Clinical paperOut-of-hospital cardiac arrest (OHCA) attended by mobile emergency teams with a physician on board. Results of the Spanish OHCA Registry (OSHCAR)☆
Introduction
The real incidence of OHCA is not well known. Based on out-of-hospital emergency medical services (EMS) data, OHCA affects more than 275,000 people a year in Europe,1 with an incidence of 38 cases per 100,000 people per year. These data vary greatly between different European countries,2, 3 and even between different regions of the same country.4 Apart from specific initiatives,5 one must consult regional and national registries to obtain real figures in clinical practice. Frequent references are made to national registries, but most provide only partial data.6, 7, 8 Some nationwide European registries, with significant population coverage and a long history, provide continuous data on the incidence and outcome of OHCA and they constitute an important source of knowledge about this process.9, 10 However, in general, most data come from exclusively paramedic-staffed EMS and countries with high rates of cardiac mortality.11 There are only partial data on the incidence and outcomes of OHCA care by physician-led EMS in a Mediterranean country,2, 12 an aspect that generates much debate in OHCA care.13 Our goal was to describe the incidence of OHCA and outcomes in a whole country with public EMS using ambulances with a physician on board.
Section snippets
Methods
Spanish OHCA Registry (OSHCAR) is a prospective registry of consecutive OHCA cases attended by emergency medical teams belonging to the Public EMS of Spain. The registry continuously receives its data from the EMS of all 17 autonomous communities of Spain along with municipal-level EMS in two major cities, Madrid and Zaragoza, representing all the public out-of-hospital services in Spain.
The map of Spain with its 17 autonomous regions and their population is shown in Supplementary material.
Results
Nineteen EMS participated in the recruitment of patients. During the study period, advanced life support (ALS) was initiated in 9347 cases. The number and percentage of cases included by each EMS and region is shown in Table 1. The incidence of OHCA treated by EMS in Spain, adjusted for the overall population coverage of the 19 EMS, according to the official census of 2014, was 18.62 per 105 inhabitants per year.
Demographic and assistance characteristics are shown in Table 2. Resuscitation was
Discussion
These are the first prospectively obtained results of OHCA treated by physician-led EMS in an entire country. Our data confirm a lower incidence of cases than in most countries with similar EMS, whether physician-led or not.2, 5, 17 Although variability in the incidence of OHCA is frequent in all Europe, the difference is very pronounced in our country, with the lowest rate of all,17 20 per 100,00 inhabitants, previously reported in other studies.2, 12, 17 This important difference is probably
Conflict of interest statement
Dr. Rosell-Ortiz, on behalf of all the authors of the mentioned manuscript, declared nothing to disclose.
Acknowledgements
The authors wish to thank all dispatch centers, ambulance services and first responders for their help in ongoing data collection.
The Registry was funded by a public Research Grant from the Spanish Health Ministry (Instituto de Investigación de Salud Carlos III, Fondo de Investigaciones Sanitarias, exp. number PI12-01912) and co-funded by a research grant from the European Commission.
The list with the complete OHSCAR investigators is shown in the annex (see Supplementary material).
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi: 10.1016/j.resuscitation.2017.01.029.