PREHOSPITAL RESUSCITATION IN URBAN CONDIT IONS - RESULTS AND DECISIVEPROGNOSTIC FACTORS

From 1983 to 1991, 214 patients (age 62+/-15 years; 72% male) with out -of-hospital cardiac arrest were resuscitated in the field and transpo rted to the hospital with basic cardiac life support only (manual ches t compression, assisted ventilation by bag-air-valve). In 64 patients (30%; 95% confidence interval [CI]: 24-36%) a stable circulation allow ing admission to the intensive care unit was restored in the emergency room. 26 patients (12%; CI: 8-17%) survived to hospital discharge. 20 patients showed no or only mild neurological impairment, 4 had modera te cognitive deficits, and 2 patients were in a permanent vegetative s tate. Multiple logistic regression revealed by-stander resuscitation b efore arrival of the ambulance (odds ratio [OR]: 4.7 [CI: 1.5-14.7]; p < 0.01) and ventricular fibrillation on arrival in the emergency room (OR: 42.8 [CI: 5.2-350]; p = 0.0005) to be statistically significant predictors of survival. These data justify continuation and extension of resuscitation efforts in the emergency room if patients were given only basic cardiac life support in the field and during transport. Pat ients who arrive in ventricular fibrillation and who were resusciated by a bystander prior to the arrival of the ambulance team have a reali stic chance of survival. Delegation of competence to defibrillate to t rained, non-physician ambulance personnel may reduce the duration or c ardiac arrest in patients with ventricular fibrillation and thus save lives.