Out-of-hospital cardiac arrest. Analysis and stratification of intervention levels

pp 177-184

Abstract

Between 1986-1989, we received 77 calls because of out of hospital cardiac arrest (Level I). Attention average time was 6 minutes. We excluded 29 patients, 23 for delayment in the aid-requirement and 6 because of known terminal illnesses; 48 patients received cardiopulmonary resuscitation (CPR) (Level II), their average age was 68.7 years old, and 29 patients (60.4 %) belonged to male sex. We could establish the cause of death in 19 patients (46.3 %): it was cardiovascular in 17 patients (89.5%). Eight of them (47 %) had an acute myocardial infarction (AMI). The clinical presentation was asystole (AS) in 35 patients (73 %), ventricular fibrillation (VF) in 7 (14.5 %) and electro mechanical dissociation (EMD) in 6 (12.5 %). We achieved primary success in 12 patients (25%): 1,7.5% had had AS, 42.8 % VF and 50% EMD. The 42 % of female population and the 14 % of men could be reanimated and hospitalized. From the 12 patients hospitalized (Level III) just 7 (58.4 %) could be admitted in the Intensive Care Unit, while the other five died in the emergency ward. Four patients were discharged, and all of them were alive after 13.2 months of follow-up (Level IV). All the patients developed heart failure, two were in functional class II and two in class III. One of them underwent an aortic valve replacement because of aortic stenosis. Conclusions and guidelines to promote better assistance: 1) When it could be established, the cardiovascular disease was the principal cause of out of hospital cardiac arrest, being AMI the most frequent. 2) AS was the most frequent clinical presentation and it had the worse result and prognosis. 3) Females had better CPR initial success. 4) Age didn't affect success rate in this group. 5) Four levels of assistance were considered and can be enhanced: Level I requires intensive community education in basic CPR; Level II needs permanent medical and paramedical acreditation and revision of mobile intensive care units; Level III must be provided of better hospital sctructure and resources, and Level IV should be taken over by a group of different specialist trained in the follow-up of patients discharged after an out of hospital cardiac arrest. 6) Finally, we think that this paper will contribute to establish the way of working in our community to assist the out of hospital cardiac arrest as a whole.