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Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2020

Open Access 01-12-2020 | Original research

Description of Emergency Medical Services, treatment of cardiac arrest patients and cardiac arrest registries in Europe

Authors: Ingvild B. M. Tjelmeland, Siobhan Masterson, Johan Herlitz, Jan Wnent, Leo Bossaert, Fernando Rosell-Ortiz, Kristin Alm-Kruse, Berthold Bein, Gisela Lilja, Jan-Thorsten Gräsner, on behalf of GL2020 Epidemiology group and participating countries

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2020

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Abstract

Background

Variation in the incidence, survival rate and factors associated with survival after cardiac arrest in Europe is reported. Some studies have tried to fill the knowledge gap regarding the epidemiology of out-of-hospital cardiac arrest in Europe but were unable to identify reasons for the reported differences. Therefore, the purpose of this study was to describe European Emergency Medical Systems, particularly from the perspective of country and ambulance service characteristics, cardiac arrest identification, dispatch, treatment, and monitoring.

Methods

An online questionnaire with 51 questions about ambulance and dispatch characteristics, on-scene management of cardiac arrest and the availability and dataset in cardiac arrest registries, was sent to all national coordinators who participated in the European Registry of Cardiac Arrest studies. In addition, individual invitations were sent to the remaining European countries.

Results

Participants from 28 European countries responded to the questionnaire. Results were combined with official information on population density. Overall, the number of Emergency Medical Service missions, level of training of personnel, availability of Helicopter Emergency Medical Services and the involvement of first responders varied across and within countries. There were similarities in team training, availability of key resuscitation equipment and permission for ongoing performance of cardiopulmonary resuscitation during transported. The quality of reporting to cardiac arrest registries varied, as well as the data availability in the registries.

Conclusions

Throughout Europe there are important differences in Emergency Medical Service systems and the response to out-of-hospital cardiac arrest. Explaining these differences is complicated due to significant variation in how variables are reported to and used in registries.
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Literature
1.
go back to reference Zive DM, Schmicker R, Daya M, Kudenchuk P, Nichol G, Rittenberger JC, et al. Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium. Resuscitation. 2018;131:74–82.CrossRef Zive DM, Schmicker R, Daya M, Kudenchuk P, Nichol G, Rittenberger JC, et al. Survival and variability over time from out of hospital cardiac arrest across large geographically diverse communities participating in the Resuscitation Outcomes Consortium. Resuscitation. 2018;131:74–82.CrossRef
2.
go back to reference Beck B, Bray J, Cameron P, Smith K, Walker T, Grantham H, et al. Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: results from the Aus-ROC Epistry. Resuscitation. 2018;126:49–57.CrossRef Beck B, Bray J, Cameron P, Smith K, Walker T, Grantham H, et al. Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: results from the Aus-ROC Epistry. Resuscitation. 2018;126:49–57.CrossRef
3.
go back to reference Ong MEH, Shin SD, De Souza NNA, Tanaka H, Nishiuchi T, Song KJ, et al. Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: the Pan Asian Resuscitation Outcomes Study (PAROS). Resuscitation. 2015;96:100–8.CrossRef Ong MEH, Shin SD, De Souza NNA, Tanaka H, Nishiuchi T, Song KJ, et al. Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: the Pan Asian Resuscitation Outcomes Study (PAROS). Resuscitation. 2015;96:100–8.CrossRef
4.
go back to reference Gräsner J-T, Lefering R, Koster RW, Masterson S, Böttiger BW, Herlitz J, et al. EuReCa ONE; 27 Nations, ONE Europe, ONE Registry. Resuscitation. 2016;105:188–95.CrossRef Gräsner J-T, Lefering R, Koster RW, Masterson S, Böttiger BW, Herlitz J, et al. EuReCa ONE; 27 Nations, ONE Europe, ONE Registry. Resuscitation. 2016;105:188–95.CrossRef
5.
go back to reference Gräsner J-T, Wnent J, Herlitz J, Perkins GD, Lefering R, Tjelmeland I, et al. Survival after out-of-hospital cardiac arrest in Europe - results of the EuReCa TWO study. Resuscitation. 2020;148:218–26.CrossRef Gräsner J-T, Wnent J, Herlitz J, Perkins GD, Lefering R, Tjelmeland I, et al. Survival after out-of-hospital cardiac arrest in Europe - results of the EuReCa TWO study. Resuscitation. 2020;148:218–26.CrossRef
6.
go back to reference Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 2015;96:328–40.CrossRef Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 2015;96:328–40.CrossRef
7.
go back to reference Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3(1):63–81.CrossRef Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3(1):63–81.CrossRef
8.
go back to reference Buick JE, Ray JG, Kiss A, Morrison LJ. The association between neighborhood effects and out-of-hospital cardiac arrest outcomes. Resuscitation. 2016;103:14–9.CrossRef Buick JE, Ray JG, Kiss A, Morrison LJ. The association between neighborhood effects and out-of-hospital cardiac arrest outcomes. Resuscitation. 2016;103:14–9.CrossRef
9.
go back to reference Rea TD, Cook AJ, Stiell IG, Powell J, Bigham B, Callaway CW, et al. Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. Ann Emerg Med. 2010;55(3):249–57.CrossRef Rea TD, Cook AJ, Stiell IG, Powell J, Bigham B, Callaway CW, et al. Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. Ann Emerg Med. 2010;55(3):249–57.CrossRef
10.
go back to reference Dyson K, Brown SP, May S, Smith K, Koster RW, Beesems SG, et al. International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template. Resuscitation. 2019;138:168–81. Dyson K, Brown SP, May S, Smith K, Koster RW, Beesems SG, et al. International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template. Resuscitation. 2019;138:168–81.
11.
go back to reference Sun KM, Song KJ, Shin SD, Tanaka H, Shaun GE, Chiang WC, et al. Comparison of emergency medical services and trauma care systems among Pan-Asian countries: an international, multicenter, population-based survey. Prehosp Emerg Care. 2017;21(2):242–51.CrossRef Sun KM, Song KJ, Shin SD, Tanaka H, Shaun GE, Chiang WC, et al. Comparison of emergency medical services and trauma care systems among Pan-Asian countries: an international, multicenter, population-based survey. Prehosp Emerg Care. 2017;21(2):242–51.CrossRef
12.
go back to reference Beck B, Bray JE, Smith K, Walker T, Grantham H, Hein C, et al. Description of the ambulance services participating in the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry. Emerg Med Australas. 2016;28(6):673–83.CrossRef Beck B, Bray JE, Smith K, Walker T, Grantham H, Hein C, et al. Description of the ambulance services participating in the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry. Emerg Med Australas. 2016;28(6):673–83.CrossRef
13.
go back to reference Davis DP, Garberson LA, Andrusiek DL, Hostler D, Daya M, Pirrallo R, et al. A descriptive analysis of emergency medical service systems participating in the resuscitation outcomes consortium (ROC) network. Prehosp Emerg Care. 2007;11(4):369–82.CrossRef Davis DP, Garberson LA, Andrusiek DL, Hostler D, Daya M, Pirrallo R, et al. A descriptive analysis of emergency medical service systems participating in the resuscitation outcomes consortium (ROC) network. Prehosp Emerg Care. 2007;11(4):369–82.CrossRef
14.
go back to reference Govindarajan P, Lin L, Landman A, McMullan JT, McNally BF, Crouch AJ, et al. Practice variability among the EMS systems participating in cardiac arrest registry to enhance survival (CARES). Resuscitation. 2012;83(1):76–80.CrossRef Govindarajan P, Lin L, Landman A, McMullan JT, McNally BF, Crouch AJ, et al. Practice variability among the EMS systems participating in cardiac arrest registry to enhance survival (CARES). Resuscitation. 2012;83(1):76–80.CrossRef
15.
go back to reference Takei Y, Inaba H, Yachida T, Enami M, Goto Y, Ohta K. Analysis of reasons for emergency call delays in Japan in relation to location: high incidence of correctable causes and the impact of delays on patient outcomes. Resuscitation. 2010;81(11):1492–8.CrossRef Takei Y, Inaba H, Yachida T, Enami M, Goto Y, Ohta K. Analysis of reasons for emergency call delays in Japan in relation to location: high incidence of correctable causes and the impact of delays on patient outcomes. Resuscitation. 2010;81(11):1492–8.CrossRef
16.
go back to reference Tranberg T, Lippert FK, Christensen EF, Stengaard C, Hjort J, Lassen JF, et al. Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest: a nationwide study. Eur Heart J. 2017;38(21):1645–52.CrossRef Tranberg T, Lippert FK, Christensen EF, Stengaard C, Hjort J, Lassen JF, et al. Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest: a nationwide study. Eur Heart J. 2017;38(21):1645–52.CrossRef
17.
go back to reference Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Koster RW. AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest. Resuscitation. 2020;150:170–7.CrossRef Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Koster RW. AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest. Resuscitation. 2020;150:170–7.CrossRef
18.
go back to reference Lee SCL, Mao DR, Ng YY, Leong BSH, Supasaovapak J, Gaerlan FJ, et al. Emergency medical dispatch services across Pan-Asian countries: a web-based survey. BMC Emerg Med. 2020;20(1):8.CrossRef Lee SCL, Mao DR, Ng YY, Leong BSH, Supasaovapak J, Gaerlan FJ, et al. Emergency medical dispatch services across Pan-Asian countries: a web-based survey. BMC Emerg Med. 2020;20(1):8.CrossRef
20.
go back to reference Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VR, Deakin CD, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines for post-resuscitation care 2015: section 5 of the European Resuscitation Council guidelines for resuscitation 2015. Resuscitation. 2015;95:202–22.CrossRef Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VR, Deakin CD, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines for post-resuscitation care 2015: section 5 of the European Resuscitation Council guidelines for resuscitation 2015. Resuscitation. 2015;95:202–22.CrossRef
21.
go back to reference Fischer M, Kamp J, Riesgo LGC, Robertson-Steel I, Overton J, Ziemann A, et al. Comparing emergency medical service systems-a project of the European Emergency Data (EED) project. Resuscitation. 2011;82(3):285–93.CrossRef Fischer M, Kamp J, Riesgo LGC, Robertson-Steel I, Overton J, Ziemann A, et al. Comparing emergency medical service systems-a project of the European Emergency Data (EED) project. Resuscitation. 2011;82(3):285–93.CrossRef
22.
go back to reference Zive D, Koprowicz K, Schmidt T, Stiell I, Sears G, Van Ottingham L, et al. Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest. Resuscitation. 2011;82(3):277–84.CrossRef Zive D, Koprowicz K, Schmidt T, Stiell I, Sears G, Van Ottingham L, et al. Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest. Resuscitation. 2011;82(3):277–84.CrossRef
23.
go back to reference Okubo M, Schmicker RH, Wallace DJ, et al. Variation in survival after out-of-hospital cardiac arrest between emergency medical services agencies. JAMA Cardiol. 2018;3(10):989–99.CrossRef Okubo M, Schmicker RH, Wallace DJ, et al. Variation in survival after out-of-hospital cardiac arrest between emergency medical services agencies. JAMA Cardiol. 2018;3(10):989–99.CrossRef
24.
go back to reference Oving I, Masterson S, Tjelmeland IBM, Jonsson M, Semeraro F, Ringh M, et al. First-response treatment after out-of-hospital cardiac arrest: a survey of current practices across 29 countries in Europe. Scand J Trauma Resusc Emerg Med. 2019;27(1):112.CrossRef Oving I, Masterson S, Tjelmeland IBM, Jonsson M, Semeraro F, Ringh M, et al. First-response treatment after out-of-hospital cardiac arrest: a survey of current practices across 29 countries in Europe. Scand J Trauma Resusc Emerg Med. 2019;27(1):112.CrossRef
25.
go back to reference Shibahashi K, Ishida T, Kuwahara Y, Sugiyama K, Hamabe Y. Effects of dispatcher-initiated telephone cardiopulmonary resuscitation after out-of-hospital cardiac arrest: a nationwide, population-based, cohort study. Resuscitation. 2019;144:6–14.CrossRef Shibahashi K, Ishida T, Kuwahara Y, Sugiyama K, Hamabe Y. Effects of dispatcher-initiated telephone cardiopulmonary resuscitation after out-of-hospital cardiac arrest: a nationwide, population-based, cohort study. Resuscitation. 2019;144:6–14.CrossRef
26.
go back to reference Noel L, Jaeger D, Baert V, Debaty G, Genin M, Sadoune S, et al. Effect of bystander CPR initiated by a dispatch centre following out-of-hospital cardiac arrest on 30-day survival: adjusted results from the French National Cardiac Arrest Registry. Resuscitation. 2019;144:91–8.CrossRef Noel L, Jaeger D, Baert V, Debaty G, Genin M, Sadoune S, et al. Effect of bystander CPR initiated by a dispatch centre following out-of-hospital cardiac arrest on 30-day survival: adjusted results from the French National Cardiac Arrest Registry. Resuscitation. 2019;144:91–8.CrossRef
27.
go back to reference Neves Briard J, de Montigny L, Ross D, de Champlain F, Segal E. Is distance to the nearest registered public automated defibrillator associated with the probability of bystander shock for victims of out-of-hospital cardiac arrest? Prehosp Disaster Med. 2018;33(2):153–9. Neves Briard J, de Montigny L, Ross D, de Champlain F, Segal E. Is distance to the nearest registered public automated defibrillator associated with the probability of bystander shock for victims of out-of-hospital cardiac arrest? Prehosp Disaster Med. 2018;33(2):153–9.
28.
go back to reference Kiyohara K, Nitta M, Sato Y, Kojimahara N, Yamaguchi N, Iwami T, et al. Ten-year trends of public-access defibrillation in Japanese school-aged patients having neurologically favorable survival after out-of-hospital cardiac arrest. Am J Cardiol. 2018;122(5):890–7.CrossRef Kiyohara K, Nitta M, Sato Y, Kojimahara N, Yamaguchi N, Iwami T, et al. Ten-year trends of public-access defibrillation in Japanese school-aged patients having neurologically favorable survival after out-of-hospital cardiac arrest. Am J Cardiol. 2018;122(5):890–7.CrossRef
29.
go back to reference Waalewijn RA, de Vos R, Koster RW. Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in Utstein style. Resuscitation. 1998;38(3):157–67.CrossRef Waalewijn RA, de Vos R, Koster RW. Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in Utstein style. Resuscitation. 1998;38(3):157–67.CrossRef
30.
go back to reference Madsen Hardig B, Lindgren E, Östlund E, Herlitz J, Karlsten R, Rubertsson S. Outcome among VF/VT patients in the LINC (LUCAS IN Cardiac arrest) trial – a randomised, controlled trial. Resuscitation. 2017; In press accepted manuscript. Madsen Hardig B, Lindgren E, Östlund E, Herlitz J, Karlsten R, Rubertsson S. Outcome among VF/VT patients in the LINC (LUCAS IN Cardiac arrest) trial – a randomised, controlled trial. Resuscitation. 2017; In press accepted manuscript.
31.
go back to reference Seewald S, Obermaier M, Lefering R, Bohn A, Georgieff M, Muth C-M, et al. Application of mechanical cardiopulmonary resuscitation devices and their value in out-of-hospital cardiac arrest: a retrospective analysis of the German Resuscitation Registry. PLoS One. 2019;14(1):e0208113.CrossRef Seewald S, Obermaier M, Lefering R, Bohn A, Georgieff M, Muth C-M, et al. Application of mechanical cardiopulmonary resuscitation devices and their value in out-of-hospital cardiac arrest: a retrospective analysis of the German Resuscitation Registry. PLoS One. 2019;14(1):e0208113.CrossRef
Metadata
Title
Description of Emergency Medical Services, treatment of cardiac arrest patients and cardiac arrest registries in Europe
Authors
Ingvild B. M. Tjelmeland
Siobhan Masterson
Johan Herlitz
Jan Wnent
Leo Bossaert
Fernando Rosell-Ortiz
Kristin Alm-Kruse
Berthold Bein
Gisela Lilja
Jan-Thorsten Gräsner
on behalf of GL2020 Epidemiology group and participating countries
Publication date
01-12-2020
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-020-00798-7

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