Better management of out-of-hospital cardiac arrest increases survival rate and improves neurological outcome in the Swiss Canton Ticino.
OBJECTIVE
To determine the incidence of out-of-hospital cardiac arrest (OHCA) fulfilling Utstein criteria in the Canton Ticino, Switzerland, the survival rate of OHCA patients and their neurological outcome.


RESULTS
All OHCAs treated in Canton Ticino between 1 January 2005 and 31 December 2014 were followed until either death or hospital discharge. The survival and neurological outcome of those OHCA fulfilling Utstein criteria are reported. A total of 3367 OHCAs occurred in the Canton Ticino over a 10-year period. Resuscitation was attempted in 2298 patients; of those 1492 (65%) were of presumed cardiac origin, 454 fulfilling the Utstein comparator criteria. About 69% [95% confidence interval (CI), 66.6-71.4%] of the patients had a bystander-witnessed arrest; a dispatched cardiopulmonary resuscitation (CPR) steadily and significantly increased from 2005 to 2014. Out-of-hospital cardiac arrest occurred prevalently home (67%), in men (71%) of a mean age of 71 ± 13 years. There were no statistically significant differences either in demographic characteristics of OHCA victims over these years or in presenting rhythm. There was a progressive increase in the survival at discharge from 15% in 2005 to 55% in 2014; overall 96% (95% CI, 93.3-99.9%) of the survivors had a good neurological outcome.


CONCLUSIONS
The significant increase in Utstein comparator survival rates and improved neurological outcome in OHCA victims in Canton Ticino are the result of an effective OHCA management programme which includes large-scale public education, a coordinated fast EMS response, high density of external defibrillators, and advances in clinical interventions for OHCAs.
Fondazione Ticino Cuore, Breganzona, Switzerland Anesthesiology and Intensive Care, Clinica Luganese, Lugano, Switzerland.
Romano
R
Mauri
Fondazione Ticino Cuore, Breganzona, Switzerland.
Roman
R
Burkart
Fondazione Ticino Cuore, Breganzona, Switzerland.
Claudio
C
Benvenuti
Fondazione Ticino Cuore, Breganzona, Switzerland Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
Maria Luce
ML
Caputo
Fondazione Ticino Cuore, Breganzona, Switzerland Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
Tiziano
T
Moccetti
Fondazione Ticino Cuore, Breganzona, Switzerland Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
Alessandro
A
Del Bufalo
Fondazione Ticino Cuore, Breganzona, Switzerland Division of Cardiology, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland.
Augusto
A
Gallino
Fondazione Ticino Cuore, Breganzona, Switzerland Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland.
Carlo
C
Casso
Fondazione Ticino Cuore, Breganzona, Switzerland Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland.
Luciano
L
Anselmi
Division of Anesthesiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
Tiziano
T
Cassina
Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Catherine
C
Klersy
Fondazione Ticino Cuore, Breganzona, Switzerland Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland angelo.auricchio@cardiocentro.org.
Angelo
A
Auricchio
D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology*; D009460:Neurologic Examination; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010351:Patient Discharge; D020127:Recovery of Function; D012042:Registries; D012151:Resuscitation / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
Bystander resuscitation; Neurological outcome; Out-of hospital cardiac arrest; Survival