Out-of-Hospital Cardiac Arrest in the 1990s: Population-Based Study in the Maastricht Are on Incidence, Characteristics and Survival

Objectives. We sought to describe the incidence, characteristics and survival of out-of-hospital sudden cardiac arrest (SCA) in the Maastricht are of The Netherlands. Background. Incidence and survival rates of out-of-hospital SC in different communities are often based on the number of victims resuscitated by the emergency medical services. Our population-based study in the Maastricht are allows information on all victims of witnessed and unwitnessed SC occurring outside the hospital. Methods. Incidence, patient characteristics and survival rates were determined by prospectively collecting information on all cases of SC occurring in the age group 20 to 75 years between January 1, 1991 and December 31, 1994. Survival rates were related to the site of the event (at home vs. outside the home) and the presence or absence of witness and rhythm at the time of the resuscitation attempt in out-of-hospital SCA. Results. Five hundred fifteen patients were included (72% men, 28% women). In 44% of men and 53% of women, SC was most likely the first manifestation of heart disease. In patients known to have had previous myocardial infarction (MI), the mean interval between the MI and SC was 6.5 years, with >50% having left ventricular ejection fraction >30%. The mean yearly incidence of SC was 1 in 1,000 inhabitants. Of all deaths in the age groups studied, 18.5% were sudden. Nearly 80% of SCAs occurred at home. In 60% of all cases of SC witness was present. Cardiac resuscitation, which was attempted in 51% of all subjects, resulted overall in 32 (6%) of 515 patients being discharged alive from the hospital. Survival rates for witnessed SC were 8% (16 of 208 subjects) at home and 18% (15 of 85 subjects) outside the home (95% confidence interval 1% to 18.8%). Conclusions. The majority of victims of SC cannot be identified before the event. Sudden cardiac arrest usually occurs at home, and the survival of those with witnessed SC at home was low compared with that outside the home, indicating the necessity of optimizing out-of-hospital resuscitation, especially in the at-home situation.