This study assessed the impact of austerity measures in Greece on survival rates of out-of-hospital cardiac arrest victims. Data was collected from a Greek hospital on immediate and 24-hour survival pre-crisis (2007-2010) and during the crisis (2011-2014). Results showed no significant difference in return of spontaneous circulation or 24-hour survival between the two periods, suggesting healthcare workers were working hard to maintain standards despite budget cuts. However, overall survival rates remained low compared to international studies, highlighting the need for more Greek data on cardiac arrests.

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Sudden cardiac arrests remain one of the main causes of mortality internationally, while most of
them occur in an out-of-hospital setting. Τheir management requires delivery of high quality
cardiopulmonary resuscitation (CPR), both outside and inside the hospital, according to well
described, scientifically proven algorithms1.
In opposition to many other European countries, there is no sufficient data from Greece
concerning neither the overall survival of cardiac arrest victims nor their neurological outcome
or the quality of CPR delivered to them by healthcare personnel. The accumulation of this data
becomes even more crucial during our country’s present financial circumstances since, according
to bibliography, austerity measures can affect all-cause mortality in a negative way2,3.
INTRODUCTION
OBJECTIVES AND METHODS
RESULTS
During the first 4-year period (pre-crisis) a total of 201 out-of-hospital cardiac arrests were
transferred to our institution’s emergency department, which correlates with an incidence of 32
per 10000 patients managed in the ER. 4 of them developed ROSC (1,99%) with 2 of them
surviving the first 24 hours (1%).
During the second 4-year period (crisis) a total of 230 out-of-hospital cardiac arrests were
transferred to the ER, which correlates with an incidence of 35 per 10000 patients managed in
the ER. 11 of them developed ROSC (4,78%) with 7 of them surviving the first 24 hours
(3,04%).
There was no significant change in ROSC (4.78% vs 1.99%, p=0.11) and 24-hour survival
(3.04% vs 1.00%, p=0.14) of the out-of-hospital cardiac arrest victims that were transferred to
our hospital between the 2 periods. According to this data, an assumption about the victims
overall survival rates being lower than 3.04% in our institution can be made.
Finally, the dramatic decline of the mean age of cardiac arrest victims in 2010, the year the
memorantum was signed is quite a notable fact.
CONCLUSION
Despite the austerity measures implemented in the Hellenic Healthcare System4 and the
shrinkage of our hospital’s budget in the years following the financial crisis, data from our
institution imply no significant change in the immediate and 24-hour survival rates of out-of-
hospital cardiac arrest victims between the two periods.
The results of the study may suggest current healthcare personnel’s overexertion in order to
adjust to these challenging times.
On the other hand, immediate, 24-hour and presumably overall survival of the out-of-hospital
arrests remains considerably low in our institution compared to international bibliography5. This
is quite alarming given the fact that this study is the first major attempt of cardiac arrest survival
estimation in a Greek hospital, nationally.
The confirmation and interpretation of the present study’s results require the conduction of
similar studies by other Greek secondary and tertiary healthcare institutions, in order to acquire a
clearer picture concerning cardiac arrests in our country.
REFERENCES
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C., Skrifvars, M.B., Smith, G.B., Sunde, K., Deakin, C.D., Koster, R.W., Monsieurs, K.G.,
Nikolaou, N.I., 2015. European Resuscitation Council Guidelines for Resuscitation 2015:
Section 3. Adult advanced life support. Resuscitation, European Resuscitation Council
Guidelines for Resuscitation 2015European Resuscitation Council Congress - Prague 2015 95,
100–147. doi:10.1016/j.resuscitation.2015.07.016
2. Falagas, M.E., Vouloumanou, E.K., Mavros, M.N., Karageorgopoulos, D.E., 2009.
Economic crises and mortality: a review of the literature. Int. J. Clin. Pract. 63, 1128–1135.
doi:10.1111/j.1742-1241.2009.02124.x
3. Fountoulakis, K.N., Grammatikopoulos, I.A., Koupidis, S.A., Siamouli, M., Theodorakis,
P.N., 2012. Health and the financial crisis in Greece. The Lancet 379, 1001–1002.
doi:10.1016/S0140-6736(12)60422-X
4. Kondilis, E., Giannakopoulos, S., Gavana, M., Ierodiakonou, I., Waitzkin, H., Benos, A.,
2013. Economic Crisis, Restrictive Policies, and the Population’s Health and Health Care: The
Greek Case. Am. J. Public Health 103, 973–979. doi:10.2105/AJPH.2012.301126
5. Vargas, M., Sutherasan, Y., Pelosi, P., 2015. Out-of-hospital Cardiac Arrest and Survival to
Hospital Discharge: A Series of Systemic Reviews and Meta-analyses, in: Prof, J.-L.V. (Ed.),
Annual Update in Intensive Care and Emergency Medicine 2015, Annual Update in Intensive
Care and Emergency Medicine 2015. Springer International Publishing, pp. 289–314.
The aim of this study is to assess the impact of the austerity measures, implemented in the
Hellenic Healthcare System, during the ongoing national financial crisis. Data from a Greek
general hospital regarding the immediate and 24-hour survival of out-of-hospital cardiac arrest
victims were collected.
A retrospective study was conducted on all the patients who experienced an out-of-hospital
cardiac arrest and were transferred to the emergency department of our hospital (Pammakaristos
General Hospital of Athens) during an eight-year period (2007-2014). The cardiac arrests were
divided into two four-year sessions (2007-2010 and 2011-2014). The first and the second
quadrennium represented the pre-crisis and the financial crisis period respectively. 1-1-2011 was
chosen as the cutoff date of the pre-crisis era as it is generally admitted that the consequences of
crisis emerged after the signing of the first memorandum in mid-2010, with the remaining 6
months being considered as enough for the austerity measures to be implemented in the Hellenic
Healthcare System.
Data concerning victims’ ROSC (return of spontaneous circulation) and 24-hour survival were
then compared between the two periods using Z-test (two-tailed hypothesis) with p values below
0.05 being considered statistically significant.
1,2“Pammakaristos” Athens General Hospital- 1Internal Medicine and 2General Surgery Departments (zisimosmed@gmail.com), 3University of Crete- Department of Economic Science,
4 “Laikon” General Hospital- 1st Department of Internal Medicine, Athens, 5‘’Metaxa’’ Special Cancer Hospital-Department of Medical Oncology, 6“Ilion” Primary National Health
Network- Biopathology Department, 7Naval and Veteran Hospital of Athens- Department of Orthopaedics, 8 “G.Gennimatas” Athens General Hospital- 2nd Department of General
Surgery, 9“Erithros Stavros” General Hospital of Athens- 2nd Department of General Surgery, 10“St Vinzenz” Dusseldorf General Hospital- General Surgery Department
Zisimangelos Solomos1, Maria Tatsi2, Emmanouil Spathis3, Victoria Psomiadou2 , Angeliki Tsifi4, Konstantinos Miltiadou5,
Dimitrios Theodoridis6, Anastasios Spathis7, Konstantinos Kostoulas8, Gionous Sourtse9, Dimitra Sofia10
THE IMPACT OF THE ECONOMIC RECESSION ON THE SURVIVAL OF OUT-OF-
HOSPITAL CARDIAC ARREST VICTIMS ΙΝ A GENERAL HOSPITAL
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
2007 2008 2009 2010 2011 2012 2013 2014
Immediate and 24-hour survival rates (%)
Immediate survival rate 24-hour survival rate
0
10
20
30
40
50
60
70
2007 2008 2009 2010 2011 2012 2013 2014
Cardiac arrests Immediate survivors 24-hour survivors
Out-of-hospital cardiac arrests, immediate and 24-hour survivors per year
58.0
60.0
62.0
64.0
66.0
68.0
70.0
72.0
74.0
76.0
2007 2008 2009 2010 2011 2012 2013 2014
Mean age of cardiac arrests per year