Circumstances of out of hospital cardiac arrest in patients with ischaemic heart disease

OBJECTIVES: To discover the circumstances of out of hospital cardiac death irrespective of resuscitation attempts. DESIGN: Prospective community study over the two years 1994 and 1995. SETTING: The health districts of Brighton, South Glamorgan, and York, UK. SUBJECTS: 1290 victims of sudden death or cardiac arrest caused by coronary heart disease who were under 76 years of age. INTERVENTIONS: Basic and advanced life support for witnessed cardiac arrests. MAIN OUTCOME MEASURES: Survival to reach hospital and for 30 days after the arrest. RESULTS: 35 (35%) of 101 patients (mean age 64) whose arrest was witnessed by a doctor or paramedic survived for 30 days compared with 9 of 464 (2%) whose arrest was witnessed by a relative or bystander at home (mean age 66) and 15 of 200 (8%) whose arrest was witnessed in a public place (mean age 61). None of the 525 victims of an unwitnessed arrest survived but the majority of those whose arrest was witnessed had complained of new symptoms before the arrest. Victims who were given basic life support by relatives or bystanders had better survival (14 of 183 (8%)) than those who were not (10 of 481 (2%), p < 0.001). Of the 20% of arrests that occurred in public places, few were in places where public access defibrillators would now be available. CONCLUSIONS: The burden of out of hospital cardiac arrest is mainly in the home but most victims have premonitory symptoms. Public education to seek help urgently for new or prolonged chest pain seems the most promising method to address the problem.