title: Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience.
abstract: All patients with primary cardiac disease presenting with out-of-hospital sudden cardiac death (OH-SCD) to a provincial hospital were reviewed retrospectively over a 5-year period from 1985 to 1989. This coincided with the introduction of out-of-hospital defibrillation (OH-DEFIB) by ambulance officers. Of 215 patients, 17 (9%) survived to leave hospital alive, 15 of whom underwent OH-DEFIB. There was an increase in survivors from 4%, prior to OH-DEFIB, to 9% of all cardiac arrests, but this was not statistically significant (P = 0.3). However, long term survival amongst immediate survivors was associated with a statistically significant improvement following the introduction of OH-DEFIB (15 of 30 (50%) vs. 2 of 19 (10.5%), P < 0.01). Mean call-out, at-scene and transfer times did not significantly vary between survivors and non-survivors. A total of 155 (72%) had a known cardiac history, with the majority (74%) of arrests occurring at home. Of 134 witnessed arrests, only 46 (34%) underwent bystander-initiated cardiopulmonary resuscitation (CPR). A programme in CPR aimed at relatives of known cardiac patients, and the adoption of a paramedic protocol which improves oxygenation at the time of arrest are recommended.
authors.affiliation: Ipswich General Hospital, Queensland, Australia.
authors.forename: I A
authors.initials: IA
authors.lastname: Scott
authors.forename: G J
authors.initials: GJ
authors.lastname: Fitzgerald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D000552:Ambulances; D001315:Australia / Q000453:epidemiology; D016757:Death, Sudden, Cardiac; D004554:Electric Countershock; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome