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Emergency system prospective performance evaluation for cardiac arrest in Lombardia, an Italian region
G Citerio1, D Galli, G C Cesana
1Dipartimento di Anestesia e Rianimazione, Azienda Ospedale San Gerardo di monza, Nuovo Ospedale San Gerardo, Via Donizetti, 106, 20052 Monza (MI), Italy. g.citerio@hsgerardo.org
Insights
Evaluating out-of-hospital cardiac arrest care using performance indicators shows bystander CPR significantly reduces mortality. Advanced life support (ALS) also improved survival rates compared to basic life support (BLS).
Area of Science:
- Emergency medicine
- Public health
- Quality improvement
Background:
- Assessing the quality of out-of-hospital medical services is crucial for patient outcomes.
- Performance indicators and novel databases can provide objective data for quality evaluation.
Purpose of the Study:
- To evaluate the quality of out-of-hospital medical services using performance indicators.
- To analyze outcomes for patients experiencing non-traumatic cardiac arrest.
Main Methods:
- Prospective data collection over 90 days across three emergency dispatch centers in Lombardia.
- Inclusion of 178 patients in non-traumatic cardiac arrest, with follow-up at 1 day and 1 month.
- Observational study design without specific interventions.
Main Results:
- The mean interval from call to scene arrival was 8.5 minutes.
- Bystander cardiopulmonary resuscitation (CPR) was associated with significant mortality reduction (85.7% vs. 95.8%).
- Advanced life support (ALS) interventions showed a mortality reduction (86.7%) compared to basic life support (BLS) (97%), with 24-hour and 1-month survival rates of 9% and 6.17% respectively.
Conclusions:
- Quality monitoring provides objective data on interventions and outcomes in emergency medical services.
- Data-driven insights are essential for planning and implementing effective quality improvement programs.
Background:
The aim of this research is to evaluate quality of out-of-hospital medical services in our country, using performance indicators and a new computerised database.
Methods:
(a)
Experimental Design:
Data were collected prospectively in three emergency dispatch centres for 90 days. Follow-up was evaluated at 1 day and 1 month after the event. This paper presents data on the cardiac arrest cohort only. (b)
Setting:
Three emergency dispatch centres in Lombardia. (c)
Patients:
One hundred and seventy-eight patients in non-traumatic cardiac arrest were enrolled. (d)
Interventions:
None. The study was observational only.
Results:
Mean interval between phone call and arrival on scene was 8.5+/-3.5 min. BLS manoeuvres were carried out from bystanders only in 15% of the cohort; this was associated with significant mortality reduction (85.7 versus 95.8%, chi(2) P<0.05). One hundred and thirty-three patients (75%) received assistance from BLS crews while only 45 patients (25%) were assisted by ALS medical personel, with a significant mortality reduction (ALS deaths 86.7%, BLS deaths 97%). Total 24 h survival was 9% and survival at 1 month declined to 6.17%.
Conclusions:
Quality monitoring produces objective information on interventions and outcomes. Only with this information, is it possible to implement improvement programmes that are planned according to the data presented.