Incidence of EMS-treated out-of-hospital cardiac arrest in the United States
Introduction
Out-of-hospital sudden cardiac arrest (SCA) due to heart disease is a considerable public health burden in the US. Substantial resources are directed at treatment of SCA by maintaining and enhancing the “chain of survival” through prompt activation by emergency telephone 9-1-1, early bystander CPR, rapid defibrillation, and timely advanced cardiac life support [1]. However, the potential impact of ongoing efforts to improve the chain of survival is unclear in part because national estimates of the incidence (and to a lesser extent, survival), of treatable cases of SCA are uncertain. Cobb et al. [2] extrapolated the incidence estimate from the City of Seattle, which constitutes approximately 0.2% of the US population, and estimated that 184,000 all-rhythm emergency medical services (EMS)-treated cardiac arrests would occur in the US annually. Other approaches that in part use death certificate information have estimated much larger national incidence of potential SCA, approaching 500,000 persons annually, though presumably not all are treatable [3]. The aim of this investigation was to determine a representative national incidence of EMS-treated all-rhythm and ventricular fibrillation (VF) SCA as well as determine survival in order better to understand the potential public health implications of improving the “chain of survival”.
Section snippets
Study design
We used Medline to identify peer-reviewed articles published between 1 January 1980 and 31 March 2003 that reported a US community’s emergency medical services SCA experience. Our search terms were cardiac arrest, heart arrest, pre-hospital, out-of-hospital, survival, resuscitation and United States. The exact search strategy was: (CARDIAC ARREST OR HEART ARREST) and (“OUT OF HOSPITAL OR PREHOSPITAL OR PRE-HOSPITAL) and (SURV∗ OR RESUS∗) and the US. We also conducted the search without the term
Results
Investigations from 35 communities were included in the study [2], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39]. The communities ranged in racial composition from 12% (Rochester, MN) to 66% non-Caucasian (Memphis, TN) and ranged in size from over 7 million persons (New York City) to 5000 persons (San Juan Island, Washington) with all communities
Discussion
In this collection of published US community reports of EMS-treated cardiac arrest, the incidence of all-rhythm SCA was approximately 55 per 100,000 person-years and the incidence of ventricular fibrillation SCA was approximately 21 per 100,000 person-years. Taken together, the communities account for approximately 26 million persons, 9% of the US population, and report the EMS SCA experience of approximately 66 million person-years of observation. Although the communities were not randomly
Conclusions
The results of this study provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of SCA. Treated out-of-hospital SCA accounts for hundreds of thousands of deaths annually in the US, though the figure is far less than the national estimate of out-of-hospital heart disease death. Whether some of these untreated deaths might be treatable and prevented if EMS was activated sooner is unknown. A broad range of survival from EMS-treated
Acknowledgements
The investigation was presented at the Resuscitation Session of the 2003 American Heart Association Scientific Sessions in Orlando, Florida.
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