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PubMed2002

The X-linked lymphoproliferative disease gene product SAP is expressed in activated T and NK cells.

The unique manifestation of the inherited immunodeficiency, X-linked lymphoproliferative disease (XLP), is the impaired control of EBV infection. The gene, which carries mutations or is deleted in the patients, has been identified (Xq25). The encoded protein (SAP, 128 aa) contains a single SH2 domain and binds to signaling lymphocytic activation molecule (SLAM) and to other related surface molecules that are expressed on activated T, B and NK cells. SAP modifies signal transduction through its association with these molecules. Initially it was assumed that SAP acts passively by interfering and blocking active interactions involving other SH2 carrying molecules. We demonstrated that SAP protein is expressed in activated T and NK, but not in activated B cells. This finding is in line with the fact that in vitro performance of effector cells derived from XLP patients is impaired. However, it is still not known why the severe symptoms (fatal mononucleosis or malignant lymphoproliferation in the survivors of the primary infection) are elicited by EBV. We studied SAP expression in several Burkitt lymphoma (BL) derived lines. In contrast to normal B cells, certain lines expressed SAP. These were all type I cells in the Burkitt line nomenclature: they expressed only one of the EBV encoded proteins (EBNA-1) and their phenotype corresponded to resting B cells. Lymphoblastoid cell lines and type III BLs, whose phenotype resembled activated B cells and expressed all nine EBV encoded proteins, were devoid of SAP. The relationship between cell activation and SAP expression is reciprocal in T and B cells i.e. BL lines, activated T and NK cells express SAP, while BL blasts do not express SAP. This opposite relationship may be exploited for studies about the function of SAP.

Antigens, CD↗
PubMed1985

Expansion of emergency medicine's responsibilities for preclinical education of medical students.

Many medical schools have required emergency medicine courses for freshmen medical students, usually through participation in BLS (basic life support) or EMT activities. For several years students at our institution have participated in a required emergency medical technician-ambulance grade (EMT-A) course. While retaining much of the material presented in that original EMT-A course, the course has now been expanded to serve as the medical students' introduction to clinical medicine. This expansion resulted from the belief that emergency medicine provides initial patient contact in the presence of a faculty uniquely suited to introduce the broad domain of clinical medicine to the medical student. Emergency physicians, more than any other specialists, must possess the ability to obtain an incisive history promptly, perform an accurate physical examination, and arrive at an assessment with limited laboratory and radiologic data. Initial access to the clinical education of medical students provides the opportunity to direct their efforts in a prioritized fashion, and thus helps to organize their thought processes for further development as clinicians. Departments of emergency medicine should be willing to accept this incremental responsibility for the introduction of the medical student to the clinical and laboratory assessment of patients.

Clinical Competence↗
PubMed1998

Emergency medicine in France.

The Essonne region of France is situated to the south of Paris. A population of more than 1 million, heavy commercial traffic, and industrial centers mandate first-rate prehospital and hospital emergency medicine. Medical education in France comprises 3 years of basic medical science, followed by 3 years of hospital rotations and a residency of variable length. Emergency medicine is struggling for recognition as a specialty. The ED at the hospital center in Corbeil-Essonnes, France, has 21,000 visits per year, accounting for 30% of hospital admissions. The physical plant is modern and well-organized, with 13 beds. Attention is paid to quality improvement. Prehospital emergency care also receives due attention. A two-tiered system of BLS ambulances run by the fire department and ALS ambulances run by hospitals provide 24-hour emergency coverage. Because of aggressive triage, only 65% of requests for service result in dispatch of an ambulance. Tasks for physicians involved in emergency medicine in France today include further development of firemen's medical skills, development and use of telemedicine, and accreditation of emergency medicine as a recognized specialty.

Ambulances↗
PubMed2002

Mutational analysis of critical residues determining antigen presentation and activation of HLA-DQ0602 restricted T-cell clones.

Three different HLA-DQ0602 restricted T-lymphocyte clones (clones 5, 44, and 48) specific for two different Herpes simplex virus type 2 (HSV-2) VP16 peptides were used in a series of proliferation assays with BLS-1 cell lines expressing mutated HLA-DQ0604 molecules as APC. Up to four residues in the peptide-binding region of DQ0604 were replaced by the respective DQ0602 residue. For all three clones, residue beta70 played a crucial role in TCR recognition; beta30 and beta57 were important, although beta86 was less significant. Clone 5 and 48, specific to the HSV-2 VP16 369--379 peptide, responded to the same mutated DQ0604 molecules. Both clones could be stimulated only when the antigen presenting DQ molecule contained the DQ0602-like Gly at position beta70. Stimulation of clone 44, which recognized a different HSV-2 VP16 epitope (VP16 40-50), was less restricted. Molecular homology modeling showed that the beta70Arg of DQ0604 partially covered the peptide around P5/P6. Interactions of beta70 with residues from the antigen-peptide and polymorphic residues at positions beta30 and beta57 can modulate this effect. Supported by molecular modeling data, we conclude that the distinct molecular topography of DQ0602 is not contributed by a single residue, but rather the interactions of various polymorphic DQ residues with particular antigenic peptides.

Antigen Presentation↗
PubMed1997

Emergency, cardiac arrest! Can we teach the skills?

The European Resuscitation Council (ERC) has produced basic life support (BLS) and advanced life support (ALS) guidelines (1992) in an attempt to standardize the training and delivery of cardiopulmonary resuscitation (CPR). In response to this, the Avon and Gloucestershire College of Health, Glenside Centre (now University of the West of England), conducted a small survey, testing students' knowledge and skills in delivering CPR. Students were able to improve knowledge levels, but did not uniformly improve practical skills. Following this, the college formed a resuscitation team whose members coordinate CPR training in the curriculum, using uniform teaching packs which follow the ERC Guidelines (ERC 1992a), and resuscitation equipment purchased by the college as the result of the research findings. In addition to maintaining uniform content, sessions are compulsory and students' CPR skills are tested, with a 70% competency level set as a pass. Student results and attendance are stored on a college database, along with tutor information regarding updating of CPR skills. To achieve these developments, the college has had to consider time allocation within the curriculum, training of tutors, funding of resources and funding of a compulsory training programme, which supports a ratio of one tutor to six students. Evaluations of the changes are favourable, as students' CPR skills and knowledge show obvious improvement and the students' general confidence and enthusiasm are enhanced.

Cardiopulmonary Resuscitation↗
PubMed2000

Cardiopulmonary resuscitation skills in nurses and nursing students.

The purpose of this study is to describe the basic cardiac life-support (BLS) skills of nurses and nursing students in southern Finland and Hungary, and to assess the influence of resuscitation teaching and other group characteristics on performance. The data for the study were collected in the spring and autumn of 1997. The study group consisted of 75 nurses from Helsinki University Central Hospital's medical outcome unit, 188 final term students in four nursing institutes in Uusimaa county and 35 final term students in a Hungarian institute of nursing. A total of 298 people (34 men and 264 women) participated in the study. Background information was collected using a structured questionnaire devised specifically for this study. Resuscitation skills were measured using the Skillmeter Anne manikin. The manikin was placed supine during the test. After completing the questionnaire, every participant attempted resuscitation on the manikin - which was supplied with a printer - for 4 min. The results were printed out and attached to the questionnaires. The data were analysed using two-way frequency tables and logistic regression. Statistical differences were calculated using the chi(2)-test. The results showed that 53% of the participants had studied resuscitation during the last 6 months, but 7% had never participated in resuscitation teaching. Before testing, 55% of the participants estimated that their resuscitation skills were good. The results showed that 36% first assessed the patient's response, 67% opened the airway but only 3% determined pulselessness before starting to resuscitate. Twenty-one percent of the participants compressed correctly for at least half of the test and 33% ventilated correctly at least half of the time. Logistic regression showed that the best predictors for good response assessment skills went to those who were nursing students who had studied resuscitation skills sometime during the previous 6 months. The best predictor of the skill to open the airway was a positive attitude towards personal cardiopulmonary resuscitation (CPR) skills, i.e. self-confidence. The predictor for adequate skills in artificial ventilation was that they belonged in the group of nursing students who had benefited from recent resuscitation training (<6 months). In conclusion, the skills of the participants of the study can not be considered adequate in terms of an adequate and prompt assessment of the need for resuscitation, and a 50% success rate in artificial ventilation and chest compression.

Adult↗
PubMed2000

Life supporting first aid (LSFA) teaching to Brazilians by television spots.

Accidents in developing countries are frequent and have high mortality and morbidity rates. In Brazil, in 1995-1996, the year of this study, life supporting first aid (LSFA), which includes cardiopulmonary resuscitation (CPR) basic life support (BLS) was not taught in schools. With the population of 165 million, the only way to teach the adult population on a large scale would be by television (TV), that is widely viewed. This study compares two groups of factory employees - 86 controls without TV exposure to LSFA and 116 exposed to brief LSFA skill demonstrations on TV. Their ability to acquire eight LSFA skills was evaluated: external hemorrhage control; immobilization of a suspected forearm fracture; treatment of a skin burn by cold flush; body alignment after a fall; positioning for shock and coma; airway control by backward tilt of the head; and CPR (steps A-B-C). Simulated skill performance on the evaluating nurse or manikin was tested at 1 week, 1 month, and 13 months. In the control group, 1-31% performed individual skills correctly; as compared to 9-96% of the television group (P<0.001). There was excellent retention over 13 months. Over 50% of the television group performed correctly five of the eight skills, including positioning and hemorrhage control. Television viewing increased correct airway control performance from 5 to 25% of trainees, while it remained at 3% in the control group. CPR-ABC performance, however, was very poor in both groups. We conclude that a significant proportion of factory workers can acquire simple LSFA skills through television viewing alone, except for the skill acquisition of CPR steps B (mouth-to-mouth ventilation) and C (external chest compressions) which need coached manikin practice.

Adult↗
PubMed2001

Chain of survival: differences in early access and early CPR between policemen and high-school students.

Immediate activation of the emergency medical service (EMS) and cardiopulmonary resuscitation (CPR) increases the incidence of return of spontaneous circulation and the number discharged from hospital. The American Heart Association (AHA) and the European Resuscitation Council describe CPR as an ordinate sequence of eight steps. The objectives of this study were to assess the general knowledge of EMS and CPR and to analyse the retention of the CPR steps 2 months after a Basic Life Support (BLS)-course conducted according to AHA standards. We studied two populations from the same geographical area, law enforcement agents (LEA), since they are often the first to intervene, and high school students (HSS) since they are more likely to participate in such courses. HSS were more responsive and receptive than LEA. In order to increase the retention of the sequence of CPR steps, the number of steps should be reduced and refresher courses should be included in training programmes. Early access and early CPR are still not completely effective in the geographical area studied.

Adolescent↗
PubMed2001

European Resuscitation Council Guidelines 2000 for Automated External Defibrillation. A statement from the Basic Life Support and Automated External Defibrillation Working Group(1) and approved by the Executive Committee of the European Resuscitation Council.

The European Resuscitation Council (ERC) last issued guidelines for Automated External Defibrillators (AEDs) in 1998 [1]. The American Heart Association, together with representatives from the International Liaison Committee on Resuscitation (ILCOR), then undertook a series of evidence-based evaluations of the science of resuscitation [2] which culminated in the publication of "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" in August 2000 [3,4]. The Basic Life Support and Automated External Defibrillation Working Group (BLS&AED Working Group of the ERC) has considered this document and has recommended changes in the ERC AED guidelines. These are presented in this paper.

Algorithms↗
PubMed2001

European Resuscitation Council Guidelines 2000 for Adult Advanced Life Support. A statement from the Advanced Life Support Working Group(1) and approved by the Executive Committee of the European Resuscitation Council.

The European Resuscitation Council (ERC) last issued guidelines for Basic Life Support (BLS) in 1998 [1]. These were based on the 1997 International Liaison Committee on Resuscitation (ILCOR) Advisory Statements [2]. In 1999 and 2000 representatives of ILCOR, at the invitation of the American Heart Association, met on a number of occasions in Dallas to agree a Consensus on Science upon which future guidelines would be based. Representatives from the ERC played a prominent role in the deliberations, which culminated in the publication of "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care--A Consensus on Science" in August 2000 [3]. The consensus was evidence-based wherever possible. The ERC ALS Working Group has considered this document and has recommended some changes in the guidelines that will be suitable for European practice. These changes, together with a summary of the Sequence of Actions in ALS, are presented in this paper.

Adult↗
PubMed2002

Retention of basic life support skills 6 months after training with an automated voice advisory manikin system without instructor involvement.

AIM: To evaluate the retention of skills 6 months after training in ventilation and chest compressions (CPR) on a manikin with computer based on-line voice advisory feedback and the possible effects of initial overtraining. METHODS: Thirty five volunteers had 20 min provisional CPR training on a manikin with computer based voice advisory feedback but without an instructor. The appropriate feedback was taken from a pre-recorded list depending on performance measured by the manikin--computer system versus set limits for ventilation and compression variables. One group in addition was randomised to receive 10 similar 3 min training sessions during 1 week in the following month (overtrained group). All ventilation and compression variables were measured without feedback before and after the initial training session, with feedback immediately thereafter, and both without and with feedback 6 months after the initial training session. RESULTS: The initial training improved all variables. Compressions with correct depth increased from a mean of 33 to 77%, and correct inflations from a mean of 9 to 58%. After 6 months, the results for the controls were not significantly different from pre-training, except for a higher of correct inflations (18%), while the overtrained group had better retention of skills including the correct compression depth (mean 61%) and inflations (mean 42%). When verbal feedback was added both the compressions and ventilations immediately improved both when tested immediately and 6 months after the initial training session. CONCLUSIONS: The computer-based voice advisory manikin (VAM) feedback system can improve immediate performance of basic life support (BLS) skills, with better long-term retention with overtraining.

Adult↗
PubMed2002

Effect of rescuer fatigue on performance of continuous external chest compressions over 3 min.

Guidelines for the performance of cardiopulmonary resuscitation (CPR) have been revised recently and now advocate that chest compressions are performed without interruption for 3 min in patients during asystole and pulseless electrical activity. The aim of the present study was to determine if rescuer fatigue occurs during 3 min of chest compressions and if so, the effects on the rate and quality of compressions. Forty subjects competent in basic life support (BLS) were studied. They performed continuous chest compressions on a Laerdal Skillmeter Resusci-Anne manikin for two consecutive periods of 3 min separated by 30 s. The total number of compressions attempted was well maintained at approximately 100 min(-1) throughout the period of study. However, the number of satisfactory chest compressions performed decreased progressively during resuscitation (P < 0.001) as follows: first min, 82 min(-1); second, 68 min(-1); third, 52 min(-1); fourth, 70 min(-1); fifth, 44 min(-1); sixth, 27 min(-1). We observed significant correlations between the number of satisfactory compressions performed and both height and weight of the rescuer. Female subjects achieved significantly fewer satisfactory compressions compared with males (P = 0.03). Seven subjects (five female, two male) were unable to complete the second 3-min period because of exhaustion. We conclude that rescuer fatigue adversely affects the quality of chest compressions when performed without interruption over a 3-min period and that this effect may be greater in females due to their smaller stature. Consideration should be given to rotating the rescuer performing chest compressions after 1 min intervals.

Adult↗
PubMed2003

A survey of the in-hospital response to cardiac arrest on general wards in the hospitals of Rome.

OBJECTIVE: To investigate the response to cardiac arrest in general wards. METHODS: Direct interview with the cardiac arrest team (CAT) members in 32 hospitals in Rome, Italy. RESULTS: The majority of CATs are activated by telephone but only two (6%) hospitals have a dedicated telephone number for emergency calls. The CAT always includes a physician, who is usually an anaesthesiologist (30 hospitals, 94%), and usually includes one or two other members (23 hospitals, 72%). In 21 hospitals (65%) there is less than one defibrillator per floor but in only six hospitals (19%), CATs are equipped with defibrillators. Resuscitation guidelines are adopted by 15 teams (47%). The Utstein style of data collection is used in only one hospital. The most common problems reported by the CATs are: insufficient training of ward personnel (29 hospitals, 91%), insufficient staff (19 hospitals, 59%) and insufficient equipment (18 hospitals, 56%). Average maximum arrival time for the CAT to arrive is 220 s, but varies significantly between single-building and the multiple-building hospitals (88 vs. 390 s; P<0.001). CONCLUSIONS: The majority of the cardiac arrest teams have acceptable response times, but their efficiency may be impaired by the lack of staff, equipment and co-ordination with the ward personnel. CAT members identified a strong need for BLS training of ward personnel. More widespread introduction of standard protocols for resuscitation and reporting of cardiac arrest are necessary to evaluate aspects that may need improvement.

Data Collection↗
PubMed2003

Results of the introduction of an automated external defibrillation programme for non-medical personnel in Galicia.

OBJECTIVES: To describe the plan and development of a programme for the introduction of automated external defibrillation for non medical personnel and to report the results of the first 10 months of activity in a community which is predominently rural, such as Galicia. METHODS: The plan for introduction of the project included aspects of logistics, training and control. We studied cardiac arrests, that were treated in basic life support ambulances (BLS-A) equipped with automated external defibrillators (AEDs), from 1st March to 31st December 2001. RESULTS: Our community benefits from pioneering legislation in Spain. During the 10 months of study, 28 AEDs were in service, mostly in urban areas. In all cases, a thorough control of the quality of the service in which AEDs was used was carried out. 12% of the patients, who were victims of sudden cardiac death (SCD) and were found in ventricular fibrillation (VF), survived and were discharged from hospital. However, the percentage of patients found in VF is only around 26%. This is due to long assistance intervals (from the call to the arrival on site), and an important delay from the moment when circulatory collapse takes place until the emergency service 061 is called, more than 5 min in half the cases. CONCLUSIONS: The programme followed for the introduction of AEDs in Galicia was adapted to the socio-demographic characteristics of the population. The prehospital emergency assistance model was developed, executed and controlled by the Public Emergency Health Foundation of Galicia 061 (PEHF-061). The overall results of our first 10 months experience with the automated external defibrillation programme were as to be expected. In general, they are comparable to other published reports; however, ways of shortening the times from the point of collapse to defibrillation must be found, mainly by training the population and through the extension of automated external defibrillation provision to other first responders.

Adult↗
PubMed2003

EMS defibrillation-first policy may not improve outcome in out-of-hospital cardiac arrest.

OBJECTIVE: Early defibrillation using automated external defibrillators (AEDs) has been advocated to improve survival in witnessed out-of-hospital cardiac arrest (OHCA) due to pulseless ventricular tachycardia (VT) and ventricular fibrillation (VF). However, when VT/VF is untreated and prolonged for more than a few minutes, defibrillation using AEDs may fail. METHODS: This retrospective study reviewed the charts from local emergency medical service (EMS) between the years 1993 to 2001 to evaluate the value of the AED after its introduction into our EMS. All witnessed OHCA due to VT/VF were analysed; cases of collapse witnessed by EMS were excluded. The primary endpoint was defined as survival to hospital discharge and at 1-year follow-up, and the secondary endpoint as survival without major neurological deficit. A total of 76 patients were treated for witnessed VT/VF before the implementation of the AED and 92 patients after its implementation. RESULTS: Before the introduction of paramedic AED defibrillation, physician defibrillation was performed at 15.6 min (+/-5.5, S.D.). After the introduction of AED defibrillation, paramedic defibrillation was performed at 5.7 min (+/-2.4, S.D.); the mean response interval from the call to defibrillation was shortened significantly (P<0.001). At the same time, survival to hospital discharge decreased from 23.7% (18/76 patients) to 14.1% (13/92) (P=0.112) and at 1-year follow-up from 17.1% (13/76) to 9.8% (9/92) (P=0.161). Favourable neurological outcome at 1-year follow-up also decreased from 14.5% (11/76) to 8.7% (8/92) (P=0.239). CONCLUSION: Implementation of the AED did not improve survival or a favourable neurological outcome in patients with OHCA due to VF/VT. However, with 5.7 min time to defibrillation, our EMS did not meet the criteria for early defibrillation. For prolonged periods of VT/VF, initial basic life support (BLS) may be superior to immediate AED. If response times of <4 min cannot be attained by the emergency systems, reconsidering of resuscitation algorithms seems to be advisable.

Algorithms↗
PubMed1996

Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse.

International guidelines for cardiopulmonary resuscitation (CPR) in adults advocate that cardiac arrest be recognized within 5-10 s, by the absence of a pulse in the carotid arteries. However, validation of first responders' assessment of the carotid pulse has begun only recently. We aimed (1) to develop a methodology to study diagnostic accuracy in detecting the presence or absence of the carotid pulse in unresponsive patients, and (2) to evaluate diagnostic accuracy and time required by first responders to assess the carotid pulse. In 16 patients undergoing coronary artery bypass grafting, four groups of first responders (EMT-1: 107 laypersons with basic life support (BLS) training; EMT-2: 16 emergency medical technicians (EMTs) in training; PM-1: 74 paramedics in training; PM-2: 9 certified paramedics) performed, single-blinded and randomly allocated, carotid pulse assessment either during spontaneous circulation, or during non-pulsatile cardiopulmonary bypass. Time to diagnosis of carotid pulse status, concurrent haemodynamics and diagnostic accuracy were recorded. In 10% (6/59), an absent carotid pulse was not recognized as pulselessness. In 45% (66/147), a pulse was not identified despite a carotid pulse with a systolic pressure > or = 80 mmHg. Thus, although sensitivity of all participants for central pulselessness approached 90%, specificity was only 55%. Both sensitivity and, to a lesser degree, specificity improved with increasing training; blood pressure or heart rate had no significant effect. The median diagnostic delay was 24 s (minimum 3 s). When no carotid pulse was found, delays were significantly longer (30 s: minimum 13 s), than when a carotid pulse was identified (15 s; minimum 3 s) (P < 0.0001). Of all participants, only 15% (31/206) produced correct diagnoses within 10 s. Only 1/59 (2%) identified pulselessness correctly within 10 s. Our cardiopulmonary bypass model of carotid pulse assessment proved to be feasible and realistic. We conclude that recognition of pulselessness by rescuers with basic CPR training is time-consuming and inaccurate. Both intensive retraining of professional rescuers and reconsideration of guidelines about carotid pulse assessment are warranted.

Adult↗
PubMed1997

Poor correlation of mouth-to-mouth ventilation skills after basic life support training and 6 months later.

The purpose of the present study was to evaluate the cardiopulmonary resuscitation (CPR) skills of medical students after a 2-h basic life support class (n = 129) and 6 months later (n = 113). Mean +/- SD written test score decreased from 6.4 +/- 0.7 to 6.2 +/- 0.8 (P = 0.03). Mean +/- SD breaths delivered before CPR decreased from 2.9 +/- 0.6 to 2.2 +/- 1.2 (P = 0.0001), ventilation rate increased from 12.2 +/- 1.9 to 14.3 +/- 5.0 breaths/min (P = 0.0001), tidal volume increased from 0.75 +/- 0.2 to 0.8 +/- 0.31 (P = 0.11), minute ventilation from 9.1 +/- 2.6 to 10.8 +/- 3.61 (P = 0.0001), and stomach inflation from 13 +/- 22 to 18 +/- 27% of CPR breaths (P = 0.11). Mean +/- SD chest compression/min decreased from 56 +/- 9 to 54 +/- 12 (P = 0.34), depth of chest compression increased from 41 +/- 6 to 46 +/- 7 mm (P = 0.0001), hands held incorrectly on the thorax increased from 22 +/- 27 to 23 +/- 32% (P = 0.59), and leaning on the chest from 4 +/- 12 to 18 +/- 28% of compressions (P < 0.0001). In summary, ventilation skills were unpredictable; there was only a 5% chance that a given student would achieve the same mouth-to-mouth ventilation performance in both the BLS class and 6 months later. Despite the respiratory mechanics of the CPR manikin which prevented stomach inflation much better than an unconscious patient with an unprotected airway, stomach inflation occurred repeatedly. Teachers of basic life support classes need to consider the respiratory mechanics of the CPR manikin being used to assure clinically realistic and appropriate mouth-to-mouth ventilation skills.

Adult↗
PubMed1998

Epidemiology and survival rate of out-of-hospital cardiac arrest in north-east Italy: The F.A.C.S. study. Friuli Venezia Giulia Cardiac Arrest Cooperative Study.

The results of the first epidemiological, prospective, multicentric study on cardiac arrest in a geographical Italian region are reported. On 708 consecutive cardiac arrests, 438 underwent cardiopulmonary resuscitation (CPR). Of these, 344 were identified of cardiac aetiology. The underlying initial rhythm was: 166 asystole (48.3%), 104 ventricular fibrillation (30.2%), 74 pulseless electrical activity (21.5%). The best outcome occurred in patients whose cardiac arrest was witnessed by the EMS (49% return of spontaneous circulation (ROSC), 21% hospital discharge). When cardiac arrest was witnessed by lay people, 20.5% had ROSC and 4.4% were discharged alive from the hospital. When it was unwitnessed ROSC and hospital discharge were 8.6 and 1.7%, respectively. Ventricular fibrillation was highly predictive of outcome. Both ROSC and hospital discharge correlated inversely with the delay of the first defibrillation. Overall, the highest probability of survival was achieved when CPR interventions were started within the first minutes after collapse. Basic Life Support (BLS) manoeuvres began after 9 min of untreated cardiac arrest were still followed by a ROSC, but none of these patients survived. The incidence of prehospital cardiac arrest in our population was estimated to be in proportion of 0.95/1000 per year with a survival rate of 6.7%.

Cardiopulmonary Resuscitation↗