Reanimaties in en rond Amsterdam: uitkomsten en factoren die de uitkomsten bepalen

To determine the results of out-of-hospital resuscitation attempts until discharge from the hospital, and to identify the factors in the organisation of emergency care which determine the outcome.

Design

Prospective, observational.

Method

A member of the study group collected data on resuscitations in and around Amsterdam (combined urban and rural region; approximately 1.3 million people), during and immediately after the resuscitation attempt. This individual was notified by the Central Ambulance Transport Station for Amsterdam and surrounding areas of each resuscitation attempt between 1 June 1995-31 July 1997 where the collapse was not trauma-related. The data included time intervals, circumstances, alarm raising and the course until death or discharge from the hospital. Multivariate logistic regression analysis was used to determine the effect of the various procedures on survival.

Results

Of the 1046 patients with a cardiac cause of circulatory arrest, 134 (13) survived until discharge. When witnessed by, and resuscitated by ambulance staff this figure was 39 (50/128), for lay-witness resuscitation attempts it was 11 (82/778) and without witness the survival rate was 1 (2/140). The median interval from collapse until the emergency number (112) was called was 1 minute. The median interval from collapse until dispatch of an ambulance was 4 minutes, 10.5 minutes until the arrival of the ambulance at the patient's side and 11.5 minutes until the first defibrillatory shock was administered. Bystander basic life support was carried out in 53 (493/922) of all cases where there was a lay witness to the collapse, with a hospital-discharge rate of 14 (69/493). Without bystander basic life support, the hospital survival rate was 6 (26/429). In the group of 1030 patients whose collaps was witnessed, each minute of delay in starting basic life support or in administration of the first defibrillatory shock and in the start of advanced cardiac life support resulted in a 26, 17 and 11 decline in probability of survival, respectively. Half of all survivors (70/139) did not require advanced cardiac life-support measures.

Conclusion

The survival rate following resuscitation was 13 (1-39). Unfavourable prognostic factors included the minutes lost until a call to the emergency services was made, time lost during interpretation and processing of the telephone call, time lost until the start of basic life-support, and time lost until defibrillation attempts.