title: Out-of-hospital resuscitation in Estonia: a bystander-witnessed sudden cardiac arrest.
abstract: OBJECTIVE
  To evaluate the results of the first epidemiological study on out-of-hospital resuscitation in Estonia.
  
  
  METHODS
  A prospective cohort study of 2108 consecutive standardized reports on out-of-hospital resuscitation attempts from 1 January 1999 to 31 December 2002 was conducted according to the Utstein style.
  
  
  RESULTS
  In all, 67.3% (1419/2108) of the cardiac arrests were of presumed cardiac aetiology and 60.2% (854/1419) of them were bystander-witnessed. Of these, the 28% bystander cardiopulmonary resuscitation was initiated, and the first rhythm was recorded as ventricular fibrillation or pulseless ventricular tachycardia in 40% of the cases. In the subgroup of patients with bystander-witnessed cardiac arrest of cardiac origin, 10.7% (91/854) were discharged alive in good cerebral performance categories and 7.7% were alive at the 1-year follow-up. The chances of survival increased if the median response time interval was <6 min, cardiac arrest occurred in a public place, patients received bystander cardiopulmonary resuscitation and had an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia. The discharge rate was 24% (82/343) in the subgroup of patients who had bystander-witnessed cardiac arrest of cardiac origin and an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia. In this subgroup, the survival rate was 42.6% (40/94) in Tartu urban area, 16.9% (22/130) in Tallinn urban area and 16.8% (20/119) in other regions of Estonia (mostly urban and suburban areas).
  
  
  CONCLUSIONS
  The results demonstrate that despite the progress in the management of out-of-hospital cardiac arrest in Estonia, only one centre (Tartu) achieves a better survival rate. Further improvements are needed to raise the quality of the Estonian emergency medical services system, especially in rural areas.
authors.affiliation: Clinic of Anaesthesiology and Intensive Care, Tartu University Clinics, Estonia. Aleksander.Sipria@kliinikum.ee
authors.forename: Aleksander
authors.initials: A
authors.lastname: Sipria
authors.forename: Vassili
authors.initials: V
authors.lastname: Novak
authors.forename: Aire
authors.initials: A
authors.lastname: Veber
authors.forename: Arkadi
authors.initials: A
authors.lastname: Popov
authors.forename: Veronika
authors.initials: V
authors.lastname: Reinhard
authors.forename: Georgi
authors.initials: G
authors.lastname: Slavin
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services; D004957:Estonia / Q000453:epidemiology; D005260:Female; D005392:First Aid / Q000706:statistics & numerical data*; D006323:Heart Arrest / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis