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The impact of response time reliability on CPR incidence and resuscitation success: a benchmark study from the German Resuscitation Registry

Jürgen Neukamm1†, Jan-Thorsten Gräsner2*†, Jens-Christian Schewe3, Martin Breil3, Jan Bahr4, Ulrich Heister3, Jan Wnent5, Andreas Bohn6, Gilbert Heller2, Bernd Strickmann7, Hans Fischer8, Clemens Kill9, Martin Messelken1, Berthold Bein2, Roman Lukas6, Patrick Meybohm2, Jens Scholz2 and Matthias Fischer1

Author Affiliations

1 Department of Anesthesiology and Intensive Care, Klinik am Eichert, Eichertstraße 3, D-73035 Göppingen, Germany

2 Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, D-24105 Kiel, Germany

3 Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Street 25, D-53105 Bonn, Germany

4 Department of Anesthesiology, Emergency Medicine and Intensive Care University Hospital Göttingen, Robert-Koch-Strasse 40, D-37099 Göttingen, Germany

5 Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany

6 Department of Anesthesiology and Intensive Care Medicine, University Hospital Münster, D-48149 Münster, Germany

7 Department of Anesthesiology and Intensive Care, Klinikum Ravensberg, Halle (Westfalen), Emergency Medical Services System of the County of Gütersloh, Winnebrockstraße 1, D-33790 Gütersloh, Germany

8 Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Hoppe-Seyler-Straße 3, D-72076 Tübingen, Germany

9 Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Baldingerstrasse, D-35043 Marburg, Germany

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Critical Care 2011, 15:R282 doi:10.1186/cc10566

Published: 24 November 2011

Abstract

Introduction

Sudden cardiac arrest is one of the most frequent causes of death in the world. In highly qualified emergency medical service (EMS) systems, including well-trained emergency physicians, spontaneous circulation may be restored in up to 53% of patients at least until admission to hospital. Compared with these highly qualified EMS systems, markedly lower success rates are observed in other systems. These data clearly show that there are considerable differences between EMS systems concerning treatment success following cardiac arrest and resuscitation, although in all systems international guidelines for resuscitation are used. In this study, we investigated the impact of response time reliability (RTR) on cardiopulmonary resuscitation (CPR) incidence and resuscitation success by using the return of spontaneous circulation (ROSC) after cardiac arrest (RACA) scores and data from seven German EMS systems participating in the German Resuscitation Registry.

Methods

Anonymised patient data after out-of-hospital cardiac arrest gathered from seven EMS systems in Germany from 2006 to 2009 were analysed with regard to socioeconomic factors (population, area and EMS unit-hours), process quality (RTR, CPR incidence, special CPR measures and prehospital cooling), patient factors (age, gender, cause of cardiac arrest and bystander CPR). End points were defined as ROSC, admission to hospital, 24-hour survival and hospital discharge rate. χ2 tests, odds ratios and the Bonferroni correction were used for statistical analyses.

Results

Our present study comprised 2,330 prehospital CPR patients at seven centres. The incidence of sudden cardiac arrest ranged from 36.0 to 65.1/100,000 inhabitants/year. We identified two EMS systems (RTR < 70%) that reached patients within 8 minutes of the call to the dispatch centre 62.0% and 65.6% of the time, respectively. The other five EMS systems (RTR > 70%) reached patients within 8 minutes of the call to the dispatch centre 70.4% up to 95.5% of the time. EMS systems arriving relatively later at the patients side (RTR < 70%) initiate CPR less frequently and admit fewer patients alive to hospital (calculated per 100,000 inhabitants/year) (CPR incidence (1/100,000 inhabitants/year) RTR > 70% = 57.2 vs RTR < 70% = 36.1, OR = 1.586 (99% CI = 1.383 to 1.819); P < 0.01) (admitted to hospital with ROSC (1/100,000 inhabitants/year) RTR > 70% = 24.4 vs RTR < 70% = 15.6, OR = 1.57 (99% CI = 1.274 to 1.935); P < 0.01). Using ROSC rate and the multivariate RACA score to predict outcomes, we found that the two groups did not differ, but ROSC rates were higher than predicted in both groups (ROSC RTR > 70% = 46.6% vs RTR < 70% = 47.3%, OR = 0.971 (95% CI = 0.787 to 1.196); P = n.s.) (ROSC RACA RTR > 70% = 42.4% vs RTR < 70% = 39.5%, OR = 1.127 (95% CI = 0.911 to 1.395); P = n.s.)

Conclusion

This study demonstrates that, on the level of EMS systems, faster ones more often initiate CPR and increase the number of patients admitted to hospital alive. Furthermore, we show that, with very different approaches, all centres that adhere to and are intensely trained according to the 2005 European Resuscitation Council guidelines are superior and, on the basis of international comparisons, achieve excellent success rates following CPR.