Survival of resuscitated cardiac arrest patients with ST-elevation myocardial infarction (STEMI) conveyed directly to a Heart Attack Centre by ambulance clinicians.

OBJECTIVE: This study reports survival outcomes for patients resuscitated from out-of-hospital cardiac arrest (OHCA) subsequent to ST-elevation myocardial infarction (STEMI), and who were conveyed directly by ambulance clinicians to a specialist Heart Attack Centre for expert cardiology assessment, angiography and possible percutaneous coronary intervention (PCI). METHODS: This is a retrospective descriptive review of data sourced from the London Ambulance Service's OHCA registry over a one-year period. RESULTS: We observed excellent survival rates for our cohort of patients with 66% of patients surviving to be discharged from hospital, the majority of whom were still alive after one year. Those who survived tended to be younger, to have had a witnessed arrest in a public place with an initial cardiac rhythm of VF/VT, and to have been transported to the specialist centre more quickly than those who did not. CONCLUSION: A system allowing ambulance clinicians to autonomously convey OHCA STEMI patients who achieve a return of spontaneous circulation directly to a Heart Attack Centre is highly effective and yields excellent survival outcomes.

Increases in survival from out-of-hospital cardiac arrest: a five year study.

OBJECTIVE: This study reports improvements in survival from out-of-hospital cardiac arrest in London over a five year period from 2007 to 2012 and explores the potential reasons for the very striking increases observed. METHODS: Data from the London Ambulance Service's cardiac arrest registry from 2007 to 2012 were analysed retrospectively for all patients who met the Utstein comparator group criteria (an arrest of a presumed cardiac cause that was bystander witnessed with an initial rhythm of VF/VT). RESULTS: We observed an increase in survival from out-of-hospital cardiac arrest during the five year period, with incremental improvements each year from 12% to 32% for the Utstein comparator group of patients. CONCLUSION: We suggest that a range of important changes made to pre-hospital cardiac care in London over the last five years have contributed to the observed increase in survival over the study period. In addition we advocate a range of further initiatives to continue improving survival from out-of-hospital cardiac arrest.