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Cardiac arrest in Stockholm with special reference to the ambulance organization
J Jakobsson1, O Nyquist, N Rehnqvist
1Department of Anaesthesia and Intensive Care, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
Insights
This study found that early bystander cardiopulmonary resuscitation (CPR) significantly increases the chance of ventricular tachycardia/fibrillation (VT/VF) in cardiac arrest patients. Prompt CPR is crucial for improving outcomes in emergency cardiac events.
Area of Science:
- Emergency Medicine
- Cardiology
- Public Health
Background:
- Cardiac arrest (CA) is a critical medical emergency with significant mortality.
- Understanding the incidence and characteristics of CA is vital for improving pre-hospital care.
- Bystander interventions like CPR can impact patient outcomes.
Purpose of the Study:
- To determine the incidence of cardiac arrest in a defined population.
- To analyze factors influencing the occurrence and initial rhythm of cardiac arrest.
- To evaluate the impact of bystander CPR and ambulance response time on ventricular tachycardia/fibrillation (VT/VF) prevalence.
Main Methods:
- A one-year observational study of all cardiac arrest patients attended by three ambulance teams.
- Data collection included CA incidence, demographics, location, witness status, bystander CPR, ambulance delay, and initial cardiac rhythm.
- Statistical analysis was performed to compare VT/VF incidence based on CPR status and response times.
Main Results:
- An incidence of 110 cardiac arrests per 100,000 inhabitants per year was recorded.
- Most CAs occurred in the elderly, at home, and during the day.
- Bystander CPR was associated with a higher incidence of VT/VF (67% vs. 45%) and was present in 86% of cases with bystander CPR and rapid ambulance arrival (<8 min).
Conclusions:
- Early bystander CPR significantly increases the likelihood of VT/VF upon ambulance arrival.
- Prompt medical intervention, especially when combined with bystander CPR, is associated with the presence of a shockable rhythm.
- Further research into optimizing bystander CPR training and integration with emergency medical services is warranted.
Abstract:
During a one-year period all patients with cardiac arrest (CA) taken care of by three ambulances were studied. An incidence of 110 cardiac arrests/100,000 inhabitants/year was found. The majority of CAs affected the elderly and occurred during the day in their homes. The majority of CAs were witnessed but cardiopulmonary resuscitation (CPR) had been initiated by bystanders in only a few cases. The ambulance arrived within a mean time of 7.7 +/- 4.0 min. Forty-eight per cent of the CA patients showed ventricular tachycardia or ventricular fibrillation (VT/VF) on ambulance arrival. Patients with a prolonged ambulance delay showed a lower incidence of VT/VF than patients with a short delay. Patients in whom CPR had been initiated by bystanders showed a significantly higher incidence of VT/VF (67%) than unattended patients (45%). Bystander CPR was furthermore associated with an increased incidence of VT/VF in patients with prolonged ambulance delay. VT/VF was present at the time when the ambulance arrived in 86% of the CA patients who had received CPR from a bystander and were reached within 8 min by the ambulance.