Dual dispatch early defibrillation in out-of-hospital cardiac arrest in a mixed urban-rural population.

AIMS: The effects of a system based on minimally trained first responders (FR) dispatched simultaneously with the emergency medical services (EMS) of the local hospital in a mixed urban and rural area in Northwestern Switzerland were examined. METHODS AND RESULTS: In this prospective study 500 voluntary fire fighters received a 4-h training in basic-life-support using automated-external-defibrillation (AED). FR and EMS were simultaneously dispatched in a two-tier rescue system. During the years 2001-2008, response times, resuscitation interventions and outcomes were monitored. 1334 emergencies were included. The FR reached the patients (mean age 60.4 ± 19 years; 65% male) within 6 ± 3 min after emergency calls compared to 12 ± 5 min by the EMS (p<0.0001). Seventy-six percent of the 297 OHCAs occurred at home. Only 3 emergencies with resuscitation attempts occurred at the main railway station equipped with an on-site AED. FR were on the scene before arrival of the EMS in 1166 (87.4%) cases. Of these, the FR used AED in 611 patients for monitoring or defibrillation. CPR was initiated by the FR in 164 (68.9% of 238 resuscitated patients). 124 patients were defibrillated, of whom 93 (75.0%) were defibrillated first by the FR. Eighteen patients (of whom 13 were defibrillated by the FR) were discharged from hospital in good neurological condition. CONCLUSIONS: Minimally trained fire fighters integrated in an EMS as FR contributed substantially to an increase of the survival rate of OHCAs in a mixed urban and rural area.

Quality of life in long-term survivors of out-of-hospital cardiac arrest.

STUDY OBJECTIVE: The quality of life in long-term survivors of out-of-hospital cardiac arrest may be a good outcome measure after resuscitation. Therefore, the psychosocial situation and quality of life in such patients after successful resuscitation was evaluated. METHODS: Patients with out-of-hospital cardiac arrest in a community referred to a single tertiary care centre were compared with matched controls. Quality of life was evaluated in 50 consecutive arrest cases (40 males, 10 females; 60+/-13 years) 5-68 months (mean 31.7) after resuscitation according to American Heart Association protocols. RESULTS: The Psychological General Well-being Index questionnaire indicated no significant differences in anxiety, depression, vitality, general well-being, or self-control between patients and controls. However, the Nottingham Health Profile questionnaire demonstrated significant decreases in physical mobility (14.5+/-18.1 vs. 4.0+/-8.5, P=0.0001), energy levels (25.3+/-31.0 vs. 2.0+/-8.0, P=0.0001), emotional reactions (11.3+/-16.6 vs. 4.0+/-10.2, P=0.009), and sleep patterns (19.2+/-28.6 vs. 8.4+/-16.7, P=0.023) in the arrest patients. Little differences were measured with the Everyday-Life Questionnaire. 49 of the 50 arrest patients judged their situation after resuscitation worth living; no significant changes in familial, and psychosocial parameters occurred. CONCLUSIONS: The quality of life was associated with few changes in psychosocial profile after successful resuscitation. The subjective negative factors bore little impact on the quality of daily living in our patients. Thus, continued efforts to improve out-of-hospital resuscitation measures for cardiac arrest are justified since long-term survivors can expect a good quality of life after successful resuscitation.