title: Incidence of cross-border emergency care and outcomes of cardiopulmonary resuscitation in a unique European region.
abstract: BACKGROUND
  Emergency medical service (EMS) systems in Europe have developed differently due to legal, educational and organisational aspects. The aim of the present study was to compare cardiopulmonary resuscitation (CPR) outcomes and characteristics in three differently organised and staffed EMS systems in close vicinity.
  
  
  METHODS
  We analysed the charts of patients treated in the EMS systems of the cities of Aachen (Germany), Heerlen (The Netherlands) and Eupen (Belgium), retrospectively. Main outcome measures were the rate of return of spontaneous circulation (ROSC), hospital discharge and cerebral performance after 1 year. Furthermore, factors influencing neurological outcome and the incidence of cross-border emergency assistance were assessed.
  
  
  RESULTS
  Of 852 patients found unresponsive with no palpable pulse and/or the absence of breathing, CPR was performed in 322 patients. The overall rate of ROSC was 44.1 and 13.7% of patients were discharged alive. A good neurological outcome was observed in 95.5% of survivors. The rate of ventricular fibrillation was significantly higher (46.9% versus 21.9 and 21.2%, p < 0.05) and the total amount of epinephrine given during CPR significantly lower (4.5+/-5.2 mg versus 9.8+/-10.8 and 8.4+/-6.2 mg, p < 0.05) in the Dutch system. No significant differences in outcome variables were observed between the systems. Neurological outcome was favourable when the arrest was witnessed, occurred in a public place, the initial rhythm was shockable, a low total amount of adrenaline (epinephrine) was given and the call-response interval was short. In 1.2% of the cases cross-border emergency care was provided.
  
  
  CONCLUSIONS
  Despite medical and organisational discrepancies, outcomes of CPR in three neighbouring EMS systems are comparable. Neurological outcome is influenced by demographical, organisational and medical factors. Cross-border emergency assistance for CPR is almost undetectable and needs improvement.
authors.affiliation: Department of Anaesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany. mfries@ukaachen.de
authors.forename: Michael
authors.initials: M
authors.lastname: Fries
authors.forename: Stefan
authors.initials: S
authors.lastname: Beckers
authors.forename: Johannes
authors.initials: J
authors.lastname: Bickenbach
authors.forename: Max
authors.initials: M
authors.lastname: Skorning
authors.forename: Svenja
authors.initials: S
authors.lastname: Krug
authors.forename: Enno
authors.initials: E
authors.lastname: Nilson
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.forename: Ralf
authors.initials: R
authors.lastname: Kuhlen
mesh_terms: D001530:Belgium; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services / Q000592:standards*; D004837:Epinephrine / Q000008:administration & dosage; D005858:Germany; D006323:Heart Arrest / Q000150:complications / Q000628:therapy; D006801:Humans; D009426:Netherlands; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology
chemical_list: D004837:Epinephrine