PREHOSPITAL CARDIAC-ARREST IN LEICESTERSHIRE - TARGETING AREAS FOR IMPROVEMENT

Objective-To identify the impact of advanced life support skills on ou tcome for prehospital cardiac arrest in a defined population and to as sess the value of certain physiological variables in predicting the ou tcome in those successfully resuscitated in the accident and emergency (A&E) department; to identify areas for improvement in the outcome of such patients. Design-Prospective 12 month study. Setting-Leicestersh ire, United Kingdom. Main outcome measure-Survival to hospital dischar ge and status at 6 months. Results-266 patients were identified as hav ing suffered a prehospital cardiac arrest; of these, 86 had their resu scitation attempt terminated in the community by a general practitione r and 180 were transferred to the A&E department of the Leicester Roya l Infirmary Of the latter, 159 were felt to be of cardiac aetiology, a nd 19 were eventually discharged from hospital. All survivors had expe rienced a witnessed cardiac arrest, ventricular fibrillation (VF) bein g identified as the initial rhythm. After adjusting for age and sex us ing logistic regression, the Glasgow coma score (GCS) was found to be associated with subsequent mortality (chi(2) = 18.22 on 2 df, P < 0.00 01). Compared to a baseline GCS of 9-15, the relative odds of death fo r a GCS of 3 were 25.3 (95% confidence interval 4.3 to 149.9), while a GCS of 4-8 gave a relative odds of death of 12.18 (95% CI 1.8 to 80.2 ). No significant association was found between postarrest arterial pH and mortality. Conclusions-The immediate GCS on admission is a predic tor of outcome and it is important to monitor its trend in the first 2 4 h. Multidisciplinary audit and joint guidelines with other specialti es are important in optimising the care of these patients.