A comparison between patients suffering in-hospital and out-of-hospital cardiac arrest in terms of treatment and outcome

Abstract

Aim. To compare treatment and outcome amongst patients suffering in- hospital and out-of-hospital cardiac arrest in the same community. Patients. All patients suffering in-hospital cardiac arrest in Sahlgrenska University Hospital covering half the catchment area of the community of Goteborg (500 000 inhabitants) and all patients suffering out-of-hospital cardiac arrest in the community of Goteborg. Criteria for inclusion were that resuscitation efforts should have been attempted. Time of survey. From 1 November 1994 to 1 November 1997. Methods. Data were recorded both prospectively and retrospectively. Results. In total, 422 patients suffered in-hospital cardiac arrest and 778 patients suffered out-of-hospital cardiac arrest. Patients with in-hospital cardiac arrest included more women and were more frequently found in ventricular fibrillation. The median interval between collapse and defibrillation was 2 min in in-hospital cardiac arrest compared with 7 min in out-of-hospital cardiac arrest (< 0.001). The proportion of patients being discharged from hospital was 37.5% after in-hospital cardiac arrest, compared with 8.7% after out-of-hospital cardiac arrest (P < 0.001). Corresponding figures for patients found in ventricular fibrillation were 56.9 vs. 19.7% (P < 0.001) and for patients found in asystole 25.2 vs. 1.8% (P < 0.001). Conclusion. In a survey evaluating patients with in-hospital and out-of- hospital cardiac arrest in whom resuscitation efforts were attempted, we found that the former group had a survival rate more than four times higher than the latter. Possible strong contributing factors to this observation are: (i) shorter time interval to start of treatment, and (ii) a prepared selection for resuscitation efforts.