Michael Colquhoun1. 1. Pre-hospital Emergency Research Unit and Wales Heart Research Institute, Wales College of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, United Kingdom. Mick.colquhoun@ambulance.wales.nhs.uk
Abstract
BACKGROUND: Sudden cardiac arrest is a common mechanism of premature death in the community. Resuscitation is often possible, but no large study of resuscitation by doctors who practice there has been published. METHODS: General practitioners (GPs) equipped with defibrillators reported 555 patients with cardiac arrest in whom they attempted resuscitation. FINDINGS: Average age was 65.4, 75% male. Most arrests (49%) occurred at the patient's home but some (18%) occurred at or near the doctors' surgeries. Heart disease was responsible for 88% of the arrests: in these cases resuscitation to leave hospital alive was frequently successful (148 of 436 attempts, 34%). Success was rare (one of 59, <2%) when the arrest was due to non-cardiac disease. Resuscitation was most common when the first monitored rhythm was shockable (VF/VT) and defibrillated promptly: 144 out of 351 (41%) patients surviving. VF/VT was most common with early rhythm monitoring, particularly when the doctor was present (63% survival), or nearby (54%). When VF/VT complicated AMI, 72% of those defibrillated within 1min of onset survived. With delayed attendance, the frequency of VF/VT fell and asystole or Pulseless Electrical Activity (PEA) became more common. Survival after resuscitation was rare for patients presenting with these rhythms: five of 202 (2.5%). No such patient survived unless the rhythm could be converted to VF/VT with drugs or basic life support and subsequently shocked. CONCLUSION: Primary care doctors equipped with defibrillators attend patients with cardiac arrest under circumstances in which resuscitation is frequently successful. This presents a unique opportunity to reduce mortality from sudden cardiac arrest.
BACKGROUND:Sudden cardiac arrest is a common mechanism of premature death in the community. Resuscitation is often possible, but no large study of resuscitation by doctors who practice there has been published. METHODS: General practitioners (GPs) equipped with defibrillators reported 555 patients with cardiac arrest in whom they attempted resuscitation. FINDINGS: Average age was 65.4, 75% male. Most arrests (49%) occurred at the patient's home but some (18%) occurred at or near the doctors' surgeries. Heart disease was responsible for 88% of the arrests: in these cases resuscitation to leave hospital alive was frequently successful (148 of 436 attempts, 34%). Success was rare (one of 59, <2%) when the arrest was due to non-cardiac disease. Resuscitation was most common when the first monitored rhythm was shockable (VF/VT) and defibrillated promptly: 144 out of 351 (41%) patients surviving. VF/VT was most common with early rhythm monitoring, particularly when the doctor was present (63% survival), or nearby (54%). When VF/VT complicated AMI, 72% of those defibrillated within 1min of onset survived. With delayed attendance, the frequency of VF/VT fell and asystole or Pulseless Electrical Activity (PEA) became more common. Survival after resuscitation was rare for patients presenting with these rhythms: five of 202 (2.5%). No such patient survived unless the rhythm could be converted to VF/VT with drugs or basic life support and subsequently shocked. CONCLUSION: Primary care doctors equipped with defibrillators attend patients with cardiac arrest under circumstances in which resuscitation is frequently successful. This presents a unique opportunity to reduce mortality from sudden cardiac arrest.