We sought to describe the incidence, characteristics and survival of out-of-hospital
sudden cardiac arrest (SCA) in the Maastricht area of The Netherlands.
Incidence and survival rates of out-of-hospital SCA in different communities are often
based on the number of victims resuscitated by the emergency medical services. Our
population-based study in the Maastricht area allows information on all victims of
witnessed and unwitnessed SCA occurring outside the hospital.
Incidence, patient characteristics and survival rates were determined by prospectively
collecting information on all cases of SCA 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 a
witness and rhythm at the time of the resuscitation attempt in out-of-hospital SCA.
Five hundred fifteen patients were included (72% men, 28% women). In 44% of men and
53% of women, SCA was most likely the first manifestation of heart disease. In patients
known to have had a previous myocardial infarction (MI), the mean interval between
the MI and SCA was 6.5 years, with >50% having a left ventricular ejection fraction
>30%. The mean yearly incidence of SCA 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 SCA a 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 SCA were 8% (16 of 208 subjects)
at home and 18% (15 of 85 subjects) outside the home (95% confidence interval 1% to
18.8%).
The majority of victims of SCA cannot be identified before the event. Sudden cardiac
arrest usually occurs at home, and the survival of those with a witnessed SCA 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.