Cardiac arrest in Ontario: circumstances, community response, role of prehospital defibrillation and predictors of survival.
OBJECTIVE
To describe the patient characteristics, circumstances and community response in cases of out-of-hospital cardiac arrest; to evaluate the effect on survival of the introduction of prehospital defibrillation; and to identify factors that predict survival.


METHODS
Population-based before-and-after clinical trial.


METHODS
Five Ontario communities: London, Sudbury, the Greater Niagara region, Kingston and Ottawa.


METHODS
A consecutive sample of 1510 primary cardiac arrest patients who were transported to hospital by ambulance over 2 years.


METHODS
The use of defibrillators by ambulance attendants.


METHODS
Patient characteristics (sex and age), circumstances of arrest (place, whether arrest was witnessed and cardiac rhythm), citizen response (whether cardiopulmonary resuscitation [CPR] was started by a bystander, time to access to emergency medical services and time to initiation of CPR), emergency medical services response (ambulance response time, time to initiation of CPR and time to rhythm analysis with defibrillator) and survival rates.


RESULTS
A total of 92.1% of the patients were 50 years of age or older, and 68.3% were men. Overall, 79.6% of the arrests occurred in the home. The average ambulance response time for witnessed cases was 7.8 minutes. The overall survival rate was 2.5%. The survival rates before and after defibrillators were introduced were similar, and the general functional outcome of the survivors did not differ significantly between the two phases. Factors predicting survival included patient's age, ambulance response time and whether CPR was started before the ambulance arrived.


CONCLUSIONS
The survival rate was lower than expected. The availability of prehospital defibrillation did not affect survival. To improve survival rates after cardiac arrest ambulance response times must be reduced and the frequency of bystander-initiated CPR increased. Once these changes are in place a beneficial effect from advanced manoeuvres such as prehospital defibrillation may be seen.
Brison
R J
RJ
Division of Emergency Medicine, Queen's University, Kingston, ON.
Davidson
J R
JR
Dreyer
J F
JF
Jones
G
G
Maloney
J
J
Munkley
D P
DP
O'Connor
H M
HM
Rowe
B H
BH
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors