Abstract 25: Site of Cardiac Arrest: At Home and in Public Places, 2 Different Realities
One of the current debates on strategies to improve survival in cardiac arrest (CA) is whether the approach must be different as it occurs at home or in a public place. Our objective was to compare survival at hospital discharge of patients resuscitated from CA according to the place of the event.
Methods: prospective cohort study from the Andalusian Registry of Out-of-hospital CA (Spain). Consecutive patients with CA of cardiac aetiology cared for by out-of-hospital emergency teams from Jan-2008 to Dec-2010. Dependent variable: place of CA (CA at home vs CA at public place). Multivariate analysis.
Results: Advance life support maneuvers were performed in 2960 patients. Cardiac aetiology was diagnosed in 2331(78.75%) cases. Of these, 1328(57%) cases occurred at home. Distribution by gender and age was male 69% vs 76.6% (p<0.0001), age 63.53 vs 61.47 years (p=0.002) at home vs public place respectively. The event was not witnessed in 52.1% vs 68.8% (home/public, p<0.0001) and there was basic life support by witness in 35.2% vs 56.7% (home/public, p<0.001) cases. Initial rhythm was shockable in 13.26% vs 26.79% (home/public, p<0.0001). The median interval between collapse and emergency team on scene was 11 vs 12 minutes (home/public, p=0.04). Return of spontaneous circulation and hospital admission were achieved in 22.8% vs 33.4%(p<0.0001) patients and survival at hospital discharge with good neurological function (CPC1-2) in 5.72% vs 13.35% (p=0.006) home/public patients respectively. In the multivariate analysis, variables associated with the site of event: witness (OR 0.412;CI 0.245-0.692, p=0.001) survival with CPC1-2 (OR 2.294;CI 1.338-3-931.692, p=0.003).
Conclusions: Cardiac arrest at home is less witnessed and shows a survival rate lower than that occurring in public places and may require a specific strategy to improve outcomes.
- © 2011 by American Heart Association, Inc.