Out-of-hospital cardiac arrest cases in Johannesburg, South Africa: a first glimpse of short-term outcomes from a paramedic clinical learning database.

OBJECTIVES: To describe and assess outcomes of adult out-of-hospital cardiac arrest cases occurring in the greater Johannesburg metropolitan area recorded over a 7-year period in a student paramedic clinical learning database.
DESIGN: Retrospective case review. OUTCOME MEASURE: Return of spontaneous circulation (ROSC).
METHOD: Out-of-hospital cardiac arrest cases were extracted from the database and subjected to Utstein-style descriptive analysis. Logistic regression analysis was used to determine factors predictive of ROSC.
RESULTS: A total of 563 confirmed cardiac arrest cases with complete Utstein-style data was identified and extracted. A small number of paediatric cases was excluded and further analysis was conducted on 510 adult cases of whom 205 (40%) were selected for resuscitation. The median response time was 9 minutes. In 153 of the 205 cases (75%) the cause of arrest was presumed to be cardiac, 140 of the arrests (68%) were witnessed and bystander cardiopulmonary resuscitation was performed in 74 cases (36%). Forty-seven cases (23%) were found in a shockable rhythm and ROSC occurred in 36 (18%) of resuscitated cases. The only significant predictor of ROSC was the initial rhythm of arrest (p<0.001).
CONCLUSION: The proportion of cardiac arrest patients resuscitated was small as was the proportion of patients found in shockable rhythms and those with ROSC. Long response times may explain these findings, but a larger, prospective study on out-of-hospital cardiac arrest in Johannesburg is needed to confirm this.