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The Pre-Hospital Arrest Survival Evaluation (PHASE) Study

Gary Lombardi, MD; E. John Gallagher, MD; Paul, MD

JAMA. 1994;271(9):678-683.

Abstract
Objective.
—To determine survival from out-of-hospital cardiac arrest in New York City and to compare this with other urban, suburban, and rural areas.

Design.
—Observational cohort study.

Setting.
—New York City.

Participants.
—Consecutive out-of-hospital cardiac arrests occurring between October 1, 1990, and April 1, 1991.

Intervention.
—Trained paramedics performed immediate postarrest interviews with care providers, using a standardized questionnaire.

Main Outcome Measures.
—Entry criteria, elapsed time intervals, and nodal events conformed to Utstein recommendations. The single target end point was death or discharge home.

Results.
—Of 3243 consecutive cardiac arrests on which resuscitation was attempted, 2329 (72%) met entry criteria as primary cardiac events. Overall survival was 1.4% (99% confidence interval [CI], 0.9% to 2.3%). No patients were lost to follow-up. Survival from witnessed ventricular fibrillation was 5.3% (99% CI, 2.9% to 8.8%). Using survival from witnessed ventricular fibrillation for intersystem comparison, our survival rate was similar to that of Chicago, III (4.0%; 99% CI, 1.9% to 7.5%; P=.41), the only other large city on which data were available. However, it was significantly lower than that reported from midsized urban/suburban areas (33.0%; 99% CI, 30.4% to 35.6%; P<.0001) and suburban/rural areas (12.6%; 99% CI, 8.9% to 16.3%; P<.0001). Survival rate among arrests occurring after arrival of emergency medical services personnel (8.5%; 99% CI, 4.7% to 14.0%) was comparable with Chicago (6.6%; 99% CI, 3.3% to 11.5%; P=.41) but markedly lower than King County, Washington (36%; 99% CI, 28.6% to 43.8%; P<.0001).

Conclusions.
—Survival from out-of-hospital cardiac arrest in New York City was poor. This was partly attributable to lengthy elapsed time intervals at every step in the chain of survival. However, examination of survival among arrests occurring after emergency medical services arrival suggests that other features may predispose residents of large cities to higher cardiac arrest mortality than individuals living in more suburban or rural settings. Since half the US population resides in large metropolitan areas, this represents a public health problem of considerable magnitude.

(JAMA. 1994;271:678-683)

Author Affiliations
From the Departments of Medicine, Epidemiology, and Social Medicine, Albert Einstein College of Medicine, Bronx, NY. During 1 year of the project, Dr Gallagher was a Visiting Clinical Scholar, Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Conn.

Footnotes
Reprint requests to Emergency Department 1-W-20, Bronx Municipal Hospital, Bronx, NY 10461 (Dr Gallagher).

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