Estimation of the Rate of Preventable Deaths After Out-of-Hospital Cardiac Arrest: A Preliminary Study

ABSTRACT

PURPOSE: The wide range of survival rates after out-of-hospital cardiac arrest (OHCA) suggests that some deaths are preventable if an optimal emergency medical service (EMS) system is operated. The objective of this study was to propose a definition of preventable cardiac arrest death (PCAD) and to estimate the rate of PCAD in an area. METHODS: This was a prospective cohort study of OHCA patients in the Gangnam-gu area of Korea. We collected data for OHCA patients from January to December 2009. PCAD was defined as an arrest case who is expected to survive if the patient received optimal first aid from bystanders and EMS personnel. A consensus panel of three emergency physicians determined whether each event was preventable or not. The survivability of each event was calculated using formulas from previous studies. RESULTS: Among 104 arrests (an incidence of 18.3 per 100,000/year), 44 unexpected, non-traumatic arrests were analyzed. According to expert opinion, 16 of 30 (53%) who died within 24 hours after cardiac arrest were considered cases of PCAD. Survivability calculated using a previous formula was above 50% in 70% of patients. The Kappa value between the two estimations was only 0.247. CONCLUSION: The PCAD rate of Gangnam-gu area was estimated to be 53.3~70%. No bystander cardiopulmonary resuscitation, a delay in EMS activation, no use of an automated external defibrillator, or a delay in EMS arrival were considered problems in the process of pre-hospital care for sudden cardiac arrest.