Cardiac Arrest Registries
Cardiac arrest registries can provide valuable information on the demographics of those whosuffer a cardiac emergency, on the circumstances of the collapse, on the emergency responseand on outcomes. Registry data can estimate the likely incidence of cardiac arrests requiringresponse by the EMS. Registries however underestimate the total number of SCDs as they donot include arrests that were not witnessed. Neither do they include events for which nocardiac arrest is called, for example in sudden collapse of someone with other seriousmorbidity.
Death certificate data and data compiled by the EMS were analysed for the State ofWashington in the year 2000.17 There were 3,577 deaths from cardiac disease in thispopulation of nearly 2 million. The EMS responded to 39% of all heart disease deaths,representing 57% of out-of-hospital events (including 128 people who were successfullyresuscitated and discharged from hospital).
Using multiple sources of information, SCD incidence was 53 per 100 000 (median [central]age 69 years, 57% male) in 2002 in Multnomah County in Oregon, representing 6% ofannual mortality.18 Resuscitation was attempted in two-thirds of cases and 8% survived tohospital discharge. One in five cases was identified using sources other than first responders.
A retrospective analysis of death certificates for 2002 using ICD-10 codes and location ofdeath gave an estimated SCD rate of 153 per 100,000 (median age 81, 51% male) whichwould have greatly overestimated the required EMS response.
The Helsinki Cardiac Arrest Registry reported an incidence of out-of-hospital cardiac arrest of 80 per 100,000 inhabitants per year between 1994 and 1999.19 A similar rate (9.2 / 10,000)was reported for 1997 – 2000 by the Maastricht Circulatory Arrest Registry.20 Sudden deathrepresented 19% of all deaths.
If, as in Washington State, the EMS in Ireland respond to 39% of all cardiac deaths, thiswould have corresponded to 3,169 such deaths in 2002, or 81 per 100,000 population, similarto rates reported by other North European countries.
There have been several studies of the circumstances of sudden collapse. The Belfast study ofout-of-hospital deaths in 2003 – 2004 used multiple sources of information to identifySCDs.
There were 297 such deaths in 12 months, 66% of which were in men. The meanage was 68 years (65 in men and 72 in women). The majority, 78%, occurred at home, 16%were in a public place and the remainder in a nursing home; 93% were attended by theEMS. The mean ‘call to response’ interval was 8 minutes and 27% were in ventricularfibrillation (VF) when the EMS arrived. This was higher (53%) in witnessed arrests. In thoseattended by the EMS, nearly one in ten were resuscitated to reach hospital alive and 7%survived to hospital discharge.
Several studies have examined the factors associated with successful resuscitation. Whenresuscitation was attempted in the Helsinki Registry, fifty-seven patients (17%) survived todischarge.20 Nearly one-third survived when collapse was bystander witnessed and thediagnosis was cardiac arrest with VF as the initial rhythm.
The Swedish Cardiac Arrest Registry found the following factors influenced the likelihood ofsurvival at 1 month: an initial rhythm of VF, shorter time to arrival by the EMS (below themedian i.e. better than the response time in the middle when ordered sequentially), arrestoccurring outside the home, arrest which was witnessed, one where bystander CPR wasinitiated and in younger (below the median) people.
In Seattle, Washington, the annual incidence of cardiac arrest with VF as the first identified rhythm decreased from 0.85 per 1,000 population in 1980 to 0.38 per 1,000 in the year2000.The Swedish Cardiac Arrest Registry reported that between 1992 and 2003 the meanage of out-of-hospital cardiac arrests increased from 68 to 70 years and percentage offemales increased from 29% to 32%.25 There was a decrease in cases of cardiac origin from75% to 61% and a decrease from 36% to 25% of arrests with VF as the initial rhythm. Thesechanges reflect the changing patterns of mortality in many developed countries, withdecreasing death rates and a smaller proportion of deaths being attributed to cardiovasculardisease.
Some studies of cardiac arrest use data from cardiac arrest registries; others add supplementary data from other sources. The case definition for registration may vary, toinclude all cases of sudden collapse or only those cases where resuscitation was attempted.The International Resuscitation Network registry aims to study emergency response andoutcomes.
Audit of emergency response in Ireland will be facilitated by the establishment of a cardiac arrest registry, with data collection to international standards. Chapter 6 of this report considers information systems and surveillance, and makes recommendations toimprove the collection of data relevant to SCD in Ireland.
Death certificate data and data compiled by the EMS were analysed for the State ofWashington in the year 2000.17 There were 3,577 deaths from cardiac disease in thispopulation of nearly 2 million. The EMS responded to 39% of all heart disease deaths,representing 57% of out-of-hospital events (including 128 people who were successfullyresuscitated and discharged from hospital).
Using multiple sources of information, SCD incidence was 53 per 100 000 (median [central]age 69 years, 57% male) in 2002 in Multnomah County in Oregon, representing 6% ofannual mortality.18 Resuscitation was attempted in two-thirds of cases and 8% survived tohospital discharge. One in five cases was identified using sources other than first responders.
A retrospective analysis of death certificates for 2002 using ICD-10 codes and location ofdeath gave an estimated SCD rate of 153 per 100,000 (median age 81, 51% male) whichwould have greatly overestimated the required EMS response.
The Helsinki Cardiac Arrest Registry reported an incidence of out-of-hospital cardiac arrest of 80 per 100,000 inhabitants per year between 1994 and 1999.19 A similar rate (9.2 / 10,000)was reported for 1997 – 2000 by the Maastricht Circulatory Arrest Registry.20 Sudden deathrepresented 19% of all deaths.
If, as in Washington State, the EMS in Ireland respond to 39% of all cardiac deaths, thiswould have corresponded to 3,169 such deaths in 2002, or 81 per 100,000 population, similarto rates reported by other North European countries.
There have been several studies of the circumstances of sudden collapse. The Belfast study ofout-of-hospital deaths in 2003 – 2004 used multiple sources of information to identifySCDs.
There were 297 such deaths in 12 months, 66% of which were in men. The meanage was 68 years (65 in men and 72 in women). The majority, 78%, occurred at home, 16%were in a public place and the remainder in a nursing home; 93% were attended by theEMS. The mean ‘call to response’ interval was 8 minutes and 27% were in ventricularfibrillation (VF) when the EMS arrived. This was higher (53%) in witnessed arrests. In thoseattended by the EMS, nearly one in ten were resuscitated to reach hospital alive and 7%survived to hospital discharge.
Several studies have examined the factors associated with successful resuscitation. Whenresuscitation was attempted in the Helsinki Registry, fifty-seven patients (17%) survived todischarge.20 Nearly one-third survived when collapse was bystander witnessed and thediagnosis was cardiac arrest with VF as the initial rhythm.
The Swedish Cardiac Arrest Registry found the following factors influenced the likelihood ofsurvival at 1 month: an initial rhythm of VF, shorter time to arrival by the EMS (below themedian i.e. better than the response time in the middle when ordered sequentially), arrestoccurring outside the home, arrest which was witnessed, one where bystander CPR wasinitiated and in younger (below the median) people.
In Seattle, Washington, the annual incidence of cardiac arrest with VF as the first identified rhythm decreased from 0.85 per 1,000 population in 1980 to 0.38 per 1,000 in the year2000.The Swedish Cardiac Arrest Registry reported that between 1992 and 2003 the meanage of out-of-hospital cardiac arrests increased from 68 to 70 years and percentage offemales increased from 29% to 32%.25 There was a decrease in cases of cardiac origin from75% to 61% and a decrease from 36% to 25% of arrests with VF as the initial rhythm. Thesechanges reflect the changing patterns of mortality in many developed countries, withdecreasing death rates and a smaller proportion of deaths being attributed to cardiovasculardisease.
Some studies of cardiac arrest use data from cardiac arrest registries; others add supplementary data from other sources. The case definition for registration may vary, toinclude all cases of sudden collapse or only those cases where resuscitation was attempted.The International Resuscitation Network registry aims to study emergency response andoutcomes.
Audit of emergency response in Ireland will be facilitated by the establishment of a cardiac arrest registry, with data collection to international standards. Chapter 6 of this report considers information systems and surveillance, and makes recommendations toimprove the collection of data relevant to SCD in Ireland.
posted by AED Ireland at
11:50 AM
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