Out-of-Hospital Cardiac Arrest in Bariloche: Incidence, Distribution and Context. Evaluation of the Potential Usefulness of an Automated External Defibrillator Program

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Abstract

Background: The incidence and distribution of potentially resuscitable out-of-hospital cardiac arrests in a community should be determined before implementing an automated external defibrillator program in order to anticipate its effectiveness.

Objectives: The aims of this study were: 1) to determine the annual incidence, distribution and context of out-of-hospital cardiac arrest in the city of Bariloche; and 2) according to the information obtained, to evaluate the potential usefulness of an automated external defibrillator program in the city, in public locations or in the patients’ homes.

Methods: A one-year prospective registry of out-of-hospital cardiac arrests was carried out in the setting of the REGIBAR study, using The Registry Office as source of information. The cases of myocardial infractions hospitalized and presenting as cardiac arrest prior to arrival at hospital were also analyzed. Verbal autopsies were performed to establish if the death was due to cardiovascular disease and to determine its context. Out-of-hospital cardiac arrests were classified as those occurring within the patient’s home or
in public locations. The presence of cohabitants and witnesses of cardiac arrests occurring at home and the history of myocardial infarction/heart failure were recorded.

Results: During the study period, 61 out-of-hospital cardiac arrests occurred (age: 78.3; range: 47-100), 40% were women and 52% were ≥ 80 years of age. Incidence: 53/100, 000 person-years. None of the cases of cardiac arrest prior to hospital arrival undergoing resuscitation reached the hospital alive. Prior myocardial infarction/heart failure was present in 11.5% (7/61) of the cases. Sixty cardiac arrests occurred at home and one took place in a public space. The emergency medical service system was contacted in 20%
of the cases and 10% underwent cardiopulmonary resuscitation. Seventy-five percent (45/60) of the subjects who experienced cardiac arrest at home were not living alone, but only in 12% (7/60) of cases cohabitants witnessed their death.

Conclusions: The incidence of out-of-hospital cardiac arrest in Bariloche was 53/100,000 person-years. Only one case occurred in a public space. An emergency medical service attended 1 out of 5 cases and half of these cases underwent cardiopulmonary resuscitation. None of the cases of out-of-hospital cardiac arrest arrived alive at hospital. Only 1 out of 10 cardiovascular deaths at home was witnessed. The implementation of an automated external defibrillator program does not represent an advisable strategy in Bariloche.