Elsevier

Resuscitation

Volume 63, Issue 1, October 2004, Pages 17-24
Resuscitation

Incidence of EMS-treated out-of-hospital cardiac arrest in the United States

https://doi.org/10.1016/j.resuscitation.2004.03.025Get rights and content

Abstract

Background: The potential impact of efforts to improve the chain of survival for out-of-hospital sudden cardiac arrest (SCA) is unclear in part because estimates of the incidence of treatable cases of SCA are uncertain. The aim of the investigation was to determine a representative national incidence of emergency medical services (EMS)-treated all-rhythm and ventricular fibrillation (VF) SCA as well as survival. Methods: We used Medline to identify peer-reviewed articles published between 1 January 1980 and 31 March 2003 that reported a US community’s EMS SCA experience. Inclusion criteria required the study to include at least 25 cases, report the total number of all-rhythm and/or ventricular fibrillation arrests, and provide information about population size and study duration. Incidence was computed by dividing the total number of SCA events by the product of the community’s population and the study duration. Results: Reports from 35 communities met the inclusion criteria. A total of 35,801 all-rhythm EMS-treated cardiac arrests occurred during 62.11 million person-years of observation resulting in an overall incidence of 54.99 per 100,000 person-years. The incidence of ventricular fibrillation-rhythm SCA was 21.32 per 100,000 person-years. Sensitivity analyses generally produced similar results. Applying these results to the US population, 155,000 persons would experience EMS-treated all-rhythm SCA and 60,000 persons would experience EMS-treated ventricular fibrillation-rhythm SCA annually in the US. Survival was 8.4% for all-rhythm and 17.7% for ventricular fibrillation SCA. Conclusion: The results provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of SCA.

Sumàrio

Introdução:O impacto potencial dos esforços para melhorar a cadeia de sobrevivência para as paragens cardı́acas súbitas (SCA) pré-hospitalares é desconhecido, em parte porque as estimativas da incidência de casos tratáveis de SCA são imprecisas. O objectivo da investigação foi determinar uma incidência nacional representativa das SCA tratadas pelos Serviços de Emergência Médica (EMS) em todos os ritmos e em fibrilhação ventricular (VF), assim como a sobrevida.

Métodos: Usamos a Medline para identificar artigos revistos por peritos e publicados entre 1 de Janeiro de 1980 e 31 de Março de 2003, apresentando experiências de SCA tratadas pelos EMS em comunidades americanas. Os critérios de inclusão obrigaram a que o estudo incluı́sse pelo menos 25 casos, registos do número total de paragens em todos os ritmos e/ou fibrilhação ventricular e informação sobre o tamanho da população e a duração do estudo. A incidência foi calculada pela razão entre o número total de eventos de SCA e o produto da população pela duração do estudo.

Resultados:Resultados de 35 comunidades cumpriram os critérios de inclusão. Ocorreram 35.801 paragens cardı́acas em todos os ritmos, tratadas pelos EMS, em 62,11 milhões de pessoas/ano de observação, o que resultou numa incidência global de 54,99 por 100.000 pessoas/ano. A incidência de SCA com ritmo de fibrilhação ventricular foi de 21,32 por 100.000 pessoas/ano. As análises de sensibilidade obtiveram resultados similares. Aplicando estes resultados à população dos Estados Unidos, anualmente 155.000 pessoas sofrem SCA em todos os ritmos e 60.000 pessoas sofrem SCA em ritmo de fibrilhação ventricular, tratadas pelos EMS. A sobrevida foi de 8,4% para SCA em todos os ritmos e de 17,7% em fibrilhação ventricular.

Conclusão:Os resultados fornecem uma base para avaliar as limitações e oportunidades dos cuidados dos EMS em relação ao peso das SCA na saúde pública.

Resumen

Antecedentes: El impacto potencial de los esfuerzos para mejorar la cadena de sobrevida para paro cardiaco súbito(SCA) extrahospitalario no es claro en parte porque las estimaciones de la incidencia de casos tratables de SCA es incierta. El objetivo de esta investigación es determinar una incidencia nacional representativa SCA tratados por los servicios de emergencia médicas por todos los ritmos y por fibrilación ventricular(VF) al igual que la sobrevida.

Métodos: Usamos Medline para identificar artı́culos de revisión publicados entre Enero 1 1980 y Marzo 31 2003 que reportara la experiencia de SCA tratado por EMD en la comunidad de EEUU. Los criterios de inclusión del estudio requirieron que el estudio fuera de al menos 25 casos, que reportara el numero total de SCA por todos los ritmos y / o por VF, y que proporcionara información acerca del tamaño de la población y duración del estudio. La incidencia fue computada dividiendo el número total de eventos SCA por el producto de la población de la comunidad y la duración del estudio.

Resultados: Reportes de 35 comunidades alcanzaron los criterios de inclusión. Ocurrieron un total de 35801 SCA por todos los ritmos, tratados por EMS ocurrieron durante 62.11 millones de persona-años de observación resultando en una incidencia global de 54.99 por 100000persona-año. La incidencia de SCA por VF fue de 21.32 por 100000 persona-año.Los análisis de sensibilidad generalmente produjeron resultados similares. Al aplicar los resultados a la población de EEUU, 155000 personas experimentarı́an SCA por todos los ritmos tratado por EMS y 60000 personas experimentarı́an SCA en VF tratado por EMS anualmente en los EEUU. La sobrevida fue 8.4% para SCA por todos los ritmos y 17.7% para SCA porVF.

Conclusión: El resultado proporciona un medio para evaluar oportunidades y limitaciones de los cuidados de EMS con relación a los marcos de salud pública del SCA.

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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