What Else Is Needed to Improve Survival from Out-of-Hospital Cardiac Arrest to Hospital Admission? Data from a Prospective Registry for the Years 2020-2023 in the Italian Province of Varese.
Journal of Clinical Medicine · 2023-11-23 · Registry study
Abstract
Around the world, data on out-of-hospital cardiac arrest (OHCA) are heterogeneous in terms of outcomes and reporting, and not all registries follow the Utstein recommendations for uniform OHCA data collection. This study reports data on OHCA occurring in recent years in a limited territory to analyze, in a homogenous setting, the circumstances and interventions affecting survival to hospital admission. OHCA data from the province of Varese for the years 2020-2022 were extracted from a prospective registry. For survival to hospital admission, the impact of pandemic waves and variables known to affect survival was evaluated both in the overall population and in the subgroup of patients in whom cardiopulmonary resuscitation (CPR) was initiated or continued by the emergency medical service (EMS). Overall, 3263 OHCAs occurred mainly at home (88%), with a time to intervention of 13.7 min, which was significantly longer during lockdown (15.7 min). Bystanders performed CPR in 22% of the cases and used automatic external defibrillator (AED) in 2.2% of the cases. Overall survival to hospital admission was 7.7%. In the multivariate analysis, in the general population, occurrence near a public building (OR 1.92), the presence of witnesses (OR 2.65), and a shockable rhythm (OR 7.04) were independent predictors of survival to hospital admission, whereas age (OR 0.97) and occurrence during a pandemic wave (OR 0.62) were associated with significantly worse survival to hospital admission. In the group of patients who received CPR, AED shock by bystanders was the only independent predictor of survival (OR 3.14) to hospital admission. Among other factors, early defibrillation was of crucial importance to improve survival to hospital admission in possibly rescuable patients. The occurrence of OHCA during pandemic waves was associated with longer intervention time and worse survival to hospital admission.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Automated external defibrillator · Bystanders · COVID-19 pandemic · Mortality & survival · Time intervals
Related articles
- Out-of-Hospital Cardiac Arrest Response and Outcomes During the COVID-19 Pandemic. (JACC Clin Electrophysiol, 2021)
- Comparison of out-of-hospital cardiac arrests during the COVID-19 pandemic with those before the pandemic: an updated systematic review and meta-analysis. (Front Public Health, 2023)
- Impact of pandemic-related movement restriction on public access defibrillation in Japan: a retrospective cohort study. (BMJ Open, 2024)
- Mobile applications enhance out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis. (BMC Health Serv Res, 2025)
- Out-of-Hospital Cardiac Arrest during the COVID-19 Pandemic: A Systematic Review. (Healthcare (Basel), 2023)
- Cumulative effect of public health interventions on time interval to first chest compression and survival outcomes in out-of-hospital cardiac arrest. (Resuscitation, 2025)