786677

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CNU0010.1177/1474515118786677European Journal of Cardiovascular NursingDanielis et al.

Original Article

European Journal of Cardiovascular Nursing

A five-year retrospective study of

1­–8
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DOI: 10.1177/1474515118786677
https://doi.org/10.1177/1474515118786677

north-east Italian urban area journals.sagepub.com/home/cnu

Matteo Danielis1, Martina Chittaro2, Amato De Monte1,

Giulio Trillò1 and Davide Durì1

Abstract
Background: The reporting and analysing of data of out-of-hospital cardiac arrests encourages the quality improvement
of the emergency medical services. For this reason, the establishment of a sufficiently large patient database is intended
to allow analysis of resuscitation treatments for out-of-hospital cardiac arrests and performances of different emergency
medical services.
Aims: The aim of this study was to describe the demographics, characteristics, outcomes and determinant factors of
survival for patients who suffered an out-of-hospital cardiac arrest.
Methods: this was a retrospective study including all out-of-hospital cardiac arrest cases treated by the emergency
medical service in the district of Udine (Italy) from 1 January 2010–31 December 2014.
Results: A total of 1105 out-of-hospital cardiac arrest patients were attended by the emergency medical service. Of
these, 489 (44.2%) underwent cardiopulmonary resuscitation, and return of spontaneous circulation was achieved in
142 patients (29%). There was a male predominance overall, and the main age was 72.6 years (standard deviation 17.9).
Cardiopulmonary resuscitation before emergency medical service arrival was performed on 62 cases (44%) in the return
of spontaneous circulation group, and on 115 cases (33%) in the no return of spontaneous circulation group (p<0.024).
Among the 142 cases of return of spontaneous circulation, 29 (5.9%) survived to hospital discharge. There was a smaller
likelihood of return of spontaneous circulation when patients were female (odds ratio 0.61, 0.40–0.93). Patients who had
an out-of-hospital cardiac arrest with an initial shockable rhythm (odds ratio 6.33, 3.86–10.39) or an age <60 years (odds
ratio 2.91, 1.86–4.57) had a greater likelihood of return of spontaneous circulation. In addition, bystander cardiopulmonary
resuscitation (odds ratio 1.56, 1.04–2.33) was associated with an increased chance of return of spontaneous circulation.
Conclusion: The incidence of out-of-hospital cardiac arrest and survival rate lies within the known range. A wider
database is necessary to achieve a better knowledge of out-of-hospital cardiac arrest and to drive future investments in
the healthcare system.

Keywords
Out-of-hospital cardiac arrest, outcome, emergency medical service, cardiopulmonary resuscitation, survival.

Date received: 28 September 2017; revised: 13 June 2018; accepted: 13 June 2018

Introduction
Out-of-hospital cardiac arrest (OHCA) is one of the lead-
ing causes of death in Europe, with an incidence of
350,000–700,000 cases/year.1,2 In 2014, the European
Registry of Cardiac arrest (EuReCa One) recorded 10,682
events in one month in a population of about 174 m citi-
zens in 27 European countries; of these, 773 events
occurred in Italy among a study population of 8 m citi-
zens.3 The Friuli Venezia Giulia Arrest Cooperative Study
1Department of Anaesthesia and Intensive Care, Azienda Sanitaria
Universitaria Integrata di Udine, Italy
2Pneumology and Respiratory Physiopathology, Azienda Sanitaria
Universitaria Integrata di Udine, Italy
Corresponding author:
Matteo Danielis, Department of Anaesthesia and Intensive Care,
Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330 –
33100 Udine, Italy.
Email: danielis.matteo@gmail.com
2 European Journal of Cardiovascular Nursing 00(0)
(FACS) in 1998 accounted an incidence of 0.95/1000
inhabitants events with a survival rate of 6.7%.4 Recently,
a retrospective cohort study based on the District of Trieste
(Friuli Venezia Giulia, Italy), reported an incidence of
OHCAs of 287/100,000 with a survival rate of 8.5%.5
Sudden cardiac death accounts for 78.5% of cases of
OHCA,4 in the majority of cases due to acute coronary
syndrome though other causes such as congenital cardi-
opathy or arrhythmias may contribute.6 Initially, the
rhythm is ventricular fibrillation (VF) in 25–30% of cases
followed by ventricular tachycardia (VT).7 Asystole and
pulseless electrical activity (PEA) are less frequent and
may be the result of a delayed monitoring of the arrest.8,9
Early cardiopulmonary resuscitation (CPR) and the
availability of an automated external defibrillator (AED)
are associated with significantly higher long-term survival
of OHCA victims.10 It has been reported that bystander
CPR and short intervention time are associated with
increased survival post-cardiac arrest.11,12
Reporting and analysing data from OHCAs may encour-
age the quality improvement of the emergency medical ser-
vice (EMS). Therefore, establishing a sufficiently large
patient database is the main goal for identification of the best
treatment methods for OHCAs and organization of services.
The aim of this study was to investigate OHCA events
in the district of Udine (Friuli Venezia Giulia, Italy) in
terms of incidence, features and outcomes.
Methods
Design
A retrospective and cohort study was adopted, including
all OHCA cases treated by the EMS in the district of Udine
between 1 January 2010–31 December 2014.
Setting and population
The Udine district is part of Friuli Venezia Giulia, a region
in the north-east of Italy. The EMS system targets 180,000
citizens. In Italy, 112 (emergency telephone number) calls
are filtered through an Emergency Call Centre, and are
processed by trained nurses that assign a priority colour
code: red (emergency), yellow (urgency), green (deferra-
ble), and white (not critical). Subsequently, they dispatch
the most appropriate team for each case. Nurses and vol-
unteers (non-healthcare qualified professionals) in the
ambulance often become first responders in the local EMS;
in addition, vehicles staffed by emergency physicians can
support selected cases. All the OHCA intervention proto-
cols are based on the recommendations of the International
Liaison Committee on Resuscitation (ILCOR).
Data collection
Study data were obtained from the database of the EMS
that was hosted by the Udine University Hospital, part
of the Azienda Sanitaria Universitaria Integrata di
Udine, Italy.
The EMS medical director extracted the pertinent data
of all patients who suffered an OHCA which was con-
firmed and attended by EMS. The researchers of this study
maintained the anonymity and confidentiality of the data
collected in strict accordance with the Italian law.
Furthermore, data collection and study design were carried
out according to the Helsinki Declaration.
Data were collected and reported using the Utstein
style, a method developed for uniform reporting of data
from OHCAs and to solve a major problem in resuscita-
tion research.13 Following this reporting style, we included
a flow chart with cardiac arrests and outcome variables.
The cardiac arrest variables were the aetiology (chest
pain, chronic kidney disease, lost of consciousness, neu-
rological problem, trauma, hypoglycaemia, tentamen,
unknown or other cause), causes of not carrying out resus-
citation (time criteria, serious injuries, dead body, termi-
nal illness or other), number of CPRs performed, initial
rhythm detected (VF, VT, PEA and asystole), and inci-
dence of return of spontaneous circulation (ROSC).
The outcome variables included 30-day, one-month and
one-year survival, and the neurological status of survivors
according to the cerebral performance category (CPC) at
discharge. The CPC scale is composed of five categories:
a CPC score of one or two represented a favourable neuro-
logical outcome, while a CPC score of 3–5 was considered
as an unfavourable neurological outcome (score=1: good
cerebral performance; 2: moderate cerebral disability; 3:
severe cerebral disability; 4: coma or vegetative state; and
5: brain death).14
The EMS time was defined as the interval in minutes
from call to arrival at the scene of event.
Study outcomes
The primary outcome was the incidence of ROSC in OHCA.
Secondary outcomes included survival, neurological status
among those patients who survived to discharge as deter-
mined by CPC score, determinant factors of ROSC, such as
EMS intervention time, minutes of CPR, CPR started by lay-
person/bystander, initial cardiac rhythm and defibrillations.
Statistical analysis
Collected data were entered into a Microsoft Excel work-
sheet and all statistical analysis was performed using R
Statistical Software (version 3.4.1, Foundation for Statistical
Computing, Vienna, Austria). Continuous variables (age,
time intervals) are displayed as mean, first, second, third
quartile and standard deviation (SD). Nominal variables
(gender, CPR, ROSC, sending dispatch code, initial rhythm,
aetiology and outcome) are displayed as absolute number
and percentage. Student’s unpaired t-test was used to ana-
lyse comparisons between means and categorical variables
were analysed using chi-squared test for independence.
Danielis et al. 3

Figure 1.  Main data of out-of-hospital cardiac arrests (OHCAs) reported with Utstein style.
Missing data for cases not resuscitated (n=5) and aetiology (n=4). CKD: chronic kidney disease; CPC: cerebral performance category; CPR: car-
diopulmonary resuscitation; LoC: loss of consciousness; PEA: pulseless electrical activity; ROSC: return of spontaneous circulation; VF: ventricular
fibrillation; VT: ventricular tachycardia.

Logistic regression was performed to determine the
predictors of the main outcome (ROSC) for the patient
submitted to CPR. Each potential variable was considered
separately to obtain odds ratio (ORs) for the individual
effect of each predictor on the main outcome. All predictor
variables used in the univariate analysis were used in the
multivariable analysis to obtain adjusted ORs. A p value of
<0.05 was considered significant for all tests.
Results
The EMS dealt with a total of 1105 OHCAs in the district
of Udine from 1 January 2010–31 December 2014, with
an incidence of 123/100,000 inhabitants/year. Most of the
OHCAs (742, 67%) occurred during daytime (from
08:00–20:00). We specified that EMS providers did not
witness the cardiac arrests, and confirmed OHCAs at the
time of their arrival.
Figure 1 shows the Utstein data elements characterising
OHCAs. Four hundred and three (37%) were immediately
coded as OHCAs by dispatch nurses, whereas the remain-
ing 702 cases were classified under different dispatch rea-
sons: loss of consciousness (231, 21%), acute respiratory
failure (169, 15%), unknown problems (74, 7%), trauma
(59, 5%), chest pain (30, 3%), neurological problems (35,
3%), tentamen (suicide attempt, 33, 3%), hypoglycaemia
4 European Journal of Cardiovascular Nursing 00(0)

Table 1.  Characteristics of patients submitted to cardiopulmonary resuscitation (CPR).

Variable ROSC (n=142) No ROSC (n=347) p

Age (mean, SD) 67.5±18.1 74.8±18.2 <0.001
Sex, F (n, %) 41 (29%) 137 (40%) 0.028
M (n, %) 100 (71%) 207 (60%)  
Sending dispatch code (n, %)  
White 3 (2%) 3 (1%)  
Green 7 (5%) 15 (4%)  
Yellow 44 (31%) 141 (41%) 0.583
Red 87 (62%) 188 (54%)  
EMS intervention time (min) 8’ 53’’ 9’ 18’’ 0.031
(mean, I, II, III quartile) 5/8/10 6/8/12
Minutes of CPR (min) 28.6 31.4 0.062
(mean, I, II, III quartile) 18.5/26/36 20/29/40
CPR started by layperson/bystander (n, %) 62 (44%) 115 (33%) 0.024
Initial rhythm  
VT/VF (n, %) 55 (39%) 9 (3%) <0.001
Asystole/PEA/not reported (n, %) 87 (61%) 338 (97%)
Defibrillation (n, %) 59 (42%) 48 (14%) <0.001

EMS: emergency medical service; PEA: pulseless electrical activity; ROSC: return of spontaneous circulation; SD: standard deviation; VF: ventricular
fibrillation; VT: ventricular tachycardia.
Missing data for gender (n=4) and sending dispatch code (n=1).

Table 2.  Distribution of out-of-hospital cardiac arrests over the five years.

Event 2010 2011 2012 2013 2014 p

(n=200) (n=166) (n=246) (n=245) (n=248)
CPR (n, %) 83 (42%) 81 (49%) 112 (46%) 111 (45%) 102 (41%) 0.55
ROSC (n,%) 24 (12%) 26 (16%) 28 (12%) 33 (14%) 31 (12%) 0.781
Alive (n, %) 3 (2%) 4 (2%) 6 (2%) 9 (4%) 7 (3%) 0.497

CPR: cardiopulmonary resuscitation; ROSC: return of spontaneous circulation.

(5, <1%), and others (i.e. haemorrhages, intoxications,
abdominal pain, psychiatric disorders, electrocution).
Resuscitation was withheld in 616 cases (55.8%):
262 (43%) of those cases showed signs unequivocally
associated with death; 162 (26%) cases were found in
cardiac arrest too late and resuscitation was withheld for
time criteria, 46 (8%) had a serious injury, 141 (23%)
were terminally ill. A total of 489 patients (44.2%)
underwent CPR. There was an overall male predomi-
nance, and the mean age was 72.6 years (SD 17.9). VF
and pulseless VT are the shockable rhythms that
appeared in the monitor of 87 patients (18%). Of the
489 patients, ROSC was achieved in 142 patients (29%).
Among the 142 cases of ROSC, 77 died in the first 24 h,
26 within 30 days, five in one year, and five after one
year, 29 of them (5.9% of those receiving CPR) sur-
vived to hospital discharge.
Pre-EMS arrival, CPR was performed on 62 cases (44%)
in the ROSC group, and on 115 cases (33%) in the no ROSC
group (p<0.024). The median EMS intervention time was
eight minutes in the two groups (Table 1). In six cases (1%),
the dispatch code was white, in 22 (5%) green, in 185 (38%)
yellow, and in 275 (56%) red, with no difference between
the two groups.
Table 2 shows that the incidence of CPR, ROSC and
survivors remained constant over the five years of obser-
vation. Considering all OHCAs, patients undergoing CPR
ranged from 41–49%; of these, ROSC occurred in cases
which ranged from 12–16%, and survival rate ranged from
2–4%. Similarly, the interval in minutes from dispatch to
arrival at site of collapse over the time remained the same
(Figure 2). Specifically, in 2010, 2012 and 2013 the median
EMS intervention time was eight minutes (SD=5), in 2011
was eight (SD=4) and in 2014 was nine (SD=6; p=0.21).
Nurse-assisted telephone bystander CPR instructions are
used in Italy. CPR started by layperson/bystander before
EMS arrival was performed on 177 cases (16%), over a
period of five years (Table 3).
The association of potential predictor variables with the
outcome ROSC is summarised in Table 4. In the univariate
analysis, patients with a ROSC were less likely to be
female (OR 0.61, 0.40–0.93) compared to non-survivors.
Patients who had an OHCA with an initial shockable
rhythm (OR 6.33, 3.86–10.39) or an age <60 years (OR
Danielis et al. 5
2.91, 1.86–4.57) had a greater likelihood of ROSC. In
addition, bystander CPR (OR 1.56, 1.04–2.33) was associ-
ated with an increased chance of ROSC.
Discussion
The incidence of OHCAs in our setting was 123/100,000
inhabitants/year. Previously, other studies in our region
investigated epidemiology and survival rate of OHCAs.
The FACS study reported 150 cases of cardiac arrest due to
cardiac aetiology based on a population of 157,098 in one
year. Incidence was 95/100,000 inhabitants/year, with an
overall survival rate on resuscitation attempts of 6.7%.4
More recently, Sanson et al., in 2016, registered a total of
678 OHCAs due to different aetiology in a one-year retro-
spective study, with an incidence of 287/100,000 inhabit-
ants/year and a survival rate of 8.5% of those receiving
CPR.5 Data reported in the international literature varies
greatly around the world. A prospective multi-centre
observational study of all OHCAs from 2006–2007,
reported an incidence ranging from 72–59 inhabitants/year
in 11 North American sites, with a rate of survival to dis-
charge ranging from 7.7–39.4%.15 Other data suggested an
OHCA incidence of 207/100,000 inhabitants/year, as
reported in a cohort of patients with OHCAs who were
Figure 2.  Interval in minutes from dispatch to arrival at the
site of collapse over the five years. 0: 2010; 1: 2011; 2=2012;
3= 2013; 4=2014.
Table 3.  Cardiopulmonary resuscitation (CPR) started by layperson/bystander over the five years.
2010 2011
(n=200) (n=166)
CPR started by layperson/bystander (n, %) 33 (16%) 26 (16%)
treated by the Vienna Ambulance Service.16 This means
that the OHCA phenomenon must be linked to the demo-
graphic and clinical characteristics of the study population.
Furthermore, geographical features (urban vs rural) and
type of EMS are determinants when performing an epide-
miological analysis.
Historically, it’s well known that a shockable rhythm
(VF/VT) is correlated with a higher survival rate.8 We
found that an initial shockable rhythm had higher chance
of ROSC in patients with a cardiac arrest (OR 5.89, 3.49–
9.95, p<0.0001). Non-shockable arrest rhythms (PEA and
asystole) represented an increasing proportion of reported
cases of OHCA. Studies of non-shockable rhythms are
becoming gradually more important because of the larger
numbers of arrests with those rhythms as well as their sig-
nificantly worse outcomes.17,18 The goal is the conversion
from non-shockable to shockable rhythms during the
course of resuscitation.
Our results confirm a trend of poor survival rate, with a
high incidence of OHCAs. However, 18 survivors (62%)
showed a good neurological recovery with a CPC value of
one. A population-based cohort study in the Netherlands
reported that the proportion of surviving patients that had
a favourable neurological outcome at discharge remained
high throughout the study period of seven years (89.9–
95.1%).19 Previous studies have shown that time to defi-
brillation decreased and survival increased with the
implementation of AED and CPR programmes.20,21 In our
study, CPR started by a bystander before EMS arrival was
performed in only 177 cases (16%), without an increase
over the study period. In 2015, Hasselqvist-Ax et al. ana-
lysed a total of 30,381 OHCAs in Sweden in a 10-year
period. CPR was performed before the arrival of EMS in
15,512 cases (51.1%) and this result was associated with
an increased 30-day survival rate (OR 2.15; 95% confi-
dence interval (CI), 1.88–2.45).22 In our country, across the
Province of Brescia, development of a programme based
on diffuse deployment of AEDs operated by trained volun-
teers was associated with an increase of survival rate from
0.9% in the historical cohort to 3% in the study population
(p=0.0015).10 In the future, the goal will be to increase
bystander CPR and AED use, to improve long-term sur-
vival and the other outcomes from cardiac arrests.
In our study, EMS response time was similar to other
research studies.5,23,24 Literature analysis confirms that the
most suitable time of emergency response in OHCA is still
unknown, as well as the intensity and duration of treatment
by the EMS. However, EMS response time, including the
2012 2013 2014 Total p
(n=246) (n=245) (n=248) (n=1105)
42 (17%) 37 (15%) 39 (16%) 177 (16%) 0.975
6 European Journal of Cardiovascular Nursing 00(0)
Table 4.  Logistic regression analysis was performed to investigate the influence of different variables on chance of return of
spontaneous circulation (ROSC).
Univariate analysis
Characteristics OR (95% CI)
Sex (female) 0.61 (0.40–0.93)
Age<60 years 2.91 (1.86–4.57)
Cardiac aetiology 1.19 (0.80–1.78)
CPR duration>20 min 1.42 (0.93–2.16)
EMS response time>8 min 0.77 (0.52–1.15)
Shockable initial rhythm 6.33 (3.86–10.39)
CPR started by layperson/bystander 1.56 (1.04–2.33)
CI: confidence interval; CPR: cardiopulmonary resuscitation; EMS: emergency medical service; OR: odds ratio.
time used to access the EMS dispatch centre and for per-
forming call processing and dispatch of the rescue
resources, should be as short as possible. It is well known
that rapid resuscitation performed within the first four
minutes after OHCA shows a favourable prognostic factor
for higher survival.24
Our study reported six (1%) cases of white (not criti-
cal) and 22 (5%) cases of green (not very critical) dis-
patch runs, that were subsequently identified as OHCAs
upon arrival of the ambulance. This may highlight a lack
of effort in education of the whole population on proper
EMS activation. A previous study in Danish and Swedish
countries, aimed to analyse and compare the accuracy of
OHCA recognition by medical dispatchers.25 Data from
cardiac arrest databases were merged with audio record-
ings of emergency call data, and showed that the sensi-
tivities for recognition of cardiac arrest (calculated with
data from electronically registered data) were only
40.9% in Denmark and 78.4% in Sweden (p<0.001).
When adding data from the audio recordings, the sensi-
tivities were 80.7% and 86.0% for the two regions
respectively (p=0.06). ‘Unclear problem’ was the most
frequent dispatch code for audited non-recognised
OHCA. In conclusion, for EMS nurses, prehospital tri-
age of patients with cardiac arrest is a difficult task, and
the recognition of cardiac arrest by citizens seems to be
challenging in the prehospital setting.25 A high compli-
ance to the follow the priority tool and mandatory ques-
tions is important and facilitates the assignment to
recognise OHCA and dispatch correct resources with the
right priority. Further studies to identify the causes
underlying (or related to) underestimation of red codes,
like OHCA, should be implemented and are strongly
recommended.
Limitations
This study shows some limitations due to its retrospective
nature. First of all the lack of data. No variables on previ-
ous history of the patients or the intra-hospital events were
Multivariate analysis
p OR (95% CI) p
0.023 0.74 (0.46–1.18) 0.207
<0.0001 2.51 (1.53–4.13) 0.0003
0.377 0.90 (0.57–1.44) 0.687
0.102 1.57 (0.98–2.51) 0.059
0.211 0.85 (0.54–1.31) 0.468
<0.0001 5.89 (3.49–9.95) <0.0001
0.028 1.21 (0.75–1.94) 0.416
available except for survival. Secondly, all the data came
from a single metropolitan area served by a dedicated
emergency central, a model since discontinued with the
recent adoption of a single dispatch centre covering the
whole Friuli Venezia Giulia Region.
Implications for practice and the
nursing perspective
Although survival rates for OHCA are disappointing,
rapid and effective basic and advanced life support
(ALS) are crucial to improve survival, prevent neuro-
logical deficit and improve the quality of life of patients
suffering from cardiac arrest.10 Nurses play a key role in
the management of OHCAs; in Italian EMS they are
often the first on the scene of an OHCA. This translates
to the need for all nursing staff to be currently CPR and
defibrillator-certified and further trained to the level of
ALS. However, the certificate alone is not enough;
refresher training in a simulated environment with
emphasis on quality is crucial.26
In an out-of-hospital environment, emergency nurses
need to keep their skills updated including both technical
skills, such as managing defibrillation, airway and ventila-
tion, lines, drugs and tubes, and non-technical skills, such
as communication, decision making, teamwork and lead-
ership.27 Furthermore, the starting point is the continuous
improvement of the education of nursing students, in order
to improve self-efficacy and critical thinking skills in
emergency cardiac arrest situations.
Secondly, emergency nurses should be involved in
community training programmes and guide citizens to
improve the skills of CPR and early defibrillation use.
Some strategies to improve CPR training may be adopted
into civic, work or school activities; 30-minute training
sessions, whether with video self-instruction or group
training, can achieve good post-training CPR knowl-
edge.28 In our study, the majority of OHCAs were cor-
rectly identified by dispatchers, but a better knowledge of
the phenomenon amongst the population through CPR
Danielis et al. 7
courses is desirable, to improve the ability to recognise
an OHCA followed by prompt activation of the EMS.
Very few studies have investigated the outcomes related
to OHCA, considering that the dispatching code (in terms
of priority) is merely based on telephone calls. It is fun-
damental, indeed, that the bystander who is making the
call explains the situation clearly, helping the staff trained
to receive emergency calls to recognise cardiac arrest-
related symptoms promptly.29 Therefore, education and
awareness among the population remain important steps
in reducing the impact of this event, in order to prevent
cardiac arrest and identify all risk factors as early as pos-
sible. In addition, several studies have aimed to identify
public locations and houses where cardiac arrests are
most likely to occur. Studies have reported data showing
that many public access defibrillation (PAD) programmes
have been implemented worldwide and have demon-
strated improved cardiac arrest outcomes.2,30,31 Current
and future research should also explore the potential of
digital resources and public knowledge through mobile
media and social media.32
Thirdly, in our study we highlight incidence data from
OHCAs through different territories and countries, due to
the diversity of the populations under investigation and the
different strategies for the management of cardiac arrest.
Some points deserve reflection for emergency staff. There
is a need to understand how to best standardise and imple-
ment care decisions around advance directives, such as do
not attempt resuscitation (DNAR) and end of life care,
including education of patients and families.33 Moreover,
quality of life assessments, and patient utilization of
healthcare resources after hospital discharge, should be
evaluated. Nowadays, consciousness of patient prefer-
ences and values for their own end of life care has driven
increased implementation of advance directives also in
Italy, recently normed by law.
Not lastly, accurate documentation using well-designed
standard reporting systems is critical in resuscitations for
subsequent evaluation for continuous improvement. A
wide (regional or national) database implementing Utstein-
style reporting13 is necessary to achieve a better knowl-
edge of OHCA and drive future investments in regional
health care. The goal should be to use epidemiology as a
‘story’, which leads to understanding the causes and
directs interventions.
Conclusions
Though extremely variable in dependence of the consid-
ered setting, the incidence of OHCA in our study still lays
in the known range. As a major time-dependant disease, in
our district the prognosis remains poor, though the major-
ity of patients who survived cardiac arrest returned to nor-
mal life. This work emphasises the need for a larger
database, regional or national, to draw definite conclusions
on the phenomenon and to asses areas of future interven-
tions to improve outcomes.
Implications for practice
•• Nurses should continue to expand their resus-
citation skills and tasks.
•• Educational and advisory services for citizens
should be implemented.
•• There is a need for recognition of the impor-
tance of end of life and unnecessary treatments.
•• Epidemiological analyses are necessary to
guide decision-making on public health.
Conflict of interest
The authors declare that there is no conflict of interest.
Funding
This research received no specific grant from any funding agency
in the public, commercial, or not-for-profit sectors.
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