Prognosis after cardiac arrest occurring outside intensive care and coronary units

Emergency calls to a total of 1686 patients with verified cardiac arrest in the University Hospital, Arhus, were made in the 8-year period 1969-1977. Among the patients, cardiac arrest occurred outside the hospital in 1347, in the general wards in 240, while it was present on arrival at the emergency room in 99. Resuscitation was attempted in 1172 patients; 181 survived for at least 24 hours, and 72 were discharged alive, including 13 with residual brain damage. The prognosis was best when cardiac arrest occurred in the general wards (13% discharged) and poorest when it occurred outside the hospital (4% discharged). However, in the latter group, the prognosis showed considerable improvement when resuscitation was initiated at once by a doctor or by laymen present at the accident site (16% discharged). As regards the mechanism of cardiac arrest, ventricular fibrillation was found to be a relatively favourable prognostic sign (10% discharged), whereas almost none of the patients with asystole or severe bradycardia survived. The possibility of improving the prognosis of cardiac arrest occurring outside hospital by the establishment of mobile coronary care units and by instructing lay people in the technique of cardiopulmonary resuscitation is discussed.