Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander Cl and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective

摘要

In a national perspective, to describe survival among patients found in ventricular fibrillation or pulseless ventricular tachycardia witnessed by a bystander and with a presumed cardiac aetiology and answer two principal questions: (1) what are the changes over time? and (2) which are the factors of importance? Observational register study. Sweden. All patients included in the Swedish Out of Hospital Cardiac Arrest Register between 1 January 1990 and 31 December 2009 who were found in bystander-witnessed ventricular fibrillation with a presumed cardiac aetiology. Bystander cardiopulmonary resuscitation (CPR) and defoliation. Survival to 1 month. In all, 7187 patients fulfilled the set criteria. Age, place of out-of-hospital cardiac arrest (OHCA) and gender did not change. Bystander CPR increased from 46% to 73%; 95% Cl for OR 1.060 to 1.081 per year. The median delay from collapse to defoliation increased from 12 min to 14 min (p for trend 0.0004). Early survival increased from 28% to 45% (95% Cl 1.044 to 1.065) and survival to 1 month increased from 12% to 23% (95% Cl 1.058 to 1.086). Strong predictors of early and late survival were a short interval from collapse to defibrillation, bystander CPR, female gender and OHCA outside the home. In a long-term perspective in Sweden, survival to 1 month after ventricular fibrillation almost doubled. This was associated with a marked increase in bystander CPR. Strong predictors of outcome were a short delay to defoliation, bystander CPR, female gender and place of collapse.