Outcomes from out-of-hospital cardiac arrest in the Wellington region of New Zealand. Does use of the Fire Service make a difference?
OBJECTIVE
Survival from community cardiac arrest in the Wellington region was analysed and compared with similar data reported nationally and internationally. In particular, the impact of a dual fire and ambulance service response was studied.


METHODS
A retrospective comparative study was undertaken of out-of-hospital cardiac arrests in the Wellington region between 1 July 2007 and 31 December 2009. Data was collected from Wellington Free Ambulance and hospital records in accordance with the Utstein template. The New Zealand Fire Service provided details of firefighter attendance and timings. The primary outcome measure was survival to hospital discharge.


RESULTS
Overall survival to hospital discharge was 11% (37/339) whilst survival from initial ventricular fibrillation or tachycardia (VF/VT) was 21% (34/161). Initial VF/VT was more common in witnessed than unwitnessed arrests (57% v. 35%, p=0.001) and this mirrored survival in these groups (15% vs 6%, p=0.01). Survival to hospital discharge was also associated with younger age and shorter emergency service response time. Bystanders attempted CPR in 55% and the fire service in 50% but neither intervention influenced outcome. Although, when activated, the fire service arrived on average 1-2 minutes ahead of the ambulance, the dual response did not influence survival to hospital admission or discharge.


CONCLUSIONS
Survival from out-of-hospital cardiac arrest in Wellington is similar to that of other New Zealand cities and better than that reported from several large centres overseas. The combined fire and ambulance response was not shown to have any beneficial impact on survival over and above that achieved by the ambulance service alone. System changes are proposed to try and improve survival from community cardiac arrest in Wellington.
Department of Surgery and Anaesthesia, University of Otago, PO Box 7343, Wellington 6242, New Zealand. andrew.swain@otago.ac.nz
Andrew H
AH
Swain
Tasmin
T
Barry
Sarah R
SR
Hoyle
Grant
G
Haywood
Hayley
H
Cameron
Peter D
PD
Larsen
D000368:Aged; D000552:Ambulances; D005260:Female; D061388:Firefighters; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods*; D016896:Treatment Outcome