• Patrick Sulzgruber, Fritz Sterz, Andreas Schober, Thomas Uray, Raphael Van Tulder, Pia Hubner, Christian Wallmüller, Diana El-Tattan, Nikolaus Graf, Gerhard Ruzicka, Christoph Schriefl, Andreas Zajicek, Angelika Buchinger, Lorenz Koller, Anton N Laggner, and Alexander Spiel.
• 1 Department of Emergency Medicine, Medical University of Vienna, Austria.
• Eur Heart J Acute Cardiovasc Care. 2016 Nov 1; 5 (7): 3-12.

AimCardiac arrest (CA) is still associated with high mortality and morbidity. Data on the changes in management and outcomes over a long period of time are limited. Using data from a single emergency department (ED), we assessed changes over two decades.MethodsIn this single-center observational study, we prospectively included 4133 patients receiving cardiopulmonary resuscitation and being admitted to the ED of a tertiary care hospital between January 1992 and December 2012.ResultsThere was a significant improvement in both 6-month survival rates (+10.8%; p < 0.001) and favorable neurological outcome (+4.7%; p < 0.001). While the number of witnessed CA cases decreased (-4.7%; p < 0.001) the proportion of patients receiving bystander basic life support increased (+8.3%; p < 0.001). The proportion of patients with initially shockable ECG rhythms remained unchanged, but cardiovascular causes of CA decreased (-9.6%; p < 0.001). Interestingly, the time from CA until ED admission increased (+0.1 hours; p = 0.024). The use of percutaneous coronary intervention and therapeutic hypothermia were significantly associated with survival.ConclusionsOutcomes of patients with CA treated at a specialized ED have improved significantly within the last 20 years. Improvements in every link in the chain of survival were noted.

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