scholarly journals N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Indicator for 30-Day Mortality Following Out-of-Hospital Cardiac Arrest: A prospective observational study.

2020 ◽  
Author(s):  
Reidun Aarsetøy ◽  
Torbjørn Omland ◽  
Helge Røsjø ◽  
Heidi Strand ◽  
Thomas Werner Lindner ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Natriuretic Peptide ◽  
Troponin T ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Sudden Cardiac Arrest ◽  
Cardiac Biomarkers ◽  
Prognostic Information ◽  
Clinical Trial Registration ◽  
Hospital Cardiac Arrest

Abstract Background: Early risk stratification applying cardiac biomarkers may prove useful in sudden cardiac arrest patients. We investigated the prognostic utility of early-on levels of high sensitivity cardiac troponin-T (hs-cTnT), copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with out-of-hospital cardiac arrest (OHCA).Methods: We conducted a prospective observational unicenter study, including patients with OHCA of assumed cardiac origin from the southwestern part of Norway from 2007 until 2010. Blood samples for later measurements were drawn during cardiopulmonary resuscitation or at hospital admission.Results: A total of 114 patients were included, 37 patients with asystole and 77 patients with VF as first recorded heart rhythm. Forty-four patients (38.6 %) survived 30-day follow-up. Neither hs-cTnT (p = 0.49), nor copeptin (p = 0.39) differed between non-survivors and survivors, whereas NT-proBNP was higher in non-survivors (p < 0.001) and significantly associated with 30-days all-cause mortality in univariate analysis, with a hazard ratio (HR) for patients in the highest compared to the lowest quartile of 4.6 (95% confidence interval (CI), 2.1 – 10.1), p < 0.001. This association was no longer significant in multivariable analysis applying continuous values, [HR 0.96, (95% CI, 0.64 - 1.43), p = 0.84]. Similar results were obtained by dividing the population by survival at hospital admission, excluding non-ROSC patients on-scene [HR 0.93 (95% CI, 0.50 - 1.73), P = 0.83]. We also noted that NT-proBNP was significantly higher in asystole- as compared to VF-patients, p < 0.001.Conclusions: Early-on levels of hs-cTnT, copeptin and NT-proBNP did not provide independent prognostic information following OHCA. Prediction was unaffected by excluding on-scene non-ROSC patients in the multivariable analysis. Clinical Trial Registration: ClinicalTrials. gov, NCT02886273.

scholarly journals N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Indicator for 30-Day Mortality Following Out-of-Hospital Cardiac Arrest: A prospective observational study.

2020 ◽  
Author(s):  
Reidun Aarsetøy ◽  
Torbjørn Omland ◽  
Helge Røsjø ◽  
Heidi Strand ◽  
Thomas Werner Lindner ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Natriuretic Peptide ◽  
Troponin T ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Sudden Cardiac Arrest ◽  
Cardiac Biomarkers ◽  
Prognostic Information ◽  
Clinical Trial Registration ◽  
Hospital Cardiac Arrest

Abstract Background: Early risk stratification applying cardiac biomarkers may prove useful in sudden cardiac arrest patients. We investigated the prognostic utility of early-on levels of high sensitivity cardiac troponin-T (hs-cTnT), copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with out-of-hospital cardiac arrest (OHCA).Methods: We conducted a prospective observational unicenter study, including patients with OHCA of assumed cardiac origin from the Southwestern part of Norway from 2007 until 2010. Blood samples for later measurements were drawn during cardiopulmonary resuscitation or at hospital admission. Results: A total of 114 patients were included, 37 patients with asystole and 77 patients with VF as first recorded heart rhythm. Forty-four patients (38.6%) survived 30-day follow-up. Neither hs-cTnT (p = 0.49), nor copeptin (p = 0.39) differed between non-survivors and survivors, whereas NT-proBNP was higher in non-survivors and significantly associated with time to death, with a hazard ratio (HR) for patients in the highest compared to the lowest quartile of 4.6 (95% CI 2.1 – 10.1), p < 0.001. This association was attenuated in the multivariable analysis [HR 2.18 (95% CI 0.83 – 5.72)], p = 0.11. NT-proBNP was significantly higher in asystole- as compared to VF-patients, p < 0.001.Conclusions: In OHCA, NT-proBNP was significantly associated with 30-day survival in univariate analysis, but associations were attenuated after multivariable adjustment. Hs-cTnT and copeptin did not provide prognostic information following OHCA.Clinical Trial Registration: ClinicalTrials. gov, NCT02886273.

scholarly journals N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Indicator for 30-Day Mortality Following Out-of-Hospital Cardiac Arrest: A prospective observational study

2020 ◽  
Author(s):  
Reidun Aarsetøy ◽  
Torbjørn Omland ◽  
Helge Røsjø ◽  
Heidi Strand ◽  
Thomas Werner Lindner ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Natriuretic Peptide ◽  
Troponin T ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Sudden Cardiac Arrest ◽  
Cardiac Biomarkers ◽  
Prognostic Information ◽  
Clinical Trial Registration ◽  
Hospital Cardiac Arrest

Abstract Background Early risk stratification applying cardiac biomarkers may prove useful in sudden cardiac arrest patients. We investigated the prognostic utility of early-on levels of high sensitivity cardiac troponin-T (hs-cTnT), copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with out-of-hospital cardiac arrest (OHCA). Methods We conducted a prospective observational unicenter study, including patients with OHCA of assumed cardiac origin from the southwestern part of Norway from 2007 until 2010. Blood samples for later measurements were drawn during cardiopulmonary resuscitation or at hospital admission. Results A total of 114 patients were included, 37 patients with asystole and 77 patients with VF as first recorded heart rhythm. Forty-four patients (38.6%) survived 30-day follow-up. Neither hs-cTnT (p = 0.49), nor copeptin (p = 0.39) differed between non-survivors and survivors, whereas NT-proBNP was higher in non-survivors and significantly associated with time to death, with a hazard ratio (HR) for patients in the highest compared to the lowest quartile of 4.6 (95% CI 2.1–10.1), p < 0.001. This association was attenuated in the multivariable analysis [HR 2.18 (95% CI 0.83–5.72)], p = 0.11. NT-proBNP was significantly higher in asystole- as compared to VF-patients, p < 0.001. Conclusions In OHCA, NT-proBNP was significantly associated with 30-day survival in univariate analysis, but associations were attenuated after multivariable adjustment. Hs-cTnT and copeptin did not provide prognostic information following OHCA. Clinical Trial Registration: ClinicalTrials. gov, NCT02886273.

Abstract 135: N-Terminal Pro-B-Type Natriuretic Peptide May Serve as a Prognostic Indicator for 30-Day Mortality Following Out-Of-Hospital Cardiac Arrest, Whereas Both High-Sensitivity Cardiac Troponin-T and Copeptin Did Not Yield Prognostic Information

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Reidun Aarsetoey ◽  
Torbjorn Omland ◽  
Helge Rosjo ◽  
Heidi Strand ◽  
Hildegunn Aarsetoey ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Troponin T ◽  
Univariate Analysis ◽  
Heart Rhythm ◽  
Cox Proportional Hazards Model ◽  
Prognostic Indicators ◽  
Prognostic Information ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Introduction: Sudden cardiac arrest (SCA) may be due to different underlying conditions. Prior heart disease is a major risk factor, and coronary artery disease is the most common underlying cause. Hs-cTnT and copeptin are used for early diagnosis of acute myocardial infarction, and may also serve as prognostic indicators following an acute coronary syndrome. NT-proBNP is a marker of heart failure and may act as a predictor of mortality in SCA patients. These three biomarkers in relation to ventricular fibrillation (VF) and asystole on scene during resuscitation has not, to our knowledge, been evaluated. Hypothesis: We hypothesized that early-on levels of hs-cTnT, copeptin and NT-proBNP may relate to prognosis. Methods: From February 2007 until November 2010 blood samples were collected from patients aged > 18 years with out-of-hospital cardiac arrest of assumed cardiac origin. EDTA-blood was drawn during or immediately after termination of cardiopulmonary resuscitation or at hospital admission. Hs-cTnT, copeptin and NT-proBNP were all measured by standardized methods. Patients were classified according to first recorded heart rhythm. Both univariate and multivariate analyses, adjusted for age and gender, were performed using a Cox Proportional-Hazards model. Results: A total of 115 patients were included, 77 patients with VF and 38 patients with asystole as first recorded heart rhythm. Forty-four patients (38,3%) survived to 30-day follow-up. There was no significant difference in hs-cTnT (p = 0.71) or copeptin (p = 0.43) between non-survivors and survivors. The mean NT-proBNP level was significantly elevated in non-survivors compared to survivors, p = 0.001. The hazard ratio (HR) in the univariate analysis for patients with NT-proBNP in the highest quartile (Q4) compared to the lowest quartile (Q1) was 4.68 (95% CI 2.05-10.68), p = < 0.001, and in the multivariate analysis HR was 2.52 (95% CI 0.97-6.53), p = 0.058. All patients in the asystole group died. Only NT-proBNP differed between the two groups, with significantly higher values in the asystole group, p = < 0.001. Conclusion: Applying hs-cTnT, copeptin and NT-proBNP for assessment of prognosis in SCA patients with either VF or asystole, only NT-proBNP was found to yield prognostic information.

scholarly journals Mechanisms of Arrhythmogenicity of Hypertrophic Cardiomyopathy-Associated Troponin T (TNNT2) Variant I79N

2021 ◽  
Vol 9 ◽  
Author(s):  
Sanam Shafaattalab ◽  
Alison Y Li ◽  
Marvin G Gunawan ◽  
BaRun Kim ◽  
Farah Jayousi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hypertrophic Cardiomyopathy ◽  
Action Potential ◽  
Natriuretic Peptide ◽  
Troponin T ◽  
Sudden Cardiac Arrest ◽  
Human Action ◽  
Significant Shift ◽  
Ecm Remodeling ◽  
Increased Risk

Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiovascular disease and often results in cardiac remodeling and an increased incidence of sudden cardiac arrest (SCA) and death, especially in youth and young adults. Among thousands of different variants found in HCM patients, variants of TNNT2 (cardiac troponin T—TNNT2) are linked to increased risk of ventricular arrhythmogenesis and sudden death despite causing little to no cardiac hypertrophy. Therefore, studying the effect of TNNT2 variants on cardiac propensity for arrhythmogenesis can pave the way for characterizing HCM in susceptible patients before sudden cardiac arrest occurs. In this study, a TNNT2 variant, I79N, was generated in human cardiac recombinant/reconstituted thin filaments (hcRTF) to investigate the effect of the mutation on myofilament Ca2+ sensitivity and Ca2+ dissociation rate using steady-state and stopped-flow fluorescence techniques. The results revealed that the I79N variant significantly increases myofilament Ca2+ sensitivity and decreases the Ca2+ off-rate constant (koff). To investigate further, a heterozygous I79N+/−TNNT2 variant was introduced into human-induced pluripotent stem cells using CRISPR/Cas9 and subsequently differentiated into ventricular cardiomyocytes (hiPSC-CMs). To study the arrhythmogenic properties, monolayers of I79N+/− hiPSC-CMs were studied in comparison to their isogenic controls. Arrhythmogenesis was investigated by measuring voltage (Vm) and cytosolic Ca2+ transients over a range of stimulation frequencies. An increasing stimulation frequency was applied to the cells, from 55 to 75 bpm. The results of this protocol showed that the TnT-I79N cells had reduced intracellular Ca2+ transients due to the enhanced cytosolic Ca2+ buffering. These changes in Ca2+ handling resulted in beat-to-beat instability and triangulation of the cardiac action potential, which are predictors of arrhythmia risk. While wild-type (WT) hiPSC-CMs were accurately entrained to frequencies of at least 150 bpm, the I79N hiPSC-CMs demonstrated clear patterns of alternans for both Vm and Ca2+ transients at frequencies &gt;75 bpm. Lastly, a transcriptomic analysis was conducted on WT vs. I79N+/−TNNT2 hiPSC-CMs using a custom NanoString codeset. The results showed a significant upregulation of NPPA (atrial natriuretic peptide), NPPB (brain natriuretic peptide), Notch signaling pathway components, and other extracellular matrix (ECM) remodeling components in I79N+/− vs. the isogenic control. This significant shift demonstrates that this missense in the TNNT2 transcript likely causes a biophysical trigger, which initiates this significant alteration in the transcriptome. This TnT-I79N hiPSC-CM model not only reproduces key cellular features of HCM-linked mutations but also suggests that this variant causes uncharted pro-arrhythmic changes to the human action potential and gene expression.

scholarly journals Contacts to the healthcare system prior to out-of-hospital cardiac arrests

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Zylyftari ◽  
S.G Moller ◽  
M Wissenberg ◽  
F Folke ◽  
C.A Barcella ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
General Population ◽  
Healthcare System ◽  
Early Identification ◽  
Sudden Cardiac Arrest ◽  
Funding Source ◽  
Horizon 2020 ◽  
One Year ◽  
Public Grant ◽  
Hospital Cardiac Arrest

Abstract Background Patients who suffer a sudden out-of-hospital cardiac arrest (OHCA) may be preceded by warning symptoms and healthcare system contact. Though, is currently difficult early identification of sudden cardiac arrest patients. Purpose We aimed to examine contacts with the healthcare system up to two weeks and one year before OHCA. Methods OHCA patients were identified from the Danish Cardiac Arrest Registry (2001–2014). The pattern of healthcare contacts (with either general practitioner (GP) or hospital) within the year prior to OHCA of OHCA patients was compared with that of 9 sex- and age-matched controls from the background general population. Additionally, we evaluated characteristics of OHCA patients according to the type of healthcare contact (GP/hospital/both/no-contact) and the including characteristics of contacts, within two weeks prior their OHCA event. Results Out of 28,955 OHCA patients (median age of 72 (62–81) years and with 67% male) of presumed cardiac cause, 16,735 (57.8%) contacted the healthcare system (GP and hospital) within two weeks prior to OHCA. From one year before OHCA, the weekly percentages of contacts to GP were relatively constant (26%) until within 2 weeks prior to OHCA where they markedly increased (54%). In comparison, 14% of the general population contacted the GP during the same period (Figure). The weekly percentages of contacts with hospitals gradually increased in OHCA patients from 3.5% to 6.5% within 6 months, peaking at the second week (6.8%), prior to OHCA. In comparison, only 2% of the general population had a hospital contact in that period (Figure). Within 2 weeks of OHCA, patients contacted GP mainly by telephone (71.6%). Hospital diagnoses were heterogenous, where ischemic heart disease (8%) and heart failure (4.5%) were the most frequent. Conclusions There is an increase in healthcare contacts prior to “sudden” OHCA and overall, 54% of OHCA-patients had contacted GP within 2 weeks before the event. This could have implications for developing future strategies for early identification of patients prior to their cardiac arrest. Figure 1. The weekly percentages of contacts to GP (red) and hospital (blue) within one year before OHCA comparing the OHCA cases to the age- and sex-matched control population (N cases = 28,955; N controls = 260,595). Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020

scholarly journals 156 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

2020 ◽  
Vol 37 (12) ◽  
pp. 825.1-825
Author(s):  
Ed Barnard ◽  
Daniel Sandbach ◽  
Tracy Nicholls ◽  
Alastair Wilson ◽  
Ari Ercole
Keyword(s):  
Overall Survival ◽  
Cardiac Arrest ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Multivariable Analysis ◽  
Discharge Data ◽  
Successful Resuscitation ◽  
Bystander Cpr ◽  
Number Percentage ◽  
Hospital Cardiac Arrest

Aims/Objectives/BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Aim: to compare differential determinants of survival to hospital admission and survival to hospital discharge for traumatic (TCA) and non-traumatic cardiac arrest (NCTA).Methods/DesignAn analysis of 9109 OHCA in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for NTCA and TCA. Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. Data reported as number (percentage), number (percentage (95% CI)) and median (IQR) as appropriate. Continuous data have been analysed with a Mann-Whitney U test, and categorical data have been analysed with a χ2 test. Analyses were performed using the R statistical programming language.Results/ConclusionsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95%CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander-CPR was dependent on geographical socioeconomic status.NTCA and TCA are clinically distinct entities with different predictors for outcome and should be reported separately. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

Out-of-hospital sudden cardiac arrest in children with congenital heart defects

2017 ◽  
Vol 103 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Jarle Jortveit ◽  
Jakob Klcovansky ◽  
Gaute Døhlen ◽  
Leif Eskedal ◽  
Sigurd Birkeland ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Sudden Cardiac Arrest ◽  
Supplementary Information ◽  
Clinical Registry ◽  
Birth Registry ◽  
Live Births ◽  
Hospital Cardiac Arrest

AimsOut-of-hospital sudden cardiac arrest (SCA) is a rare but devastating event in children and adolescents. The risk is assumed to be higher in children with congenital heart defects (CHDs) than in healthy individuals. The aim of the present study was to investigate the rate of and survival after out-of-hospital cardiac arrest in children 2–18 years old with CHDs.Methods and resultsData concerning all live births in Norway between 1994 and 2009 were retrieved from the Medical Birth Registry of Norway, the patient administrative systems at all hospitals in Norway, the Oslo University Hospital’s Clinical Registry for Congenital Heart Defects and the Norwegian Cause of Death Registry. Survivors were followed through 2012, and supplementary information for the deceased children was retrieved from medical records at Norwegian hospitals. Among the 943 871 live births in Norway from 1994 to 2009, 11 272 (1.2%) children had a CHD. We identified 11 (0.1%) children 2–18 years old with CHDs who experienced out-of-hospital SCA. The estimated rate of out-of-hospital SCA in children 2–18 years old with CHD was 10 per 100 000 person-years. Early cardiopulmonary resuscitation was initiated in all patients. Three children survived.ConclusionsThe incidence of and survival after out-of-hospital SCA in children with CHDs were comparable to the reported rates in the general child population.

Abstract 26: Prevalence and Pattern of Myocardial Injury in Patients With Cardiac vs Non-Cardiac Cause of Out-Of-Hospital Cardiac Arrest: A One-Year Multicenter Clinical Experience With the High-Sensitivity Troponin T Assay

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
David E Hamilton ◽  
Bradley J Petek ◽  
Lindsay G Panah ◽  
Sean R Mendez ◽  
Philip E Dormish ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Myocardial Injury ◽  
Troponin T ◽  
Clinical Care ◽  
High Sensitivity ◽  
Severity Of Injury ◽  
High Sensitivity Troponin T ◽  
One Year ◽  
Hospital Cardiac Arrest

Introduction: Myocardial injury is common after out-of-hospital-cardiac arrest (OHCA). However, little is known about the role of early serial hs-TnT in patients with OHCA for identifying myocardial injury, and whether the prevalence and severity of injury differs according to cardiac (CV) vs noncardiac (non-CV) cause of OHCA. Hypothesis: Early hs-TnT will demonstrate high rates of myocardial injury after OHCA regardless of etiology. However, in the first 6 hours after OHCA the extent of hs-TnT elevation and rate of rise will be higher in patients with CV vs non-CV etiology. Methods: Multicenter retrospective study including OHCA patients presenting from 4/1/2018 to 4/1/2019. Hs-TnT was drawn as part of routine clinical care. Results: Baseline hs-TnT was measured in 120 patients after OHCA due to CV (n=51) and non-CV (n=69) etiologies, with subsequent serial hs-TnT values at 1hr, 3hrs, and 6hrs. Hs-TnT was greater than the 99 th percentile in 97% (115/120) of patients and myocardial injury (hs-TnT> 52ng/L) was detected in 88% (105/120) of patients (no difference between CV vs non-CV etiology). Median hs-TnT values were compared between CV and non-CV etiologies of OHCA identifying no difference in hs-TnT at baseline (Figure: 54 [IQR 18-134] vs. 41 [IQR 19-100]; p=0.357) but significantly higher hs-TnT in patients with CV etiology at 1hr (159 [IQR 80-392] vs 93 [IQR 42-247]; p=0.049), 3hrs (400 [IQR 168-1005] vs 151 [IQR 75-401] p=0.009), and 6hrs (746 [IQR 248-1965] vs 251 [IQR 75-580]; p=0.001). Additionally, hs-TnT rise from baseline was present in both CV and non-CV etiologies but was significantly higher in patients with CV etiology (p = 0.005). Conclusions: As identified by hs-TnT, myocardial injury was prevalent in patients with both CV and non-CV cause of OHCA. Baseline hs-TnT was no different in patients with CV vs non-CV cause, however, over the first 6 hours both absolute value and rate of hs-TnT rise were significantly higher for patients with CV vs non-CV etiology of OHCA.

Abstract 219: Out-of-Hospital Cardiac Arrest in Vienna 2014

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Markus Keferböck ◽  
Philip Datler ◽  
Mario Krammel ◽  
Elisabeth Lobmeyer ◽  
Alexander Nürnberger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Sudden Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Medical Personnel ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays. Method: Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated. Results: During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing. Conclusion: The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.

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