Out-of-hospital cardiac arrest in North-East Germany: increased resuscitation efforts and improved survival

In the years after 1989 major political and socioeconomic changes have take n place in East Germany. In parallel, emergency medical services (EMS) were restructured according to western standards. In Stralsund the EMS was rest ructured from a single to a two tier system with implementation of a second ambulance base in 1990. The number of household telephone extensions more than doubled. To analyze the effects of these changes, patients receiving a dvanced life support (ALS) for out-of-hospital cardiac arrest of cardiac or igin (OHCA) between 1984 and 1988, and from 1991 to 1997 were studied. Adju sted per 100 000 inhabitants, the number of OHCA patients receiving ALS inc reased from 11 per year before 1989 to 52 per year after 1990 (P < 0.01). S urvival without relevant neurologic defects was achieved in 3.7% (2/53) of patients before 1989 and in 8.1% (22/273) after 1990. Response time of the ALS unit shortened from 11.0 +/- 1.4 to 9.0 +/- 0.4 min (n.s.), while respo nse time of any EMS shortened from 11.0 +/- 1.4 to 6.1 +/- 0.3 min (P < 0.0 05). Adjusted for observation period and population served, there was a 10- fold increase in the number of resuscitations attempted at home and an 8-fo ld increase in the absolute number of OHCA survivors without relevant neuro logical defects. In parallel to socioeconomic changes, the restructuring of the EMS in Stralsund and the rapid expansion of the telephone network led to a significant increase in the number of patients successfully resuscitat ed from OHCA. If the present results can be transferred to other former soc ialist countries of East and Middle Europe, they may have important implica tions for the EMS in these regions. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.