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Population per km 2 in Countries Surveyed. Legend: Population density calculated per km 2 in relation to total population of the country. The numbers are from the official webpage of the European Union, Europa.eu. * Unite Kingdom excluding Wales
Source publication
Background
Variation in the incidence, survival rate and factors associated with survival after cardiac arrest in Europe is reported. Some studies have tried to fill the knowledge gap regarding the epidemiology of out-of-hospital cardiac arrest in Europe but were unable to identify reasons for the reported differences. Therefore, the purpose of thi...
Context in source publication
Context 1
... participating countries, national populations varied from 375,000 in Iceland to over 83 million in Germany [19]. Population density ranged from 3.6 to almost 510 population/km 2 (Fig. 1). Data on the number of EMS missions per 1000 inhabitants per year were available for 19 countries and varied from 12 in France to 268 in Lithuania. In 75% of countries the EMS was described as publicly funded. Germany had the greatest number of hospitals per million inhabitants while Finland had the lowest (23 vs 3.6 respectively). ...
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Background: To investigate the perception of telephone-assisted cardiopulmonary resuscitation (T-CPR) after out-of-hospital cardiac arrest (OHCA) among emergency medical service (EMS) providers in China.
Methods: A multicentre, cross-sectional, descriptive, online questionnaire survey study was conducted on the perception among emergency centres in...
Citations
... In general, there are EMS systems with very different characteristics throughout Europe. 9 When interpreting data from registries and comparing these between countries, thorough knowledge of the EMS characteristics of each country is necessary for interpretation. ...
Out-of-hospital cardiac arrest (OHCA) is a major health issue throughout Europe. Due to limited knowledge about the epidemiology of OHCA in Europe, in 2011, the European Registry of Cardiac Arrest (EuReCa) project was established. Initially based on existing resuscitation registries in a few countries, the network expanded and in October 2014 the EuReCa ONE study was launched, bringing together 27 countries and showing that appropriate data acquisition (10,682 cases submitted) is feasible within Europe. EuReCa TWO was conducted from October to December 2017 and included 37,054 cases. EuReCa THREE data collection was carried out from September to November 2022 and data analysis is currently being conducted. EuReCa TWO and THREE studies generated more robust data, with both studies covering 3-month periods in 28 countries, respectively. While EuReCa TWO focused on the bystander, EuReCa THREE investigated the impact of time-related aspects (time from call to scene, time at scene, transport times and other) on resuscitation outcomes. EuReCa is a network supporting countries in their ambition to establishing continuously running registries as quality management tools and for scientific work.
... Regions with more robust and well-organized EMS systems tend to report better outcomes for OHCA patients. 16,17 Given the constraints in resource-limited settings like Pakistan, the International Liaison Committee on Resuscitation (ILCOR) recently introduced the concept of a 'chainmail of survival' to address the challenges in managing OHCA patients. 18 This model features multiple interconnected supports rather than a singular chain, enhancing the system's resilience even when some components are compromised, considering the available resources. ...
Pakistan's Emergency Medical Services (EMS) are a critical component of its healthcare system, providing pre-hospital emergency care across a nation with over 220 million people. This article explores the evolutionary journey of Pakistan's EMS, highlighting both the challenges it faces and the strides it has made, with a specific emphasis on patients experiencing out-of-hospital cardiac arrest (OHCA). To extract relevant information, we searched MEDLINE & Embase data bases using MeSH terms "Emergency Medical Services" OR "EMS" AND "Out-of-Hospital-Cardiac-Arrest" OR "OHCA" AND "Pakistan". In addition, we also retrieved information from the EMS leadership in Pakistan through e-mails. We delve into the significance of key performance indicators for OHCA, advocate for the establishment of OHCA registries to improve patient outcomes, address regional disparities in pre-hospital care, and acknowledge the gradual progress of the EMS system.
... Although demanded, 3 important outcome factors are seldom reported in major trials, and even basic variables and data points are often recorded insufficiently due to limited resources. 4 Scientific research serves as a foundational pillar for advancements in the medical field; therefore, cultivating the next generation of researchers is a critical priority. However, early career researchers face barriers in both career and research development. ...
Aim of the study
Cardiac arrest research has not received as much scientific attention as research on other topics. Here, we aimed to identify cardiac arrest research barriers from the perspective of an international group of early career researchers.
Methods
Attendees of the 2022 international masterclass on cardiac arrest registry research accompanied the Global Out-of-Hospital Cardiac Arrest Registry collaborative meeting in Utstein, Norway, and used an adapted hybrid nominal group technique to obtain a diverse and comprehensive perspective. Barriers were identified using a web-based questionnaire and discussed and ranked during an in-person follow-up meeting. After each response was discussed and clarified, barriers were categorized and ranked over two rounds. Each participant scored these from 1 (least significant) to 5 (most significant).
Results
Nine participants generated 36 responses, forming seven overall categories of cardiac arrest research barriers. “Allocated research time” was ranked first in both rounds. “Scientific environment”, including appropriate mentorship and support systems, ranked second in the final ranking. “Resources”, including funding and infrastructure, ranked third. “Access to and availability of cardiac arrest research data” was the fourth-ranked barrier. This included data from the cardiac arrest registries, medical devices, and clinical studies. Finally, “uniqueness” was the fifth-ranked barrier. This included ethical issues, patient recruitment challenges, and unique characteristics of cardiac arrest.
Conclusion
By identifying cardiac arrest research barriers and suggesting solutions, this study may act as a tool for stakeholders to focus on helping early career researchers overcome these barriers, thus paving the road for future research.
... 3 In spite of the Utstein recommendations for data collection by OHCA registries, 3 PROMs data are rarely routinely collected. 8 PROMs scores for OHCA survivors and a control population, but with conflicting results. [9][10][11] Australian OHCA survivors were reported to have favourable health compared to a matched population index. ...
Introduction: Self-perceived health status data is usually collected using patient-reported outcome measures. Information from the patients' perspective is one of the important components in planning person-centred care. The study aimed to compare EQ-5D-5L in survivors after out-of-hospital cardiac arrest (OHCA) with data for Norwegian population controls. Secondary aim included comparing characteristics of respondents and non-respondents from the OHCA population. Methods: In this cross-sectional survey, 714 OHCA survivors received an electronic EQ-5D-5L questionnaire 3-6 months following OHCA. EQ-5D-5L assesses for five dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with five-point descriptive scales and overall health on a visual analogue scale from 0 (worst) to 100 (best) (EQ VAS). Results are used to calculate the EQ index ranging from À0.59 (worst) to 1 (best). Patient responses were matched for age and sex with existing data from controls, collected through a postal survey (response rate 26%), and compared with Chi-square tests or t-tests as appropriate. Results: Of 784 OHCA survivors, 714 received the EQ-5D-5L, and 445 (62%) responded. Respondents had higher rates of shockable first rhythm and better cerebral performance category scores than the non-respondents. OHCA survivors reported poorer health compared to controls as assessed by EQ-5D-5L dimensions, the EQ index (0.76 ± 0.24 vs 0.82 ± 0.18), and EQ VAS (69 ± 21 vs 79 ± 17), except for the pain/discomfort dimension. Conclusions: Norwegian OHCA survivors reported poorer health than the general population as assessed by the EQ-5D-5L. PROMs use in this population can be used to inform follow-up and health care delivery.
... Emergency medical services are heterogeneous in organization and available competence, which therefore complicate comparisons. [34][35][36][37] Notably, Anglo-American EMS teams are largely comprised of paramedics while EMS teams in parts of Europe are a physician-based system. [34,36,38] Each ambulance in Sweden is staffed with a registered or specialist nurse, and several regions have access to physician-staffed, second tier EMS units. ...
Background
Prehospital tracheal intubation (TI) is associated with increased mortality in patients with penetrating trauma, and the utility of prehospital advanced airway management is debated. The increased incidence of deadly violence in Sweden warrants a comprehensive evaluation of current airway management for patients with penetrating trauma in the Swedish prehospital environment and on arrival in the emergency department (ED).
Methods
This was an observational, multicenter study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 included in the Swedish national trauma register (SweTrau) between 2011 and 2019. We investigated the frequency and characteristics of prehospital and ED TI, including 30-day mortality and patient characteristics associated with TI.
Result
Of 816 included patients, 118 (14.5%) were intubated prehospitally, and 248 (30.4%) were intubated in the ED. Patients who were intubated prehospitally had a higher ISS, 33 (interquartile range [IQR] 25, 75), than those intubated in the ED, 25 (IQR 18, 34). Prehospital TI was associated with a higher associated mortality, OR 4.26 (CI 2.57, 7.27, p < 0.001) than TI in the ED, even when adjusted for ISS (OR 2.88 [CI 1.64, 5.14, p < 0.001]). Hemodynamic collapse (≤ 40 mmHg) and low GCS score (≤ 8) were the characteristics most associated with prehospital TI. Traumatic cardiac arrests (TCAs) occurred in 154 (18.9%) patients, of whom 77 (50%) were intubated prehospitally and 56 (36.4%) were intubated in the ED. A subgroup analysis excluding TCA showed that patients with prehospital TI did not have a higher mortality rate than those with ED TI, OR 2.07 (CI 0.93, 4.51, p = 0.068), with OR 1.39 (0.56, 3.26, p = 0.5) when adjusted for ISS.
Conclusion
Prehospital TI was associated with a higher mortality rate than those with ED TI, which was specifically related to TCA; intubation did not affect mortality in patients without cardiac arrest. Mortality was high when airway management was needed, regardless of cardiac arrest, thereby emphasizing the challenges posed when anesthesia is needed. Several interventions, including whole blood transfusions, the implementation of second-tier EMS units and measures to shorten scene times, have been initiated in Sweden to counteract these challenges.
... Emergency Medical Services (EMS) vary considerably worldwide and between European countries. 1 Several previous studies have described EMS systems in different European countries, 2-6 but the latest description of the Norwegian EMS system was in 2004 by Langhelle et al. 7 The EMS has undergone significant professionalisation in organisation, level of education and capability to assess and treat acutely sick or injured patients. As early as 1889, the first horse-drawn carriages started transporting patients in Norway. ...
Background
Norway has a long coastline, steep mountains, and wide fjords, which presents some challenges to the prehospital emergency healthcare system. In recent years, the prehospital emergency medical services (EMS) have undergone significant changes, structurally, in terms of professionalisation of the services and in the education level of the personnel. In this article, we aim to describe the current structure for handling prehospital medical emergencies.
Methods
For healthcare, Norway is divided into four Regional Health Authorities, consisting of 19 Health Trusts, where 18 have an EMS. There is a dedicated medical emergency number, 113, that terminates in 16 emergency medical communication centres. The use of air and boat ambulances, in addition to traditional ambulances, seeks to meet the challenges in the EMS system.
Strengths and limitations
The Norwegian EMS is an advanced system with highly educated staff; however, this level of care comes with an equally high cost.
Conclusion
The Norwegian EMS can handle emergencies nationwide, providing advanced care at the scene and during transport. The geography and demography challenge the idea of equal care, but the open publishing of data from national quality registries seeks to identify and address potential differences.
... Det er fire pågående doktorgrader som bruker data fra registeret. Det er publisert flere vitenskapelige artikler de siste 3 år som bruker data fra Hjertestansregisteret [5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21]. ...
... During the observed period, 8% of resuscitated patients survived until hospital discharge (with variations between countries ranging from 0% to 18%). In addition to EuReCa, in recent years, there have been several reports from individual European countries regarding the survival of OHCA patients, where the numbers also vary significantly: Norway 14% [7], Sweden 11.2% [8], Ireland 6% [8], France 4.9% [9] and Spain 13% [10]. ...
Background and Objectives: Despite advancements in modern medicine, the survival rate of patients after out-of-hospital cardiac arrest (OHCA) remains low. The proportion of OHCA patients who could be saved under ideal circumstances is unknown. A significant portion of patients experience cardiac arrest due to irreversible conditions. The survival of patients with reversible causes depends on the prompt initiation of basic life support (BLS) and early defibrillation. In order to increase the chances of survival, the motorcycle paramedic (MP) project was implemented in Ljubljana in 2003. The MP is equipped with an AED. In the case of OHCA with a shockable rhythm, he performs defibrillation before the arrival of the emergency medical team (EMT). The aim of this study was to evaluate whether the MP, by reducing response times to OHCA patients, increases the survival and outcome of these patients compared to the EMT. Materials and Methods: A retrospective analysis of OHCA cases within the area covered by Ljubljana Emergency Medical Service (EMS) was conducted for the period from January 2003 to December 2022. Instances where the MP arrived at the scene before the EMT were considered MP interventions and classified as the MP group; all other interventions were classified as the EMT group. Results: Between January 2003 and December 2022, the EMT performed resuscitation on 3352 patients. In 316 cases, the MP was simultaneously activated and arrived at the scene before the EMT. The response time in the MP group was shorter compared to the EMT group (7.7 ± 4.1 min vs. 9.9 ± 6.5 min, p < 0.001). In 16 patients, return of spontaneous circulation (ROSC) was achieved before the arrival of the EMT. The MP group had a higher ROSC rate, a larger proportion of patients were discharged from the hospital and there were more patients with a good neurological outcome compared to the EMT group (44.3% vs. 36.9%, p = 0.009; 18.7% vs. 13.0%, p = 0.005; 15.9% vs. 10.6%, p = 0.004, respectively). Conclusion: This study has demonstrated that the implementation of the MP into the EMS in Ljubljana has resulted in shorter response times, an increased survival rate and improved neurological outcome for OHCA patients.
... There were no restrictions to language, publication type, state, and date. Since there are differences between the European EMS [8][9] we decided to add another search in Google Scholar to identify new studies (last five years) specifically originating from German-speaking countries and only published in German language. ...
Background:
Feedback is essential for personal and professional development, also in emergency services. However, EMS usually ends at the interface with the emergency department, thus, the long-term effect of initiated emergency measures often remains unclear for emergency personnel. Digital, data-driven tools providing systematic feedback on patients' outcome may be valuable to improve emergency service quality and patient safety.
Objectives:
To provide an overview about current approaches for cross-sectoral digital feedback systems in EMS.
Methods:
Literature review in PubMed/MEDLINE and Google Scholar in accordance with the PRISMA statement.
Results:
The search resulted in 567 articles out of which only three were identified as eligible. In only one study cross-sectoral feedback was used to improve quality.
Conclusion:
Although feedback is described as a method for improving the quality of the rescue service and feedback is also considered in the description of the requirements for digitization, there seems to be no technical implementation of a cross-sectoral feedback system so far.
... There were also missing information such as level of blood loss, amount of trauma-specific intervention which could have been interesting to compare between both the groups to better understand survival rate differences. Finally, we chose no flow >60 min not to start CPR; however, in literature, there has been no comprehensive description of Emergency Medical Systems in Europe regarding the exact identification of the time since the occurrence of cardiac arrest and thus, no formal recommended timing to start or not CPR when facing prolonged cardiac arrest [36,37]. Absolute standardized differences before and after matching. ...
Background and importance
Trauma is an important cause of paediatric out-of-hospital cardiac arrest (OHCA) with a high mortality rate.
Objectives
The first aim of this study was to compare the survival rate at day 30 and at hospital discharge following paediatric traumatic and medical OHCA. The second aim was to compare the rates of return of spontaneous circulation and survival rates at hospital admission (Day 0).
Setting and participants
This multicentre comparative post-hoc study was conducted between July 2011 and February 2022 based on the French National Cardiac Arrest Registry data. All patients aged <18 years with OHCA were included in the study.
Outcome measures and analysis
Patients with traumatic aetiology were matched with those with medical aetiology using propensity score matching. Endpoint was the survival rate at day 30.
Main results
There were 398 traumatic and 1061 medical OHCAs. Matching yielded 227 pairs. In non-adjusted comparisons, days 0 and 30 survival rates were lower in the traumatic aetiology group than in the medical aetiology group [19.1% vs. 24.0%, odds ratio (OR) 0.75, 95% confidence interval (CI) 0.56–0.99, and 2.0% vs. 4.5%, OR 0.43, 95% CI, 0.20–0.92, respectively]. In adjusted comparisons, day 30 survival rate was lower in the traumatic aetiology group than in the medical aetiology group (2.2% vs. 6.2%, OR 0.36, 95% CI, 0.13–0.99).
Conclusion
In this post-hoc analysis, paediatric traumatic OHCA was associated with a lower survival rate than medical cardiac arrest.
