Resuscitation of patients in cardiac arrest outside hospital. Comparison of two different organizations of mobile coronary care in one community

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Abstract
We have compared the effectiveness of two different mobile coronary care systems with regard to mortality from cardiac arrest (CA) outside hospital in Gothenburg, Sweden. In period 1, the mobile coronary care unit (MCCU) was part of a randomized study of the effect of an MCCU versus standard ambulances on early mortality from ischaemic heart disease. The MCCU was single, hospital based and manned by two CCU nurses and two ambulance drivers. The organization ran on workdays 08.00 a.m. to 17.00p.m. from October, 1973 to May, 1978, corresponding to twelve months of effective lime. One-year data for the MCCU have been calculated by extrapolating to a 100% allocation to the MCCU. In period 2, from November, 1980, through December, 1981, also corresponding to twelve months of effective time, the system was reorganized to a mobile intensive care unit (MICU) manned by paramedics 24 h all days of the week, and part of the time by CCU nurses. The MICU was dispatched to all suspected emergencies and the treatment capacity was defibrillation, endotracheal intubation and, part of the time, drugs. Simultaneously with the MICU, the nearest standard ambulance was dispatched and the first crew to arrive started cardiopulmonary resuscitation (CPR). Comparing the extrapolated data from period 1 with the exact data from period 2, there was an increase in period 2 of dispatches to subjects in CA due to heart disease from 59 to 181. The retrieval of subjects in ventricular fibrillation (VF) increased from 20 to 87 as a result of reduced delay times from the collapse to alarm, start of CPR and defibrillation. The number of patients less than 75 years old, discharged alive from hospital increased from 6 to 19. In subjects retrieved in VF in period 2, 43% survived if CPR was started within 5 min and 7% if CPR was delayed more than 5 min. 56% of the cases received CPR within 5 min and defibrillation within 8 min and 50% of them survived, but if defibrillation was delayed more than 8 min, only 14% survived. In conclusion the reorganization of an MCCU system from a single, hospital based MCCU manned by CCU nurses and ambulance drivers to a decentralized rapid response system with paramedics was associated with an improvement from 6 to 19 survivors, less than 75 years old, in one year.

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