Cardiac arrest care and emergency medical services in Canada.

BACKGROUND Heart disease is the primary cause of mortality in Canada and survival to hospital discharge from out-of-hospital cardiac arrest is low. OBJECTIVE To provide an overview of the outcomes for out-of-hospital cardiac arrest in Canada. METHODS A national, descriptive, Utstein-style analysis of cardiac arrest care and emergency medical services was conducted. Data were compiled from five sources: the City of Edmonton Emergency Response Department, the British Columbia Ambulance Service, the Nova Scotia Emergency Health Services, the Urgences-santé corporation of the Montreal Metropolitan region and the Ontario Prehospital Advanced Life Support (OPALS) Study database. RESULTS There were 5288 cardiac arrests from a range of small communities to large provincial cardiac arrest registries in 2002. They were men (62.6% to 70.1%) in their sixties and seventies, witnessed (35.2% to 55.0%), rarely receiving bystander cardiopulmonary resuscitation (CPR) (14.7% to 46.0%), often in asystole (35.7% to 51.3%), arresting at home (56.1%) and rarely surviving to hospital discharge (4.3% to 9.0%). Bystander CPR and early first responder defibrillation were significantly associated with increased survival. Cardiac arrest incidence rates per 100,000 varied between 53 and 59 among provinces and followed a downward trend. CONCLUSIONS The results of this study could be an important first step toward a national cardiac arrest registry comparing the impact of regional differences in patient and system characteristics. Many communities do not have accurate data on their performance with regards to the chain of survival, or need to significantly improve their capacity for providing citizen bystander CPR and rapid first responder defibrillation.