Leonello Avalli1, Tommaso Mauri2, Giuseppe Citerio3, Maurizio Migliari3, Anna Coppo3, Matteo Caresani4, Barbara Marcora3, Gianpiera Rossi5, Antonio Pesenti6. 1. Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy. Electronic address: l.avalli@hsgerardo.org. 2. Institutions Dipartimento di Scienze della Salute, Università Milano-Bicocca, Monza, Italy. 3. Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy. 4. Institutions AAT, Monza, Brianza, Italy. 5. Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy; Institutions Azienda Regionale Emergenza Urgenza, Milano, Regione Lombardia, Italy. 6. Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy; Institutions Dipartimento di Scienze della Salute, Università Milano-Bicocca, Monza, Italy; Institutions Azienda Regionale Emergenza Urgenza, Milano, Regione Lombardia, Italy.
Abstract
INTRODUCTION: Before the introduction of the new international cardiac arrest treatment guidelines in 2005, patients with out-of-hospital cardiac arrest (OHCA) of cardiac origin in Northern Italy had very poor prognosis. Since 2006, a new bundle of care comprising use of automated external defibrillators (AEDs) and therapeutic hypothermia (TH) was started, while extracorporeal CPR program (ECPR) for selected refractory CA and dispatcher-assisted cardio-pulmonary resuscitation (CPR) was started in January 2010. OBJECTIVES: We hypothesized that a program of bundled care might improve outcome of OHCA patients. METHODS: We analyzed data collected in the OHCA registry of the MB area between September 2007 and August 2011 and compared this with data from 2000 to 2003. RESULTS: Between 2007 and 2011, 1128 OHCAs occurred in the MB area, 745 received CPR and 461 of these had a CA of presumed cardiac origin. Of these, 125 (27%) achieved sustained ROSC, 60 (13%) survived to 1 month, of whom 51 (11%) were discharged from hospital with a good neurological outcome (CPC≤2), and 9 with a poor neurological outcome (CPC>2). Compared with data from the 2000 to 2003 periods, survival increased from 5.6% to 13.01% (p<0.0001). In the 2007-2011 group, low-flow time and bystander CPR were independent markers of survival. CONCLUSIONS: OHCA survival has improved in our region. An increased bystander CPR rate associated with dispatcher-assisted CPR was the most significant cause of increased survival, but duration of CA remains critical for patient outcome.
INTRODUCTION: Before the introduction of the new international cardiac arrest treatment guidelines in 2005, patients with out-of-hospital cardiac arrest (OHCA) of cardiac origin in Northern Italy had very poor prognosis. Since 2006, a new bundle of care comprising use of automated external defibrillators (AEDs) and therapeutic hypothermia (TH) was started, while extracorporeal CPR program (ECPR) for selected refractory CA and dispatcher-assisted cardio-pulmonary resuscitation (CPR) was started in January 2010. OBJECTIVES: We hypothesized that a program of bundled care might improve outcome of OHCA patients. METHODS: We analyzed data collected in the OHCA registry of the MB area between September 2007 and August 2011 and compared this with data from 2000 to 2003. RESULTS: Between 2007 and 2011, 1128 OHCAs occurred in the MB area, 745 received CPR and 461 of these had a CA of presumed cardiac origin. Of these, 125 (27%) achieved sustained ROSC, 60 (13%) survived to 1 month, of whom 51 (11%) were discharged from hospital with a good neurological outcome (CPC≤2), and 9 with a poor neurological outcome (CPC>2). Compared with data from the 2000 to 2003 periods, survival increased from 5.6% to 13.01% (p<0.0001). In the 2007-2011 group, low-flow time and bystander CPR were independent markers of survival. CONCLUSIONS: OHCA survival has improved in our region. An increased bystander CPR rate associated with dispatcher-assisted CPR was the most significant cause of increased survival, but duration of CA remains critical for patient outcome.
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