de desfibriladores externos automáticos en espacios públicos y privados donde exista afluencia de público. Montevideo, 13 de julio de 2009. Disponible en: http://archivo.presidencia.gub.uy/ _web/decretos/2009/07/CM780%20.pdf Consulta: 2 de feb de 2013.
(22) Dunne RB, Compton S, Zalenski RJ, Swor R, Welch R, Bock BF. Outcomes from out-of-hospital cardiac arrest in Detroit. Resuscitation 2007; 72(1):59-65.
(23) Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation 2010; 81(11):1479-87.
(24) Franek O, Pokorna M, Sukupova P. Pre-hospital cardiac arrest in Prague, Czech Republic-the Utstein-style report. Resuscitation 2010; 81(7):831-5.
(25) Waalewijn RA, de Vos R, Koster RW. Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in 'Utstein' style. Resuscitation 1998; 38(3):157-67.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
