title: Outcome of out-of-hospital cardiac arrest over a period of 15 years in comparison to the RACA score in a physician staffed urban emergency medical service in Germany.
abstract: BACKGROUND
  Patient outcome after out of hospital cardiac arrest (OHCA) depends on the cardiopulmonary resuscitation (CPR) performance and might also be influenced by organisation of the emergency medical service (EMS) and implementation of guidelines.
  
  
  OBJECTIVE
  To assess the rate of return of spontaneous circulation (ROSC) after cardiac arrest to the predicted rate by the ROSC after cardiac arrest (RACA) score over a 15-year period reflecting three different implemented ALS-guidelines in a physician-staffed EMS.
  
  
  METHODS
  All adult patients with non-traumatic OHCA in the EMS of Bonn from 1996 to 2011 were included. Utstein data from three 5-years time periods (1996-2001, 2001-2006, 2006-2011) representing different ALS-guideline implementations were collected. Group comparisons were made in terms of incidence, epidemiology and short-term outcome of CPR with emphasis on changes over time and factors of importance. In each group observed ROSC rate were compared to the predicted ROSC rates (the RACA score).
  
  
  RESULTS
  CPR by the ALS unit was attempted in a total of 1989 patients (735, 666, and 588 patients in the first, second and third period, respectively). Average crude incidence of CPR per 100,000 person-years decreased over time (61.3; 55.5; 49.0/100,000/years) while patients treated were significantly older (65.5 ± 16.5; 67.9 ± 15; 68.9 ± 15.7 (p<0.001)). Observed ROSC rates were higher than predicted by the RACA score in all time periods, however, admittance to ICU decreased significantly from 50% in the first five-year period to 38% last five-year period (p<0.001). From first to third period the proportion of arrests with first observed rhythm of VT/VF arrests did not change (29% vs. 27%, p=0.323) nor there were changes in bystander CPR rates (17% vs. 17%, p=0.520).
  
  
  CONCLUSIONS
  In a 15-years period and in the setting of a physician-staffed EMS the ROSC rates remain higher than predicted by the RACA score but the admittance to the ICU after OHCA declined significantly. This finding was accompanied by a decrease in CPR incidence and an increase in age of patients.
authors: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Street 25, 53105 Bonn, Germany. Electronic address: jens-christian.schewe@ukb.uni-bonn.de.
authors: Jens-Christian
authors: JC
authors: Schewe
authors: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Street 25, 53105 Bonn, Germany.
authors: Jochen
authors: J
authors: Kappler
authors: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Street 25, 53105 Bonn, Germany.
authors: Ulrich
authors: U
authors: Heister
authors: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Street 25, 53105 Bonn, Germany.
authors: Stefan Udo
authors: SU
authors: Weber
authors: Emergency Medical System Oberbergischer Kreis, Department of Emergency Medicine, Lockenfeld 12, 51709 Marienheide, Germany.
authors: Christian Jens
authors: CJ
authors: Diepenseifen
authors: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Street 25, 53105 Bonn, Germany.
authors: Benjamin
authors: B
authors: Frings
authors: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Street 25, 53105 Bonn, Germany.
authors: Andreas
authors: A
authors: Hoeft
authors: Department of Anaesthesiology and Intensive Care, Klinik am Eichert, ALB FILS Kliniken, Eichertstraße 3, 73035 Göppingen, Germany.
authors: Matthias
authors: M
authors: Fischer
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010820:Physicians / Q000600:supply & distribution*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D000078329:Workforce
keywords: CPR; Cardiac arrest; EMS; OHCA resuscitation; Outcome; RACA