New treatment bundles improve survival in out-of-hospital cardiac arrest patients : a historical comparison

Introduction: Before the introduction of the new international cardiac arrest treatment guidelines in 2005, patients with out-of-hospital cardiac arrest (OHCA) of cardiac origin in Northern Italy had very poor prognosis. Since 2006, a new bundle of care comprising use of automated external defibrillators (AEDs) and therapeutic hypothermia (TH) was started, while extracorporeal CPR program (ECPR) for selected refractory CA and dispatcher-assisted cardio-pulmonary resuscitation (CPR) was started in January 2010. Objectives: We hypothesized that a program of bundled care might improve outcome of OHCA patients. Methods: We analyzed data collected in the OHCA registry of the MB area between September 2007 and August 2011 and compared this with data from 2000 to 2003. Results: Between 2007 and 2011, 1128 OHCAs occurred in the MB area, 745 received CPR and 461 of these had a CA of presumed cardiac origin. Of these, 125 (27%) achieved sustained ROSC, 60 (13%) survived to 1 month, of whom 51 (11%) were discharged from hospital with a good neurological outcome (CPC. ≤. 2), and 9 with a poor neurological outcome (CPC. >. 2).Compared with data from the 2000 to 2003 periods, survival increased from 5.6% to 13.01% (p<. 0.0001). In the 2007-2011 group, low-flow time and bystander CPR were independent markers of survival. Conclusions: OHCA survival has improved in our region. An increased bystander CPR rate associated with dispatcher-assisted CPR was the most significant cause of increased survival, but duration of CA remains critical for patient outcome.