Cardiac arrest patients in an alpine area during a six year period.

Abstract

The components of the 'chain of survival' remain the strongest pathway to save more people from out-of-hospital cardiac arrest. The 'Utstein Style' terminology has been applied to this study to evaluate survival in patients cared for by Emergency Medical Technicians--Defibrillation (EMT-D) and physicians in a rural alpine area. Over a 6-year period in a descriptive observational study with prospective data collection special efforts were made to identify weaknesses in the 'links' of our emergency cardiac care system considering the special geographical and legal aspects. Data from all emergency calls dispatched by the ambulance centre for patients with cardiac arrest were collected and are presented as a median and interquartile range. We recorded 368 cardiac arrests and in 338 patients resuscitation was attempted. Ventricular fibrillation (VF) was observed in 118 patients (35%), of whom 13 (4%) were defibrillated by EMT-Ds and 105 (31%) by physicians. Response times were 1 (0,2) min to call, 8 (6-11) min to arrival of first tier and 16 (10-26) min to defibrillation. Restoration of spontaneous circulation was achieved in 54 (46%) VF-patients. In EMT-D vs. physician treated VF-patients 1 year survival was 1 (8%) versus 20 (19%). With the exception of publications on avalanche victims and mountaineers, there are no reports of patients with out-of-hospital cardiac arrest in alpine areas. Response intervals and survival rate are not as poor as might be expected and are similar to metropolitan areas.