Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in Utstein style.

The purpose of this study was to describe the chain of survival in Amsterda m and its surroundings and to suggest areas for improvement. To ensure accu rate data, collection was made by research personnel during the resuscitati on, according to the Utstein recommendations. Between June 1, 1995 and Augu st 1, 1997 all consecutive cardiac arrests were registered. Patient charact eristics, resuscitation characteristics and time intervals were analyzed in relation to survival. From the 1046 arrests with a cardiac etiology and wh ere resuscitation was attempted, 918 cases were not witnessed by EMS person nel. The analysis focussed on these 918 patients of whom 686 (75%) died dur ing resuscitation, 148 (16%) died during hospital admission and 84 patients (9%) survived to hospital discharge. Patient and resuscitation characteris tics associated with survival were: age, VF as initial rhythm, witnessed ar rest and bystander CPR. EMS arrival time was significantly shorter for surv ivors (median 9 min) compared to non-survivors (median 11 min). In 151 case s the police was also alerted and arrived 5 min (median) earlier than EMS p ersonnel. Using the OPC/CPC good functional health was observed in 50% of t he survivors and moderate performance in 29%. All links in the chain of sur vival must be strengthened, but equipping the police with semi-automatic de fibrillators may be the most useful intervention to improve survival. (C) 1 998 Elsevier Science ireland Ltd. All rights reserved.