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Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience

I A Scott1, G J Fitzgerald

  • 1Ipswich General Hospital, Queensland, Australia.

Archives of Emergency Medicine
|March 1, 1993
PubMed

Insights

Out-of-hospital defibrillation (OH-DEFIB) by paramedics significantly improved long-term survival for sudden cardiac arrest patients. While immediate survival rates showed a slight, non-significant increase, OH-DEFIB dramatically boosted survival among those initially resuscitated.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Public Health

Background:

  • Out-of-hospital sudden cardiac death (OH-SCD) is a critical medical emergency.
  • The introduction of out-of-hospital defibrillation (OH-DEFIB) by ambulance officers aimed to improve survival rates.
  • Understanding the impact of OH-DEFIB on survival is crucial for emergency cardiac care protocols.

Purpose of the Study:

  • To evaluate the impact of introducing out-of-hospital defibrillation (OH-DEFIB) on survival rates for patients experiencing out-of-hospital sudden cardiac death (OH-SCD).
  • To assess the relationship between OH-DEFIB and both immediate and long-term survival outcomes.
  • To identify factors influencing survival, including response times and bystander interventions.

Main Methods:

  • Retrospective review of 215 patients with primary cardiac disease presenting with OH-SCD over a 5-year period (1985-1989).
  • Comparison of survival rates before and after the introduction of OH-DEFIB by ambulance officers.
  • Analysis of patient demographics, cardiac history, arrest location, witnessed status, bystander CPR, and response times.

Main Results:

  • Out of 215 patients, 17 (9%) survived to hospital discharge; 15 of these received OH-DEFIB.
  • Immediate survival increased from 4% to 9% post-OH-DEFIB introduction, a change not statistically significant (P = 0.3).
  • Long-term survival among immediate survivors significantly improved with OH-DEFIB (50% vs. 10.5%, P < 0.01).
  • Response times did not significantly differ between survivors and non-survivors.
  • Only 34% of witnessed arrests received bystander-initiated cardiopulmonary resuscitation (CPR).

Conclusions:

  • Out-of-hospital defibrillation (OH-DEFIB) significantly enhances long-term survival for sudden cardiac arrest patients.
  • There is a need for improved public awareness and training in cardiopulmonary resuscitation (CPR), particularly for relatives of cardiac patients.
  • Paramedic protocols focusing on optimizing oxygenation during cardiac arrest warrant adoption to further improve outcomes.

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