Prise en charge des arrêts cardiaques extrahospitaliers sur un territoire français


cardiac arrest
neurological prognosis

How to Cite

Martinez, M. ., Mainsel , A., Lefebvre , T., Espinouse , S., Guenier , P., Savu , A., Carle , O., Massacrier , S., Parsis , P., & Viallon , A. (2021). Prise en charge des arrêts cardiaques extrahospitaliers sur un territoire français. Mediterranean Journal of Emergency Medicine, (28), 13-20. Retrieved from


Aim: The survival rate of out-of-hospital cardiac arrests (OHCA) remain slow in France (4.9%). The main objective of our study was to describe the management of OHCA in Loire and North Ardèche. Secondary objectives were to identify factors influencing survival and neurological prognosis at day 30 (D30).

Procedure: Retrospective study based on data from the French national register (RéAC) and including all OHCA for whom

resuscitation was undertaken from January 1, 2013 to August 31, 2018.

Results: The study included 1984 OHCA, 69% of whom were male, with a median age of 68 years old [55-80]. A witness was present in 1265 cases (64%) and started a cardiopulmonary resuscitation (CPR) in 44.5% of cases. The etiology was medical in 88.9% of cases. The initial rhythm was shockable in 6.4% of cases. Seventy-nine patients (4%) survived at day- 30, 56 of whom had a good neurological prognosis (2.8%). Factors improving survival were: early CPR and defibrillation (OR 2.21 [1.02-4.80]), the occurrence in a public place (OR 2.39 [1.27-4.52]) and the presence of gasps at the beginning of care (OR 3.27 [1.49-7.20]). Factors reducing survival were: traumatic etiology (OR 0.11 [0.01-0.85]), non-shockable rhythm (OR 0.09 [0.04-0.19]), advanced age (OR 0.96 [0.95-0.98]), longer no-flow time (OR 0.95 [0.91-0.99]) and an adrenaline dose

≥ 3 mg (OR 0.09 [0.04-0.18]). The same factors influenced the neurological prognosis at D30.

Conclusion: Our data were comparable to national data. The intervention of witnesses is crucial on the prognosis and needs to be encouraged.



Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: asystematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010; 3:63-81.

Berdowski J, Berg R, Tijssen J, Koster RW. Global incidences of out- of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation 2010; 81:1479-87.

Gräsner JT, Lefering R, Koster RW, Masterson S, Böttiger BW, Herlitz J, e t al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one-month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation 2016; 105:188-95.

Luc G, Baert V, Escutnaire J, Genin M, Vilhelm C, Di Pompéo C, et al. Epidemiology of out-of-hospital cardiac arrest: a French national incidence and mid-term survival rate study. Anaesth Crit Care Pain Med 2019; 38:131-5.

Olasveengen TM, de Caen AR, Mancini ME, Maconochie IK, Aickin R, A tkins DL, et al. International Consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary. Resuscitation 2017; 121:201-14.

Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C,et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med 2018; 379:711-21.

Maria V, Pasquale B, Carmine I,Giuseppe S. Epinephrine for out of hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. Resuscitation 2019; 136:54-60.

White L, Melhuish T, Holyoak R, Ryan T, Kempton H, Vlok R. Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis. Am J Emerg Med 2108; 36:2298-306.

Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T, et al. European resuscitation council guidelines for resuscitation 2015. Resuscitation 2105; 95:81-99.

Baert V, Escutnaire J, Nehme Z, Mols P, Lagadec S, Vilhelm C, et al. Development of an online, universal, Utstein registry-based, care practice report card to improve out-of-hospital resuscitation practices. J Eval Clin Pract 2018; 24:431-8.

Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest. Resuscitation 2015; 96:328-40.

Jabre P, Penaloza A, Pinero D, Duchateau FX, Borron SW, Javaudin F, et al. Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after out-of- hospital cardiorespiratory arrest: arandomized clinical trial. JAMA 2018; 319:779-87.

Fouche PF, Simpson PM, Bendall J, Thomas RE, Cone DC, Doi SA. Airways in out-of-hospital cardiac arrest: systematic review and meta- analysis. Prehosp Emer Care 2014; 18:244-56.

B ougouin W, Lamhaut L, Marijon E,Jost D, Dumas F, Deye N. Characteristics and prognosis of sudden cardiac death in Greater Paris. Intensive Care Med 2014; 40:846-54.

Martinell L, Nielsen N, Herlitz J,Karlsson T, Horn J, Wise MP, et al. Early predictors of poor outcome after out-of-hospital cardiac arrest. Crit Care 2017; 21:96.

Morrison LJ, Verbeek PR, Vermeulen MJ, Kiss A, Allan KS, Nesbitt L, et al. Derivation and evaluation of a termination of resuscitation clinical prediction rule for advanced life support providers. Resuscitation 2007; 74:266-75.

Wiel E, Di Pompéo C, Segal N,Luc G, Marc JB, Vanderstraeten C, et al. Age discrimination in out-of-hospital cardiac arrest care: a case-control study. Eur J Cardio Vasc Nurs 2018; 17:505-12.

Maupain C, Bougouin W, Lamhaut L, Deye N, Diehl JL, Geri G, et al. T he CAHP (Cardiac Arrest Hospital Prognosis) score: a tool for r isk stratification after out-of-hospital cardiac arrest. Eur Heart J 2016; 37:3222-8.

Javaudin F, Desce N, Le Bastard Q, De Carvalho H, Le Conte P, Escutnaire J, et al. Impact of pre-hospital vital parameters on the neurological outcome of out-of-hospital cardiac arrest:results from the French national cardiac arrest registry. Resuscitation 2018; 133:5-11.

Debaty G, Labarere J, Frascone RJ, Wayne MA, Swor RA, Mahoney BD, et al. Long-term prognostic value of gasping during out-of-hospital cardiac arrest. J Am Coll Cardiol 2017; 70:1467-76.

Nakahara S, Tomio J, Ichikawa M, Nakamura F, Nishida M, Takahashi H, et al. Association of bystander interventions with neurologically intact survival among patients with bystander-witnessed out-of-hospital cardiac arrest in japan. JAMA 2015; 314:247-54.

Wissenberg M, Lippert FK, Folke F, Weeke P, Hansen CM, Christensen EF, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA 2013; 310:1377-84.

Lukas RP, Van Aken H, Mölhoff T, Weber T, Rammert M, Wild E, et al. Kids save lives: a six-year longitudinal study of schoolchildren learning cardiopulmonary resuscitation: who should do the teaching and will the effects last? Resuscitation 2016; 101:35-40.

Ringh M, Fredman D, Nordberg P, Stark T, Hollenberg J. Mobile phone technology identifies and recruits trained citizens to perform CPR on out- of-hospital cardiac arrest victims prior to ambulance arrival. Resuscitation 2011; 82:1514-8.

Zijlstra JA, Stieglis R, Riedijk F, Smeekes M, van der Worp WE, Koster RW. Local lay rescuers with AEDs, alerted by text messages, contribute to early defibrillation in a Dutch out-of-hospital cardiac arrest dispatch system. Resuscitation 2014; 85:1444-9.

Latimer AJ, McCoy AM, Sayre MR. Emerging and future technologies in out-of-hospital cardiac arrest care. Cardiol Clinic 2018; 36:429-41.