Survival after prehospital cardiac arrest in Spain: a review of the literature

Spanish studies on prehospital cardiac arrest are reviewed, to compare early survival

rates, and to estimate the prevalence of shockable arrhythmias and cardiopulmonary

resuscitation (CPR) attempts before emergency responders arrive. We first reviewed

Spanish studies that evaluated prehospital cardiac arrest published between 1999 and

2011. The data extracted were as follows: number of events attended, heart rhythm on

arrival of assistance, number of patients recovering circulation on site, survival on

hospital discharge, times CPR had been attempted before arrival of emergency

responders, and time until arrival of the responders. Relative frequencies were then

compared. Eleven observational studies relevant to the objective were located. CPR

success rates ranged from 9.9% to 59.4% in these studies. Ventricular fibrillation was the

heart rhythm initially detected in 14.9% to 54.5% of the patients across the studies, and

CPR had been tried before the emergency responders arrived in 2.3% to 36.8% of the

case series. A total of 8089 patients were considered candidates for CPR in the studies

reviewed; 22.4% (95% CI, 21.5%-23.4%) were alive on arrival at a hospital emergency

department. Spanish emergency response services in different geographical regions vary

greatly in their efficacy, but the quality is low overall. Better strategies to improve

response times and reduce delays in providing defibrillation should be designed, and

training in basic CPR techniques should be more widespread in the population.