EVALUATION OF OUTCOME FOLLOWING CARDIAC-ARREST IN PATIENTS PRESENTINGTO 2 SCOTTISH EMERGENCY DEPARTMENTS

Objectives: To compare and contrast outcomes following cardiac arrest managed in two Accident and Emergency departments, and to identify fac tors which might account for such differences. Design: Prospective 1-y ear evaluation of patients sustaining an out-of-hospital cardiac arres t. Setting: The Accident and Emergency departments of the Edinburgh (E RI) and Glasgow (GRI) Royal Infirmaries which serve two large urban mu nicipalities. Patients: All patients sustaining a prehospital cardiac arrest and brought to ERI or GRI were included. Children(<13 years), t hose declared dead on arrival at the scene, and events related to pois oning, near drowning, trauma and pregnancy were excluded. Measurements and main results: There were 297 prehospital arrests from ERI, and 15 8 from GRI. Eighty-two (27.6%) were admitted as 'in-patients' to ERI a nd 23 (14.6%) to GRI (P < 0.01). Thirty-nine (13.1%) survived to hospi tal discharge from ERI; 13 (8.2%) survived to discharge from GRI (NS). The proportion of VF/VT:Asystole observed was significantly different between the two centres - 162:98 from ERI, 54:73 from GRI (P < 0.001) . Significantly more prehospital arrests were witnessed and received b ystander CPR in those brought to ERI (P < 0.02). For the combined VF/V T/Asystole groups the ERI ambulance response times were significantly shorter (P < 0.01). However, there was no significant difference in th e collapse to EMS arrival at the scene times between ERI and GRI. Two survivors from ERI had asystole as their initial observed rhythm. From GRI, one survivor had asystole, one had electromechanical dissociatio n and in another the initial rhythm was unknown. No survivor to discha rge had severe neurological disability. Conclusions: Patients sufferin g out-of-hospital cardiac arrests in Edinburgh have a significantly be tter chance of being admitted to a ward. There is a trend favouring be tter survival to discharge in Edinburgh, but with the numbers investig ated this does not achieve statistical significance. Amongst those fac tors which contribute to survival there are fewer witnessed arrests, l ess bystander CPR and slower ambulance response times in those brought to GRI. There is a need to investigate the environment in which patie nts collapse, to train the public in CPR, and to review the efficiency and resourcing of the ambulance service.