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Marinaro J, Guliani S, Dettmer T, Pruett K, Dixon D, Braude D. Out-of-hospital extracorporeal membrane oxygenation cannulation for refractory ventricular fibrillation: A case report. J Am Coll Emerg Physicians Open 2020; 1:153-157. [PMID: 33000029 PMCID: PMC7493553 DOI: 10.1002/emp2.12033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 01/14/2023] Open
Abstract
Out-of-hospital cardiac arrest survival continues to be dismal with the only recent improvement being that of extracorporeal cardiopulmonary resuscitation (E-CPR) or cardiopulmonary resuscitation (CPR), augmented by extracorporeal membrane oxygenation (ECMO). Minimizing time until initiation of E-CPR is critical to improve neurologically intact survival. Bringing E-CPR to the patient rather than requiring transport to the emergency department may increase the number of patients eligible for E-CPR and the chances for a good outcome. We developed a out-of-hospital E-CPR (P-ECMO) program that includes the novel use of a hand-crank and emergency medical services (EMS) providers as first assistants. Here, we report the first P-ECMO procedure in North America for refractory ventricular fibrillation involving a 65-year-old male patient who was cannulated in the field within the recommended 60-minute low-flow window and transported to our institution where he underwent coronary stenting. Details of program design and the procedure used may allow other systems to consider implementation of a P-ECMO program.
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Affiliation(s)
- Jon Marinaro
- Department of Emergency Medicine, Division of Prehospital CareUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
- UNM Center for Adult Critical CareUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
| | - Sundeep Guliani
- Department of Emergency Medicine, Division of Prehospital CareUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
- UNM Center for Adult Critical CareUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
- Department of Surgery, Division of Trauma and Vascular SurgeryUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
| | - Todd Dettmer
- Department of Emergency Medicine, Division of Prehospital CareUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
- UNM Center for Adult Critical CareUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
| | - Kimberly Pruett
- Department of Emergency Medicine, Division of Prehospital CareUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
| | - Doug Dixon
- Department of Emergency Medicine, Division of Prehospital CareUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
| | - Darren Braude
- Department of Emergency Medicine, Division of Prehospital CareUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
- Deparment of AnesthesiologyUniversity of New Mexico School of MedicineAlbuquerqueNew Mexico
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Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Koster RW. AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest. Resuscitation 2020; 150:170-177. [PMID: 32045663 DOI: 10.1016/j.resuscitation.2020.01.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND For out-of-hospital cardiac arrest (OHCA) in residential areas, a dispatcher driven alert-system using text messages (TM-system) directing local rescuers (TM-responders) to OHCA patients was implemented and the desired density of automated external defibrillators (AEDs) or TM-responders investigated. METHODS We included OHCA cases with the TM-system activated in residential areas between 2010-2017. For each case, densities/km2 of activated AEDs and TM-responders within a 1000 m circle were calculated. Time intervals between 112-call and first defibrillation were calculated. RESULTS In total, 813 patients (45%) had a shockable initial rhythm. In 17% a TM-system AED delivered the first shock. With increasing AED density, the median time to shock decreased from 10:59 to 08:17 min. (p < 0.001) and shocks <6 min increased from 6% to 12% (p = 0.024). Increasing density of TM-responders was associated with a decrease in median time to shock from 10:59 to 08:20 min. (p < 0.001) and increase of shocks <6 min from 6% to 13% (p = 0.005). Increasing density of AEDs and TM-responders resulted in a decline of ambulance first defibrillation by 19% (p = 0.016) and 22% (p = 0.001), respectively. First responder AED defibrillation did not change significantly. Densities of >2 AEDs/km2 did not result in further decrease of time to first shock but >10 TM-responders/km2 resulted in more defibrillations <6 min. CONCLUSION With increasing AED and TM-responder density within a TM-system, time to defibrillation in residential areas decreased. AED and TM-responders only competed with ambulances, not with first responders. The recommended density of AEDs and TM-responders for earliest defibrillation is 2 AEDs/km2 and >10 TM-responders/km2.
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Affiliation(s)
- Remy Stieglis
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands.
| | - Jolande A Zijlstra
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands
| | - Frank Riedijk
- Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands
| | - Martin Smeekes
- Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands
| | | | - Rudolph W Koster
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands
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Sarkisian L, Mickley H, Schakow H, Gerke O, Jørgensen G, Larsen ML, Henriksen FL. Global positioning system alerted volunteer first responders arrive before emergency medical services in more than four out of five emergency calls. Resuscitation 2020; 152:170-176. [PMID: 31923531 DOI: 10.1016/j.resuscitation.2019.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/21/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
Abstract
AIM To evaluate response rates for volunteer first responders (VFRs) activated by use of a smartphone GPS-tracking system and to compare response times of VFRs with those of emergency medical services (EMS). Furthermore, to evaluate 30-day-survival after out-of-hospital cardiac arrest (OHCA) on a rural island. METHODS Since 2012 a GPS-tracking system has been used on a rural island to activate VFRs during all emergency calls requesting an EMS. When activated, three VFRs were recruited and given distinct roles, including collection of the nearest automatic external defibrillator (AED). We retrospectively investigated EMS response data from April 2012 to December 2017. These were matched with VFR response times from the GPS-tracking system. The 30-day survival in OHCA patients was also assessed. RESULTS In 2266 of 2662 emergency calls (85%) at least one VFR arrived to the site before EMS. Median response times for VFRs (n = 2662) was 4:46 min:sec (IQR 3:16-6:52) compared with 10:13 min:sec (6:14-13:41) for EMS (p < 0.0001). A total of 17 OHCAs took place in public locations and 65 in residential areas. Thirty-day survival in these were 24% and 15%, respectively. CONCLUSION Use of a smartphone GPS-tracking system to dispatch VFRs ensures that in more than four of five cases, a VFR arrives to the site before EMS. Response times for VFRs were also found to be lower than EMS response times. Finally, the 30-day survival of OHCA patients in a rural area, based on these results, surpass our expectations.
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Affiliation(s)
- Laura Sarkisian
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, Odense C, 5000, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Hans Mickley
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, Odense C, 5000, Denmark.
| | - Henrik Schakow
- Emergency Medical Services, Region of Southern Denmark, Damhaven 12, Vejle, 7100, Denmark.
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, J.B. Winsløws Vej 4, Odense C, 5000, Denmark.
| | - Gitte Jørgensen
- Emergency Medical Services, Region of Southern Denmark, Damhaven 12, Vejle, 7100, Denmark.
| | - Mogens Lytken Larsen
- Department of Clinical Medicine, Aalborg University Hospital, Søndre Skovvej 15, Aalborg, 9000, Denmark.
| | - Finn Lund Henriksen
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, Odense C, 5000, Denmark.
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Kwon OY. The changes in cardiopulmonary resuscitation guidelines: from 2000 to the present. J Exerc Rehabil 2019; 15:738-746. [PMID: 31938692 PMCID: PMC6944876 DOI: 10.12965/jer.1938656.328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 12/28/2022] Open
Abstract
This review aims to determine the changes made in the cardiopulmonary resuscitation (CPR) guidelines from 2000 to the present. The study was mainly undertaken by using International Guidelines from American Heart Association. The main change of CPR was chest compression skill. The guidelines have improved high-quality CPR through the change of chest compression skill. The latest adult CPR guidelines are as follows: (a) push chest quickly (100-120/min), (b) compress appropriately (5-6 cm), (c) relax chest fully (complete chest recoil), (d) avoid interruption of compression, and (e) avoid hyperventilation. The understanding of the latest CPR skills will be helpful in improving survival rate from sudden cardiac death.
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Affiliation(s)
- Oh Young Kwon
- Department of Medical Education and Medical Humanities, College of Medicine, Kyung Hee University, Seoul,
Korea
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Goralnick E, Chaudhary MA, McCarty JC, Caterson EJ, Goldberg SA, Herrera-Escobar JP, McDonald M, Lipsitz S, Haider AH. Effectiveness of Instructional Interventions for Hemorrhage Control Readiness for Laypersons in the Public Access and Tourniquet Training Study (PATTS): A Randomized Clinical Trial. JAMA Surg 2019; 153:791-799. [PMID: 29801156 DOI: 10.1001/jamasurg.2018.1099] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Several national initiatives have emerged to empower laypersons to act as immediate responders to reduce preventable deaths from uncontrolled bleeding. Point-of-care instructional interventions have been developed in response to the scalability challenges associated with in-person training. However, to our knowledge, their effectiveness for hemorrhage control has not been established. Objective To evaluate the effectiveness of different instructional point-of-care interventions and in-person training for hemorrhage control compared with no intervention and assess skill retention 3 to 9 months after hemorrhage control training. Design, Setting, and Participants This randomized clinical trial of 465 laypersons was conducted at a professional sports stadium in Massachusetts with capacity for 66 000 people and assessed correct tourniquet application by using different point-of-care interventions (audio kits and flashcards) and a Bleeding Control Basic (B-Con) course. Non-B-Con arms received B-Con training after initial testing (conducted from April 2017 to August 2017). Retesting for 303 participants (65%) was performed 3 to 9 months after training (October 2017 to January 2018) to evaluate B-Con retention. A logistic regression for demographic associations was performed for retention testing. Interventions Participants were randomized into 4 arms: instructional flashcards, audio kits with embedded flashcards, B-Con, and control. All participants received B-Con training to later assess retention. Main Outcomes and Measures Correct tourniquet application in a simulated scenario. Results Of the 465 participants, 189 (40.7%) were women and the mean (SD) age was 46.3 (16.1) years. For correct tourniquet application, B-Con (88% correct application [n = 122]; P < .001) was superior to control (n = 104 [16%]) while instructional flashcards (n = 117 [19.6%]) and audio kit (n = 122 [23%]) groups were not. More than half of participants in point-of-care arms did not use the educational prompts as intended. Of 303 participants (65%) who were assessed 3 to 9 months after undergoing B-Con training, 165 (54.5%) could correctly apply a tourniquet. Over this period, there was no further skill decay in the adjusted model that treated time as either linear (odds ratio [OR], 0.98; 95% CI, 0.95-1.03) or quadratic (OR, 1.00; 95% CI, 1.00-1.00). The only demographic that was associated with correct application at retention was age; adults aged 18 to 35 years (n = 58; OR, 2.39; 95% CI, 1.21-4.72) and aged 35 to 55 years (n = 107; OR, 1.77; 95% CI, 1.04-3.02) were more likely to be efficacious than those older than 55 years (n = 138). Conclusions and Relevance In-person hemorrhage control training for laypersons is currently the most efficacious means of enabling bystanders to act to control hemorrhage. Laypersons can successfully perform tourniquet application after undergoing a 1-hour course. However, only 54.5% retain this skill after 3 to 9 months, suggesting that investigating refresher training or improved point-of-care instructions is critical. Trial Registration ClinicalTrials.gov Identifier: NCT03479112.
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Affiliation(s)
- Eric Goralnick
- Brigham and Women's Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Muhammad A Chaudhary
- Brigham and Women's Hospital, Center for Surgery and Public Health, Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Justin C McCarty
- Brigham and Women's Hospital, Center for Surgery and Public Health, Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Edward J Caterson
- Brigham and Women's Hospital, Center for Surgery and Public Health, Department of Surgery, Harvard Medical School, Boston, Massachusetts.,Brigham and Women's Hospital, Division of Plastic Surgery, Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Scott A Goldberg
- Brigham and Women's Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Juan P Herrera-Escobar
- Brigham and Women's Hospital, Center for Surgery and Public Health, Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Meghan McDonald
- Brigham and Women's Hospital, Division of Trauma, Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Stuart Lipsitz
- Brigham and Women's Hospital, Center for Surgery and Public Health, Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Adil H Haider
- Brigham and Women's Hospital, Center for Surgery and Public Health, Department of Surgery, Harvard Medical School, Boston, Massachusetts.,Deputy Editor
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Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial. Crit Care Med 2019; 46:1722-1730. [PMID: 30063490 DOI: 10.1097/ccm.0000000000003339] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. Secondary hypotheses were that temporal reductions in mortality would be seen and would have accelerated after publication of the target temperature management trial. DESIGN Retrospective cohort study (January 2005 to December 2016). SETTING The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation adult patient database containing greater than 2 million admission episodes from 186 Australian and New Zealand ICUs. PATIENTS Sixteen-thousand two-hundred fifty-two adults from 140 hospitals admitted to ICU after out-of-hospital cardiac arrest. INTERVENTIONS The primary exposure of interest was admission before versus after publication of the target temperature management trial. MEASUREMENTS AND MAIN RESULTS The primary outcome variable to evaluate changes in temperature management was lowest temperature in the first 24 hours in ICU. The primary clinical outcome variable of interest was inhospital mortality. Secondary outcomes included proportion of patients with fever in the first 24 hours in ICU. Mean ± SD lowest temperature in the first 24 hours in ICU in pre- and posttarget temperature management trial patients was 33.80 ± 1.71°C and 34.70 ± 1.39°C, respectively (absolute difference, 0.98°C [99% CI, 0.89-1.06°C]). Inhospital mortality rate decreased by 1.3 (99% CI, -1.8 to -0.9) percentage points per year from January 2005 until December 2013 and increased by 0.6 (99% CI, -1.4 to 2.6) percentage points per year from January 2014 until December 2016 (change in slope 1.9 percentage points per year [99% CI, -0.6 to 4.4]). Fever occurred in 568 (12.8%) of 4,450 pretarget temperature management trial patients and 853 (16.5%) of 5,184 posttarget temperature management trial patients (odds ratio, 1.35 [99% CI, 1.16-1.57]). CONCLUSIONS The average lowest temperature of postcardiac arrest patients in the first 24 hours in ICU rose after publication of the target temperature management trial. This change was associated with an increased frequency of fever not seen in the target temperature management trial.
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Villa GF, Kette F, Balzarini F, Riccò M, Manera M, Solaro N, Pagliosa A, Zoli A, Migliori M, Sechi GM, Odone A, Signorelli C. Out-of-hospital cardiac arrest (OHCA) Survey in Lombardy: data analysis through prospective short time period assessment. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:64-70. [PMID: 31517891 PMCID: PMC7233661 DOI: 10.23750/abm.v90i9-s.8710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The results of out-of-hospital cardiac arrests (OHCA) are usually reported through data collected collected via "ad hoc" registries, but in large populations, samples of short time periods can be used to apply the results to the entire population. We would like to describe the situation of Lombardy to provide evidence on successful procedures, which may be carried out in a larger context. METHODS Observational, prospective, analytical, single cohort study in Lombardy population. Data of OHCA of cardiac aetiology, according to "Utstein Style", with resuscitation attempts started by the Emergency Medical Service (EMS), were collected for 40 days subdivided in 10-day-periods in all seasons 2014-15 via Operating System "Emergency Management" (EmMa). RESULTS Of 1219 cases, 536 events of witnessed OHCA of presumed cardiac etiology were analyzed. Outcomes were: sustained Return Of Spontaneous Circulation ROSC (25.6%), Survival Event in Emergency Department (22.8%), Survival after 24 hours (21.2%) and Survival after hospital discharge at home 30 days after (11.2%). Statistically significant results were found in age, rhythm of presentation, and resuscitation by bystanders. Sex, seasonality and rescue timing did not differ statistically. CONCLUSIONS Overall the thirty-day survival rate was similar to studies with larger databases. Our data are consistent with the concept that all emergency service should provide CPR instructions for every citizen who activate the EMS in the suspect of a SCA; further investigation should clarify how long interval could be useful for ROSC and sustained ROSC in patients resuscitated by lay people using CPR instructions.
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Bogle BM, Rosamond WD, Snyder KT, Zègre-Hemsey JK. The Case for Drone-assisted Emergency Response to Cardiac Arrest: An Optimized Statewide Deployment Approach. N C Med J 2019; 80:204-212. [PMID: 31278178 DOI: 10.18043/ncm.80.4.204] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite evidence linking rapid defibrillation to out-of-hospital cardiac arrest (OHCA) survival, bystander use of automatic external defibrillators (AEDs) remains low, due in part to AED placement and accessibility. AED-equipped drones may improve time-to-defibrillation, yet the benefits and costs are unknown.METHODS We designed drone deployment networks for the state of North Carolina using mathematical optimization models to select drone stations from existing infrastructure by specifying the number of stations and the targeted AED arrival time. Expected outcomes were evaluated over the drone's lifespan (4 years). We estimated the following parameters: proportion of OHCAs within a targeted AED delivery time, bystander utilization of AEDs, survival/neurological status, and incremental cost per quality-adjusted life year (QALY).RESULTS Statewide, 16,503 adults aged 18 or older were expected to experience OHCA with an attempted resuscitation over 4 years. Compared to no drone network, all proposed drone networks were expected to improve survival outcomes. For example, assuming 46% of OHCAs have bystanders willing to use an AED, a 500-drone network decreased the median time of defibrillator arrival from 7.7 to 2.7 minutes compared to no drone network. Expected survival rates doubled (24.5% versus 12.3%), resulting in an additional 30,267 QALYs ($858/incremental QALY). If just 4.5% of OHCAs had willing bystanders, 13.8% of victims would have survived. Sensitivity analysis demonstrated that an AED drone network remained cost-effective over a wide range of assumptions.CONCLUSIONS With proper integration into existing systems, large-scale networks for drone AED delivery have the potential to substantially improve OHCA survival rates while remaining cost-effective. Public health researchers should consider advocating for feasibility studies and policy development surrounding drones.
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Affiliation(s)
- Brittany M Bogle
- senior data scientist, IBM Corporation, Research Triangle Park, North Carolina
| | - Wayne D Rosamond
- professor, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kyle T Snyder
- director, NextGen Air Transportation Consortium, North Carolina State University, Raleigh, North Carolina
| | - Jessica K Zègre-Hemsey
- assistant professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Sun CL, Karlsson L, Torp-Pedersen C, Morrison LJ, Brooks SC, Folke F, Chan TC. In Silico Trial of Optimized Versus Actual Public Defibrillator Locations. J Am Coll Cardiol 2019; 74:1557-1567. [DOI: 10.1016/j.jacc.2019.06.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/06/2019] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
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Fridling JI, Shapiro DS, Jacobs LM. Creating Model Stop the Bleed Training Programs at Three Distinct Institutions. Am Surg 2019. [DOI: 10.1177/000313481908500815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jeremy I.G. Fridling
- Frank H. Netter MD School of Medicine Quinnipiac University North Haven, Connecticut
| | - David S. Shapiro
- Frank H. Netter MD School of Medicine Quinnipiac University North Haven, Connecticut Saint Francis Hospital and Medical Center Hartford, Connecticut
| | - Lenworth M. Jacobs
- Department of Emergency Medicine and Traumatology University of Connecticut School of Medicine Farmington, Connecticut Hartford Hospital Hartford, Connecticut
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Hansen SM, Hansen CM, Folke F, Rajan S, Kragholm K, Ejlskov L, Gislason G, Køber L, Gerds TA, Hjortshøj S, Lippert F, Torp-Pedersen C, Wissenberg M. Bystander Defibrillation for Out-of-Hospital Cardiac Arrest in Public vs Residential Locations. JAMA Cardiol 2019; 2:507-514. [PMID: 28297003 DOI: 10.1001/jamacardio.2017.0008] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Bystander-delivered defibrillation (hereinafter referred to as bystander defibrillation) of patients with out-of-hospital cardiac arrests (OHCAs) remains limited despite the widespread dissemination of automated external defibrillators (AEDs). Objective To examine calendar changes in bystander defibrillation and subsequent survival according to a public or a residential location of the cardiac arrest after nationwide initiatives in Denmark to facilitate bystander-mediated resuscitative efforts, including bystander defibrillation. Design, Setting, and Participants This nationwide study identified 18 688 patients in Denmark with first-time OHCA from June 1, 2001, to December 31, 2012, using the Danish Cardiac Arrest Registry. Patients had a presumed cardiac cause of arrest that was not witnessed by emergency medical services personnel. Data were analyzed from April 1, 2015, to December 10, 2016. Exposures Nationwide initiatives to facilitate bystander resuscitative efforts, including bystander defibrillation, consisted of resuscitation training of Danish citizens, dissemination of on-site AEDs, foundation of an AED registry linked to emergency medical dispatch centers, and dispatcher-assisted guidance of bystander resuscitation efforts. Main Outcomes and Measures The proportion of patients who received bystander defibrillation according to the location of the cardiac arrest and their subsequent 30-day survival. Results Of the 18 688 patients with OHCAs (67.8% men and 32.2% women; median [interquartile range] age, 72 [62-80] years), 4783 (25.6%) had a cardiac arrest in a public location and 13 905 (74.4%) in a residential location. The number of registered AEDs increased from 141 in 2007 to 7800 in 2012. The distribution of AED location was consistently skewed in favor of public locations. Bystander defibrillation increased in public locations from 3 of 245 (1.2%; 95% CI, 0.4%-3.5%) in 2001 to 78 of 510 (15.3%; 95% CI, 12.4%-18.7%) in 2012 (P < .001) but remained unchanged in residential locations from 7 of 542 (1.3%; 95% CI, 0.6%-2.6%) in 2001 to 21 of 1669 (1.3%; 95% CI, 0.8%-1.9%) in 2012 (P = .17). Thirty-day survival after bystander defibrillation increased in public locations from 8.3% (95% CI, 1.5%-35.4%) in 2001/2002 to 57.5% (95% CI, 48.6%-66.0%) in 2011/2012 (P < .001) in residential locations, from 0.0% (95% CI, 0.0%-19.4%) in 2001/2002 to 25.6% (95% CI, 14.6%-41.1%) in 2011/2012 (P < .001). Conclusions and Relevance Initiatives to facilitate bystander defibrillation were associated with a marked increase in bystander defibrillation in public locations, whereas bystander defibrillation remained limited in residential locations. Concomitantly, survival increased after bystander defibrillation in residential and public locations.
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Affiliation(s)
- Steen Møller Hansen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Carolina Malta Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark3Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Shahzleen Rajan
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Anesthesiology, Aalborg University Hospital, Aalborg, Denmark
| | - Linda Ejlskov
- Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark6The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark7The Danish Heart Foundation, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Søren Hjortshøj
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | | | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark3Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
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Hajari H, Salerno J, Weiss LS, Menegazzi JJ, Karimi H, Salcido DD. Simulating Public Buses as a Mobile Platform for Deployment of Publicly Accessible Automated External Defibrillators. PREHOSP EMERG CARE 2019; 24:238-244. [PMID: 31124734 DOI: 10.1080/10903127.2019.1623353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Public access defibrillation (PAD) programs seek to optimize locations of automated external defibrillators (AEDs) to minimize the time from out-of-hospital cardiac arrest (OHCA) recognition to defibrillation. Most PAD programs have focused on static AED (S-AED) locations in high traffic areas; pervasive electronic data infrastructure incorporating real-time geospatial data opens the possibility for AED deployment on mobile infrastructure for retrieval by nearby non-passengers. Performance characteristics of such systems are not known. Hypothesis: We hypothesized that publicly accessible AEDs located on buses would increase publicly accessible AED coverage and reduce AED retrieval time relative to statically located AEDs. Methods: S-AED sites in Pittsburgh, PA were identified and consolidated to 1 AED per building for analysis (n = 582). Public bus routes and schedules were obtained from the Port Authority of Allegheny County. OHCA locations and times were obtained from the Pittsburgh site of the Resuscitation Outcomes Consortium. Two simulations were conducted to assess the characteristics and impact of AEDs located on buses. In Simulation #1, geographic coverage area of AEDs located on buses (B-AEDs) was estimated using a 1/8th mile (201 m) retrieval radius during weekday, Saturday and Sunday periods. Cumulative geographic coverage across each period of the week was compared to S-AED coverage and the added coverage provided by B-AEDs was calculated. In Simulation #2, spatiotemporal event coverage was estimated for historical OHCA events, assuming constraints designed to reflect real world AED retrieval scenarios. Event coverage and AED retrieval time were compared between B-AEDs and S-AEDs across periods of the week and residential/nonresidential spatial areas. Results: Cumulative geographic coverage by S-AEDs was 23% across all periods, assuming uniform access hours. B-AEDs alone versus B-AEDs + S-AEDs covered 20% vs. 34% (weekday), 14% + 30% (Saturday), and 10% + 28% (Sunday). There was no statistically significant difference in 3-minute historical AED accessibility between only B-AEDs and only S-AEDs in standalone deployments (12% vs. 14%). However, when allowing for retrieval of either type of AED in the same scenario, event coverage was improved to 22% (p < 0.001). Conclusion: Deployment of B-AEDs may improve AED coverage but not as a standalone deployment strategy.
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Kiyohara K, Nishiyama C, Kitamura T, Matsuyama T, Sado J, Shimamoto T, Kobayashi D, Kiguchi T, Okabayashi S, Kawamura T, Iwami T. The association between public access defibrillation and outcome in witnessed out-of-hospital cardiac arrest with shockable rhythm. Resuscitation 2019; 140:93-97. [PMID: 31129227 DOI: 10.1016/j.resuscitation.2019.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/28/2019] [Accepted: 05/16/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is recommended globally that shocks by automated external defibrillators (AEDs) should be delivered immediately when a shockable out-of-hospital cardiac arrest (OHCA) occurs. However, the actual time-interval from collapse to first shock by public-access AED and its impact on subsequent outcome has not been extensively investigated in real-world settings. METHODS OHCA data from 2013 to 2015 were obtained from the All-Japan Utstein Registry. Bystander-witnessed OHCA patients with shockable rhythm who were shocked by public-access AED in public locations were included. The primary endpoint was 1-month survival with favourable neurological outcome, and the association between time-interval from collapse to first shock by public-access AED and subsequent outcome was assessed. RESULTS During the study period, 28% (2282/8126) of bystander-witnessed OHCA cases with shockable rhythm were shocked by public-access AED in public locations. The proportion of OHCA patients who were shocked by public-access AED within 5 min from collapse was 58% (1323/2282). Among these patients, the proportion of 1-month survival with favourable neurological outcome was 62% (815/1317). The proportion significantly decreased with increased time from collapse to shock by public-access AED (48% for 6-10 min, 38% for 11-15 min, 30% for 16-20 min, and 7% for 21-25 min; p-for-trend <0.001), and no patient survived if shock delivery occurred more than 26 min after OHCA. CONCLUSION In Japan, earlier shock by public-access AED led to better outcome after bystander-witnessed OHCA with shockable rhythm in public locations. However, the proportion of OHCA patients who received early shock was still low in public locations.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan.
| | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junya Sado
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | | | | | | | | | | | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
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Sandhu U, Rajyaguru C, Cheung CC, Morin DP, Lee BK. The wearable cardioverter-defibrillator vest: Indications and ongoing questions. Prog Cardiovasc Dis 2019; 62:256-264. [PMID: 31077726 DOI: 10.1016/j.pcad.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/04/2019] [Indexed: 12/28/2022]
Abstract
Multiple clinical trials have demonstrated the efficacy of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death (SCD) among specific high-risk populations. However, it remains unclear how to optimally treat those patients who are at elevated risk of cardiac arrest but are not among the presently identified groups proven to benefit from an ICD, are unable to tolerate surgical device implantation, or refuse invasive therapies. The wearable cardioverter-defibrillator (WCD) is an alternative antiarrhythmic device that provides continuous cardiac monitoring and defibrillation capabilities through a noninvasive, electrode-based system. The WCD has been shown to be highly effective at restoration of sinus rhythm in patients with a ventricular tachyarrhythmia, and one randomized trial using the WCD in patients with recent myocardial infarction at elevated risk for arrhythmic death reported a decrease in overall mortality despite no SCD mortality benefit. The current clinical indications for WCD use are varied and continue to evolve as experience with this technology increases.
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Affiliation(s)
- Uday Sandhu
- Division of Cardiology, University of California, San Francisco-Fresno Program
| | - Chirag Rajyaguru
- Division of Cardiology, University of California, San Francisco-Fresno Program
| | - Christopher C Cheung
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Daniel P Morin
- Department of Cardiology, Ochsner Medical Center and University of Queensland Ochsner Clinical School, New Orleans, LA
| | - Byron K Lee
- Division of Cardiology, Electrophysiology and Arrhythmia Service, University of California, San Francisco.
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Sanfridsson J, Sparrevik J, Hollenberg J, Nordberg P, Djärv T, Ringh M, Svensson L, Forsberg S, Nord A, Andersson-Hagiwara M, Claesson A. Drone delivery of an automated external defibrillator - a mixed method simulation study of bystander experience. Scand J Trauma Resusc Emerg Med 2019; 27:40. [PMID: 30961651 PMCID: PMC6454735 DOI: 10.1186/s13049-019-0622-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) affects some 275,000 individuals in Europe each year. Time from collapse to defibrillation is essential for survival. As emergency medical services (EMS) response times in Sweden have increased, novel methods are needed to facilitate early treatment. Unmanned aerial vehicles (i.e. drones) have potential to deliver automated external defibrillators (AED). The aim of this simulation study was to explore bystanders' experience of a simulated OHCA-situation where a drone delivers an AED and how the situation is affected by having one or two bystanders onsite. METHODS This explorative simulation study used a mixed methodology describing bystanders' experiences of retrieving an AED delivered by a drone in simulated OHCA situations. Totally eight participants were divided in two groups of bystanders a) alone or b) in pairs and performed CPR on a manikin for 5 minutes after which an AED was delivered by a drone at 50 m from the location. Qualitative data from observations, interviews of participants and video recordings were analysed using content analysis alongside descriptive data on time delays during bystander interaction. RESULTS Three categories of bystander experiences emerged: 1) technique and preparedness, 2) support through conversation with the dispatcher, and 3) aid and decision-making. The main finding was that retrieval of an AED as delivered by a drone was experienced as safe and feasible for bystanders. None of the participants hesitated to retrieve the AED; instead they experienced it positive, helpful and felt relief upon AED-drone arrival and were able to retrieve and attach the AED to a manikin. Interacting with the AED-drone was perceived as less difficult than performing CPR or handling their own mobile phone during T-CPR. Single bystander simulation introduced a significant hands-off interval when retrieving the AED, a period lasting 94 s (range 75 s-110 s) with one participant compared to 0 s with two participants. CONCLUSION The study shows that it made good sense for bystanders to interact with a drone in this simulated suspected OHCA. Bystanders experienced delivery of AED as safe and feasible. This has potential implications, and further studies on bystanders' experiences in real cases of OHCA in which a drone delivers an AED are therefore necessary.
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Affiliation(s)
- J Sanfridsson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - J Sparrevik
- Västerbotten Emergency Medical Services, SE-90737, Umeå, Sweden
| | - J Hollenberg
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - P Nordberg
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - T Djärv
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - M Ringh
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - L Svensson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - S Forsberg
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - A Nord
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - M Andersson-Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-, 501 90, Borås, Sweden
| | - A Claesson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, SE-17177, Stockholm, Sweden.
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66
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Basic resuscitation training and public-access defibrillator deployment in Buddhist temples of Thailand. Resuscitation 2019; 138:233-234. [PMID: 30922935 DOI: 10.1016/j.resuscitation.2019.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 11/24/2022]
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67
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Karlsson L, Malta Hansen C, Wissenberg M, Møller Hansen S, Lippert FK, Rajan S, Kragholm K, Møller SG, Bach Søndergaard K, Gislason GH, Torp-Pedersen C, Folke F. Automated external defibrillator accessibility is crucial for bystander defibrillation and survival: A registry-based study. Resuscitation 2019; 136:30-37. [DOI: 10.1016/j.resuscitation.2019.01.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/08/2018] [Accepted: 01/10/2019] [Indexed: 11/26/2022]
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68
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Morgan DP, Muscatello D, Hayen A, Travaglia J. Human factors influencing out-of-hospital cardiac arrest survival. Emerg Med Australas 2019; 31:600-604. [PMID: 30759497 DOI: 10.1111/1742-6723.13222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 09/04/2018] [Accepted: 11/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Programmes that reduce the time to defibrillation are likely to improve overall survival rates from out-of-hospital cardiac arrests (OHCAs). This research sought to identify human factors common among community responders taking an automated external defibrillator (AED) to a victim of an OHCA that are either barriers or enablers of desired behaviour. METHODS A qualitative methodology was used. Community members who had access to an AED and who had been notified of an incident of OHCA near them were approached to participate in the research. Participants completed a written survey and undertook a semi-structured interview. A thematic analysis was undertaken using NVivo software and triangulated against findings from an automated data-mining package, Leximancer. RESULTS The study found that 100% of people who were notified of the need for an AED responded. Twelve participants subsequently identified during interviews that they held some form of leadership role in their community. First aid training and previous experience of, and competency in managing emergencies were the strongest motivations for their response. Personal risk was not a concern when responding to victims in immediately life-threatening situations. CONCLUSION Prospective programmes may be able to be designed to increase the likelihood that community members with AEDs will respond in advance of emergency medical services by targeting common human factors, such as leadership behaviour, training, competency and experience in managing emergencies, leading to better overall survival rates from OHCA.
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Affiliation(s)
- Dominic P Morgan
- Faculty of Medicine, School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - David Muscatello
- Faculty of Medicine, School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Hayen
- Faculty of Medicine, School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joanne Travaglia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Gardett I, Broadbent M, Scott G, Clawson JJ, Olola C. Availability and Use of an Automated External Defibrillator at Emergency Medical Dispatch. PREHOSP EMERG CARE 2019; 23:683-690. [DOI: 10.1080/10903127.2018.1559565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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70
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Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas. PLoS One 2019; 14:e0211723. [PMID: 30707745 PMCID: PMC6358107 DOI: 10.1371/journal.pone.0211723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/20/2019] [Indexed: 11/19/2022] Open
Abstract
Background The chance of surviving an out-of-hospital cardiac arrest (OHCA) seems to be increased if the cardiac arrests occurs in relation to exercise. Hypothetically, an exercise-related OHCA at a sports arena would have an even better prognosis, because of an increased likelihood of bystander cardiopulmonary resuscitation (CPR) and higher availability of automated external defibrillators (AEDs). The purpose of the study was to compare survival rates between exercise-related OHCA at sports arenas versus outside of sports arenas. Methods Data from all treated exercise-related OHCA outside home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 in 10 counties of Sweden was analyzed (population 6 million). The registry has in those counties a coverage of almost 100% of all OHCAs. Results 3714 cases of OHCA outside of home were found. Amongst them, 268(7%) were exercise-related and 164 (61.2%) of those occurred at sports arenas. The 30-day survival rate was higher for exercise-related OHCA at sports arenas compared to outside (55.7% vs 30.0%, p<0.0001). OHCA-victims at sports arenas were younger (mean age±SD 57.6±16.3 years compared to 60.9±17.0 years, p = 0.05), less likely female (4.3% vs 12.2%, p = 0.02) and had a higher frequency of shockable rhythm (73.0% vs 54.3%, p = 0.004). OHCAs at arenas were more often witnessed (83.9% vs 68.9%, p = 0.007), received bystander CPR to a higher extent (90.0% vs 56.8%, p<0.0001) and the AED-use before EMS-arrival was also higher in this group (29.8% vs 11.1%, p = 0.009). Conclusion The prognosis is markedly better for exercise-related OHCA occurring at sports arenas compared to outside. Victims of exercise-related OHCA at sports arenas are more likely to receive bystander CPR and to be connected to a public AED. These findings support an increased use of public AEDs and implementation of Medical Action Plans (MAP), to possibly increase survival of exercise-related OHCA even further.
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71
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McCoy CE, Rahman A, Rendon JC, Anderson CL, Langdorf MI, Lotfipour S, Chakravarthy B. Randomized Controlled Trial of Simulation vs. Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation. West J Emerg Med 2019; 20:15-22. [PMID: 30643596 PMCID: PMC6324716 DOI: 10.5811/westjem.2018.11.39040] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/11/2018] [Accepted: 11/14/2018] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Most medical schools teach cardiopulmonary resuscitation (CPR) during the final year in course curriculum to prepare students to manage the first minutes of clinical emergencies. Little is known regarding the optimal method of instruction for this critical skill. Simulation has been shown in similar settings to enhance performance and knowledge. We evaluated the comparative effectiveness of high-fidelity simulation training vs. standard manikin training for teaching medical students the American Heart Association (AHA) guidelines for high-quality CPR. METHODS This was a prospective, randomized, parallel-arm study of 70 fourth-year medical students to either simulation (SIM) or standard training (STD) over an eight-month period. SIM group learned the AHA guidelines for high-quality CPR via an hour session that included a PowerPoint lecture with training on a high-fidelity simulator. STD group learned identical content using a low-fidelity Resusci Anne® CPR manikin. All students managed a simulated cardiac arrest scenario with primary outcome based on the AHA guidelines definition of high-quality CPR (specifies metrics for compression rate, depth, recoil, and compression fraction). Secondary outcome was time to emergency medical services (EMS) activation. We analyzed data via Kruskal-Wallis rank sum test. Outcomes were performed on a simulated cardiac arrest case adapted from the AHA Advanced Cardiac Life Support (ACLS) SimMan® Scenario manual. RESULTS Students in the SIM group performed CPR that more closely adhered to the AHA guidelines of compression depth and compression fraction. Mean compression depth was 4.57 centimeters (cm) (95% confidence interval [CI] [4.30-4.82]) for SIM and 3.89 cm (95% CI [3.50-4.27]) for STD, p=0.02. Mean compression fraction was 0.724 (95% CI [0.699-0.751]) for SIM group and 0.679 (95% CI [0.655-0.702]) for STD, p=0.01. There was no difference for compression rate or recoil between groups. Time to EMS activation was 24.7 seconds (s) (95% CI [15.7-40.8]) for SIM group and 79.5 s (95% CI [44.8-119.6]) for STD group, p=0.007. CONCLUSION High-fidelity simulation training is superior to low-fidelity CPR manikin training for teaching fourth-year medical students implementation of high-quality CPR for chest compression depth and compression fraction.
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Affiliation(s)
- C Eric McCoy
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Asif Rahman
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Juan C Rendon
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Craig L Anderson
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Mark I Langdorf
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Shahram Lotfipour
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Bharath Chakravarthy
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
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72
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Hansen SM, Hansen CM, Fordyce CB, Dupre ME, Monk L, Tyson C, Torp-Pedersen C, McNally B, Vellano K, Jollis J, Granger CB. Association Between Driving Distance From Nearest Fire Station and Survival of Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2018; 7:e008771. [PMID: 30571383 PMCID: PMC6404193 DOI: 10.1161/jaha.118.008771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Firefighter first responders dispatched in parallel with emergency medical services (EMS) personnel for out‐of‐hospital cardiac arrests (OHCA) can provide early defibrillation to improve survival. We examined whether survival following first responder defibrillation differed according to driving distance from nearest fire station to OHCA site. Methods and Results From the CARES (Cardiac Arrest Registry to Enhance Survival) registry, we identified non‐EMS witnessed OHCAs of presumed cardiac cause from 2010 to 2014 in Durham, Mecklenburg, and Wake counties, North Carolina. We used logistic regression to estimate the association between calculated driving distances (≤1, 1–1.5, 1.5–2, and >2 miles) and survival to hospital discharge following first responder defibrillation compared with defibrillation by EMS personnel. In total, 5020 OHCAs were included in the study. First responders more often applied the first automated external defibrillators at the shortest distances (≤1 mile) versus longest distances (>2 miles) (53.4% versus 46.6%, respectively, P<0.001). When compared with EMS defibrillation, first responder defibrillation within 1 mile and 1 to 1.5 miles of the nearest fire station was associated with increased survival to hospital discharge (odds ratio 2.01 [95% confidence interval 1.46–2.78] and odds ratio 1.61 [95% confidence interval 1.10–2.35], respectively). However, at the longest distances (1.5–2.0 and >2.0 miles), survival following first responder defibrillation did not differ from EMS defibrillation (odds ratio 0.77 [95% confidence interval 0.48–1.21] and odds ratio 0.97 [95% confidence interval 0.67–1.41], respectively). Conclusions Shorter driving distance from nearest fire station to OHCA location was associated with improved survival following defibrillation by first responders. These results suggest that the location of first responder units should be considered when organizing prehospital systems of OHCA care.
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Affiliation(s)
- Steen M Hansen
- 1 Duke Clinical Research Institute Duke University Durham NC.,3 Department of Clinical Epidemiology Aalborg University Hospital Aalborg Denmark
| | | | - Christopher B Fordyce
- 4 Division of Cardiology University of British Columbia Vancouver British Columbia Canada
| | - Matthew E Dupre
- 1 Duke Clinical Research Institute Duke University Durham NC.,2 Department of Population Health Sciences Duke University Durham NC
| | - Lisa Monk
- 1 Duke Clinical Research Institute Duke University Durham NC
| | - Clark Tyson
- 1 Duke Clinical Research Institute Duke University Durham NC
| | | | - Bryan McNally
- 5 Emory University School of Medicine Atlanta GA.,6 Rollins School of Public Health Emory University Atlanta GA
| | | | - James Jollis
- 1 Duke Clinical Research Institute Duke University Durham NC
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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74
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Sun CL, Karlsson L, Torp-Pedersen C, Morrison LJ, Folke F, Chan TC. Spatiotemporal AED optimization is generalizable. Resuscitation 2018; 131:101-107. [DOI: 10.1016/j.resuscitation.2018.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/21/2018] [Accepted: 08/08/2018] [Indexed: 11/16/2022]
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75
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 717] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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77
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Chambers JA, Seastedt K, Krell R, Caterson E, Levy M, Turner N. “Stop the Bleed”: A U.S. Military Installation’s Model for Implementation of a Rapid Hemorrhage Control Program. Mil Med 2018; 184:67-71. [DOI: 10.1093/milmed/usy185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/11/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- James Alan Chambers
- 11th Surgical Operations Squadron, 1060W. Perimeter Road, Suite 3K02, Joint Base Andrews, MD
| | - Kenneth Seastedt
- 11th Surgical Operations Squadron, 1060W. Perimeter Road Joint Base Andrews, MD
| | - Robert Krell
- Memorial Sloan Kettering Cancer Center, 1275 York Ave New York, NY
| | | | - Matthew Levy
- Johns Hopkins University Hospital, 600 North Wolfe Street, Baltimore, MD
| | - Nancy Turner
- 11 MDOS Squadron Readiness Liaison, 1050W. Perimeter Road Joint Base Andrews, MD
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78
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Adedinsewo D, Omole O, Oluleye O, Ajuyah I, Kusumoto F. Arrhythmia care in Africa. J Interv Card Electrophysiol 2018; 56:127-135. [PMID: 29931543 DOI: 10.1007/s10840-018-0398-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/04/2018] [Indexed: 01/10/2023]
Abstract
Data on cardiovascular disease, including arrhythmias, in Africa is limited. However, the burden of cardiovascular disease appears to be on the rise. Recent global data suggests an increase in atrial fibrillation rates despite declining rates of rheumatic heart disease. Atrial fibrillation is also associated with increased mortality in Africa. Current management with medical therapy is sub-optimal and ablation procedures, inaccessible. Atrial fibrillation is also an independent risk factor for death in patients with rheumatic heart disease. Sudden cardiac deaths from ventricular arrhythmias are under-recognized and inadequately treated with very high rates out of hospital cardiac arrest due to poor education of the general public on cardiopulmonary resuscitation skills and lack of essential healthcare infrastructure. Use of cardiac devices such as implantable defibrillators and pacemakers is low with significant regional variations and is almost non-existent in sub-Saharan Africa. There is a great unmet need for arrhythmia diagnosis and management in Africa. Governments and healthcare stakeholders need to include cardiovascular disease as a healthcare priority given the rising burden of disease and associated mortality.
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Affiliation(s)
| | | | | | - Itse Ajuyah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Fred Kusumoto
- Division of Cardiovascular Diseases, Electrophysiology and Pacing Service, Mayo Clinic, 4500 San Pablo Ave, Jacksonville, FL, 32224, USA.
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79
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Zijlstra JA, Koster RW, Blom MT, Lippert FK, Svensson L, Herlitz J, Kramer-Johansen J, Ringh M, Rosenqvist M, Palsgaard Møller T, Tan HL, Beesems SG, Hulleman M, Claesson A, Folke F, Olasveengen TM, Wissenberg M, Hansen CM, Viereck S, Hollenberg J. Different defibrillation strategies in survivors after out-of-hospital cardiac arrest. Heart 2018; 104:1929-1936. [PMID: 29903805 DOI: 10.1136/heartjnl-2017-312622] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/31/2018] [Accepted: 04/17/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival. METHODS We performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded. RESULTS A total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm. CONCLUSION Survivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.
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Affiliation(s)
- Jolande A Zijlstra
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Freddy K Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Leif Svensson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Johan Herlitz
- Department of Metabolism and Cardiovascular Research, Institute of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Mattias Ringh
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Mårten Rosenqvist
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Thea Palsgaard Møller
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Hanno L Tan
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Stefanie G Beesems
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel Hulleman
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Andreas Claesson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Theresa Mariero Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Carolina Malta Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Soren Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Hollenberg
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
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80
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EBM vs. EBM: combining evidence-based and experienced-based medicine in resuscitation research. Curr Opin Crit Care 2018; 23:199-203. [PMID: 28398910 DOI: 10.1097/mcc.0000000000000413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To discuss the clear rationale for evidence-based medicine (EvBM) in the challenging realms of resuscitation research, yet also provide case examples in which even the well designed, multicentered randomized clinical trial may have had unrecognized limitations, and thus misleading results. This is where experienced-based medicine (ExBM) helps to resolve the issue. RECENT FINDINGS Recent publications have brought to task the conclusions drawn from various clinical trials of resuscitative interventions. These articles have indicated that some major clinical trials that later determined the universal guidelines for resuscitative protocols may have been affected by unrecognized confounding variables, effect modifiers and other problems such as delayed timing. Many interventions, deemed to be ineffective because of these study factors, may actually have lifesaving effects that would have been confirmed had the proper circumstances been in place. With the right mindset, the clinician-researcher can often identify and address those situations. SUMMARY When clinical trials indicate ineffectiveness of an intervention that worked very well in other circumstances, both preclinical and clinical, clinician-investigators should continue to re-search the issues and not always take conclusions at face value.
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81
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Supportive technology in the resuscitation of out-of-hospital cardiac arrest patients. Curr Opin Crit Care 2018; 23:209-214. [PMID: 28383297 DOI: 10.1097/mcc.0000000000000409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW To discuss the increasing value of technological tools to assess and augment the quality of cardiopulmonary resuscitation (CPR) and, in turn, improve chances of surviving out-of-hospital cardiac arrest (OHCA). RECENT FINDINGS After decades of disappointing survival rates, various emergency medical services systems worldwide are now seeing a steady rise in OHCA survival rates guided by newly identified 'sweet spots' for chest compression rate and chest compression depth, aided by monitoring for unnecessary pauses in chest compressions as well as methods to better ensure full-chest recoil after compressions. Quality-assurance programs facilitated by new technologies that monitor chest compression rate, chest compression depth, and/or frequent pauses have been shown to improve the quality of CPR. Further aided by other technologies that enhance flow or better identify the best location for hand placement, the future outlook for better survival is even more promising, particularly with the potential use of another technology - extracorporeal membrane oxygenation for OHCA. SUMMARY After 5 decades of focus on manual chest compressions for CPR, new technologies for monitoring, guiding, and enhancing CPR performance may enhance outcomes from OHCA significantly in the coming years.
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82
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Out-of-hospital cardiac arrest survival in international airports. Resuscitation 2018; 127:58-62. [DOI: 10.1016/j.resuscitation.2018.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 11/20/2022]
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83
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Fernando SM, Vaillancourt C, Morrow S, Stiell IG. Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators. Resuscitation 2018; 128:138-143. [PMID: 29753856 DOI: 10.1016/j.resuscitation.2018.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/14/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Little is known regarding the quality of cardiopulmonary resuscitation (CPR) performed by bystanders in out-of-hospital cardiac arrest (OHCA). We sought to determine quality of bystander CPR provided during OHCA using CPR quality data stored by Automated External Defibrillators (AEDs). METHODS We used the Resuscitation Outcomes Consortium database to identify OHCA cases of presumed cardiac etiology where an AED was utilized. We then matched AED data to each case identified. AED data was analyzed using manufacturer software in order to determine overall measures of bystander CPR quality, changes in bystander CPR quality over time, and adherence to existing 2010 Resuscitation Quality Guidelines. RESULTS 100 cases of OHCA of presumed cardiac etiology involving bystander CPR and with corresponding AED data. Mean age was 62.3 years, and 75% were male. Bystanders demonstrated high-quality CPR over all minutes of resuscitation, with a chest compression fraction of 76%, a compression depth of 5.3 cm, and a compression rate of 111.2 compressions/min. Mean perishock pause was 26.8 s. Adherence rates to 2010 Resuscitation Guidelines for compression rate and depth were found to be 66% and 55%, respectively. CPR quality was lowest in the first minute, resulting from increased delay to rhythm analysis (mean 40.7 s). In cases involving shock delivery, latency from initiation of AED to shock delivery was 59.2 s. CONCLUSIONS We found that bystanders perform high-quality CPR, with strong adherence rates to existing Resuscitation Guidelines. High-quality CPR is maintained over the first five minutes of resuscitation, but was lowest in the first minute.
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Affiliation(s)
- Shannon M Fernando
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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84
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Dworkis DA, Weiner SG, Liao VT, Rabickow D, Goldberg SA. Geospatial Clustering of Opioid-Related Emergency Medical Services Runs for Public Deployment of Naloxone. West J Emerg Med 2018; 19:641-648. [PMID: 30013698 PMCID: PMC6040905 DOI: 10.5811/westjem.2018.4.37054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/16/2018] [Accepted: 04/20/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction The epidemic of opioid use disorder and opioid overdose carries extensive morbidity and mortality and necessitates a multi-pronged, community-level response. Bystander administration of the opioid overdose antidote naloxone is effective, but it is not universally available and requires consistent effort on the part of citizens to proactively carry naloxone. An alternate approach would be to position naloxone kits where they are most needed in a community, in a manner analogous to automated external defibrillators. We hypothesized that opioid overdoses would show geospatial clustering within a community, leading to potential target sites for such publicly deployed naloxone (PDN). Methods We performed a retrospective chart review of 700 emergency medical service (EMS) runs that involved opioid overdose or naloxone administration in Cambridge, Massachusetts, between October 16, 2016 and May 10, 2017. We used geospatial analysis to examine for clustering in general, and to identify specific clusters amenable to PDN sites. Results Opioid-related emergency medical services (EMS) runs in Cambridge, Massachusetts (MA), exhibit significant geospatial clustering, and we identified three clusters of opioid-related EMS runs in Cambridge, MA, with distinct characteristics. Models of PDN sites at these clusters show that approximately 40% of all opioid-related EMS runs in Cambridge, MA, would be accessible within 200 meters of PDN sites placed at cluster centroids. Conclusion Identifying clusters of opioid-related EMS runs within a community may help to improve community coverage of naloxone, and strongly suggests that PDN could be a useful adjunct to bystander-administered naloxone in stemming the tide of opioid-related death.
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Affiliation(s)
- Daniel A Dworkis
- Keck School of Medicine of University of Southern California, Department of Emergency Medicine, Los Angeles, California.,The Lever Institute, Los Angeles, California
| | - Scott G Weiner
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Vincent T Liao
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | | | - Scott A Goldberg
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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85
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Osterman M, Claiborne T, Liberi V. Radius of Care in Secondary Schools in the Midwest: Are Automated External Defibrillators Sufficiently Accessible to Enable Optimal Patient Care? J Athl Train 2018; 53:410-415. [PMID: 29693422 DOI: 10.4085/1062-6050-536-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sudden cardiac arrest is the leading cause of death among young athletes. According to the American Heart Association, an automated external defibrillator (AED) should be available within a 1- to 1.5-minute brisk walk from the patient for the highest chance of survival. Secondary school personnel have reported a lack of understanding about the proper number and placement of AEDs for optimal patient care. OBJECTIVE To determine whether fixed AEDs were located within a 1- to 1.5-minute timeframe from any location on secondary school property (ie, radius of care). DESIGN Cross-sectional study. SETTING Public and private secondary schools in northwest Ohio and southeast Michigan. PATIENTS OR OTHER PARTICIPANTS Thirty schools (24 public, 6 private) volunteered. MAIN OUTCOME MEASURE(S) Global positioning system coordinates were used to survey the entire school properties and determine AED locations. From each AED location, the radius of care was calculated for 3 retrieval speeds: walking, jogging, and driving a utility vehicle. Data were analyzed to expose any property area that fell outside the radius of care. RESULTS Public schools (37.1% ± 11.0%) possessed more property outside the radius of care than did private schools (23.8% ± 8.0%; F1,28 = 8.35, P = .01). After accounting for retrieval speed, we still observed differences between school types when personnel would need to walk or jog to retrieve an AED ( F1.48,41.35 = 4.99, P = .02). The percentages of school property outside the radius of care for public and private schools were 72.6% and 56.3%, respectively, when walking and 34.4% and 12.2%, respectively, when jogging. Only 4.2% of the public and none of the private schools had property outside the radius of care when driving a utility vehicle. CONCLUSION Schools should strategically place AEDs to decrease the percentage of property area outside the radius of care. In some cases, placement in a centralized location that is publicly accessible may be more important than the overall number of AEDs on site.
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86
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Dennis M, Elder A, Semsarian C, Orchard J, Brouwer I, Puranik R. A 10-year review of sudden death during sporting activities. Heart Rhythm 2018; 15:1477-1483. [PMID: 29678777 DOI: 10.1016/j.hrthm.2018.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Sudden death during sport is a rare but devastating event. Previous research has mostly focused on sudden deaths in young competitive athletes. OBJECTIVE The purpose of this study was to characterize the demographics and etiologies of sudden cardiac death during sport in Australia. METHODS All autopsies conducted at our forensic medicine facility between 2006 and 2015 inclusive were reviewed. Sporting-related deaths among those 7-65 years of age were identified. Data collected included subject height, weight, gender, circumstances of death, and pathologic findings at autopsy. RESULTS A total of 19,740 autopsies were completed in the study period: 12,395 in subjects age 18-65 years (adults) and 385 in subjects age 7-17 years (children). There were 201 sports-related adult deaths at an incidence rate of 0.76-1.49 per 100,000 participant-years. Of the deaths, 74% were witnessed. Of the adult cases, 68% (n = 136) were due to cardiac causes, with coronary artery disease the most frequent cause (n = 90 [45%]). Structural abnormalities were common in adult cardiac deaths; 51 (38%) had cardiac weight ≥500 g, and 75 (55%) had left ventricular wall thickness >15 mm. Of the 15 child deaths, 5 (33%) were arrhythmogenic or presumed arrhythmic, and 5 (33%) were inherited cardiomyopathies (2 hypertrophic cardiomyopathy, 3 arrhythmogenic right ventricular cardiomyopathy). CONCLUSION Sudden cardiac death during sport is rare. Deaths are mostly due to coronary artery disease in adults and cardiomyopathy or arrhythmia in children. Because the majority of sports deaths are witnessed, they present an opportunity to enhance outcomes by cardiopulmonary resuscitation training and increased availability of automated external defibrillators at sports venues.
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Affiliation(s)
- Mark Dennis
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alexander Elder
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christopher Semsarian
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, Sydney, Australia
| | - John Orchard
- School of Public Health, University of Sydney, Camperdown, Sydney, Australia
| | - Isabel Brouwer
- Department of Forensic Medicine, Glebe, Sydney, Australia
| | - Rajesh Puranik
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
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87
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Ringh M, Hollenberg J, Palsgaard-Moeller T, Svensson L, Rosenqvist M, Lippert FK, Wissenberg M, Malta Hansen C, Claesson A, Viereck S, Zijlstra JA, Koster RW, Herlitz J, Blom MT, Kramer-Johansen J, Tan HL, Beesems SG, Hulleman M, Olasveengen TM, Folke F. The challenges and possibilities of public access defibrillation. J Intern Med 2018; 283:238-256. [PMID: 29331055 DOI: 10.1111/joim.12730] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in-hospital. With the development of automated external defibrillators (AEDs), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most Western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCAs take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society.
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Affiliation(s)
- M Ringh
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - J Hollenberg
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - T Palsgaard-Moeller
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - L Svensson
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - M Rosenqvist
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - F K Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - M Wissenberg
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - C Malta Hansen
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - A Claesson
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - S Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - J A Zijlstra
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - R W Koster
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - J Herlitz
- Institute of Internal Medicine, Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M T Blom
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - J Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Air Ambulance Department, Oslo, Norway.,Department of Anaesthesiology Oslo University Hospital and University of Oslo, Oslo, Norway
| | - H L Tan
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - S G Beesems
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - M Hulleman
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - T M Olasveengen
- Department of Anaesthesiology Oslo University Hospital and University of Oslo, Oslo, Norway
| | - F Folke
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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The Current Status of Development and Implementation of Medical Emergency Response Plan in Schools. Pediatr Emerg Care 2018; 34:189-192. [PMID: 27077997 DOI: 10.1097/pec.0000000000000689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Automated external defibrillators (AEDs) have been widely distributed at schools in Japan. We have demonstrated that ventricular fibrillation accounted for 68% of nontraumatic sudden cardiac arrest (SCA) in schools, suggesting that a well-prepared medical emergency response plan (MERP) for schools would improve the outcomes of SCA patients. However, it is uncertain if the MERP has been well developed or implemented in Japanese schools. METHODS AND RESULTS We conducted a cross-sectional study of schools in Osaka using a postal questionnaire. Survey items included type of school, number of students, school staff and teaching staff, number of AEDs used and the place of installation, cardiopulmonary resuscitation (CPR) training to school staff, MERP development and implementation, and the number of SCA cases they experienced. The response rate to this survey was 44% (764 of 1728 schools). Every school except for 4 have installed at least 1 AED. Thirty-six percent of schools, however, have not yet developed and implemented a MERP for SCA. Moreover, 49% of schools surveyed have not conducted a rehearsal training session for SCA in the previous 3 years, although 95% of schools provided CPR training courses to school staff. A total of 15 schools have experienced 16 presumed or actual SCA cases in the study period. Of the 15 schools, 6 schools reported that bystanders experienced psychological stress. CONCLUSIONS A MERP for SCA has not yet been fully developed and implemented in the schools surveyed in our study despite widely distributed AEDs and CPR training.
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González-Otero DM, Ruiz de Gauna S, Ruiz J, Rivero R, Gutierrez J, Saiz P, Russell JK. Performance of cardiopulmonary resuscitation feedback systems in a long-distance train with distributed traction. Technol Health Care 2018; 26:529-535. [PMID: 29710761 PMCID: PMC6087461 DOI: 10.3233/thc-181241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest is common in public locations, including public transportation sites. Feedback devices are increasingly being used to improve chest-compression quality. However, their performance during public transportation has not been studied yet. OBJECTIVE To test two CPR feedback devices representative of the current technologies (accelerometer and electromag- netic-field) in a long-distance train. METHODS Volunteers applied compressions on a manikin during the train route using both feedback devices. Depth and rate measurements computed by the devices were compared to the gold-standard values. RESULTS Sixty-four 4-min records were acquired. The accelerometer-based device provided visual help in all experiments. Median absolute errors in depth and rate were 2.4 mm and 1.3 compressions per minute (cpm) during conventional speed, and 2.5 mm and 1.2 cpm during high speed. The electromagnetic-field-based device never provided CPR feedback; alert messages were shown instead. However, measurements were stored in its internal memory. Absolute errors for depth and rate were 2.6 mm and 0.7 cpm during conventional speed, and 2.6 mm and 0.7 cpm during high speed. CONCLUSIONS Both devices were accurate despite the accelerations and the electromagnetic interferences induced by the train. However, the electromagnetic-field-based device would require modifications to avoid excessive alerts impeding feedback.
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Affiliation(s)
- Digna M. González-Otero
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Sofía Ruiz de Gauna
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Jesus Ruiz
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Raquel Rivero
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - J.J. Gutierrez
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Purificación Saiz
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - James K. Russell
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
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Rao P, Kern KB. Improving Community Survival Rates from Out-of-Hospital Cardiac Arrest. Curr Cardiol Rev 2018; 14:79-84. [PMID: 29737258 PMCID: PMC6088442 DOI: 10.2174/1573403x14666180507160555] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/31/2018] [Accepted: 04/25/2018] [Indexed: 12/24/2022] Open
Abstract
Out of hospital cardiac arrest affects 350,000 Americans yearly and is associated with a high mortality rate. Improving survival rates in this population rests on the prompt and effective implementation of four key principles. These include 1) early recognition of cardiac arrest 2) early use of chest compressions 3) early defibrillation, which in turn emphasizes the importance of public access defibrillation programs and potential for drone technology to allow for early defibrillation in private or rural settings 4) early and aggressive post-arrest care including the consideration of therapeutic hypothermia, early coronary angiography +/- percutaneous coronary intervention and a hyper-invasive approach to out-of-hospital refractory cardiac arrest.
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Affiliation(s)
- Prashant Rao
- University of Arizona, College of Medicine, Sarver Heart Center, Tucson, Arizona, USA
| | - Karl B. Kern
- University of Arizona, College of Medicine, Sarver Heart Center, Tucson, Arizona, USA
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91
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Chung CH, Wong PCY. A Six-Year Prospective Study of Out-of-Hospital Cardiac Arrest Managed by a Voluntary Ambulance Organisation. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To obtain a database on the epidemiology of prehospital cardiac arrest and its management by a voluntary ambulance service, with the view for developing future strategies and service improvement. Design A 6-year prospective study from December 1998 to November 2004, using the Utstein-style template. Setting A voluntary ambulance service in Hong Kong. Subjects and methods Ambulance members had to complete and submit a specially designed data form after managing a cardiac arrest case, together with the ambulance run record and the automated external defibrillator (AED) computer printout, if appropriate. Main outcome measures Survival to hospital discharge and return of spontaneous circulation after resuscitation. Results A total of 72 cardiac arrests occurred during the period, with patients' age ranging from 29 to 106 years (mean 73.4). Most cardiac arrests occurred at home (46 or 63.9%). There were 58 witnessed cardiac arrests (80.5%), but bystander cardiopulmonary resuscitation (CPR) was started in only nine cases (15.5%) before the arrival of the ambulance crew. Six patients had evidence of rigor mortis or dependent lividity on ambulance arrival. For the 61 patients with electrocardiogram strips, the initial presenting rhythm on the AED was asystole in 45 (73.8%), pulseless electrical activity in 5 (8.2%), and ventricular fibrillation (VF) in 11 (18.0%). The median call-to-arrival time for VF cases (4.0 minutes) was significantly shorter than that of non-VF rhythms (8.5 minutes) [Mann-Whitney U test p=0.008]. Five patients had return of spontaneous circulation after resuscitation, but only one survived to hospital discharge. Conclusions Bystander CPR and ambulance response time are two areas requiring urgent improvement in our locality. As the majority of cardiac arrests occurred at home, the cost-effectiveness of public access defibrillation for Hong Kong is unclear. However, strategic placement of AED at high incidence' locations should be seriously considered.
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92
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Agerskov M, Hansen MB, Nielsen AM, Møller TP, Wissenberg M, Rasmussen LS. Return of spontaneous circulation and long-term survival according to feedback provided by automated external defibrillators. Acta Anaesthesiol Scand 2017; 61:1345-1353. [PMID: 28901546 PMCID: PMC5698742 DOI: 10.1111/aas.12992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 01/23/2023]
Abstract
Background We aimed to investigate the effect of automated external defibrillator (AED) feedback mechanisms on survival in out‐of‐hospital cardiac arrest (OHCA) victims. In addition, we investigated converting rates in patients with shockable rhythms according to AED shock waveforms and energy levels. Methods We collected data on OHCA occurring between 2011 and 2014 in the Capital Region of Denmark where an AED was applied prior to ambulance arrival. Patient data were obtained from the Danish Cardiac Arrest Registry and medical records. AED data were retrieved from the Emergency Medical Dispatch Centre (EMDC) and information on feedback mechanisms, energy waveform and energy level was downloaded from the applied AEDs. Results A total of 196 OHCAs had an AED applied prior to ambulance arrival; 62 of these (32%) provided audio visual (AV) feedback while no feedback was provided in 134 (68%). We found no difference in return of spontaneous circulation (ROSC) at hospital arrival according to AV‐feedback; 34 (55%, 95% confidence interval (CI) [13–67]) vs. 72 (54%, 95% CI [45–62]), P = 1 (odds ratio (OR) 1.1, 95% CI [0.6–1.9]) or 30‐day survival; 24 (39%, 95% CI [28–51]) vs. 53 (40%, 95% CI [32–49]), P = 0.88 (OR 1.1 (95% CI [0.6–2.0])). Moreover, we found no difference in converting rates among patients with initial shockable rhythm receiving one or more shocks according to AED energy waveform and energy level. Conclusions No difference in survival after OHCA according to AED feedback mechanisms, nor any difference in converting rates according to AED waveform or energy levels was detected.
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Affiliation(s)
- M. Agerskov
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. B. Hansen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - A. M. Nielsen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Emergency Medical Services, Copenhagen; University of Copenhagen; Copenhagen Denmark
| | - T. P. Møller
- Emergency Medical Services, Copenhagen; University of Copenhagen; Copenhagen Denmark
| | - M. Wissenberg
- Emergency Medical Services, Copenhagen; University of Copenhagen; Copenhagen Denmark
- Department of Cardiology; Gentofte Hospital; University of Copenhagen; Copenhagen Denmark
| | - L. S. Rasmussen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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Garg R, Ahmed SM, Kapoor MC, Mishra BB, Rao SSCC, Kalandoor MV, Divatia JV, Singh B. Basic cardiopulmonary life support (BCLS) for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital. Indian J Anaesth 2017; 61:874-882. [PMID: 29217852 PMCID: PMC5703000 DOI: 10.4103/ija.ija_637_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The cardiopulmonary resuscitation guideline of Basic Cardiopulmonary Life Support (BCLS) for management of adult victims with cardiopulmonary arrest outside the hospital provides an algorithmic stepwise approach for optimal outcome of the victims by trained medics and paramedics. This guideline has been developed considering the need to have a universally acceptable practice guideline for India and keeping in mind the infrastructural limitations of some areas of the country. This guideline is based on evidence elicited in the international and national literature. In the absence of data from Indian population, the excerpts have been taken from international data, discussed with Indian experts and thereafter modified to make them practically applicable across India. The optimal outcome for a victim with cardiopulmonary arrest would depend on core links of early recognition and activation; early high-quality cardiopulmonary resuscitation, early defibrillation and early transfer to medical facility. These links are elaborated in a stepwise manner in the BCLS algorithm. The BCLS also emphasise on quality check for various steps of resuscitation.
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Affiliation(s)
- Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Syed Moied Ahmed
- Department of Anaesthesiology and Critical Care, J N Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
- Address for correspondence: Prof. Syed Moied Ahmed, Department of Anaesthesiology and Critical Care, J N Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India. E-mail:
| | | | | | - SSC Chakra Rao
- Department of Anaesthesiology, Care Emergency Hospital, Kakinada, Andhra Pradesh, India
| | | | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Baljit Singh
- Department of Anaesthesiology and Intensive Care, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Buckley AM, Cox AT, Rees P. Shocking the system: AEDs in military resuscitation. J ROY ARMY MED CORPS 2017; 164:297-301. [PMID: 28986388 DOI: 10.1136/jramc-2017-000776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/09/2017] [Accepted: 05/27/2017] [Indexed: 11/04/2022]
Abstract
Automated external defibrillator (AED) devices have been in routine clinical use since the early 1990s to deliver life-saving shocks to appropriate patients in non-clinical environments. As expectations of survival from out-of-hospital cardiac arrest increase, and evidence incontrovertibly points to reduced timelines as the most crucial factor in achieving return of spontaneous circulation, questions regarding the availability and location of AEDs in the UK military need to be readdressed. This article explores the background of AEDs and reviews their history, life-saving potential and defines current and best practice. It goes on to review the evidence surrounding training and looks to identify knowledge gaps that might be addressed effectively by future research. Finally, it makes recommendations regarding training, availability of AEDs on military bases and locations most likely to deliver good outcomes for military personnel in the future.
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Affiliation(s)
- Andrew M Buckley
- Department of Acute Medicine, Northwick Park Hospital, Harrow, UK
| | - A T Cox
- Royal Centre Defence Medicine, Defence Medical Services, Lichfield, UK
| | - P Rees
- Department of Cardiology, University of St Andrews, St Andrews, Fife, UK
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Smith CM, Lim Choi Keung SN, Khan MO, Arvanitis TN, Fothergill R, Hartley-Sharpe C, Wilson MH, Perkins GD. Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 3:264-273. [PMID: 29044399 DOI: 10.1093/ehjqcco/qcx023] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/12/2017] [Indexed: 11/14/2022]
Abstract
Public access defibrillation initiatives make automated external defibrillators available to the public. This facilitates earlier defibrillation of out-of-hospital cardiac arrest victims and could save many lives. It is currently only used for a minority of cases. The aim of this systematic review was to identify barriers and facilitators to public access defibrillation. A comprehensive literature review was undertaken defining formal search terms for a systematic review of the literature in March 2017. Studies were included if they considered reasons affecting the likelihood of public access defibrillation and presented original data. An electronic search strategy was devised searching MEDLINE and EMBASE, supplemented by bibliography and related-article searches. Given the low-quality and observational nature of the majority of articles, a narrative review was performed. Sixty-four articles were identified in the initial literature search. An additional four unique articles were identified from the electronic search strategies. The following themes were identified related to public access defibrillation: knowledge and awareness; willingness to use; acquisition and maintenance; availability and accessibility; training issues; registration and regulation; medicolegal issues; emergency medical services dispatch-assisted use of automated external defibrillators; automated external defibrillator-locator systems; demographic factors; other behavioural factors. In conclusion, several barriers and facilitators to public access defibrillation deployment were identified. However, the evidence is of very low quality and there is not enough information to inform changes in practice. This is an area in urgent need of further high-quality research if public access defibrillation is to be increased and more lives saved. PROSPERO registration number CRD42016035543.
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Affiliation(s)
- Christopher M Smith
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | | | - Mohammed O Khan
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, UK
| | | | - Rachael Fothergill
- London Ambulance Service NHS Trust, 18-20 Pocock Street, London SE1 0BW, UK
| | | | - Mark H Wilson
- Imperial College, Neurotrauma Centre, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Gavin D Perkins
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
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Prescribing an automated external defibrillator for children at increased risk of sudden arrhythmic death. Cardiol Young 2017; 27:1271-1279. [PMID: 28606196 DOI: 10.1017/s1047951117000026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Automated external defibrillators can be life-saving in out-of-hospital cardiac arrest. OBJECTIVE Our aim was to review our experience of prescribing automated external defibrillators for children at increased risk of sudden arrhythmic death. METHODS We reviewed all automated external defibrillators issued by the Scottish Paediatric Cardiac Electrophysiology Service from 2005 to 2015. All parents were given resuscitation training according to the Paediatric Resuscitation Guidelines, including the use of the automated external defibrillator. RESULTS A total of 36 automated external defibrillators were issued to 36 families for 44 children (27 male). The mean age at issue was 8.8 years. Diagnoses at issue included long QT syndrome (50%), broad complex tachycardia (14%), hypertrophic cardiomyopathy (11%), and catecholaminergic polymorphic ventricular tachycardia (9%). During the study period, the automated external defibrillator was used in four (9%) children, and in all four the automated external defibrillator correctly discriminated between a shockable rhythm - polymorphic ventricular tachycardia/ventricular fibrillation in three patients with one or more shocks delivered - and non-shockable rhythm - sinus rhythm in one patient. Of the three children, two of them who received one or more shocks for ventricular fibrillation/polymorphic ventricular tachycardia survived, but one died as a result of recurrent torsades de pointes. There were no other deaths. CONCLUSION Parents can be taught to recognise cardiac arrest, apply resuscitation skills, and use an automated external defibrillator. Prescribing an automated external defibrillator should be considered for children at increased risk of sudden arrhythmic death, especially where the risk/benefit ratio of an implantable defibrillator is unclear or delay to defibrillator implantation is deemed necessary.
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Galatianou I, Karlis G, Apostolopoulos A, Intas G, Chalari E, Gulati A, Iacovidou N, Chalkias A, Xanthos T. Body mass index and outcome of out-of-hospital cardiac arrest patients not treated by targeted temperature management. Am J Emerg Med 2017; 35:1247-1251. [DOI: 10.1016/j.ajem.2017.03.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/17/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022] Open
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Modeling a novel hypothetical use of postal collection boxes as automated external defibrillator access points. Resuscitation 2017; 120:26-30. [PMID: 28847755 DOI: 10.1016/j.resuscitation.2017.08.220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/20/2017] [Accepted: 08/21/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Optimizing placement of Automated External Defibrillators (AED) can increase survival after an out-of-hospital cardiac arrest (OHCA). Using postal collection boxes (PCB) as locations for AEDs could potentially enhance accessibility and streamline maintenance. In this study, we modeled the hypothetical effects of deploying AEDs at PCB locations. HYPOTHESIS We hypothesized that PCB-AEDs would increase AED coverage overall and in residential areas, and reduce the distance from OHCA to an AED. METHODS AEDs in Pittsburgh, PA were identified by the University of Pittsburgh Resuscitation Logistics and Informatics Venture (n=747). PCB locations were obtained from the United States Postal Service (n=479). OHCA locations from 2009 to 2014 were obtained from the Pittsburgh site of the Resuscitation Outcomes Consortium. AED coverage assuming a ¼ mile radius around each AED was estimated for known AEDs, PCB-AEDs (hypothetical AED locations), and known AEDs augmented by PCB-AEDs, both overall and for residential and non-residential zones. Linear distance from each OHCA to the nearest AED was calculated and compared between the sets. RESULTS The set of known AEDs augmented with PCB-AEDs covered more of the city overall (55% vs 30%), as well as greater proportions of residential (62% vs 27%) and non-residential areas (45% vs 30%). The median distance from OHCA to AED was significantly shorter when known AEDs were augmented with PCB-AEDs (0.12mi vs 0.32mi; p=0.001). CONCLUSION Augmenting existing publicly accessible AEDs with AEDs deployed at PCBs can increase AED spatial coverage in both residential and non-residential areas, and reduce the distance from AED to OHCA.
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Influence of Gender on the Performance of Cardiopulmonary Rescue Teams: A Randomized, Prospective Simulator Study. Crit Care Med 2017. [PMID: 28622215 DOI: 10.1097/ccm.0000000000002375] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Little is known about the influence of gender on resuscitation performance which may improve future education in resuscitation. The aim of this study was to compare female and male rescuers in regard to cardiopulmonary resuscitation and leadership performance. DESIGN Prospective, randomized simulator study. SETTING High-fidelity patient simulator center of the medical ICU, University Hospitals Basel (Switzerland). SUBJECTS Two hundred sixteen volunteer medical students (108 females and 108 males) of two Swiss universities in teams of three. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed data on the group and the individual level separately. The primary outcome on the group level was the hands-on time within the first 180 seconds after the onset of the cardiac arrest. Compared with male-only teams, female-only teams showed less hands-on time (mean ± SD) (87 ± 41 vs 109 ± 33 s; p = 0.037) and a longer delay before the start of chest compressions (109 ± 77 vs 70 ± 56 s; p = 0.038). Additionally, female-only teams showed a lower leadership performance in different domains and fewer unsolicited cardiopulmonary resuscitation measures compared with male-only teams. On the individual level, which was assessed in mixed teams only, female gender was associated with a lower number of secure leadership statements (3 ± 2 vs 5 ± 3; p = 0.027). Results were confirmed in regression analysis adjusted for team composition. CONCLUSIONS We found important gender differences, with female rescuers showing inferior cardiopulmonary resuscitation performance, which can partially be explained by fewer unsolicited cardiopulmonary resuscitation measures and inferior female leadership. Future education of rescuers should take gender differences into account.
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Claesson A, Herlitz J, Svensson L, Ottosson L, Bergfeldt L, Engdahl J, Ericson C, Sandén P, Axelsson C, Bremer A. Defibrillation before EMS arrival in western Sweden. Am J Emerg Med 2017; 35:1043-1048. [DOI: 10.1016/j.ajem.2017.02.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022] Open
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