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EDITORIALS: Johan Engdahl Outcome after cardiac arrest outside hospital BMJ 2002; 325: 503-504 [Full text]

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Just a thought for on the spot care.

M G Bhat   (8 September 2002)

DEATHS DUE TO ACUTE MYOCARDIAL INFARCTION OUTSIDE HOSPITAL IN THREE CUBAN PROVIN

Alfredo D. Espinosa-Brito, Alfredo A. Espinosa-Roca, Yenisei Quintero-Mendez, Yaineli Cutino-Mas   (18 September 2002)

Just a thought for on the spot care. 8 September 2002
M G Bhat, consultant surgeon Manipal Hospital, Bangalore, India Send response to journal: Re: Just a thought for on the spot care.	The availability of telemedicine services may improve the outcome in some of these patients. On the spot relay to an emergency coronary care centre may give support and help on immediate treatment by experts. This can be used by the trained ambulance personnel and initiate the immediate care. I wonder whether such facility is used anywhere? mgbhat.
DEATHS DUE TO ACUTE MYOCARDIAL INFARCTION OUTSIDE HOSPITAL IN THREE CUBAN PROVIN 18 September 2002
Alfredo D. Espinosa-Brito Hospital Dr. Gustavo Aldereguía Lima, Ave. 5 de Septiembre and Calle 51 A, Cienfuegos 55 100, CUBA, Alfredo A. Espinosa-Roca, Yenisei Quintero-Mendez, Yaineli Cutino-Mas Send response to journal: Re: DEATHS DUE TO ACUTE MYOCARDIAL INFARCTION OUTSIDE HOSPITAL IN THREE CUBAN PROVIN	Dear Sir: Cardiac arrest outside hospital is a dramatic event anywhere and anytime. As Engdahl wrote in his very interesting editorial, “despite enormous efforts to improve survival during the past three decades, cardiac arrest outside hospital still makes a disproportionately large contribution to mortality in the Western world”. (1) We can add, this is also the picture in the developing countries. Many times the present human beings transfer their technological dreams to actions without a real validation of the new interventions. That is the case of the deployment of automated external defibrillators in selected sites, to be used by (trained) laypersons, as a way to achieve faster defibrillation and improved survival after cardiac arrest outside hospital. (1,2) Pell and colleages contributed to clarify the potential (and actual) impact of this public health intervention. (2) We studied the place where 42 575 deaths due to Acute Myocardial Infarction ocurred, in three Cuban provinces, during ten years (1990- 1999). The provinces were: Ciudad de La Habana, in the western part of the country, where the capital city is, a totally urban province; Cienfuegos, in the center and southern part of the island, with 75% of urban areas; and Las Tunas, in the eastern part, with about 60% of urban population. The percentages of deaths ocurred outside hospital due to this, the first cause of cardiac arrest, were: Ciudad de La Habana: 56.8%, Cienfuegos: 68.8% and Las Tunas: 59.5%. The proportion of those who died outside hospital (24 864) by groups of age (< 60 and 60 years and over) according to the place of death are shown in this table. DEATHS DUE TO ACUTE MYOCARDIAL INFARCTION OUTSIDE HOSPITAL, BY GROUPS OF AGE (< 60 YEARS AND 60 YEARS AND OVER ) AND PLACE OF DEATH. DATA FROM THREE CUBAN PROVINCES, 1990-1999. Number of Deaths Other health institutions (%) Groups of age <60 ? 60 <60 60 Ciudad Habana 2 696 16 522 12.9 6.7 Cienfuegos 432 2769 23.1 13.8 Las Tunas 362 2083 6.6 6.1 Domicile (%) Other places (%) Groups of age < 60 ? 60 < 60 ? 60 Ciudad Habana 57.8 82.5 29.3 10.8 Cienfuegos 58.4 80.2 18.4 6.0 Las Tunas 68.2 82.5 25.2 11.4 As we can see, in spite of some differences among provinces, most Acute Myocardial Infarction outside hospital deaths occur in patients' homes too, with greater percentages in elderly people, which is not surprising. It is also evident the lower percentages of those who died at other places, the target group for a desfibrillation programme. So, we agree with Engdahl (1) that a careful examination of the epidemiological conditions in the community, such as the one presented by Pell et al, (2) is essential before considering the benefits of implementation of a public access defibrillation programme. This is crucial in developing countries, as Cuba is, where it is necessary to invest the scarcy money in those appropiate interventions with proved impact in public health. Sincerely, Prof. Alfredo D. Espinosa-Brito, MD, PhD Alfredo A. Espinosa-Roca, MD Yenisei Quintero-Méndez, MD Yainelí Cutiño-Más, MD Internal Medicine Department, Hospital "Dr. Gustavo Aldereguía Lima", Ave. 5 de Septiembre y Calle 51A, Cienfuegos 55 100, Cuba. e-mail: espinosa@perla.inf.cu REFERENCES. 1. Engdahl J. Outcome after cardiac arrest outside hospital (editorial). BMJ 2002;325:503-504. 2. Pell JP, Sirel JM, Marsden AK, Ford I, Walker NL, Cobbe SM. Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study. BMJ 2002;325:515.