How a system saves lives: Results of Luxembourg's nationwide cardiac arrest project.
Resuscitation Plus · 2025-10-10 · Quasi-experimental
Abstract
BACKGROUND: In 2018 the prehospital Emergency Medical System (EMS) in Luxembourg underwent a major reorganization by the creation of a single EMS structure. We aimed to study the impact of this reorganization on outcome after out-of-hospital cardiac arrest (OHCA). METHODS STUDY DESIGN: We conducted a before-and-after study on outcome after OHCA in Luxembourg taking advantage of the existing EuReCa studies protocols and case report forms. The first period extended from October 2017 to September 2018, and the second from September 2021 to August 2022. SETTING: Nationwide observational database on OHCA. PARTICIPANTS: All OHCA patients within the territory of the Grand Duchy of Luxembourg reported through an emergency call. INTERVENTION: None. MAIN OUTCOMES AND MEASURES: The primary outcome was the survival rate after OHCA. Secondary outcomes were rates of bystander and phone cardio-pulmonary resuscitation (CPR), return of spontaneous circulation (ROSC) rates and arrival times of EMS. RESULTS: Over the 2 time periods, the incidence of OHCA emergency calls remained stable, whereas the confirmed OHCA increased from 236 to 375 cases per year. Bystander and phone CPR rates significantly increased, by 1.5 and 5-fold, respectively. EMS response time was significantly reduced (16:19 min vs 11:03 min, p < 0.001) and associated with significantly improved survival (OR per minute 0.83, 95 % CI 0.73-0.95). Hospital admission with ROSC increased non-significantly from 19 % to 24 % (p = 0.08) and 1-month survival increased significantly from 9 (3.8 %) to 37 survivors (9.8 %) (p = 0.006), corresponding to 28 additional lives saved within one year. No statistically significant difference could be shown on 1-month survival or ROSC rate when phone CPR or bystander CPR were performed. CONCLUSION: Over 4 years, major structural and organizational EMS changes led to significantly shorter EMS response times and were accompanied by a significant increase of survival after OHCA. Whether other factors also have contributed to better survival remains unclear.
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Tags
Bystanders · Dispatchers & call takers · Mortality & survival · Time intervals
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