Hostname: page-component-84b7d79bbc-dwq4g Total loading time: 0 Render date: 2024-07-27T22:57:57.409Z Has data issue: false hasContentIssue false
  • English
  • Français

Analysis of Prehospital Scene Time and Survival from Out-of-Hospital, Non-Traumatic, Cardiac Arrest

Published online by Cambridge University Press:  28 June 2012

Daniel W. Spaite ,
Elizabeth A. Criss ,
Terence D. Valenzuela ,
Harvey W. Meislin  and
John Ross
Daniel W. Spaite*
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, USA
Elizabeth A. Criss
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, USA
Terence D. Valenzuela
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, USA Medical Division Tucson Fire Department, Tucson, Arizona, USA
Harvey W. Meislin
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, USA
John Ross
Affiliation:
Medical Division Tucson Fire Department, Tucson, Arizona, USA
*
Presented to the 6th Annual Scientific Assembly of the National Association of EMS Physicians, June 14–17, 1990, Houston, Texas, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

The purpose of this study was to determine whether shorter prehospital scene time (ST) is associated with an increased survival rate in non-traumatic, out-of-hospital, cardiac arrest (CA) in a medium-sized, metropolitan EMS system. Information was retrieved for all adult victims (age ≥18 years) of CA treated and transported by a metropolitan fire department over a 16month period (6/87–9/88). Data were retrieved from the fire department's database, hospital records, and death certificates. Statistical analysis of continuous variables was performed using the two-tailed, Student's t-test and non-parametric evaluations were performed by square analysis with p<0.05 considered significant. Two hundred ninety-eight cases were recorded of which 293 patients (98.3%) had documented ST (study group). Seventy-nine patients (27.0%) had ST <12 minutes, while 214 (73.0%) had ST≥12 minutes. Patients with ST <12 minutes were more likely to have return of spontaneous circulation in the field (26.6% vs. 15.9%, p<0.05) and also were more likely to survive than were patients with ST ≥12 minutes (13.9% vs. 6.5%, p<0.05). Mean ST for survivors was significantly less than for non-survivors (12.8 vs. 15.3 min., p<0.05).

We conclude that, in our system, adult victims of CA with ST <12 minutes are more likely to survive than are patients with longer ST. In addition, the mean ST for survivors is shorter than for non-survivors. It remains unclear whether shorter ST actually has an impact on survival or is merely a reflection of a sub-group with rapid resuscitation and consequently a higher likelihood of survival. Future investigations are needed to determine whether shorter ST actually impacts the likelihood of survival from CA.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 6 , Issue 1 , March 1991 , pp. 21 - 27
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Jakobsson, J, Nyquist, O, Rehnqvist, N: Effects of early defibrillation of out-of-hospital cardiac arrest patients by ambulance personnel. Euro Heart J 1987;8:1189–1194.CrossRefGoogle ScholarPubMed
2. Bachman, JW, McDonald, GS, O'Brien, PC: A study of out-of-hospital cardiac arrests in northeastern Minnesota. JAMA 1986;256: 477–483.CrossRefGoogle ScholarPubMed
3. Pionkowski, RS, Thompson, BM, Gruckow, HW, et al. Resuscitation time in ventricular fibrillation: A prognostic indicator. Ann Emerg Med 1983;12:733–738.CrossRefGoogle ScholarPubMed
4. Ritter, G, Goldstein, S, Leighton, R, et al. The effect of bystander CPR and arrival time of EMS on successful out-of-hospital resuscitation. Am J Emerg Med 1984;2:358–359. Abstract.Google Scholar
5. Eisenberg, MS, Hadas, E, Nuri, I, et al. Sudden cardiac arrest in Israel: Factors associated with successful resuscitation. Am J Emerg Med 1988;6:319–323.Google ScholarPubMed
6. Eitel, DR, Walton, SL, Guerci, AD, et al. Out-of-hospital cardiac arrest: A six-year experience in a suburban/rural system. Ann Emerg Med 1988;17:808–812.CrossRefGoogle Scholar
7. Stults, KR, Brown, DD, Schug, VL, et al. Prehospital defibrillation performed by emergency medical technicians. N Engl J Med. 1984;310:219–223.CrossRefGoogle ScholarPubMed
8. Eisenberg, MS, Copass, MK, Hallstrom, AP, et al. Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med 1989; 302:1379–1383.CrossRefGoogle Scholar
9. Aprahamian, C, Thompson, BM, Gruchow, HW, et al. Decision making in prehospital sudden cardiac arrest. Ann Emerg Med 1986; 15:445–449.Google ScholarPubMed
10. Weaver, WD, Hill, D, Fahrenbruch, CE, et al. Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest. N Engl J Med 1988;319:661–666.CrossRefGoogle ScholarPubMed
11. Hargarten, KM, Stueven, HA, Olson, DW, et al. Prehospital experience with defibrillation of coarse ventricular fibrillation. Ann Emerg Med 1988; 17:878. Abstract.Google Scholar
12. Eisenberg, MS, Hallstrom, AP, Copass, MK, et al. Treatment of ventricular fibrillation: Emergency medical technician defibrillation and paramedic services. JAMA 1984;251: 1723–1726.Google ScholarPubMed
13. Roth, R, Stewart, RD, Rogers, K, et al. Out-of-hospital cardiac arrest: Factors associated with survival. Ann Emerg Med 1984; 13: 237–243.CrossRefGoogle ScholarPubMed
14. Weaver, DW, Cobb, LA, Hallstrom, A, et al. Considerations for improving survival from out-of-hospital cardiac arrest. Ann Emerg Med 1986; 15: 1181–1186.CrossRefGoogle ScholarPubMed
15. Eisenberg, M, Bergner, L, Hallstrom, A: Paramedic programs and out-of-hospital cardiac arrest: I. factors associated with successful resuscitation. Am J Public Health 1979; 69: 30–38.Google ScholarPubMed
16. Spaite, DW, Criss, EA, Valenzuela, TD, et al. A new model for providing prehospital medical care in large stadiums. Ann Emerg Med 1988;17:825–828.CrossRefGoogle ScholarPubMed
17. Cummins, RO, Eisenberg, MS, Hallstrom, AP, et al. Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med 1985;3:114–119.CrossRefGoogle ScholarPubMed
18. Stueven, HA, Troiano, P, Kastenson, EH, et al. Prehospital cardiac arrest: A critical analysis of factors affecting survival. Ann Emerg Med 1986;15:496. Abstract.CrossRefGoogle Scholar
19. Guzy, PM, Pearce, ML, Greenfield, S: The survival benefit of bystander cardiopulmonary resuscitation in a paramedic served metropolitan area. Am J Public Health 1983;73:766–769.CrossRefGoogle Scholar
20. Eisenberg, M, Cummins, R, Hallstrom, A: Out-of-hospital cardiac arrest: Significance of symptoms in patients collapsing before and after arrival of paramedics. Am J Emerg Med 1986;4: 116–120.CrossRefGoogle ScholarPubMed
21. Wolford, RW, Kaplan, RM, Stewart, RD: ALS witnessed prehospital cardiopulmonary arrest. Ann Emerg Med 1988;17:410. Abstract.Google Scholar
22. Litwin, P, Eisenberg, M, Hallstrom, A, et al. The location of collapse and its effect on survival from cardiac arrest. Ann Emerg Med 1987;16:787–791.CrossRefGoogle ScholarPubMed
23. Myerburg, RJ, Kessler, KM, Zaman, L, et al. Survivors of prehospital cardiac arrest. JAMA 1982; 247:1485–1490.CrossRefGoogle ScholarPubMed
24. Williams, D, McLellan, BA: Patient outcome with prehospital ventricular fibrillation: EMT-D vs. EMT-P. Ann Emerg Med 1987;16: 512–513. Abstract.Google Scholar
25. Cummins, RO, Graves, JR, Horan, S, et al. The relative contributions of early defibrillation and ACLS interventions to resuscitation and survival from prehospital cardiac arrest. Ann Emerg Med 1989;18:468. Abstract.CrossRefGoogle Scholar
26. Valenzuela, TD, Keeley, KT, Criss, EA, et al. Implementation of a computerized management information system in an urban fire department. Ann Emerg Med 1989,18:573–578.Google Scholar
27. Pepe, PE, Bickell, WH, Wyatt, CH, et al. Relationship between total prehospital time and outcome in patients with penetrating trauma. Ann Emerg Med 1986;15:626. Abstract.Google Scholar
28. Gold, CR. Prehospital advanced life support vs. “scoop and run” in trama management. Ann Emerg Med 1987;16:797–801.Google Scholar
29. Tse, D, Spake, DW, Valenzuela, TD, et al. The association between scene time, prehospital procedures, and injury severity parameters among severely injured patients. Ann Emerg Med 1989; 18:450. Abstract.CrossRefGoogle Scholar
30. Honigman, B, Rohweder, K, Moore, EE, et al. Prehospital advanced trauma life support for penetrating cardiac wounds. Ann Emerg Med 1990;19:145–150.Google ScholarPubMed
31. Wears, RL, Winton, CN: Load and go versus stay and play: Analysis of prehospital IV fluid therapy by computer simulation. Ann Emerg Med 1990;19:163–168.CrossRefGoogle ScholarPubMed
32. Gervin, AS, Fischer, RP: The importance of prompt transport in the salvage of patients with penetrating heart wounds. J Trauma 1982;22:443–448.Google ScholarPubMed
33. Smith, JP, Bodai, BI, Hill, AS, et al. Prehospital stabilization of critically injured patients: A failed concept. J Trauma 1985;25:65–70.CrossRefGoogle ScholarPubMed
34. Reines, HD, Bartlett, RL, Chudy, NE, et al. Is advanced life support appropriate for victims of motor vehicle accidents: The South Carolina highway trauma project. J Trauma 1988;28:563–569.Google ScholarPubMed
35. Cwinn, AA, Pons, PT, Moore, EE, et al. Prehospital advance life support for critical blunt trauma victims. Ann Emerg Med 1987; 16:399–403.Google ScholarPubMed
36. Pons, PT, Honigman, B, Moore, EE, et al. Prehospital advanced trauma life support for critical penetrating wounds to the thorax and abdomen. J Trauma 1985;25:828–832.CrossRefGoogle Scholar
37. Hedges, JR, Feero, S, Moore, B, et al. Factors contributing to paramedic on-scene time during evaluation and management of blunt trauma. Am J Emerg Med 1988;6:443–448.Google Scholar
38. Jacobs, LM, Sinclair, A, Beiser, A, et al. Prehospital advanced life support: Benefits in trauma. J Trauma 1984;24:8–13.CrossRefGoogle ScholarPubMed
39. O'Gorman, M, Trabulsky, P, Pilcher, DB: Zero-time prehospital IV. J Trauma 1989;29: 84–86.CrossRefGoogle Scholar
40. Spaite, DW, Joseph, M: Prehospital cricothyrotomy: An investigation of indications, technique, complications, and patient outcome. Ann Emerg Med 1990;19:279–285.CrossRefGoogle ScholarPubMed
41. Pepe, PE, Copass, MK, Joyce, TH: Prehospital endotracheal intubation: Rational for training emergency medical personnel. Ann Emerg Med 1985;14:1085–1092.CrossRefGoogle Scholar
42. Copass, MK, Oreskovich, MR, Bladergroen, MR, et al. Prehospital cardiopulmonary resuscitation of the critically injured patient. Am J Surg 1984;148:20–26.CrossRefGoogle ScholarPubMed
43. Fortner, GS, Oreskovich, MR, Copass, MK, et al. The effects of prehospital trauma care on survival from a 50 meter fall. J Trauma 1983; 23:976–981.CrossRefGoogle ScholarPubMed
44. Gildenberg, PL, Makela, M: The effect of early intubation and ventilation on outcome following head trauma, In Dacey, RG, Winn, HR, Rimel, RW et al. (eds),Trauma of the Central Nervous System. New York, Raven Press, 1985, pp. 79–90.Google Scholar
45. McSwain, GR, Garrison, WB, Artz, CP: Evaluation of resuscitation from cardiopulmonary arrest by paramedics. Ann Emerg Med 1980;9:341–345.CrossRefGoogle ScholarPubMed
46. Bonnin, MJ, Swor, R: Outcomes in unsuccessful field resuscitation attempts. Ann Emerg Med 1989;18:507–512.CrossRefGoogle ScholarPubMed
47. Kellerman, AL, Staves, DR, Hackman, BB: Inhospital resuscitation following unsuccessful prehospital advanced cardiac life support: ‘Heroic efforts’ or an exercise in futility? Ann Emerg Med 1988;17:589–594.CrossRefGoogle Scholar
48. Lewis, LM, Ruoff, B, Rush, C, et al. Is emergency department resuscitation of out-of-hospital cardiac arrest victims who arrive pulseless worthwhile? Am J Emerg Med 1990; 8:118–120.CrossRefGoogle ScholarPubMed
49. Warner, LL, Hoffman, JR, Baraff, LJ: Prognostic significance of field response in out-of-hospital ventricular fibrillation. Chest 1985;87:22–28.Google ScholarPubMed
50. Geehr, EC, Lewis, FR, Auerbach, PS: Failure of open-heart massage to improve survival after prehospital non-traumatic cardiac arrest. N Engl J Med 1986;314:1189–1190.Google Scholar
51. Wolford, RW, Kaplan, RM, Stewart, RD, et al. ALS witnessed prehospital cardiopulmonary arrest. Ann Emerg Med 1988;17:410. Abstract.Google Scholar
52. Bonnin, MJ, Pepe, PE. Clark, PS: Key role of prehospital resuscitation in survival from out-of-hospital cardiac arrest. Ann Emerg Med 1990;19:466. Abstract.Google Scholar
53. Jakobsson, J, Nyquist, O, Rehnqvist, N, et al. Prognosis and clinical follow-up of patients resuscitated from out-of-hospital cardiac arrests. Acta Med Scand 1987;222:123–132.CrossRefGoogle Scholar