[Prehospital resuscitation in urban conditions--results and prognostic decision criteria].
From 1983 to 1991, 214 patients (age 62 +/- 15 years; 72% male) with out-of-hospital cardiac arrest were resuscitated in the field and transported to the hospital with basic cardiac life support only (manual chest compression, assisted ventilation by bag-air-valve). In 64 patients (30%; 95% confidence interval [CI]: 24-36%) a stable circulation allowing admission to the intensive care unit was restored in the emergency room. 26 patients (12%; CI: 8-17%) survived to hospital discharge. 20 patients showed no or only mild neurological impairment, 4 had moderate cognitive deficits, and 2 patients were in a permanent vegetative state. Multiple logistic regression revealed bystander resuscitation before arrival of the ambulance (odds ratio [OR]: 4.7 [CI: 1.5-14.7]; p < 0.01) and ventricular fibrillation on arrival in the emergency room (OR: 42.8 [CI: 5.2-350]; p = 0.0005) to be statistically significant predictors of survival. These data justify continuation and extension of resuscitation efforts in the emergency room if patients were given only basic cardiac life support in the field and during transport. Patients who arrive in ventricular fibrillation and who were resuscitated by a bystander prior to the arrival of the ambulance team have a realistic chance of survival. Delegation of competence to defibrillate to trained, non-physician ambulance personnel may reduce the duration of cardiac arrest in patients with ventricular fibrillation and thus save lives.
Schoenenberger
R
R
Departement Innere Medizin, Kantonsspital Basel.
Stürmer
T
T
von Planta
I
I
von Planta
M
M
D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012044:Regression Analysis; D012151:Resuscitation; D012189:Retrospective Studies; D013557:Switzerland; D014505:Urban Population