European registry of cardiac arrest study THREE (EuReCa- THREE) – EMS response time influence on outcome in Europe

Jan-Thorsten Gräsner; Jan Wnent; Rolf Lefering; Johan Herlitz; Siobhan Masterson; Holger Maurer; Gavin D. Perkins; Fernando Rosell Ortiz; Ingvild B. M. Tjelmeland; Drilon Kamishi; Maximilian Moertl; Pierre Mols; Hajriz Alihodzic; Marios Ioannides; Anatolij Truhlář; Valentine Baert; Nikolaos Nikolaou; Noemi Molnar; Bergthor Steinn Jonsson; Federico Semeraro; Asta Krikscionaitiene; Carlo Clarens; Christopher Giordimaina; Remy Stieglis; Anna Zadlo; Vitor Hugo Correia; Diana Cimpoesu; Violetta Raffay; Stefan Trenkler; Matej Strnad; Jose Ignacio Ruiz; Anneli Strømsøe; André Wilmes; Scott Booth; EuReCa-THREE Collaborator Group

doi:10.1016/j.resuscitation.2025.110704

European registry of cardiac arrest study THREE (EuReCa- THREE) – EMS response time influence on outcome in Europe

Jan-Thorsten Gräsner^*
, Jan Wnent
, Rolf Lefering
, Johan Herlitz
, Siobhan Masterson
, Holger Maurer
, Gavin D. Perkins
, Fernando Rosell Ortiz
, Ingvild B. M. Tjelmeland
, Drilon Kamishi
, Maximilian Moertl
, Pierre Mols
, Hajriz Alihodzic
, Marios Ioannides
, Anatolij Truhlář
, Valentine Baert
, Nikolaos Nikolaou
, Noemi Molnar
, Bergthor Steinn Jonsson
, Federico Semeraro

Asta Krikscionaitiene, Carlo Clarens, Christopher Giordimaina, Remy Stieglis, Anna Zadlo, Vitor Hugo Correia, Diana Cimpoesu, Violetta Raffay, Stefan Trenkler, Matej Strnad, Jose Ignacio Ruiz, Anneli Strømsøe, André Wilmes, Scott Booth, EuReCa-THREE Collaborator Group

^*Corresponding author for this work

Universitätsklinikum Schleswig-Holstein Campus Kiel
European Resuscitation Council
DGAI
University of Namibia
Witten/Herdecke University
University of Borås
Mid-Western Regional Hospital Limerick
University Hospital Schleswig-Holstein
University of Warwick
University Hospitals Birmingham NHS Foundation Trust
Servicio de Urgencias y Emergencias 061
University of Oslo
Albanian Resuscitation Council
Innsbruck Medical University
Saint-Pierre University Hospital
Psychiatric Association of Bosnia-Herzegovina
University of Tuzla
Ministry of Health, Cyprus
Emergency Medical Services of the Hradec Kralove Region
Charles University
Université de Lille
Athens General Hospital
Magyar Resuscitatios Társaság
Akureyri Hospital
Ospedale Maggiore
Lithuanian University of Health Sciences
Luxembourg Resuscitation Council
Mater Dei Hospital
Amsterdam UMC - University of Amsterdam
Jagiellonian University Medical College
IP-RAM. Pré-Hospital Education Division. Emergency Department - Hospital Dr Nélio Mendonça
Grigore T. Popa University of Medicine and Pharmacy
Serbian Resuscitation Council
European University Cyprus
Pavol Jozef Šafárik University
AGEL Hospital
Maribor University Medical Centre
Prehospital unit
University of Maribor
Servicio de Emergencias Sanitarias
Dalarna University
Uppsala University
Region Dalarna
Interassociation for Rescue Services (IVR-IAS)
University of Antwerp

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Throughout Europe there are important differences in the structure and characteristics of Emergency Medical Services (EMS) and their response to out-of-hospital cardiac arrest (OHCA). The primary aim of EuReCa-THREE was to examine the epidemiology of cardiac arrest in Europe and explore the association between EMS response time and survival. Methods: EuReCa-THREE was an international, prospective, registry-based, cohort study, for which data were collected from 1 September to 30 November 2022 from 28 countries. Primary research questions were focused on assessing time intervals and their impact on outcomes. Results: Of the 45,251 confirmed OHCA cases, 32,033 were treated by the EMS i.e. resuscitation started or continued. The mean response time was 12.2 min (range 6.4–22.8), with 25% of patients were reached within 7 min. For all cases where resuscitation was started or continued by EMS, the rate of any ROSC was 31.2% (range 17.0–42.7), ROSC sustained until arrival at the emergency department and transfer of care (survived event) was 22.5%(range 12.3–25.5) and overall survival was 7.5% (range 3.1–35.0), (incidence 4.0 per 100,000 inhabitants, range 1.7–24.6). Conclusion: The results of EuReCa-THREE highlight continuing variation in the incidence, management and outcomes from OHCA across Europe. For patients who were EMS-treated, results indicate clear associations between response times and the likelihood of survival.

Original language	English
Article number	110704
Journal	Resuscitation
Early online date	2025
DOIs	https://doi.org/10.1016/j.resuscitation.2025.110704
Publication status	E-pub ahead of print - 2025

Keywords

Epidemiology
EuReCa
Out-of-hospital cardiac arrest
Response time
Resuscitation
Survival
Time intervals

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Gräsner, J.-T., Wnent, J., Lefering, R., Herlitz, J., Masterson, S., Maurer, H., Perkins, G. D., Ortiz, F. R., Tjelmeland, I. B. M., Kamishi, D., Moertl, M., Mols, P., Alihodzic, H., Ioannides, M., Truhlář, A., Baert, V., Nikolaou, N., Molnar, N., Jonsson, B. S., ... EuReCa-THREE Collaborator Group (2025). European registry of cardiac arrest study THREE (EuReCa- THREE) – EMS response time influence on outcome in Europe. Resuscitation, Article 110704. Advance online publication. https://doi.org/10.1016/j.resuscitation.2025.110704

@article{4ff7068aa2374599a9b7a9ac938ef066,

title = "European registry of cardiac arrest study THREE (EuReCa- THREE) – EMS response time influence on outcome in Europe",

abstract = "Background: Throughout Europe there are important differences in the structure and characteristics of Emergency Medical Services (EMS) and their response to out-of-hospital cardiac arrest (OHCA). The primary aim of EuReCa-THREE was to examine the epidemiology of cardiac arrest in Europe and explore the association between EMS response time and survival. Methods: EuReCa-THREE was an international, prospective, registry-based, cohort study, for which data were collected from 1 September to 30 November 2022 from 28 countries. Primary research questions were focused on assessing time intervals and their impact on outcomes. Results: Of the 45,251 confirmed OHCA cases, 32,033 were treated by the EMS i.e. resuscitation started or continued. The mean response time was 12.2 min (range 6.4–22.8), with 25\% of patients were reached within 7 min. For all cases where resuscitation was started or continued by EMS, the rate of any ROSC was 31.2\% (range 17.0–42.7), ROSC sustained until arrival at the emergency department and transfer of care (survived event) was 22.5\%(range 12.3–25.5) and overall survival was 7.5\% (range 3.1–35.0), (incidence 4.0 per 100,000 inhabitants, range 1.7–24.6). Conclusion: The results of EuReCa-THREE highlight continuing variation in the incidence, management and outcomes from OHCA across Europe. For patients who were EMS-treated, results indicate clear associations between response times and the likelihood of survival.",

keywords = "Epidemiology, EuReCa, Out-of-hospital cardiac arrest, Response time, Resuscitation, Survival, Time intervals",

author = "Jan-Thorsten Gr{\"a}sner and Jan Wnent and Rolf Lefering and Johan Herlitz and Siobhan Masterson and Holger Maurer and Perkins, \{Gavin D.\} and Ortiz, \{Fernando Rosell\} and Tjelmeland, \{Ingvild B. M.\} and Drilon Kamishi and Maximilian Moertl and Pierre Mols and Hajriz Alihodzic and Marios Ioannides and Anatolij Truhl{\'a}{\v r} and Valentine Baert and Nikolaos Nikolaou and Noemi Molnar and Jonsson, \{Bergthor Steinn\} and Federico Semeraro and Asta Krikscionaitiene and Carlo Clarens and Christopher Giordimaina and Remy Stieglis and Anna Zadlo and Correia, \{Vitor Hugo\} and Diana Cimpoesu and Violetta Raffay and Stefan Trenkler and Matej Strnad and Ruiz, \{Jose Ignacio\} and Anneli Str{\o}ms{\o}e and Andr{\'e} Wilmes and Scott Booth and \{EuReCa-THREE Collaborator Group\} and Leo Bossaert",

note = "Publisher Copyright: {\textcopyright} 2025",

year = "2025",

doi = "10.1016/j.resuscitation.2025.110704",

language = "English",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

}

Gräsner, J-T, Wnent, J, Lefering, R, Herlitz, J, Masterson, S, Maurer, H, Perkins, GD, Ortiz, FR, Tjelmeland, IBM, Kamishi, D, Moertl, M, Mols, P, Alihodzic, H, Ioannides, M, Truhlář, A, Baert, V, Nikolaou, N, Molnar, N, Jonsson, BS, Semeraro, F, Krikscionaitiene, A, Clarens, C, Giordimaina, C, Stieglis, R, Zadlo, A, Correia, VH, Cimpoesu, D, Raffay, V, Trenkler, S, Strnad, M, Ruiz, JI, Strømsøe, A, Wilmes, A, Booth, S & EuReCa-THREE Collaborator Group 2025, 'European registry of cardiac arrest study THREE (EuReCa- THREE) – EMS response time influence on outcome in Europe', Resuscitation. https://doi.org/10.1016/j.resuscitation.2025.110704

TY - JOUR

T1 - European registry of cardiac arrest study THREE (EuReCa- THREE) – EMS response time influence on outcome in Europe

AU - Gräsner, Jan-Thorsten

AU - Wnent, Jan

AU - Lefering, Rolf

AU - Herlitz, Johan

AU - Masterson, Siobhan

AU - Maurer, Holger

AU - Perkins, Gavin D.

AU - Ortiz, Fernando Rosell

AU - Tjelmeland, Ingvild B. M.

AU - Kamishi, Drilon

AU - Moertl, Maximilian

AU - Mols, Pierre

AU - Alihodzic, Hajriz

AU - Ioannides, Marios

AU - Truhlář, Anatolij

AU - Baert, Valentine

AU - Nikolaou, Nikolaos

AU - Molnar, Noemi

AU - Jonsson, Bergthor Steinn

AU - Semeraro, Federico

AU - Krikscionaitiene, Asta

AU - Clarens, Carlo

AU - Giordimaina, Christopher

AU - Stieglis, Remy

AU - Zadlo, Anna

AU - Correia, Vitor Hugo

AU - Cimpoesu, Diana

AU - Raffay, Violetta

AU - Trenkler, Stefan

AU - Strnad, Matej

AU - Ruiz, Jose Ignacio

AU - Strømsøe, Anneli

AU - Wilmes, André

AU - Booth, Scott

AU - EuReCa-THREE Collaborator Group

AU - Bossaert, Leo

PY - 2025

Y1 - 2025

N2 - Background: Throughout Europe there are important differences in the structure and characteristics of Emergency Medical Services (EMS) and their response to out-of-hospital cardiac arrest (OHCA). The primary aim of EuReCa-THREE was to examine the epidemiology of cardiac arrest in Europe and explore the association between EMS response time and survival. Methods: EuReCa-THREE was an international, prospective, registry-based, cohort study, for which data were collected from 1 September to 30 November 2022 from 28 countries. Primary research questions were focused on assessing time intervals and their impact on outcomes. Results: Of the 45,251 confirmed OHCA cases, 32,033 were treated by the EMS i.e. resuscitation started or continued. The mean response time was 12.2 min (range 6.4–22.8), with 25% of patients were reached within 7 min. For all cases where resuscitation was started or continued by EMS, the rate of any ROSC was 31.2% (range 17.0–42.7), ROSC sustained until arrival at the emergency department and transfer of care (survived event) was 22.5%(range 12.3–25.5) and overall survival was 7.5% (range 3.1–35.0), (incidence 4.0 per 100,000 inhabitants, range 1.7–24.6). Conclusion: The results of EuReCa-THREE highlight continuing variation in the incidence, management and outcomes from OHCA across Europe. For patients who were EMS-treated, results indicate clear associations between response times and the likelihood of survival.

AB - Background: Throughout Europe there are important differences in the structure and characteristics of Emergency Medical Services (EMS) and their response to out-of-hospital cardiac arrest (OHCA). The primary aim of EuReCa-THREE was to examine the epidemiology of cardiac arrest in Europe and explore the association between EMS response time and survival. Methods: EuReCa-THREE was an international, prospective, registry-based, cohort study, for which data were collected from 1 September to 30 November 2022 from 28 countries. Primary research questions were focused on assessing time intervals and their impact on outcomes. Results: Of the 45,251 confirmed OHCA cases, 32,033 were treated by the EMS i.e. resuscitation started or continued. The mean response time was 12.2 min (range 6.4–22.8), with 25% of patients were reached within 7 min. For all cases where resuscitation was started or continued by EMS, the rate of any ROSC was 31.2% (range 17.0–42.7), ROSC sustained until arrival at the emergency department and transfer of care (survived event) was 22.5%(range 12.3–25.5) and overall survival was 7.5% (range 3.1–35.0), (incidence 4.0 per 100,000 inhabitants, range 1.7–24.6). Conclusion: The results of EuReCa-THREE highlight continuing variation in the incidence, management and outcomes from OHCA across Europe. For patients who were EMS-treated, results indicate clear associations between response times and the likelihood of survival.

KW - Epidemiology

KW - EuReCa

KW - Out-of-hospital cardiac arrest

KW - Response time

KW - Resuscitation

KW - Survival

KW - Time intervals

UR - https://www.scopus.com/pages/publications/105010883728

U2 - 10.1016/j.resuscitation.2025.110704

DO - 10.1016/j.resuscitation.2025.110704

M3 - Article

C2 - 40633749

SN - 0300-9572

JO - Resuscitation

JF - Resuscitation

M1 - 110704

ER -

European registry of cardiac arrest study THREE (EuReCa- THREE) – EMS response time influence on outcome in Europe

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Keywords

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