The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe. This was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries. Data on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge. The results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe. EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events.

It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention (PCI) early after acute ST-segment elevation myocardial infarction (STEMI).

Therapeutic hypothermia may increase survival with good neurologic outcome after out-of-hospital cardiac arrest.¹ Experimental data show that therapeutic hypothermia in cardiac arrest reduces ischemic and reperfusion brain injury, with a beneficial effect of early intra-arrest cooling (ie, cooling started during cardiopulmonary resuscitation [CPR]) compared with cooling initiated at a later stage.^2-4 However, the majority of clinical studies have examined the effect of therapeutic hypothermia when cooling was initiated after hospital arrival, most often at the intensive care unit (ICU), several hours after the cardiac arrest.^1,5 Currently, treatment guidelines recommend hospital use of therapeutic hypothermia or temperature control at a temperature of 32°C to 36°C for at least 24 hours, with the strongest indication in patients with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as first rhythm.^6,7

Background—: In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a pharmaco-invasive (PI) strategy was compared with primary percutaneous coronary intervention (pPCI) in ST—segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset but unable to undergo pPCI within 1 hour. At 30 days, the PI approach was associated with a nominally but nonstatistically significant lower incidence of the composite primary end point of death, shock, congestive heart failure, and reinfarction when compared with pPCI. The aim of the present study was to determine the effect of these strategies on 1-year mortality. Methods and Results—: Vital status at 1 year was available in 936 of 944 (99.2%) and 941 of 948 (99.3%) patients in the PI and pPCI arm, respectively. At 1 year, all-cause mortality rates (6.7% versus 5.9%) were similar for PI and pPCI-treated patients ( P =0.49; risk ratio, 1.13; 95% confidence interval, 0.79–1.62). Cardiac mortality rates were similar as well (4.0% versus 4.1%, P =0.93; risk ratio, 0.98; 95% confidence interval, 0.62–1.54). Overall, only 34 patients died between day 30 and 1 year, 20 in the PI arm and 14 in the pPCI arm, of whom 20 died of noncardiac reasons (13 in the PI and 7 in the pPCI arm). There was no significant difference in 1-year all-cause mortality between the 2 groups among the prespecified key subgroups. Conclusions—: At 1 year, mortality rates in the PI and pPCI arms were similar in ST—segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset and unable to undergo pPCI within 1 hour. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00623623.