Advanced cardiac life support in the prehospital setting 1991-19%

Purpose: The purpose of this study was to evaluate the effect of the advanced cardiac life-support (ACLS) service and of bystanders on survival after cardiopulmonary arrest outside the hospitals in the Reykjavik area. Methods: The physician and two firefighters who man the emergency ambulance follow guidelines on ACLS from the American Heart Association (AHA). The data was collected prospectively according to the "Utstein Style" form. Results: From 1991-1996 there were 361 attempted resuscitations after sudden cardiopulmonary arrest thereof 308 presumed from cardiac causes. The mean response time was 4.6 min. Patients admitted to the intensive care units were 98 (31%) and 51 (17%) were discharged from the hospital. Hospital survival rate was 52%. Ventricular fibrillation or tachycardia were the most common initial rhythms seen in 176 (57%) patients, asystole in 91 (30%) and other arrhythmias (EMD, agonal) in 41 (13%). Forty-six patients (26%) with ventricular fibrillation on the first rhythm strip survived to be discharged from the hospital, 3 (3%) patients with asystole and 2 (5%) with other arrhythmias. Bystanders were present in 211 (68%) of cases and it fourfolded the likelihood of discharge (p=0.0025). 189 of the 308 (61%) cardiac arrests occurred at home and only 20 of those survived to be discharged (11%) which is significantly lower than for patents arresting elsewhere. Conclusion: Patients who arrest at home have the worst chance of surviving cardiac arrest. The likelihood of patients surviving cardiac arrests is increased significantly if the arrests are witnessed. If the initial rhythm is ventricular fibrillation or ventricular tachycardia the patients have significantly better survival rate than patients having other rhythms on the first rhythm strip. There is no statistical difference in mean response time or survival rates between this study and previous studies that have evaluated survival of cardiac arrests in the area since 1982. The ACLS performance of the crew of the emergency ambulance has however changed over the years in accordance with the guidelines of the AHA.