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Out-of-Hospital Cardiac Arrest—Review of Demographics in South Australia to Inform Decisions about the Provision of Automatic External Defibrillators within the Community

Published online by Cambridge University Press:  28 June 2012

Kathryn Zeitz ,
Hugh Grantham ,
Robert Elliot  and
Chris Zeitz
Kathryn Zeitz*
Affiliation:
State Staff Officer, St John Ambulance Aust SA Inc.; Adjunct, Flinders University, School of Nursing and Midwifery
Hugh Grantham
Affiliation:
Executive Director of Clinical Services, SA Ambulance Service; Senior Lecturer, Flinders University
Robert Elliot
Affiliation:
State Paramedic, St John Ambulance Aust SA Inc.; General Manager, Professional Standards.SA Ambulance Service
Chris Zeitz
Affiliation:
State Medical Officer, St John Ambulance Aust SA Inc., Rural and Indigenous Cardiovascular Health, University of Adelaide
*
State Staff Officer, St John Ambulance Aust SA Inc. 85 Edmund Avenue, UNLEY SA 5061, Australia E-mail: kmzeitz@onaustralia.com.au
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Abstract

Introduction:

Sudden, out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 50 per 100,000 population. Public access defibrillation is seen as one of the key strategies in the chain-of-survival for OHCA. Positioning of these devices is important for the maximization of public health outcomes. The literature strongly advocates widespread public access to automated external defibrillatiors (AEDs). The most efficient placement of AEDs within individual communities remains unclear.

Methods:

A retrospective case review of OHCAs attended by the South Australia Ambulance Service in metropolitan and rural South Australia over a 30-month period was performed. Data were analyzed using Utstein-type indicators. Detailed demographics, summative data, and clinical data were recorded.

Results:

A total of 1,305 cases of cardiac arrest were reviewed. The annual rate of OHCA was 35 per 100,000 population. Of the cases, the mean value for the ages was 66.3 years, 517 (39.6%) were transported to hospital, 761 (58.3%) were judged by the paramedic to be cardiac, and 838 (64.2%) were witnessed. Bystander cardiopulmonary resuscitation (CPR) was performed in 495 (37.9%) of cases. The rhythm on arrival was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 419 (32.1%) cases, and 315 (24.1%) of all arrests had return of spontaneous circulation (ROSC) before or on arrival at the hospital. For cardiac arrest cases that were witnessed by the ambulance service (n = 121), the incidence of ROSC was 47.1%.

During the 30-month period, there only was one location that recorded more than one cardiac arrest. No other location recorded recurrent episodes.

Conclusions:

This study did not identify any specific location that would justify defibrillator placement over any other location without an existing defibrillator. The impact of bystander CPR and the relatively low rate of bystander CPR in this study points to an area of need. The relative potential impact of increasing bystander CPR rates versus investing in defibrillators in the community is worthy of further consideration.

Keywords

automated external defibrillatorcardiac arrestout-of-hospital cardiac arrest
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 6 , December 2010 , pp. 521 - 526
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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