[Advanced cardiac life support in the prehospital setting in the Reykjavik area 1991-1996.]

Since 1982 an emergency ambulance manned by a physician and two emergency medical technicians has been operated in the Reykjavik area. The physicians have followed guidelines from the American Heart Association (AHA). Until 1986 the AHA guidelines had bicarbonate and in some instances calcium as first line treatment in cardiopulmonary resuscitation (CPR).

The purpose of this study was to evaluate the influence of the advanced cardiac life-support (ACLS) service and of bystanders on survival after cardiopulmonary arrest. Also to compare the survival rates to results of previous studies of CPR outside the hospital in the Reykjavik area.

The data was collected prospectively according to the "Utstein Style" form. From 1991-1996 there were 361 attempted resuscitations by the emergency crew. Fifty-three cardiac arrests were secondary to trauma, suicide, drowning, drug overdose and sudden infantile death. In 308 cases of sudden cardiorespiratory arrest cardiac diseases were the presumed cause in accordance with the Utstein protocol.

In the 308 cases the mean age was 67.2 years and the male/female ratio was 233:75. The mean response time was 4.6 min. Patients admitted to the intensive or cardiac care units were 98 (31%) and 51 (17%) were discharged from the hospital. Ventricular fibrillation or ventricular tachycardia were the most common initial rhythms seen in 176 (57%) patients, asystole in 91 (30%) and other arrhythmias (EMD, agonal) in 41 (13%). Fourty-six patients (26%) with ventricular fibrillation on the first rhythm strip survived to be discharged from the hospital, three (3%) patients with asystole and two (5%) with other arrhythmias. Bystanders were present in 211 (68%) of cases and it fourfoulded the likelihood of discharge (OR 4.0; 95% CI 1.5-10.4; p=0.0025). There is no statistical difference in mean response time and survival rates between this study and previous studies from 1982-1986 and 1987-1990.

When sudden cardiorespiratory arrest is witnessed the probability of survival is multiplied. We conclude that the results of ACLS outside the hospital in Reykjavik and surrounding area continue to be among the best. Changes in ACLS guidelines do not appear to have increased survival.