Description of cases in the Andalusian registry of out-of-hospital cardiac arrest and initial results

Rosell Ortiz F, Mellado Vergel FJ, Fernández Valle P, González Lobato I, Martínez Lara M, Ruiz Montero MM, Fregenal López A, Romero Morales F, Paz Rodríguez MA, Vivar Díaz I, García del Águila J, Olavarría Govantes L

Background and objective: The incidence of out-of-hospital cardiac arrest and response

outcomes are highly variable between countries or geographic regions. We aimed to

describe procedures and outcomes in these cases based on data from a regional registry.

Methods: Description and analysis of registered cases of out-of-hospital cardiac arrest

treated by an emergency response service from January 2008 to December 2010.

Descriptive statistics were analyzed; we also explored factors associated with a

satisfactory cerebral performance category (CPC) of 1 or 2 on discharge.

Results: Records were obtained for 8889 patients, of whom 3054 (34.4%) were

resuscitated; 2,103 (71.04%) of the patients were men and 857 (29%) women. The

mean (SD) age was 60.1 (17.8) years (men, 59 [17.8] years; women, 63 (19.4) years. In a

third of the calls, the patient had not lost consciousness. In 30%, no witnesses were

present at the time of cardiac arrest, and in 83.7% the time of collapse was recorded. A

shockable heart rhythm was detected at the start of resuscitation in 19.3%. Witnesses had

previously attempted resuscitation of 12.8%. Pulse was present on arrival at the hospital

in 56.7% of the patients with a shockable heart rhythm on start of resuscitation.

Discharge with a CPC1–2 was possible in 9.1%. Factors associated with a CPC1-2 were

cardiac arrest outside the home (odds ratio [OR], 2.056; 95% CI, 1.218-3.472), witnessed

event (OR, 2.137; 95% CI, 1.117-4.138), initial shockable heart rhythm (OR, 7.040; 95%

CI, 4.313-11.490), defibrillation prior to arrival of first emergency responders (OR, 2.330;

95% CI, 1.091-4.976), and cardiac etiology (OR, 2.295; 95% CI, 1.270-4.145).

Conclusions: Automatic registry of cases facilitates inclusion of all patients and minimizes bias. Factors during the period prior to the arrival of first emergency responders are key to survival in CPC1-2 status and are an aspect to target for improvement.

Fernández Valle P, Fregenal López A, García del Águila J, González Lobato I, Martínez Lara M, Mellado Vergel FJ, Olavarría Govantes L, Paz Rodríguez MA, Romero Morales F, Rosell Ortiz F, Ruiz Montero MM, Vivar Díaz I