Effects of bystander first aid, defibrillation and advanced life support on neurologic outcome and hospital costs in patients after ventricular fibrillation cardiac arrest.
OBJECTIVE
To evaluate the effects of basic life support, time to first defibrillation and emergency medical service arrival time on neurologic outcome and expenses for hospital care in patients after cardiac arrest.


METHODS
Large urban emergency medical services system and emergency department in a 2000-bed university hospital.


METHODS
Outcome and cost benefit analysis of patients admitted to the hospital after witnessed, out-of-hospital, ventricular fibrillation cardiac arrest from October 1, 1991, until December 31, 1997.


METHODS
Out of 1054 patients with out-of-hospital cardiac arrest, 276 were eligible.


RESULTS
The effects of basic and advanced life support measures on neurologic outcome and hospital expenses were evaluated. In contrast to intubation (odds ratio 1.08; 95% CI: 0.51-2.31; p=0.84), basic life support (odds ratio 0.44; 95% CI: 0.24-0.77; p=0.004) and time to first defibrillation (odds ratio 1.08; 95% CI: 1.03-1.13; p=0.001) were significantly correlated with good neurologic outcome. Among the patients who did not receive basic life support, the average cost per patient with good neurologic outcome significantly increased with the delay of the first defibrillation (p<0.001).


CONCLUSIONS
In contrast to intubation, bystander basic life support and time to first defibrillation were significantly associated with good neurologic outcome and resulted in fewer expenses spent on in-hospital efforts.
Bur
A
A
University Clinic of Emergency Medicine, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20/6/D, 1090 Vienna, Austria.
Kittler
H
H
Sterz
F
F
Holzer
M
M
Eisenburger
P
P
Oschatz
E
E
Kofler
J
J
Laggner
A N
AN
D000293:Adolescent; D000328:Adult; D022561:Advanced Cardiac Life Support / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000145:classification / Q000175:diagnosis / Q000209:etiology*; D004554:Electric Countershock / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D005392:First Aid / Q000592:standards*; D006302:Health Services Research; D006323:Heart Arrest / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000150:complications*