An urban EMS at the start of a cross-sectoral quality management system: prioritized implementation of the 2010 ERC recommendations and long-term survival after cardiac arrest

• Published in: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen Fortbildung und Qualität im Gesundheitswesen, 2015-01, Vol.109 (9-10), p.714-724
• Main Authors: Günther, Andreas, Harding, Ulf, Gietzelt, Matthias, Gradaus, Frank, Tute, Erik, Fischer, Matthias
• Format: Article
• Language: ger
• Subjects: Adult; Aged; Aged, 80 and over; Cause of Death; Emergency Medical Services - organization & administration; Emergency Medical Services - standards; Female; Germany; Guideline Adherence; Health Plan Implementation - organization & administration; Health Plan Implementation - standards; Heart Arrest - mortality; Heart Arrest - therapy; Hospitals, Urban - organization & administration; Hospitals, Urban - standards; Humans; Male; Middle Aged; National Health Programs - organization & administration; National Health Programs - standards; Outcome Assessment (Health Care) - organization & administration; Outcome Assessment (Health Care) - standards; Quality Improvement - organization & administration; Quality Improvement - standards; Registries; Resuscitation - methods; Resuscitation - standards; Survival Analysis; Survivors - statistics & numerical data; Total Quality Management - organization & administration; Total Quality Management - standards; Young Adult
• ISSN: 2212-0289
• DOI: 10.1016/j.zefq.2015.06.003

Due to limited resources, the 2010 European Resuscitation Council (ERC) guidelines could not be fully implemented in the Emergency Medical Services (EMS) of Brunswick, Germany. This is why implementation was prioritized according to local conditions. Thus, prehospital therapeutic hypothermia, mechanical chest compression and feedback systems were not established. Clinical data and long-term results were assessed by a QM system and room for improvement was identified. All attempted resuscitations from 2011 until 2014 were recorded and compared against the German Resuscitation Registry. Outcomes of adult patients following non-traumatic cardiac arrest were analyzed by year. 812 resuscitations were attempted (incidence 81.2/100,000 inhabitants/year). In the two years following full implementation since 2013 the discharge rate from hospital was 16.4 %, the discharge rate with a favorable neurologic outcome was 14.1 %, the 1-year survival rate was 14.4 % in 2013. A significant improvement of risk-adjusted ROSC rate during the investigation period was demonstrated. The discharge rates remained unchanged; the increase in the discharge rates paralleled the increase in CPR incidence. EMS response times were remarkably shorter. The implementation of the ERC guidelines chosen appears to be generally safe. Fast EMS response contributed to superior results. All links of the chain of survival showed room for improvement, especially the proportion of lay rescuer CPR and telephone-assisted CPR. The high CPR incidence might indicate room for improvement in prevention. Access to resuscitation care can hardly be evaluated. Age-related access to pre-hospital resuscitation seems to be appropriate.