Elsevier

Resuscitation

Volume 113, April 2017, Pages 90-95
Resuscitation

Clinical paper
Out-of-hospital cardiac arrest (OHCA) attended by mobile emergency teams with a physician on board. Results of the Spanish OHCA Registry (OSHCAR)

https://doi.org/10.1016/j.resuscitation.2017.01.029Get rights and content

Abstract

Most survival outcomes in out-of-hospital cardiac arrest (OHCA) are provided by emergency medical services (EMS) without a doctor on board. Our objective was to determine such outcomes in a whole country with public physician-led EMS.

Methods

We analyzed data from a nationwide prospective registry of OHCA cases attended by 19 public EMS in Spain, covering the period from 1-October 2013 to 30-October 2014.

Results

Advanced life support (ALS) was initiated in 9347 cases (incidence 18.6 cases/105 inhabitants per year). Resuscitation was considered futile in 558 cases (5.9%), and ALS was continued in 8789 cases (94.1%); mean age 63.5 ± 17 years, 72.1% men. Initial rhythm was shockable in 22.1% of cases. Basic life support (BLS) was provided by bystanders in 1602 (24%) cases (635 of them with telephone assistance from the dispatch center). Of 8789 patients receiving ALS, 72.1% men, 2669 (30.4%) patients had return of spontaneous circulation on hospital arrival, 50.6% when the initial rhythm was shockable. Hospital discharge with good neurological status (CPC1–2) was found in 11.1% of the study population and in 27.6% when considering the Utstein comparator group of patients. A total of 216 (2.5%) patients arrived at the hospital with ongoing resuscitation, of whom only one survived with CPC1–2, and 165 (1.9%) patients were included in non-heart-beating donation programs.

Conclusions

In Spain with physician-led EMS, OHCA survival with CPC1-2 reached a reasonable percentage despite only a modest contribution of bystander BLS. Ongoing resuscitation strategy seems to be futile except when considering non-heart beating donation programs.

Introduction

The real incidence of OHCA is not well known. Based on out-of-hospital emergency medical services (EMS) data, OHCA affects more than 275,000 people a year in Europe,1 with an incidence of 38 cases per 100,000 people per year. These data vary greatly between different European countries,2, 3 and even between different regions of the same country.4 Apart from specific initiatives,5 one must consult regional and national registries to obtain real figures in clinical practice. Frequent references are made to national registries, but most provide only partial data.6, 7, 8 Some nationwide European registries, with significant population coverage and a long history, provide continuous data on the incidence and outcome of OHCA and they constitute an important source of knowledge about this process.9, 10 However, in general, most data come from exclusively paramedic-staffed EMS and countries with high rates of cardiac mortality.11 There are only partial data on the incidence and outcomes of OHCA care by physician-led EMS in a Mediterranean country,2, 12 an aspect that generates much debate in OHCA care.13 Our goal was to describe the incidence of OHCA and outcomes in a whole country with public EMS using ambulances with a physician on board.

Section snippets

Methods

Spanish OHCA Registry (OSHCAR) is a prospective registry of consecutive OHCA cases attended by emergency medical teams belonging to the Public EMS of Spain. The registry continuously receives its data from the EMS of all 17 autonomous communities of Spain along with municipal-level EMS in two major cities, Madrid and Zaragoza, representing all the public out-of-hospital services in Spain.

The map of Spain with its 17 autonomous regions and their population is shown in Supplementary material.

Results

Nineteen EMS participated in the recruitment of patients. During the study period, advanced life support (ALS) was initiated in 9347 cases. The number and percentage of cases included by each EMS and region is shown in Table 1. The incidence of OHCA treated by EMS in Spain, adjusted for the overall population coverage of the 19 EMS, according to the official census of 2014, was 18.62 per 105 inhabitants per year.

Demographic and assistance characteristics are shown in Table 2. Resuscitation was

Discussion

These are the first prospectively obtained results of OHCA treated by physician-led EMS in an entire country. Our data confirm a lower incidence of cases than in most countries with similar EMS, whether physician-led or not.2, 5, 17 Although variability in the incidence of OHCA is frequent in all Europe, the difference is very pronounced in our country, with the lowest rate of all,17 20 per 100,00 inhabitants, previously reported in other studies.2, 12, 17 This important difference is probably

Conflict of interest statement

Dr. Rosell-Ortiz, on behalf of all the authors of the mentioned manuscript, declared nothing to disclose.

Acknowledgements

The authors wish to thank all dispatch centers, ambulance services and first responders for their help in ongoing data collection.

The Registry was funded by a public Research Grant from the Spanish Health Ministry (Instituto de Investigación de Salud Carlos III, Fondo de Investigaciones Sanitarias, exp. number PI12-01912) and co-funded by a research grant from the European Commission.

The list with the complete OHSCAR investigators is shown in the annex (see Supplementary material).

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi: 10.1016/j.resuscitation.2017.01.029.

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