Continuous improvements in "chain of survival" increased survival after out-of-hospital cardiac arrests: a large-scale population-based study.
BACKGROUND
The impact of ongoing efforts to improve the "chain of survival" for out-of-hospital cardiac arrest (OHCA) is unclear. The objective of this study was to evaluate the incremental effect of changes in prehospital emergency care on survival after OHCA.


RESULTS
This prospective, population-based observational study involved consecutive patients with OHCA from May 1998 through December 2006. The primary outcome measure was 1-month survival with favorable neurological outcome. Multiple logistic regression analysis was used to assess factors that were potentially associated with better neurological outcome. Among 42,873 resuscitation-attempted adult OHCAs, 8782 bystander-witnessed arrests of presumed cardiac origin were analyzed. The median time interval from collapse to call for medical help, first cardiopulmonary resuscitation, and first shock shortened from 4 (interquartile range [IQR] 2 to 11) to 2 (IQR 1 to 5) minutes, from 9 (IQR 5 to 13) to 7 (IQR 3 to 11) minutes, and from 19 (IQR 13 to 22) to 9 (IQR 7 to 12) minutes, respectively. Neurologically intact 1-month survival after witnessed ventricular fibrillation increased from 6% (6/96) to 16% (49/297; P<0.001). Among all witnessed OHCAs, earlier cardiopulmonary resuscitation (odds ratio per minute 0.89, 95% confidence interval 0.85 to 0.93) and earlier intubation (odds ratio per minute 0.96, 95% confidence interval 0.94 to 0.99) were associated with better neurological outcome. For ventricular fibrillation, only earlier shock was associated with better outcome (odds ratio 0.84, 95% confidence interval 0.80 to 0.88).


CONCLUSIONS
Data from a large, population-based cohort demonstrate a continuous increase in OHCA survival with improvement in the chain of survival. The incremental benefit of early advanced care on OHCA survival is also suggested.
Iwami
Taku
T
Kyoto University Health Service, Yoshida Honmachi, Sakyo-Ku, Kyoto 606-8501, Japan. iwamit2000@yahoo.co.jp
Nichol
Graham
G
Hiraide
Atsushi
A
Hayashi
Yasuyuki
Y
Nishiuchi
Tatsuya
T
Kajino
Kentaro
K
Morita
Hiroshi
H
Yukioka
Hidekazu
H
Ikeuchi
Hisashi
H
Sugimoto
Hisashi
H
Nonogi
Hiroshi
H
Kawamura
Takashi
T
D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D002534:Hypoxia, Brain / Q000401:mortality / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome