Canadian Medical Association journal
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The resuscitation experience of a large teaching hospital during 1973-77 was reviewed. Resuscitation was attempted on 2091 victims of cardiac arrest; 261 patients (12.5%) survived to be discharged from hospital. Coronary heart disease caused about one half of all the cardiac arrests, but was associated with a better survival rate (14.4%) than the other causes. ⋯ Patients whose arrest occurred outside hospital, where only basic life support was available, had a survival rate of just 6.3%, whereas those whose arrest occurred in the emergency room had a survival rate of 31.9%. Since these two patient groups were similar in terms of age and diagnosis, we believe that the potential survival rate for victims of cardiac arrest outside of hospital that are optimally treated is close to 30%. These data suggest that increased survival from cardiac arrest can be expected with extension of the resuscitation services both inside and outside of hospital, but particularly with increased emphasis on emergency cardiac care outside of hospital.
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Resuscitation outside of hospital of victims of cardiac arrest is a major challenge to our emergency care system. Most cities in Canada do not have a mobile advanced life support service; instead they rely on basic life support outside of hospital. The outcome in such cases and the factors affecting the outcome are largely unknown. ⋯ Data analysis revealed that: (a) none of the 58% of patients in asystole at the time of arrival at a hospital survived to be discharged, but 11% of the patients with ventricular fibrillation or tachycardia (27% of the entire group) survived; (b) the survival rate was lower when the interval from the emergency telephone call to the patient's arrival at the hospital exceeded 10 minutes; and (c) basic life support was begun immediately in 29% of the patients with ventricular fibrillation or tachycardia, and increased the survival rate fivefold. The training of private citizens in basic life support is a vital component of total emergency cardiac care. A mobile advanced life support service will be effective in saving lives if it reduces the delay before definitive care is instituted, preferably to less than 10 minutes.