Survival in out-of-hospital cardiac arrest before and after use of advanced postresuscitation care: a survey focusing on incidence, patient characteristics, survival, and estimated cerebral function after postresuscitation care.
BACKGROUND
Knowledge of the epidemiology of postresuscitation care is insufficient. We describe the epidemiology of postresuscitation care in a community from a 26-year perspective, focusing on incidence, patient characteristics, survival, and estimated cerebral function in relation to intensified postresuscitation care and initial arrhythmia.


METHODS
The study included patients with out-of-hospital cardiac arrest (OHCA) who were brought alive to a hospital ward in Göteborg, Sweden, between 1980 and 2006. Two periods (1980-2002 and 2003-2006) were compared.


RESULTS
In all, 1603 patients were included. For age, sex, and history, no significant differences between the 2 periods were seen. There was a significant multiple increase in bystander cardiopulmonary resuscitation, the use of coronary angiography, coronary revascularization, and therapeutic hypothermia. The number of patients found in ventricular fibrillation (VF) decreased (P = .011). For all patients, 1-year survival did not change significantly (27% vs 32%; P = .14). Among patients found in VF, an increase in 1-year survival was found (37% vs 57%; P < .0001), whereas no significant change was seen in nonshockable rhythm (10% vs 7%; P = .38). Survivors to discharge displaying low cerebral function (ie, cerebral performance categories score >or=3) decreased from 28% to 6% (P = .0006) among all patients.


CONCLUSIONS
After the introduction of a more intensified postresuscitation care, there was no overall improvement in survival but signs of an improved cerebral function among survivors. There was a marked increase in survival among patients found in a shockable rhythm but not among those found in a nonshockable rhythm.
Martinell
Louise
L
Medicine Clinic, NU Hospital Organisation, NAL, 461 85 Trollhättan, Sweden.
Larsson
Malena
M
Bång
Angela
A
Karlsson
Thomas
T
Lindqvist
Jonny
J
Thorén
Ann-Britt
AB
Herlitz
Johan
J
D000367:Age Factors; D000368:Aged; D001921:Brain / Q000503:physiopathology; D016887:Cardiopulmonary Resuscitation / Q000401:mortality* / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000401:mortality; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality; D012737:Sex Factors; D016019:Survival Analysis; D013548:Sweden; D014693:Ventricular Fibrillation / Q000401:mortality