Long-term survival after successful out-of-hospital resuscitation.

Between 1983 and 1989, 962 patients in Rotterdam were resuscitated outside hospital, of whom 240 (25%) could be discharged alive. A follow-up study was performed to determine prognosis in these patients. Of the 240 survivors of out-of-hospital resuscitation 80% survived after 1 year and 61% after 5 years. During the first year, 9% suffered from myocardial (re)infarction and 13% underwent coronary bypass surgery or angioplasty. Within the first 3 years after resuscitation 60% of the patients were readmitted to hospital. Permanent or temporary neurological deficits were observed in 30 patients (14%). Patients with a primary arrhythmia without myocardial infarction had a worse prognosis than patients with a cardiac arrest in the context of an infarct. Survival was better in patients in whom resuscitation was initiated by physicians or ambulance-nurses, than in patients resuscitated by lay-people. Multivariate analysis revealed that this difference could be explained by a larger proportion of patients with a primary arrhythmia in the latter group. Since long-term prognosis after out-of-hospital resuscitation is satisfactory, programmes for resuscitation courses should be stimulated. Such programmes should aim predominantly at relatives of patients with known heart disease, police officers and children.

[Long-term survival following successful resuscitation outside the hospital]. / Lange-termijnoverleving na succesvolle resuscitatie buiten het ziekenhuis.

Between 1983 and 1989, 962 patients in Rotterdam were resuscitated outside hospital, of whom 240 (25%) could be discharged alive. A follow-up study was performed to determine prognosis in these patients. Data were collected through the Municipal Health Service, Population Registries, the hospitals where the patients were admitted, and the general practitioners. Of these 240 survivors of out-of-hospital resuscitation 80% survived after 1 year and 61% after 5 years. During the first year, 9% suffered from myocardial (re)infarction and 13% underwent coronary bypass surgery or angioplasty. Within the first three years after resuscitation 60% of the patients were readmitted to a hospital. Permanent or temporary neurological deficits were observed in 30 patients (14%). Patients with a primary arrhythmia without myocardial infarction had a poorer prognosis than patients with cardiac arrest in the context of an infarct. Survival was better in patients in whom resuscitation was initiated by physicians or ambulance-nurses, than in patients resuscitated by lay-people. Multivariate analysis revealed that this difference was caused by a larger proportion of patients with a primary arrhythmia in the latter group. Since long-term prognosis after out-of-hospital resuscitation is satisfactory, programmes for resuscitation courses should be stimulated. Such courses should be aimed predominantly at relatives of patients with known heart disease, police officers and children.

Medical aspects of lay resuscitations in Rotterdam.

In the Rotterdam system of prehospital care for patients with circulatory failure, the cardiopulmonary resuscitation (CPR) training programme for lay persons contributes to the first link in the chain of care, i.e. the period of time spent awaiting the arrival of professional staff. In this paper we describe some of the medical aspects of this programme. The material used was obtained in a study of 5312 trainees who had followed a CPR course. Case histories were reconstructed of 91 victims who had been resuscitated by 109 respondents. At least 20% of resuscitated persons had collapsed as a result of non-cardiac causes. In this category the longer term survival rates were relatively the most favourable. In several instances the indication for resuscitation had been incorrect, while the technical proficiency in the delivery of CPR was often inadequate. We conclude that one course is insufficient for the development of the required 'skill'. We also conclude that the courses should dwell more elaborately on the non-cardiac causes of collapse, particularly in training programmes addressing the public at large. Attention is drawn to the need of designing and implementing special courses for family members and relatives of persons known to be cardiac patients. The need for continuing evaluation, involving active contributions from lay resuscitators, is underlined.

Integrated approach to prehospital coronary care in Rotterdam.

All ambulances in Rotterdam are equipped with monitoring and resuscitation equipment and staffed with nurses who have the primary role in cardiac emergency care before and during transport to the hospital. Patients are reached in a mean time of 7 minutes. All patients are monitored. Rhythm abnormalities are diagnosed and treated according to standing written orders. Emergency treatment including infusions and intubation can be given. A radio communications center coordinates admission to the nearest available CCU bed. Emergency calls are placed through special telephone numbers for family physicians and previous myocardial infarct patients ("free call"). Patient care by the ambulance nurses is reviewed daily. Ambulance nurses are confronted with a myocardial infarction eight times as often as a family physician--a sound reason to entrust pre-hospital care to them. To extend early treatment into the community, the municipality has subsidized a program to train city workers and volunteers in cardiopulmonary resuscitation. At the end of 1982, approximately 17,000 lay-inhabitants of Rotterdam had been trained. In 1981, 3,557 ambulance trips were made for patients suspected of having acute myocardial infarction. In approximately 40%, this diagnosis was later confirmed from hospital records. Sixty-three patients were admitted to hospital alive, 50 after successful defibrillation. Forty-two patients returned to society after hospitalization. In 24 patients, resuscitation attempts were begun by lay bystanders. Seven of the 24 were admitted to the hospital, and six were discharged alive.