title: Editor's Choice-Progress in the chain of survival and its impact on outcomes of patients admitted to a specialized high-volume cardiac arrest center during the past two decades.
abstract: OBJECTIVE
  Cardiac arrest (CA) is still associated with high mortality and morbidity. Data on the changes in management and outcomes over a long period of time are limited. Using data from a single emergency department (ED), we assessed changes over two decades.
  
  
  METHODS
  In this single-center observational study, we prospectively included 4133 patients receiving cardiopulmonary resuscitation and being admitted to the ED of a tertiary care hospital between January 1992 and December 2012.
  
  
  RESULTS
  There was a significant improvement in both 6-month survival rates (+10.8%; p < 0.001) and favorable neurological outcome (+4.7%; p < 0.001). While the number of witnessed CA cases decreased (-4.7%; p < 0.001) the proportion of patients receiving bystander basic life support increased (+8.3%; p < 0.001). The proportion of patients with initially shockable ECG rhythms remained unchanged, but cardiovascular causes of CA decreased (-9.6%; p < 0.001). Interestingly, the time from CA until ED admission increased (+0.1 hours; p = 0.024). The use of percutaneous coronary intervention and therapeutic hypothermia were significantly associated with survival.
  
  
  CONCLUSIONS
  Outcomes of patients with CA treated at a specialized ED have improved significantly within the last 20 years. Improvements in every link in the chain of survival were noted.
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sulzgruber
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schober
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Uray
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Raphael
authors.initials: R
authors.lastname: Van Tulder
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Pia
authors.initials: P
authors.lastname: Hubner
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Wallmüller
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Diana
authors.initials: D
authors.lastname: El-Tattan
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Graf
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ruzicka
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schriefl
authors.affiliation: 2 Municipal Ambulance Service of Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zajicek
authors.affiliation: 2 Municipal Ambulance Service of Vienna, Austria.
authors.forename: Angelika
authors.initials: A
authors.lastname: Buchinger
authors.affiliation: 3 Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Koller
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Anton N
authors.initials: AN
authors.lastname: Laggner
authors.affiliation: 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Spiel
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data* / Q000639:trends; D004632:Emergency Medical Services / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D011446:Prospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Cardiac arrest; cardiopulmonary resuscitation; mortality; survival