OPTIMAL DEFIBRILLATION STRATEGY AND FOLLOW-UP OF OUT-OF-HOSPITAL CARDIAC-ARREST

In the current climate of rising healthcare cost, resuscitation effort s performed outside the hospital are critically evaluated because of t heir limited success rate in some settings. As part of a quality assur ance program between the Ist January 1991 and 31st December 1993, six centres of the Belgian CPCR study group prospectively registered cardi ac arrest (CA) patients and their treatment according to the Utstein S tyle recommendations. In the group (n = 511) of patients initially fou nd in ventricular fibrillation (VF) a significantly better survival ra te was observed for those patients who received a 1st defibrillatory s hock by the Ist tier (n = 142 (27.8%)) as compared to those defibrilla ted after arrival of the 2nd tier (n = 369 (72.2%)). Median time to de livery of the first shock was significantly shorter (5 min) in the Ist tier group. In a second part of the study we describe long-term manag ement of the 28 surviving VF patients, treated by the single EMS syste m of Brugge between Ist January 1991 and 30th April 1995: only 6 patie nts eventually received an implantable cardioverter defibrillator (ICD ), whereas coronary revascularization was performed in 9 patients, and 3 patients were discharged on amiodarone only. Satisfactory long-term survival after out-of-hospital VF can be achieved by an early shock f ollowed by advanced life support and appropriate definitive treatment.