title: New treatment bundles improve survival in out-of-hospital cardiac arrest patients: a historical comparison.
abstract: BACKGROUND
  Before the introduction of the new international cardiac arrest treatment guidelines in 2005, patients with out-of-hospital cardiac arrest (OHCA) of cardiac origin in Northern Italy had very poor prognosis. Since 2006, a new bundle of care comprising use of automated external defibrillators (AEDs) and therapeutic hypothermia (TH) was started, while extracorporeal CPR program (ECPR) for selected refractory CA and dispatcher-assisted cardio-pulmonary resuscitation (CPR) was started in January 2010.
  
  
  OBJECTIVE
  We hypothesized that a program of bundled care might improve outcome of OHCA patients.
  
  
  METHODS
  We analyzed data collected in the OHCA registry of the MB area between September 2007 and August 2011 and compared this with data from 2000 to 2003.
  
  
  RESULTS
  Between 2007 and 2011, 1128 OHCAs occurred in the MB area, 745 received CPR and 461 of these had a CA of presumed cardiac origin. Of these, 125 (27%) achieved sustained ROSC, 60 (13%) survived to 1 month, of whom 51 (11%) were discharged from hospital with a good neurological outcome (CPC≤2), and 9 with a poor neurological outcome (CPC>2). Compared with data from the 2000 to 2003 periods, survival increased from 5.6% to 13.01% (p<0.0001). In the 2007-2011 group, low-flow time and bystander CPR were independent markers of survival.
  
  
  CONCLUSIONS
  OHCA survival has improved in our region. An increased bystander CPR rate associated with dispatcher-assisted CPR was the most significant cause of increased survival, but duration of CA remains critical for patient outcome.
authors: Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy. Electronic address: l.avalli@hsgerardo.org.
authors: Leonello
authors: L
authors: Avalli
authors: Institutions Dipartimento di Scienze della Salute, Università Milano-Bicocca, Monza, Italy.
authors: Tommaso
authors: T
authors: Mauri
authors: Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy.
authors: Giuseppe
authors: G
authors: Citerio
authors: Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy.
authors: Maurizio
authors: M
authors: Migliari
authors: Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy.
authors: Anna
authors: A
authors: Coppo
authors: Institutions AAT, Monza, Brianza, Italy.
authors: Matteo
authors: M
authors: Caresani
authors: Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy.
authors: Barbara
authors: B
authors: Marcora
authors: Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy; Institutions Azienda Regionale Emergenza Urgenza, Milano, Regione Lombardia, Italy.
authors: Gianpiera
authors: G
authors: Rossi
authors: Institutions Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Monza, Italy; Institutions Dipartimento di Scienze della Salute, Università Milano-Bicocca, Monza, Italy; Institutions Azienda Regionale Emergenza Urgenza, Milano, Regione Lombardia, Italy.
authors: Antonio
authors: A
authors: Pesenti
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D065386:Historically Controlled Study; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D064872:Patient Care Bundles; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Cardiopulmonary resuscitation; Emergency medical services; Out-of-hospital cardiac arrest; Outcome