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. 1996 Feb;75(2):195–199. doi: 10.1136/hrt.75.2.195

Out-of-hospital cardiac arrest due to coronary heart disease: a comparison of survival before and after the introduction of defribrillators in ambulances.

W S Leslie 1, B Fitzpatrick 1, C E Morrison 1, G C Watt 1, H Tunstall-Pedoe 1
PMCID: PMC484260  PMID: 8673761

Abstract

OBJECTIVE: To assess the actual impact on coronary mortality of equipping ambulances with defibrillators. DESIGN: Retrospective analysis of routine medical and legal records of all those who had a cardiac arrest attributed to coronary heart disease occurring outside hospital in a defined population before and after the introduction of Heartstart. SETTING: City of Glasgow, North of the River Clyde, 1984 and 1990. PATIENTS: 296 and 267 men and women aged 25-64 inclusive in 1984 and 1990 respectively who had a cardiac arrest outside hospital which was attributed to coronary heart disease (International Classification of Diseases codes 410-414, ninth revision). RESULTS: The impact on coronary mortality in 1990 of equipping ambulances with defibrillators concurred with the earlier prediction of less than 1% of all coronary deaths. The circumstances of cardiac arrest were largely unchanged; most occurred outside hospital in the victim's home and the principal witnesses were members of the victim's family. A call for help before cardiac arrest was made in very few cases and cardiopulmonary resuscitation was attempted by laypersons in less than a third of the deaths they witnessed. There was a significant increase in the number of cardiopulmonary resuscitation attempts made by ambulance crews (16% v 32%, P < 0.01). Ambulance crews, however, still attended less than half of all cases (44% and 47%). CONCLUSION: The impact of equipping ambulances with defibrillators will remain small unless strategies are introduced that focus on improving the public's response to coronary emergencies by calling for help promptly and initiating cardiopulmonary resuscitation before the arrival of the emergency services.

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Selected References

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  1. Armstrong A., Duncan B., Oliver M. F., Julian D. G., Donald K. W., Fulton M., Lutz W., Morrison S. L. Natural history of acute coronary heart attacks. A community study. Br Heart J. 1972 Jan;34(1):67–80. doi: 10.1136/hrt.34.1.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blohm M., Herlitz J., Hartford M., Karlson B. W., Risenfors M., Luepker R. V., Sjölin M., Holmberg S. Consequences of a media campaign focusing on delay in acute myocardial infarction. Am J Cardiol. 1992 Feb 1;69(4):411–413. doi: 10.1016/0002-9149(92)90244-s. [DOI] [PubMed] [Google Scholar]
  3. Cobbe S. M., Redmond M. J., Watson J. M., Hollingworth J., Carrington D. J. "Heartstart Scotland"--initial experience of a national scheme for out of hospital defibrillation. BMJ. 1991 Jun 22;302(6791):1517–1520. doi: 10.1136/bmj.302.6791.1517. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fitzpatrick B., Watt G. C., Tunstall-Pedoe H. Potential impact of emergency intervention on sudden deaths from coronary heart disease in Glasgow. Br Heart J. 1992 Mar;67(3):250–254. doi: 10.1136/hrt.67.3.250. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ho M. T., Eisenberg M. S., Litwin P. E., Schaeffer S. M., Damon S. K. Delay between onset of chest pain and seeking medical care: the effect of public education. Ann Emerg Med. 1989 Jul;18(7):727–731. doi: 10.1016/s0196-0644(89)80004-6. [DOI] [PubMed] [Google Scholar]
  6. McNeilly R. H., Pemberton J. Duration of last attack in 998 fatal cases of coronary artery disease and its relation to possible cardiac resuscitation. Br Med J. 1968 Jul 20;3(5611):139–142. doi: 10.1136/bmj.3.5611.139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Rainer T. H., Gordon M. W., Robertson C. E., Cusack S. Evaluation of outcome following cardiac arrest in patients presenting to two Scottish emergency departments. Resuscitation. 1995 Feb;29(1):33–39. doi: 10.1016/0300-9572(94)00813-u. [DOI] [PubMed] [Google Scholar]
  8. Rawles J. M., Haites N. E. Patient and general practitioner delays in acute myocardial infarction. Br Med J (Clin Res Ed) 1988 Mar 26;296(6626):882–884. doi: 10.1136/bmj.296.6626.882. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Rowley J. M., Garner C., Hampton J. R. The limited potential of special ambulance services in the management of cardiac arrest. Br Heart J. 1990 Nov;64(5):309–312. doi: 10.1136/hrt.64.5.309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Sedgwick M. L., Dalziel K., Watson J., Carrington D. J., Cobbe S. M. Performance of an established system of first responder out-of-hospital defibrillation. The results of the second year of the Heartstart Scotland Project in the 'Utstein Style'. Resuscitation. 1993 Aug;26(1):75–88. doi: 10.1016/0300-9572(93)90166-n. [DOI] [PubMed] [Google Scholar]
  11. Tunstall-Pedoe H., Kuulasmaa K., Amouyel P., Arveiler D., Rajakangas A. M., Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994 Jul;90(1):583–612. doi: 10.1161/01.cir.90.1.583. [DOI] [PubMed] [Google Scholar]
  12. Uemura K., Pisa Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat Q. 1988;41(3-4):155–178. [PubMed] [Google Scholar]
  13. Valenzuela T. D., Spaite D. W., Meislin H. W., Clark L. L., Wright A. L., Ewy G. A. Case and survival definitions in out-of-hospital cardiac arrest. Effect on survival rate calculation. JAMA. 1992 Jan 8;267(2):272–274. [PubMed] [Google Scholar]
  14. Wallbridge D. R., Tweddel A. C., Martin W., Cobbe S. M. The potential impact of patient self-referral on mortality in acute myocardial infarction. Q J Med. 1992 Nov-Dec;85(307-308):901–909. [PubMed] [Google Scholar]
  15. Weston C. F., Penny W. J., Julian D. G. Guidelines for the early management of patients with myocardial infarction. British Heart Foundation Working Group. BMJ. 1994 Mar 19;308(6931):767–771. doi: 10.1136/bmj.308.6931.767. [DOI] [PMC free article] [PubMed] [Google Scholar]

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