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Ahn HJ, Cho Y, You YH, Min JH, Jeong WJ, Ryu S, Lee JW, Cho SU, Oh SK, Park JS, Choi Y. Effect of using a home-bed mattress on bystander chest compression during out-of-hospital cardiac arrest. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919856485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Bystander cardiopulmonary resuscitation is a key component of life-saving after an out-of-hospital cardiac arrest. In the pre-arrival instructions for out-of-hospital cardiac arrest, it is recommended that the patient be laid on a flat floor. However, the most common reason for not performing cardiopulmonary resuscitation is that the bystander could not move the patient. Objectives: This study aim to investigate the effects of using a home-bed mattress on the quality of chest compression. Methods: In this prospective, randomized study, chest compression without ventilation was performed for 4 min on a Resusci Anne manikin placed on a flat floor or on three types of home-bed mattresses (hard, medium and soft). Chest compression depth, chest compression rate and chest recoil were measured from the manikin with the Laerdal PC Skill Reporting System, and changes in chest compression quality using the four different surfaces were compared. Results: Thirty participants were enrolled to perform chest compression. There was no significant difference in chest compression depth and depth accuracy between the four surfaces. The median chest compression rates were 108.1 ± 8.5, 107.0 ± 8.3, 103.3 ± 8.9 and 98.3 ± 7.9 compressions/min ( p < 0.001) for the flat floor, hard-, medium-, and soft-firmness mattresses, respectively. Moreover, there was no a significant difference in chest recoil accuracy. Conclusion: Using a home-bed mattress did not decrease the chest compression quality, except chest compression rate of soft-firmness mattress. Thus, it may be effective to initiate chest compression on a home-bed mattress if the bystander cannot move the patient to the floor.
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Affiliation(s)
- Hong Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Yongchul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Yeon Ho You
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jin Hong Min
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Won Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jin Woong Lee
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sung Uk Cho
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Se Kwang Oh
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Younhyuk Choi
- Emergency Medical Center, Yuseong Sun Hospital, Daejeon, Republic of Korea
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Association between county-level cardiopulmonary resuscitation training and changes in Survival Outcomes after out-of-hospital cardiac arrest over 5 years: A multilevel analysis. Resuscitation 2019; 139:291-298. [DOI: 10.1016/j.resuscitation.2019.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/01/2018] [Accepted: 01/09/2019] [Indexed: 01/17/2023]
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Dispatcher-assisted cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest: A structured evaluation of communication issues using the SACCIA ® safe communication typology. Resuscitation 2019; 139:144-151. [PMID: 30999084 DOI: 10.1016/j.resuscitation.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/18/2019] [Accepted: 04/03/2019] [Indexed: 12/31/2022]
Abstract
AIM To evaluate communication issues during dispatcher-assisted cardiopulmonary resuscitation (DACPR) for paediatric out-of-hospital cardiac arrest in a structured manner to facilitate recommendations for training improvement. METHODS A retrospective observational study evaluated DACPR communication issues using the SACCIA® Safe Communication typology (Sufficiency, Accuracy, Clarity, Contextualization, Interpersonal Adaptation). Telephone recordings of 31 cases were transcribed verbatim and analysed with respect to encoding, decoding and transactional communication issues. RESULTS Sixty SACCIA communication issues were observed in the 31 cases, averaging 1.9 issues per case. A majority of the issues were related to sufficiency (35%) and accuracy (35%) of communication between dispatcher and caller. Situation specific guideline application was observed in CPR practice, (co)counting and methods of compressions. CONCLUSION This structured evaluation identified specific issues in paediatric DACPR communication. Our training recommendations focus on situation and language specific guideline application and moving beyond verbal communication by utilizing the smart phone's functions. Prospective efforts are necessary to follow-up its translation into better paediatric DACPR outcomes.
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Luiz T, Marung H, Pollach G, Hackstein A. [Degree of implementation of structured answering of emergency calls in German emergency dispatch centers and effects of the introduction in daily practice]. Anaesthesist 2019; 68:282-293. [PMID: 30899970 DOI: 10.1007/s00101-019-0570-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/30/2019] [Accepted: 02/19/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The emergency call-taking process is crucial for the adequate disposition of emergency vehicles and the provision of first aid instructions. Moreover, it has a direct impact on the quality of out-of-hospital emergency care. Organizations such as the European Resuscitation Council, the German Federal Association of Emergency Medical Directors and the German Association of Emergency Dispatch Centers call for the nationwide implementation of a formal call-taking process in emergency dispatching. This is required for the provision of telephone-assisted cardiopulmonary resuscitation (T-CPR). METHODS This article presents the results of an online survey among members of the German Association of Emergency Dispatch Centers on the implementation of structured call-taking programs. The survey comprised data on the implementation of a structured call-taking process, its effects on important quality indicators such as the frequency of T‑CPR and employee satisfaction. RESULTS Of the 100 participants who completed the survey, 49 already used formal call-taking systems and 24 (47%) of the remaining 51 emergency dispatch centers intended to implement such a system. Formal call-taking systems were mainly used in the dispatch of emergency medical services (98% of emergency dispatch centers using a formal call-taking system) and fire brigades (83.7% of emergency dispatch centers using a formal call-taking system). In 42 (85.7%) of the 49 emergency dispatch centers using a formal call-taking process, this process is mandatory; however, only 27 (64.3%) reported compliance rates of more than 95% in medical emergencies. Comparing the pre-post results after the introduction of a structured approach, the quality of the inquiries improved for almost all emergency dispatch centers. On the other hand, important quality indicators, e.g. mean dispatch initiation time or the necessity of subsequently alerting an advanced life support unit to the scene, were not recorded in 42.9% and 49.0% of the dispatch centers, respectively. Of the emergency dispatch centers that analyzed the frequency of T‑CPR, 94.3% could show an increase in T‑CPR. Moreover, 79.5% of the respondents reported improved employee satisfaction. Whereas the demand for dispatchers remained nearly static, 24 out of the 49 dispatch centers that used a formal call-taking system set up new posts for quality management (maximum: 3 posts in dispatch centers handling more than 250,000 missions annually). CONCLUSION Structured emergency call-taking has not yet been comprehensively implemented in German emergency dispatch centers. Wherever it is used consistently, important quality parameters are improved. Further investigations should aim to identify crucial factors for its implementation and to analyze additional quality parameters.
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Affiliation(s)
- T Luiz
- Deutsches Zentrum für Notfallmedizin und Informationstechnologie, DENIT, Fraunhofer IESE, Fraunhofer-Platz 1, 67663, Kaiserslautern, Deutschland.
- Westpfalz-Klinikum GmbH, Kaiserslautern, Deutschland.
| | - H Marung
- Qualität und Sicherheit im Gesundheitswesen, Lübeck, Deutschland
| | - G Pollach
- Westpfalz-Klinikum GmbH, Kaiserslautern, Deutschland
| | - A Hackstein
- Fachverband Leitstellen e. V., Glücksburg, Deutschland
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Yu HY, Wang CH, Chi NH, Huang SC, Chou HW, Chou NK, Chen YS. Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation. Intensive Care Med 2018; 45:44-54. [PMID: 30547322 PMCID: PMC6334728 DOI: 10.1007/s00134-018-5496-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
Purpose Caseloads of extracorporeal cardiopulmonary resuscitation (ECPR) have increased considerably, and hospital mortality rates remain high and unpredictable. The present study evaluated the effects of the interplay between age and prolonged low-flow duration (LFD) on hospital survival rates in elderly patients to identify subgroups that can benefit from ECPR. Methods Adult patients who received ECPR in our institution (2006–2016) were classified into groups 1, 2, and 3 (18–65, 65–75, and > 75 years, respectively). Data regarding ECPR and adverse events during hospitalization were collected prospectively. The primary end point was favorable neurologic outcome (cerebral performance category 1 or 2) at hospital discharge. Results In total, 482 patients were divided into groups 1, 2, and 3 (70.5%, 19.3%, and 10.2%, respectively). LFDs were comparable among the groups (40.3, 41.0, and 44.3 min in groups 1, 2, and 3, P = 0.781, 0.231, and 0.382, respectively). Favorable neurologic outcome rates were nonsignificantly lower in group 3 than in the other groups (27.6%, 24.7%, and 18.4% for group 1, 2, and 3, respectively). Subgroup analysis revealed that the favorable neurologic outcome rates in group 1 were 36.7%, 25.4%, and 13.0% for LFDs of < 30, 30–60, and > 60 min, respectively (P = 0.005); in group 2, they were 32.1%, 21.2%, and 23.1%, respectively (P = 0.548); in group 3 they were 25.0%, 20.8%, and 0.0%, respectively (P = 0.274). Conclusion On emergency consultation for ECPR, age and low-flow duration should be considered together to predict neurologic outcome. Electronic supplementary material The online version of this article (10.1007/s00134-018-5496-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hsi-Yu Yu
- Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chih-Hsien Wang
- Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Nai-Hsin Chi
- Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Shu-Chien Huang
- Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Heng-Wen Chou
- Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Nai-Kuan Chou
- Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
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Steinskog DM, Solberg EE. Sudden cardiac arrest in sports: a video analysis. Br J Sports Med 2018; 53:1293-1298. [DOI: 10.1136/bjsports-2018-099578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/04/2022]
Abstract
ObjectivesInformation about sudden cardiac arrest (SCA) in sports arises from registries, insurance claims and various reports. Analysing video footage of SCA during sports for scientific purposes has scarcely been done. The objective of this study was to examine videotaped SCA in athletes to better understand the mechanisms of SCA.MethodsPublicly available online video databases were searched for videos displaying SCA in athletes.ResultsThirty-five online videos (26 from professional and 9 from amateur sport; 34 male victims) were obtained. Twenty-one events resulted in survival and 14 in sudden cardiac death. Level of physical activity prior to SCA was assessable in 28 videos; 19 events occurred during low-intensity, 6 during moderate-intensity and 3 during high-intensity activity. SCA predominately occurred during low-intensity compared with both moderate-intensity and high-intensity activities (p<0.01). In 26/35 videos, it was possible to observe if resuscitation was provided. Resuscitation was carried out in 20 cases; cardiopulmonary resuscitation (CPR) alone (8 cases), CPR+defibrillation (10), cardiac thump (1) or shock from an implantable cardioverter defibrillator (1). Thirteen of the 20 cases with resuscitation received an intervention within 1 min after collapse. Survival was high when intervention occurred within 1 min (12/13) compared with those who received delayed (3/5) or no intervention (1/6). Associated signs of SCA such as agonal respirations and seizure-like movements were observed in 66% of the cases.ConclusionsSCA during sport most often occurred during low-intensity activity. Prompt intervention within 1 min demonstrated a high survival rate and should be the standard expectation for witnessed SCA in athletes.
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Impact of Age-Adjusted Charlson Comorbidity on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation. J Clin Med 2018; 7:jcm7100313. [PMID: 30274271 PMCID: PMC6209870 DOI: 10.3390/jcm7100313] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022] Open
Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) has gradually come to be regarded as an effective therapy, but the hospital mortality rate after ECPR is still high and unpredictable. The present study tested whether age-adjusted Charlson comorbidity index (ACCI) can be used as an objective selection criterion to ensure the most efficient utilization of medical resources. Adult patients (age ≥ 18 years) receiving ECPR at our institution between 2006 and 2015 were included. Data regarding ECPR events and ACCI characteristics were collected immediately after the extracorporeal membrane oxygenation (ECMO) setup. Adverse events during hospitalization were also prospectively collected. The primary endpoint was survival to hospital discharge. The second endpoint was the short-term (2-year) follow-up outcome. A total of 461 patients included in the study were grouped into low ACCI (ACCI 0–3) (240, 52.1%) and high ACCI (ACCI 4–13) (221, 47.9%) groups. The median ACCI was 2 (interquartile range (IQR): 1–3) and 5 (IQR: 4–7) for the low and high ACCI groups, respectively. Cardiopulmonary resuscitation (CPR)-to-ECMO duration was comparable between the groups (42.1 ± 25.6 and 41.3 ± 20.7 min in the low and high ACCI groups, respectively; p = 0.754). Regarding the hospital survival rate, 256 patients (55.5%) died on ECMO support. A total of 205 patients (44.5%) were successfully weaned off ECMO, but only 138 patients (29.9%) survived to hospital discharge (32.1% and 27.6% in low and high ACCI group, p = 0.291). Multivariate logistic regression analysis revealed CPR duration before ECMO run (CPR-to-ECMO duration) and a CPR cause of septic shock to be significant risk factors for hospital survival after ECPR (p = 0.043 and 0.014, respectively), whereas age and ACCI were not (p = 0.334 and 0.164, respectively). The 2-year survival rate after hospital discharge for the 138 hospital survivors was 96% and 74% in the low and high ACCI groups, respectively (p = 0.002). High ACCI before ECPR does not predict a poor outcome of hospital survival. Therefore, ECPR should not be rejected solely due to high ACCI. However, high ACCI in hospital survivors is associated with a higher 2-year mortality rate than low ACCI, and patients with high ACCI should be closely followed up.
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Dami F, Fuchs V, Berthoz V, Carron PN. Régulation médicale : mise au point 2018 et développements futurs. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
En 2018, les centrales de régulation d’urgences médicales devraient toutes être en mesure d’offrir certaines plus-values essentielles aux patients : une réanimation par téléphone avec accompagnement des témoins jusqu’à l’arrivée des secours, l’utilisation de réseaux de premiers répondants, ainsi que les défibrillateurs automatiques des domaines privés et publics via des applications Internet, l’assistance aux témoins pour réaliser des injections d’épinéphrine lors de réactions allergiques sévères ou de chlorhydrate de glucagon lors d’hypoglycémie. En complément, le bénéfice attendu des centrales d’urgences médicales visà-vis du système de soins dans son ensemble implique une meilleure efficience quant à l’engagement des moyens dont elles disposent. Cela ne peut se faire qu’en collectant les données liées à l’engagement des moyens (type, nombre, niveau de priorité) et en les corrélant avec la gravité de la situation observée sur site par les intervenants. Cette analyse permet d’estimer les taux de sur-triage et de sous-triage de la centrale lors de la décision d’envoi des moyens. L’utilisation appropriée des signaux prioritaires qui en découle permet également de réduire les risques des intervenants et de la population générale. Finalement, les fusions de centrales permettent de rationaliser certains coûts fixes, de faire face à des difficultés de recrutement et de formation, mais également d’augmenter la qualité de la régulation offerte à la population.
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Hirakawa A, Hatakeyama T, Kobayashi D, Nishiyama C, Kada A, Kiguchi T, Kawamura T, Iwami T. Real-time feedback, debriefing, and retraining system of cardiopulmonary resuscitation for out-of-hospital cardiac arrests: a study protocol for a cluster parallel-group randomized controlled trial. Trials 2018; 19:510. [PMID: 30236135 PMCID: PMC6149063 DOI: 10.1186/s13063-018-2852-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background The quality of cardiopulmonary resuscitation (CPR) performed by emergency medical services (EMS) personnel affects patient outcomes after cardiac arrest. A CPR feedback device with an accelerometer mounted on a defibrillator can monitor the motion of the patient’s sternum to display and record CPR quality in real time. To evaluate the utility of real-time feedback, debriefing, and retraining using a CPR feedback device outside of the hospital, an open-label, cluster randomized controlled trial will be conducted in five municipalities of Osaka Prefecture, Japan. Methods Each EMS station within a fire department will be randomly assigned to: 1) the treatment group with real-time feedback, debriefing, and retraining using the CPR feedback device (intervention group); or 2) the conventional treatment group without real-time feedback, debriefing, and retraining (control group). This trial will include 2850 to 3020 patients over about 4 years. The primary outcome of the trial is 1-month favorable neurological survival, defined as cerebral performance category scale score 1 or 2. Secondary outcomes are 1-month survival, survival to hospital discharge, return of spontaneous circulation, and quality of CPR including fraction, depth, tempo, and ventilation rate. Discussion The trial will assess whether treatment monitored by the CPR feedback device, which allows for real-time feedback, debriefing, and retraining using CPR quality data, outperforms conventional treatment without real-time feedback, debriefing, and retraining in terms of 1-month favorable neurological survival in cardiac arrest patients receiving CPR outside the hospital. Trial registration University Hospital Medical Information Network (UMIN) Clinical Trials Registry, UMIN000021431. Registered on 11 March 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2852-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Clinical Trials and Research, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Toshihiro Hatakeyama
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan.,Department of Emergency and Critical Care Medicine, Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Daisuke Kobayashi
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | - Akiko Kada
- Department of Clinical Trials and Research, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Takeyuki Kiguchi
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Takashi Kawamura
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Taku Iwami
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan.
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Klassen AB, Marshall M, Dai M, Mann NC, Sztajnkrycer MD. Emergency Medical Services Response to Mass Shooting and Active Shooter Incidents, United States, 2014-2015. PREHOSP EMERG CARE 2018; 23:159-166. [PMID: 30118358 DOI: 10.1080/10903127.2018.1484970] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The purpose of the current study was to describe the injury patterns, EMS response and interventions to mass shooting (MS) and active shooter (AS) incidents. METHODS Retrospective analysis of 2014-2015 National Emergency Medical Services Information System (NEMSIS) data sets. Date, time, and location for MS incidents were obtained from the Gun Violence Archive and then correlated with NEMSIS data set records. AS incidents were identified through Federal Bureau of Investigation (FBI) data. A de-identified database was generated for final analysis. RESULTS A total of 608 MS incidents were identified, of which 19 were also classified as AS incidents. NEMSIS patient care data was available for 652 EMS activations representing 226 unique MS incidents. Thirty-four EMS responses to 5 unique AS incidents were similarly identified: 76% of victims were male and 80% of victims were African American. Dispatch complaint did not suggest shooting (potentially dangerous scene environment) in 15.9% of records. The most commonly reported incident locations for MS were Street/Highway (38.2%) and Home/Residence (32.4%). Location of wounds included extremities (49%), chest (12%), and head/neck (13%). Tourniquet use was documented in 6 victims. 35.9% of victims were transported to the closest facility. CONCLUSIONS MS and AS incidents are prevalent in the United States. Despite the fact that extremity wounds were common, documented EMS tourniquet use was uncommon. While MS events are high risk for responders, dispatch information was lacking in almost 15% of records. Responding EMS agencies were diverse, emphasizing the need to ensure all EMS providers are prepared to respond to MS incidents.
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Ko SY, Shin SD, Ro YS, Song KJ, Hong KJ, Park JH, Lee SC. Effect of detection time interval for out-of-hospital cardiac arrest on outcomes in dispatcher-assisted cardiopulmonary resuscitation: A nationwide observational study. Resuscitation 2018; 129:61-69. [DOI: 10.1016/j.resuscitation.2018.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/05/2018] [Accepted: 06/01/2018] [Indexed: 11/28/2022]
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Del Rios Rivera M. Eliminating Disparities in Out-of-Hospital Cardiac Arrest Survival. Circ Cardiovasc Qual Outcomes 2018; 11:e004989. [DOI: 10.1161/circoutcomes.118.004989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee SY, Ro YS, Shin SD, Song KJ, Hong KJ, Park JH, Kong SY. Recognition of out-of-hospital cardiac arrest during emergency calls and public awareness of cardiopulmonary resuscitation in communities: A multilevel analysis. Resuscitation 2018; 128:106-111. [DOI: 10.1016/j.resuscitation.2018.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/30/2018] [Accepted: 05/05/2018] [Indexed: 10/17/2022]
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Abstract
AbstractBackgroundSurvival rates following out-of-hospital cardiac arrest (OHCA) increase two to three times when cardiopulmonary resuscitation (CPR) is started by bystanders, as compared to starting CPR when Emergency Medical Services (EMS) arrives. Municipalities that have implemented dispatcher-assisted bystander CPR programs have seen increased rates of bystander CPR. Cardiopulmonary resuscitation instructions are given for victims of all ages, but it is unknown if offering instructions results in similar rates of EMS-documented bystander CPR across the age continuum in these municipalities.ObjectivesThe aim of this study was to determine if there is a difference in EMS-documented bystander CPR rates based on the age group of the OHCA victim when dispatcher CPR instructions are available in the community.MethodsThis was a three-year, retrospective chart review of OHCA patients in two municipalities within a single county that provided dispatcher-assisted CPR instructions. Bystander CPR and patient age were determined based on EMS documentation. Age was stratified into three groups: child (0-12 years), adult (13-54 years), and geriatric (≥55 years). Chi square was used to compare the rate of bystander CPR in each age group.ResultsDuring the study period, 1,993 patients were identified as being in OHCA at the time of EMS arrival. The overall bystander CPR rate was 10%. The highest rate of bystander CPR was in the child age group (19%). The lowest rate of bystander CPR was in the geriatric age group (9%). There was a statistically significant difference between age groups (P≤.01).ConclusionsThe rate of EMS-documented bystander CPR was low, even though these municipalities provided dispatcher-assisted CPR instructions. The highest rates of bystander CPR were observed in children (0-12 years). Future investigations should determine why this occurs and if there are opportunities to modify dispatcher coaching based on patient age so that bystander CPR rates improve.WeinmeisterKL, LernerEB, GuseCE, AteyyahKA, PirralloRG. Dispatcher CPR instructions across the age continuum. Prehosp Disaster Med. 2018;33(3):342–345.
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McCarthy JJ, Carr B, Sasson C, Bobrow BJ, Callaway CW, Neumar RW, Ferrer JME, Garvey JL, Ornato JP, Gonzales L, Granger CB, Kleinman ME, Bjerke C, Nichol G. Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e645-e660. [DOI: 10.1161/cir.0000000000000557] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated. This update describes recent advances in the science of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010).
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Mathiesen WT, Bjørshol CA, Kvaløy JT, Søreide E. Effects of modifiable prehospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:99. [PMID: 29669574 PMCID: PMC5907488 DOI: 10.1186/s13054-018-2017-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/21/2018] [Indexed: 11/20/2022]
Abstract
Background The modifiable prehospital system factors, bystander cardiopulmonary resuscitation (CPR), emergency medical services (EMS), response time, and EMS physician attendance, may affect short- and long-term survival for both rural and urban out-of-hospital cardiac arrest (OHCA) patients. We studied how such factors influenced OHCA survival in a mixed urban/rural region with a high survival rate after OHCA. Methods We analyzed the association between modifiable prehospital factors and survival to different stages of care in 1138 medical OHCA patients from an Utstein template-based cardiac arrest registry, using Kaplan-Meier type survival curves, univariable and multivariable logistic regression and mortality hazard plots. Results We found a significantly higher probability for survival to hospital admission (OR: 1.84, 95% CI 1.43–2.36, p < 0.001), to hospital discharge (OR: 1.51, 95% CI 1.08–2.11, p = 0.017), and at 1 year (OR: 1.58, 95% CI 1.11–2.26, p = 0.012) in the urban group versus the rural group. In patients receiving bystander CPR before EMS arrival, the odds of survival to hospital discharge increased more than threefold (OR: 3.05, 95% CI 2.00–4.65, p < 0.001). However, bystander CPR was associated with increased patient survival to discharge only in urban areas (survival probability 0.26 with CPR vs. 0.08 without CPR, p < 0.001). EMS response time ≥ 10 min was associated with decreased survival (OR: 0.61, 95% CI 0.45–0.83, p = 0.002), however, only in urban areas (survival probability 0.15 ≥ 10 min vs. 0.25 < 10 min, p < 0.001). In patients with prehospital EMS physician attendance, no significant differences were found in survival to hospital discharge (OR: 1.37, 95% CI 0.87–2.16, p = 0.17). In rural areas, patients with EMS physician attendance had an overall better survival to hospital discharge (survival probability 0.17 with EMS physician vs. 0.05 without EMS physician, p = 0.019). Adjusted for modifiable factors, the survival differences remained. Conclusions Overall, OHCA survival was higher in urban compared to rural areas, and the effect of bystander CPR, EMS response time and EMS physician attendance on survival differ between urban and rural areas. The effect of modifiable factors on survival was highest in the prehospital stage of care. In patients surviving to hospital admission, there was no significant difference in in-hospital mortality or in 1 year mortality between OHCA in rural versus urban areas.
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Affiliation(s)
- Wenche Torunn Mathiesen
- Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway. .,Norwegian Air Ambulance Foundation, Department of Research and Development, Drøbak, Norway. .,Stavanger University Hospital, Forskningens Hus, Armauer Hansensgate 2, P.O. box: 8100, 4068, Stavanger, Norway.
| | - Conrad Arnfinn Bjørshol
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Jan Terje Kvaløy
- Research Department, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Eldar Søreide
- Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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67
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Syväoja S, Salo A, Uusaro A, Jäntti H, Kuisma M. Witnessed out-of-hospital cardiac arrest- effects of emergency dispatch recognition. Acta Anaesthesiol Scand 2018; 62:558-567. [PMID: 29266165 DOI: 10.1111/aas.13051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 10/24/2017] [Accepted: 11/24/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Survival from an out-of-hospital cardiac arrest (OHCA) depends on the sequence of interventions in "the chain of survival". If OHCA is recognized in the emergency medical communication centre (EMCC), the proper emergency medical service (EMS) should be dispatched and cardiopulmonary resuscitation (CPR) instructions should be given to a bystander. The study aimed to examine the impact of OHCA recognition in the EMCC on survival rates and the main elements of the chain of survival. METHODS Data from the Helsinki University Hospital's registry of OHCA patients between 1997 and 2013 were studied. Altogether, 2054 EMCC-handled and bystander-witnessed OHCA proven events of cardiac origin were analysed. RESULTS In 80.5% of the victims, two EMS units were correctly dispatched and the OHCA was classified as recognized. Achieved return of spontaneous circulation (ROSC) and survival to hospital discharge were 49% and 23%, respectively, if cardiac arrest was recognized by the EMCC and 40% and 16% when it was not (P = 0.003 and 0.002). Dispatchers gave CPR instructions in 60% of the recognized OHCA cases. Bystander-performed CPR increased over time and was given in 58% of the recognized OHCAs and also in 17% of the unrecognized events. EMS delays were shorter if OHCA was recognized as opposed to unrecognized (8 min with an IQR 6.5-10 min vs. 9 min with an IQR 6.5-11 min; P = 0.001). CONCLUSIONS Recognition of OHCA by the EMCC was significantly associated with an increased rate of bystander-performed CPR, reduced EMS response time, and increased OHCA patient ROSC and survival rates.
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Affiliation(s)
- S. Syväoja
- Department of Anaesthesia and Intensive Care; North Karelia Central Hospital; Joensuu Finland
| | - A. Salo
- Department of Emergency Medicine; Section of EMS; Helsinki University Central Hospital; Helsinki Finland
| | - A. Uusaro
- Department of Intensive Care; Kuopio University Hospital, KYS; Kuopio Finland
| | - H. Jäntti
- Centre for Prehospital Emergency Care; Kuopio University Hospital, KYS; Kuopio Finland
| | - M. Kuisma
- Department of Emergency Medicine; Section of EMS; Helsinki University Central Hospital; Helsinki Finland
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68
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Abstract
Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Regional variations in reporting frameworks and survival mean the exact burden of OHCA to public health is unknown. Nevertheless, overall prognosis and neurological outcome are relatively poor following OHCA and have remained almost static for the past three decades. In this Series paper, we explore the aetiology of OHCA. Coronary artery disease remains the predominant cause, but there is a diverse range of other potential cardiac and non-cardiac causes to be aware of. Additionally, we describe how investigators and key stakeholders in resuscitation science have formulated specific Utstein data element domains in an attempt to standardise the definitions and outcomes reported in OHCA research so that management pathways can be improved. Finally, we identify the predictors of survival after OHCA and what primary and secondary prevention strategies can be instigated to mitigate the devastating sequelae of this growing public health issue.
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Affiliation(s)
- Aung Myat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK.
| | - Kyoung-Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
| | - Thomas Rea
- Division of General Internal Medicine, Harborview Medical Centre, University of Washington, Seattle, WA, USA
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69
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Del Rios M, Han J, Cano A, Ramirez V, Morales G, Campbell TL, Hoek TV. Pay It Forward: High School Video-based Instruction Can Disseminate CPR Knowledge in Priority Neighborhoods. West J Emerg Med 2018; 19:423-429. [PMID: 29560076 PMCID: PMC5851521 DOI: 10.5811/westjem.2017.10.35108] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction The implementation of creative new strategies to increase layperson cardiopulmonary resuscitation (CPR) and defibrillation may improve resuscitation in priority populations. As more communities implement laws requiring CPR training in high schools, there is potential for a multiplier effect and reach into priority communities with low bystander-CPR rates. Methods We investigated the feasibility, knowledge acquisition, and dissemination of a high school-centered, CPR video self-instruction program with a “pay-it-forward” component in a low-income, urban, predominantly Black neighborhood in Chicago, Illinois with historically low bystander-CPR rates. Ninth and tenth graders followed a video self-instruction kit in a classroom setting to learn CPR. As homework, students were required to use the training kit to “pay it forward” and teach CPR to their friends and family. We administered pre- and post-intervention knowledge surveys to measure knowledge acquisition among classroom and “pay-it-forward” participants. Results Seventy-one classroom participants trained 347 of their friends and family, for an average of 4.9 additional persons trained per kit. Classroom CPR knowledge survey scores increased from 58% to 93% (p < 0.0001). The pay-it-forward cohort saw an increase from 58% to 82% (p < 0.0001). Conclusion A high school-centered, CPR educational intervention with a “pay-it-forward” component can disseminate CPR knowledge beyond the classroom. Because schools are centrally-organized settings to which all children and their families have access, school-based interventions allow for a broad reach that encompasses all segments of the population and have potential to decrease disparities in bystander CPR provision.
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Affiliation(s)
- Marina Del Rios
- University of Illinois at Chicago - College of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Josiah Han
- University of Illinois at Chicago - College of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Alejandra Cano
- University of Illinois at Chicago - College of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Victor Ramirez
- University of Illinois at Chicago - College of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Gabriel Morales
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Teri L Campbell
- University of Chicago Aeromedical Network, Chicago, Illinois
| | - Terry Vanden Hoek
- University of Illinois at Chicago - College of Medicine, Department of Emergency Medicine, Chicago, Illinois
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70
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Leary M, McGovern S, Dainty KN, Doshi AA, Blewer AL, Kurz MC, Reynolds JC, Rittenberger JC, Hazinski MF. The Latest in Resuscitation Science Research: Highlights from the American Heart Association's 2017 Resuscitation Science Symposium. J Am Heart Assoc 2018; 7:JAHA.118.008589. [PMID: 29358196 PMCID: PMC5850173 DOI: 10.1161/jaha.118.008589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marion Leary
- Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA .,School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Shaun McGovern
- Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Katie N Dainty
- North York General Hospital, University of Toronto, North York, ON, Canada
| | - Ankur A Doshi
- Department of Emergency Medicine, University of Pittsburgh Post Cardiac Arrest Service, University of Pittsburgh Medical Center Presbyterian, Pittsburg, PA
| | - Audrey L Blewer
- Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama, Birmingham, AL
| | - Joshua C Reynolds
- Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Jon C Rittenberger
- Department of Emergency Medicine, University of Pittsburgh Post Cardiac Arrest Service, University of Pittsburgh Medical Center Presbyterian, Pittsburg, PA
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71
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Kurz MC. Telephone CPR: Adopting the standard of care, Just-in-time. Resuscitation 2018; 122:A6-A7. [DOI: 10.1016/j.resuscitation.2017.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 11/16/2022]
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72
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Birkun A, Glotov M, Ndjamen HF, Alaiye E, Adeleke T, Samarin S. Pre-recorded instructional audio vs. dispatchers' conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study. World J Emerg Med 2018; 9:165-171. [PMID: 29796139 DOI: 10.5847/wjem.j.1920-8642.2018.03.001] [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] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation (CPR) guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation. METHODS It was a prospective, blind, randomised controlled study involving 109 medical students without previous CPR training. In a standardized mannequin scenario, after the step of dispatcher-assisted cardiac arrest recognition, the participants performed compression-only resuscitation guided over the telephone by either: (1) the pre-recorded instructional audio (n=57); or (2) verbal dispatcher assistance (n=52). The simulation video records were reviewed to assess the CPR performance using a 13-item checklist. The interval from call reception to the first compression, total number and rate of compressions, total number and duration of pauses after the first compression were also recorded. RESULTS There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score (5.6±2.2 vs. 5.1±1.9, P>0.05) or individual criteria of the CPR performance checklist. The recording-assisted group demonstrated significantly shorter time interval from call receipt to the first compression (86.0±14.3 vs. 91.2±14.2 s, P<0.05), higher compression rate (94.9±26.4 vs. 89.1±32.8 min-1) and number of compressions provided (170.2±48.0 vs. 156.2±60.7). CONCLUSION When provided by untrained persons in the simulated settings, the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR. Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.
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Affiliation(s)
- Alexei Birkun
- Department of Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University; 295051, Lenin Blvd, 5/7, Simferopol, Russian Federation
| | - Maksim Glotov
- Department of Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University; 295051, Lenin Blvd, 5/7, Simferopol, Russian Federation
| | - Herman Franklin Ndjamen
- Department of Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University; 295051, Lenin Blvd, 5/7, Simferopol, Russian Federation
| | - Esther Alaiye
- Department of Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University; 295051, Lenin Blvd, 5/7, Simferopol, Russian Federation
| | - Temidara Adeleke
- Department of Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University; 295051, Lenin Blvd, 5/7, Simferopol, Russian Federation
| | - Sergey Samarin
- Department of Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University; 295051, Lenin Blvd, 5/7, Simferopol, Russian Federation
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73
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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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74
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Nebsbjerg MA, Rasmussen SE, Bomholt KB, Krogh LQ, Krogh K, Povlsen JA, Riddervold IS, Grøfte T, Kirkegaard H, Løfgren B. Skills among young and elderly laypersons during simulated dispatcher assisted CPR and after CPR training. Acta Anaesthesiol Scand 2018; 62:125-133. [PMID: 29143314 DOI: 10.1111/aas.13027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/06/2017] [Accepted: 10/13/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dispatcher assisted cardiopulmonary resuscitation (DA-CPR) increase the rate of bystander CPR. The aim of the study was to compare the performance of DA-CPR and attainable skills following CPR training between young and elderly laypersons. METHODS Volunteer laypersons (young: 18-40 years; elderly: > 65 years) participated. Single rescuer CPR was performed in a simulated DA-CPR cardiac arrest scenario and after CPR training. Data were obtained from a manikin and from video recordings. The primary endpoint was chest compression depth. RESULTS Overall, 56 young (median age: 26, years since last CPR training: 6) and 58 elderly (median age: 72, years since last CPR training: 26.5) participated. Young laypersons performed deeper (mean (SD): 56 (14) mm vs. 39 (19) mm, P < 0.001) and faster (median (25th-75th percentile): 107 (97-112) per min vs. 84 (74-107) per min, P < 0.001) chest compressions compared to elderly. Young laypersons had shorter time to first compression (mean (SD): 71 (11) seconds vs. 104 (38) seconds, P < 0.001) and less hands-off time (median (25th-75th percentile): 0 (0-1) seconds vs. 5 (2-10) seconds, P < 0.001) than elderly. After CPR training chest compressions were performed with a depth (mean (SD): 64 (8) mm vs. 50 (14) mm, P < 0.001) and rate (mean (SD): 111 (11) per min vs. 93 (18) per min, P < 0.001) for young and elderly laypersons respectively. CONCLUSION Despite long CPR retention time for both groups, elderly laypersons had longer retention time, and performed inadequate DA-CPR compared to young laypersons. Following CPR training the attainable CPR level was of acceptable quality for both young and elderly laypersons.
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Affiliation(s)
- M. A. Nebsbjerg
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
- Emergency Department; Aarhus University Hospital; Aarhus C Denmark
| | - S. E. Rasmussen
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
- Department of Respiratory Diseases and Allergy; Aarhus University Hospital; Aarhus C Denmark
| | - K. B. Bomholt
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
| | - L. Q. Krogh
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
- Psychiatric Department; Regional Hospital of Herning; Herning Denmark
| | - K. Krogh
- Centre for Health Sciences Education; Aarhus University; Aarhus N Denmark
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus N Denmark
| | - J. A. Povlsen
- Institute of Clinical Medicine; Aarhus University; Aarhus N Denmark
- Department of Cardiology; Aarhus University Hospital; Aarhus N Denmark
| | - I. S. Riddervold
- Prehospital Emergency Medical Services; Central Denmark Region; Aarhus N Denmark
| | - T. Grøfte
- Prehospital Emergency Medical Services; Central Denmark Region; Aarhus N Denmark
- Department of Anaesthesiology and Intensive Care; Regional Hospital of Randers; Randers Denmark
| | - H. Kirkegaard
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
- Prehospital Emergency Medical Services; Central Denmark Region; Aarhus N Denmark
| | - B. Løfgren
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus C Denmark
- Institute of Clinical Medicine; Aarhus University; Aarhus N Denmark
- Department of Internal Medicine; Regional Hospital of Randers; Randers Denmark
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75
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Shah M, Bartram C, Irwin K, Vellano K, McNally B, Gallagher T, Swor R. Evaluating Dispatch-Assisted CPR Using the CARES Registry. PREHOSP EMERG CARE 2017; 22:222-228. [DOI: 10.1080/10903127.2017.1376133] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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76
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Morgan RW, Kilbaugh TJ, Berg RA, Sutton RM. Pediatric In-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation. CURRENT PEDIATRICS REPORTS 2017. [DOI: 10.1007/s40124-017-0142-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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77
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Asai H, Fukushima H, Bolstad F, Okuchi K. Quality of dispatch-assisted cardiopulmonary resuscitation by lay rescuers following a standard protocol in Japan: an observational simulation study. Acute Med Surg 2017; 5:133-139. [PMID: 29657724 PMCID: PMC5891109 DOI: 10.1002/ams2.315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/10/2017] [Indexed: 02/04/2023] Open
Abstract
Aim Bystander cardiopulmonary resuscitation (CPR) is essential for improving the outcomes of sudden cardiac arrest patients. It has been reported that dispatch-assisted CPR (DACPR) accounts for more than half of the incidence of CPR undertaken by bystanders. Its quality, however, can be suboptimal. We aimed to measure the quality of DACPR using a simulation study. Methods We recruited laypersons at a shopping mall and measured the quality of CPR carried out in our simulation. Dispatchers provided instruction in accordance with the standard DACPR protocol in Japan. Results Twenty-three laypersons (13 with CPR training experience within the past 2 years and 10 with no training experience) participated in this study. The median chest compression rate and depth were 106/min and 33 mm, respectively. The median time interval from placing the 119 call to the start of chest compressions was 119 s. No significant difference was found between the groups with and without training experience. However, subjects with training experience more frequently placed their hands correctly on the manikin (84.6% versus 40.0%; P = 0.026). Twelve participants (52.2%, seven in trained and five in untrained group) interrupted chest compressions for 3-18 s, because dispatchers asked if the patient started breathing or moving. Conclusion This current simulation study showed that the quality of DACPR carried out by lay rescuers can be less than optimal in terms of depth, hand placement, and minimization of pauses. Further studies are required to explore better DACPR instruction methods to help lay rescuers perform CPR with optimal quality.
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Affiliation(s)
- Hideki Asai
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara Nara Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara Nara Japan
| | - Francesco Bolstad
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara Nara Japan.,Department of Clinical English Nara Medical University Kashihara Nara Japan
| | - Kazuo Okuchi
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara Nara Japan
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Tanaka H, Ong MEH, Siddiqui FJ, Ma MHM, Kaneko H, Lee KW, Kajino K, Lin CH, Gan HN, Khruekarnchana P, Alsakaf O, Rahman NH, Doctor NE, Assam P, Shin SD. Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study. Ann Emerg Med 2017; 71:608-617.e15. [PMID: 28985969 DOI: 10.1016/j.annemergmed.2017.07.484] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai). METHODS This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community. RESULTS Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95% CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95% CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95% CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival. CONCLUSION In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation.
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Affiliation(s)
- Hideharu Tanaka
- Department of Emergency Systems, Graduate School of Sport Systems, Kokushikan University, Tokyo, Japan
| | - Marcus E H Ong
- Department of Emergency Medicine, Singapore General Hospital, and the Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Fahad J Siddiqui
- Department of Epidemiology, Singapore Clinical Research Institute, Singapore, Singapore
| | - Matthew H M Ma
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | | | - Kyung Won Lee
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Kentaro Kajino
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, Osaka, Japan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han Nee Gan
- Accident and Emergency Department, Changi General Hospital, Singapore
| | | | - Omer Alsakaf
- Dubai Corporation for Ambulance Services, Dubai, United Arab Emirates
| | - Nik H Rahman
- School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Pryseley Assam
- Department of Epidemiology, Singapore Clinical Research Institute, Singapore, Singapore
| | - Sang Do Shin
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Korea
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Kudenchuk PJ. No, No, GO! A call to arms (and hands) for cardiac arrest. Heart Rhythm 2017; 14:1735-1736. [PMID: 28939207 DOI: 10.1016/j.hrthm.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Peter J Kudenchuk
- Division of Cardiology/Arrhythmia Services, University of Washington, Seattle, Washington; King County Emergency Medical Services, Public Health - Seattle & King County, Seattle, Washington.
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80
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Fukushima H, Panczyk M, Hu C, Dameff C, Chikani V, Vadeboncoeur T, Spaite DW, Bobrow BJ. Description of Abnormal Breathing Is Associated With Improved Outcomes and Delayed Telephone Cardiopulmonary Resuscitation Instructions. J Am Heart Assoc 2017; 6:JAHA.116.005058. [PMID: 28851728 PMCID: PMC5634247 DOI: 10.1161/jaha.116.005058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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 Emergency 9‐1‐1 callers use a wide range of terms to describe abnormal breathing in persons with out‐of‐hospital cardiac arrest (OHCA). These breathing descriptors can obstruct the telephone cardiopulmonary resuscitation (CPR) process. Methods and Results We conducted an observational study of emergency call audio recordings linked to confirmed OHCAs in a statewide Utstein‐style database. Breathing descriptors fell into 1 of 8 groups (eg, gasping, snoring). We divided the study population into groups with and without descriptors for abnormal breathing to investigate the impact of these descriptors on patient outcomes and telephone CPR process. Callers used descriptors in 459 of 2411 cases (19.0%) between October 1, 2010, and December 31, 2014. Survival outcome was better when the caller used a breathing descriptor (19.6% versus 8.8%, P<0.0001), with an odds ratio of 1.63 (95% confidence interval, 1.17–2.25). After exclusions, 379 of 459 cases were eligible for process analysis. When callers described abnormal breathing, the rates of telecommunicator OHCA recognition, CPR instruction, and telephone CPR were lower than when callers did not use a breathing descriptor (79.7% versus 93.0%, P<0.0001; 65.4% versus 72.5%, P=0.0078; and 60.2% versus 66.9%, P=0.0123, respectively). The time interval between call receipt and OHCA recognition was longer when the caller used a breathing descriptor (118.5 versus 73.5 seconds, P<0.0001). Conclusions Descriptors of abnormal breathing are associated with improved outcomes but also with delays in the identification of OHCA. Familiarizing telecommunicators with these descriptors may improve the telephone CPR process including OHCA recognition for patients with increased probability of survival.
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Affiliation(s)
- Hidetada Fukushima
- Arizona Department of Health Services, Phoenix, AZ .,Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan.,Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Phoenix, AZ
| | | | - Chengcheng Hu
- Department or Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ
| | - Christian Dameff
- Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Phoenix, AZ
| | | | | | - Daniel W Spaite
- Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Phoenix, AZ
| | - Bentley J Bobrow
- Arizona Department of Health Services, Phoenix, AZ.,Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Phoenix, AZ.,Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, AZ
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81
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Meischke H, Painter IS, Stangenes SR, Weaver MR, Fahrenbruch CE, Rea T, Turner AM. Simulation training to improve 9-1-1 dispatcher identification of cardiac arrest: A randomized controlled trial. Resuscitation 2017; 119:21-26. [PMID: 28760696 DOI: 10.1016/j.resuscitation.2017.07.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to test the effectiveness of simulation training, using actors to make mock calls, on improving Emergency Medical Dispatchers' (EMDs) ability to recognize the need for, and reduce the time to, telephone-assisted CPR (T-CPR) in simulated and real cardiac arrest 9-1-1 calls. METHODS We conducted a parallel prospective randomized controlled trial with n=157 EMDs from thirteen 9-1-1 call centers. Study participants were randomized within each center to intervention (i.e., completing 4 simulation training sessions over 12-months) or control (status quo). After the intervention period, performance on 9 call processing skills and 2 time-intervals were measured in 2 simulation assessment calls for both arms. Six of the 13 call centers provided recordings of real cardiac arrest calls taken by study participants during the study period. RESULTS Of the N=128 EMDs who completed the simulation assessment, intervention participants (n=66) performed significantly better on 6 of 9 call processing skills and started T-CPR 23s faster (73 vs 91s respectively, p<0.001) compared to participants in the control arm (n=62). In real cardiac arrest calls, EMDs who completed 3 or 4 training sessions were more likely to recognize the need for T-CPR for more challenging cardiac arrest calls than EMDs who completed fewer than 3, including controls who completed no training (68% vs 53%, p=0.018). CONCLUSIONS Simulation training improves call processing skills and reduces time to T-CPR in simulated call scenarios, and may improve the recognition of the need for T-CPR in more challenging real-life cardiac arrest calls. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov Trial # NCT01972087.
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Affiliation(s)
- Hendrika Meischke
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Ian S Painter
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Scott R Stangenes
- Department of Health Services, University of Washington, Seattle, WA, United States.
| | - Marcia R Weaver
- Department of Health Services and Department of Global Health, University of Washington, Seattle WA, United States
| | - Carol E Fahrenbruch
- Public Health Seattle-King County, Emergency Medical Services Division, Seattle, WA, United States
| | - Tom Rea
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Anne M Turner
- Department of Health Services and Department of Biomedical Informatics University of Washington, Seattle, WA, United States
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82
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Wu Z, Panczyk M, Spaite DW, Hu C, Fukushima H, Langlais B, Sutter J, Bobrow BJ. Telephone cardiopulmonary resuscitation is independently associated with improved survival and improved functional outcome after out-of-hospital cardiac arrest. Resuscitation 2017; 122:135-140. [PMID: 28754526 DOI: 10.1016/j.resuscitation.2017.07.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 11/17/2022]
Abstract
AIM OF STUDY This study aims to quantify the relative impact of Dispatcher-Initiated Telephone cardiopulmonary resuscitation (TCPR) on survival and survival with favorable functional outcome after out-of-hospital cardiac arrest (OHCA) in a population of patients served by multiple emergency dispatch centers and more than 130 emergency medical services (EMS) agencies. METHODS We conducted a retrospective, observational study of EMS-treated adult (≥18 years) patients with OHCA of presumed cardiac origin in Arizona, between January 1, 2011, and December 31, 2014. We compared survival and functional outcome among three distinct groups of OHCA patients: those who received no CPR before EMS arrival (no CPR group); those who received BCPR before EMS arrival and prior to or without telephone CPR instructions (BCPR group); and those who received TCPR (TCPR group). RESULTS In this study, 2310 of 4391 patients met the study criteria (median age, 62 years; IQR 50, 74; 1540 male). 32.8% received no CPR, 23.8% received Bystander-Initiated CPR and 43.4% received TCPR. Overall survival was 11.5%. Using no CPR as the reference group, the multivariate adjusted odds ratio for survival at hospital discharge was 1.51 (95% confidence interval [CI], 1.04, 2.18) for BCPR and 1.64 (95% CI, 1.16, 2.30) for TCPR. The multivariate adjusted odds ratio of favorable functional outcome at discharge was 1.58 (95% CI 1.05, 2.39) for BCPR and 1.56 (95% CI, 1.06, 2.31) for TCPR. CONCLUSION TCPR is independently associated with improved survival and improved functional outcome after OHCA.
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Affiliation(s)
- Zhixin Wu
- Department of Emergency and Critical Care Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, China
| | - Micah Panczyk
- Bureau of EMS & Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States.
| | - Daniel W Spaite
- Arizona Emergency Medicine Research Center, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States
| | - Chengcheng Hu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Blake Langlais
- Bureau of EMS & Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States
| | - John Sutter
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States
| | - Bentley J Bobrow
- Bureau of EMS & Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States; Arizona Emergency Medicine Research Center, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States
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83
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An Update on Cardiopulmonary Resuscitation in Children. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Peberdy MA, Gluck JA, Ornato JP, Bermudez CA, Griffin RE, Kasirajan V, Kerber RE, Lewis EF, Link MS, Miller C, Teuteberg JJ, Thiagarajan R, Weiss RM, O'Neil B. Cardiopulmonary Resuscitation in Adults and Children With Mechanical Circulatory Support: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e1115-e1134. [PMID: 28533303 DOI: 10.1161/cir.0000000000000504] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac arrest in patients on mechanical support is a new phenomenon brought about by the increased use of this therapy in patients with end-stage heart failure. This American Heart Association scientific statement highlights the recognition and treatment of cardiovascular collapse or cardiopulmonary arrest in an adult or pediatric patient who has a ventricular assist device or total artificial heart. Specific, expert consensus recommendations are provided for the role of external chest compressions in such patients.
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85
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Yamaguchi Y, Woodin JA, Gibo K, Zive DM, Daya MR. Improvements in Out-of-Hospital Cardiac Arrest Survival from 1998 to 2013. PREHOSP EMERG CARE 2017; 21:616-627. [PMID: 28426258 DOI: 10.1080/10903127.2017.1308604] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Out-of-hospital cardiac arrest (OHCA) remains a major public health burden. Aggregate OHCA survival to hospital discharge has reportedly remained unchanged at 7.6% for almost 30 years from 1970 to 2008. We examined the trends in adult OHCA survival over a 16-year period from 1998 to 2013 within a single EMS agency. METHODS Observational cohort study of adult OHCA patients treated by Tualatin Valley Fire & Rescue (TVF&R) from 1998 to 2013. This is an ALS first response fire agency that maintains an active Utstein style cardiac arrest registry and serves a population of approximately 450,000 in 9 incorporated cities in Oregon. Primary outcomes were survival to hospital discharge in all patients and in the subgroup with witnessed ventricular fibrillation/pulseless ventricular tachycardia (VF/VT). The impact of key covariates on survival was assessed using univariate logistic regression. These included patient factors (age and sex), event factors (location of arrest, witnessed status, and first recorded cardiac arrest rhythm), and EMS system factors (response time interval, bystander CPR, and non-EMS AED shock). We used multivariate logistic regression to examine the impact of year increment on survival after multiple imputation for missing data. Sensitivity analysis was performed with complete cases. RESULTS During the study period, 2,528 adult OHCA had attempted field resuscitation. The survival rate for treated cases increased from 6.7% to 18.2%, with witnessed VF/VT cases increasing from 14.3% to 31.4% from 1998 to 2013. Univariate analysis showed that younger age, male sex, public location of arrest, bystander or EMS witnessed event, initial rhythm of pulseless electrical activity (PEA) or VF/VT, bystander CPR, non-EMS AED shock, and a shorter EMS response time were independently associated with survival. After adjustment for covariates, the odds of survival increased by 9% (OR 1.09, 95%CI: 1.05-1.12) per year in all treated cases, and by 6% (OR 1.06, 95% 1.01-1.10) per year in witnessed VF/VT subgroups. Findings remained consistent on sensitivity analysis. CONCLUSIONS Overall survival from treated OHCA has increased over the last 16 years in this community. These survival increases demonstrate that OHCA is a treatable condition that warrants further investigation and investment of resources.
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86
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Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival. Resuscitation 2017; 115:141-147. [PMID: 28414165 DOI: 10.1016/j.resuscitation.2017.04.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 03/15/2017] [Accepted: 04/02/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated with bystander CPR, return of spontaneous circulation (ROSC), and 30-day survival. Our secondary aim was to identify patient-, setting-, and dispatcher-related predictors of OHCA recognition. METHODS We performed an observational study of all OHCA patients' emergency calls in the Capital Region of Denmark from 01/01/2013-31/12/2013. OHCAs were collected from the Danish Cardiac Arrest Registry and the Mobile Critical Care Unit database. Emergency call recordings were identified and evaluated. Multivariable logistic regression analyses were applied to all OHCAs and witnessed OHCAs only to analyse the association between OHCA recognition and bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of OHCA recognition. RESULTS We included 779 emergency calls in the analyses. During the emergency calls, 70.1% (n=534) of OHCAs were recognised; OHCA recognition was positively associated with bystander CPR (odds ratio [OR]=7.84, 95% confidence interval [CI]: 5.10-12.05) in all OHCAs; and ROSC (OR=1.86, 95% CI: 1.13-3.06) and 30-day survival (OR=2.80, 95% CI: 1.58-4.96) in witnessed OHCA. Predictors of OHCA recognition were addressing breathing (OR=1.76, 95% CI: 1.17-2.66) and callers located by the patient's side (OR=2.16, 95% CI: 1.46-3.19). CONCLUSIONS Recognition of OHCA during emergency calls was positively associated with the provision of bystander CPR, ROSC, and 30-day survival in witnessed OHCA.
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87
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Barriers to patient positioning for telephone cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Resuscitation 2017; 115:163-168. [PMID: 28385638 DOI: 10.1016/j.resuscitation.2017.03.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/22/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND 9-1-1 callers often face barriers preventing them from starting Telephone CPR (TCPR). The most common problem is getting patients to a hard, flat surface. This study describes barriers callers report when trying to move patients to a hard, flat surface and assesses conditions associated with overcoming these barriers. METHODS We audited 2396 out-of-hospital cardiac arrest (OHCA) audio recordings. A barrier was defined as any statement by the caller that the rescuer could not move the patient to the ground and into a supine position. Barriers were recorded and TCPR process metrics compared across the barrier and non-barrier groups. RESULTS There were 802 OHCAs in the study group. Roughly 26% had a barrier. Telecommunicators were less likely to start TCPR instructions in the barrier group than in the non-barrier group (OR: 0.63, 95% CI: 0.45-0.88; p=0.007). Telecommunicator-directed bystander chest compressions were more than twice as likely to start in the non-barrier group (OR: 2.2, 95% CI: 1.6-3.2; p<0.001). Median time to first compression was longer in the barrier group (276s vs 171s; p<0.001). Rescuers were 3.7 times more likely to overcome a barrier and start compressions (OR: 3.7, 95% CI: 2.0-6.8; p<0.001) when multiple bystanders were present. CONCLUSION Inability to move patients to a hard, flat surface is associated with a reduced rate of TCPR and increased time to first compression. Assessing the conditions under which such barriers are overcome is important for telecommunicator training and can help improve rates and timeliness of TCPR.
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88
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Fukushima H, Kawai Y, Asai H, Seki T, Norimoto K, Urisono Y, Okuchi K. Performance review of regional emergency medical service pre-arrival cardiopulmonary resuscitation with or without dispatcher instruction: a population-based observational study. Acute Med Surg 2017; 4:293-299. [PMID: 29123877 PMCID: PMC5674464 DOI: 10.1002/ams2.273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/01/2017] [Indexed: 12/21/2022] Open
Abstract
Background To investigate variations in emergency medical service (EMS) pre‐arrival cardiopulmonary resuscitation (CPR), including both bystander CPR without dispatch assistance and dispatch‐assisted CPR (DACPR). Methods We carried out an observational study by implementing EMS pre‐arrival CPR reports in three fire agencies. We included adult, non‐traumatic, and non‐EMS witnessed out‐of‐hospital cardiac arrests. This reporting system comprised the dispatch instruction process and bystander CPR quality based on evaluations by EMS crews who arrived on the scene. Bystander CPR was categorized as “ongoing CPR” if the bystander was performing CPR when the EMS reached the patient's side and “good‐quality CPR” if the CPR was performed proficiently. We compared the frequencies of ongoing and good‐quality CPR in the bystander CPR already started without dispatch assistance (CPR in progress) group and DACPR group. Results Of 688 out‐of‐hospital cardiac arrests, CPR was already started in 150 cases (CPR in progress group). Dispatcher CPR instruction was provided in 368 cases. Among these, callers started chest compressions in 162 cases (DACPR group). Ongoing CPR was performed in 220 cases and was more frequent in the DACPR group (128/162 [79.0%] versus 92/150 [61.3%], P < 0.001). Good‐quality CPR was more frequent in the CPR in progress group, but the difference was not statistically significant (36/92 [39.1%] versus 42/128 [29.0%], P = 0.888). Conclusions Ongoing CPR and good‐quality CPR were not frequent in EMS pre‐arrival CPR. Detailed analysis of dispatch instructions and bystander CPR can contribute to improvement in EMS pre‐arrival CPR.
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Affiliation(s)
- Hidetada Fukushima
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara City Nara Japan
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara City Nara Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara City Nara Japan
| | - Tadahiko Seki
- Department of Emergency Nara Prefectural General Hospital Nara City Nara Japan
| | | | - Yasuyuki Urisono
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara City Nara Japan
| | - Kazuo Okuchi
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara City Nara Japan
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Nuño T, Bobrow BJ, Rogge-Miller KA, Panczyk M, Mullins T, Tormala W, Estrada A, Keim SM, Spaite DW. Disparities in telephone CPR access and timing during out-of-hospital cardiac arrest. Resuscitation 2017; 115:11-16. [PMID: 28342956 DOI: 10.1016/j.resuscitation.2017.03.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 11/29/2022]
Abstract
AIM Spanish-only speaking residents in the United States face barriers to receiving potentially life-saving 911 interventions such as Telephone -cardiopulmonary resuscitation (TCPR) instructions. Since 2015, 911 dispatchers have placed an increased emphasis on rapid identification of potential cardiac arrest. The purpose of this study was to describe the utilization and timing of the 911 system during suspected out-of-hospital cardiac arrest (OHCA) by Spanish-speaking callers in Metropolitan Phoenix, Arizona. METHODS The dataset consisted of suspected OHCA from 911 centers from October 10, 2010 through December 31, 2013. Review of audio TCPR process data included whether the need for CPR was recognized by telecommunicators, whether CPR instructions were provided, and the time elements from call receipt to initiation of compressions. RESULTS A total of 3398 calls were made to 911 for suspected OHCA where CPR was indicated. A total of 39 (1.2%) were determined to have a Spanish language barrier. This averages to 18 calls per year with a Spanish language barrier during the study period, compared with 286 OHCAs expected per year among this population. The average time until telecommunicators recognized CPR need was 87.4s for the no language barrier group compared to 160.6s for the Spanish-language barrier group (p<0.001).Time to CPR instructions started was significantly different between these groups (144.4s vs 231.3s, respectively) (p<0.001), as was time to first compression, (174.4s vs. 290.9s, respectively) (p<0.001). CONCLUSIONS Our study suggests that Hispanic callers under-utilize the 911 system, and when they do call 911, there are significant delays in initiating CPR.
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Affiliation(s)
- Tomas Nuño
- Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Phoenix, AZ, United States; Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States; Division of Public Health Practice & Translational Research, Mel and Enid Zuckerman College of Public Health, University of Arizona, Phoenix, AZ, United States.
| | - Bentley J Bobrow
- Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Phoenix, AZ, United States; Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States; Bureau of Emergency Medicine and Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States
| | - Karen A Rogge-Miller
- Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Phoenix, AZ, United States
| | - Micah Panczyk
- Bureau of Emergency Medicine and Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States
| | - Terry Mullins
- Bureau of Emergency Medicine and Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States
| | - Wayne Tormala
- Bureau of Emergency Medicine and Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States
| | - Antonio Estrada
- Department of Mexican-American Studies, College of Social & Behavioral Sciences, University of Arizona, Tucson, AZ, United States
| | - Samuel M Keim
- Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Phoenix, AZ, United States; Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Daniel W Spaite
- Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Phoenix, AZ, United States; Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
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Hardeland C, Skåre C, Kramer-Johansen J, Birkenes TS, Myklebust H, Hansen AE, Sunde K, Olasveengen TM. Targeted simulation and education to improve cardiac arrest recognition and telephone assisted CPR in an emergency medical communication centre. Resuscitation 2017; 114:21-26. [PMID: 28236428 DOI: 10.1016/j.resuscitation.2017.02.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/17/2017] [Accepted: 02/02/2017] [Indexed: 11/16/2022]
Abstract
AIM Recognition of cardiac arrest and prompt activation time by emergency medical dispatch are key process measures that have been associated with improved survival after out-of-hospital cardiac arrest (OHCA). The aim of this study is to improve recognition of OHCA and time to initiation of telephone assisted chest compressions in an emergency medical communication centre (EMCC). METHODS A prospective, interventional study implementing targeted interventions in an EMCC. Interventions included: (1) lectures focusing on agonal breathing and interrogation strategy (2) simulation training (3) structured dispatcher feedback (4) web-based telephone assisted CPR training program. All ambulance-confirmed OHCA calls in the study period were assessed and relevant process and result measures were recorded pre- and post-intervention. Cardiac arrest was reported as (1) recognised, (2) not recognised or (3) delayed recognition. RESULTS We included 331 and 230 calls pre- and post-intervention, respectively. Recognition of cardiac arrest improved significantly after intervention (89 vs. 95%, p=0.024). Delayed recognition was significantly reduced (21 vs. 6%, p>0.001), as was misinterpretation of agonal breathing (25 vs. 10%, p<0.001). Telephone assisted compressions increased (71% vs. 83%, p=0.002) whereas bystander performed ventilations decreased after intervention (23% vs. 15%, p=0.016). Time intervals for initiation of chest compression instructions (2.6 vs. 2.3min, p=0.042) and delivery of telephone assisted chest compressions (3.3 vs. 2.8min, p=0.015) were significantly shortened after intervention. CONCLUSION Targeted simulation, education and feedback significantly improved recognition of OHCA and reduced time to first chest compression. Continuous measurement of key quality metrics can facilitate development of targeted education and training.
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Affiliation(s)
- Camilla Hardeland
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.
| | - Christiane Skåre
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital and University of Oslo, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Jo Kramer-Johansen
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Tonje S Birkenes
- Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway
| | - Helge Myklebust
- Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway
| | - Andreas E Hansen
- Prehospital Clinic, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Kjetil Sunde
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital and University of Oslo, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Theresa M Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital and University of Oslo, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
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Kim J, Yin T, Shinozaki K, Lampe JW, Becker LB. Potential of lysophosphatidylinositol as a prognostic indicator of cardiac arrest using a rat model. Biomarkers 2016; 22:755-763. [DOI: 10.1080/1354750x.2016.1265002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Junhwan Kim
- Laboratory for Critical Care Physiology, Department of Emergency Medicine, Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY, USA
| | - Tai Yin
- Laboratory for Critical Care Physiology, Department of Emergency Medicine, Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY, USA
| | - Koichiro Shinozaki
- Laboratory for Critical Care Physiology, Department of Emergency Medicine, Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY, USA
| | - Joshua W. Lampe
- Laboratory for Critical Care Physiology, Department of Emergency Medicine, Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY, USA
| | - Lance B. Becker
- Laboratory for Critical Care Physiology, Department of Emergency Medicine, Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY, USA
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92
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Viereck S, Palsgaard Møller T, Kjær Ersbøll A, Folke F, Lippert F. Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival-An evaluation of 548 emergency calls. Resuscitation 2016; 111:55-61. [PMID: 27923114 DOI: 10.1016/j.resuscitation.2016.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/13/2016] [Accepted: 11/18/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPRprior) versus during the emergency call following dispatcher-assisted CPR (CPRduring) - was associated with return of spontaneous circulation (ROSC) and 30-day survival. The secondary aim was to identify predictors of CPRprior. METHODS This observational study evaluated out-of-hospital cardiac arrests (OHCA) occurring in the Capital Region of Denmark from 01.01.2013 to 31.12.2013. OHCAs were linked to emergency medical dispatch centre records and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPRprior. RESULTS The study included 548 emergency calls for OHCA patients receiving bystander CPR, 34.9% (n=191) in the CPRprior group and 65.1% (n=357) in the CPRduring group. Multivariable analyses showed no difference in ROSC (OR=0.88, 95% CI: 0.56-1.38) or 30-day survival (OR=1.14, 95% CI: 0.68-1.92) between CPRprior and CPRduring. Predictors positively associated with CPRprior included witnessed OHCA and healthcare professional bystanders. Predictors negatively associated with CPRprior included residential location, solitary bystanders, and bystanders related to the patient. CONCLUSIONS The majority of bystander CPR (65%) was initiated during the emergency call, following dispatcher-assisted CPR instructions. Whether bystander CPR was initiated prior to emergency call versus during the emergency call following dispatcher-assisted CPR was not associated with ROSC or 30-day survival. Dispatcher-assisted CPR was especially beneficial for the initiation of bystander CPR in residential areas.
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Affiliation(s)
- Søren Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, Building 2, 3rd Floor, DK-2750 Copenhagen, Denmark.
| | - Thea Palsgaard Møller
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, Building 2, 3rd Floor, DK-2750 Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, Building 2, 3rd Floor, DK-2750 Copenhagen, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, Building 2, 3rd Floor, DK-2750 Copenhagen, Denmark
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93
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Ro YS, Shin SD, Song KJ, Hong KJ, Ahn KO, Kim DK, Kwak YH. Effects of Dispatcher-assisted Cardiopulmonary Resuscitation on Survival Outcomes in Infants, Children, and Adolescents with Out-of-hospital Cardiac Arrests. Resuscitation 2016; 108:20-26. [DOI: 10.1016/j.resuscitation.2016.08.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/24/2016] [Accepted: 08/20/2016] [Indexed: 11/28/2022]
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94
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Rea TD. Not just lip service: The lifesaving role of telephone CPR. Resuscitation 2016; 109:A2-A3. [PMID: 27720833 DOI: 10.1016/j.resuscitation.2016.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Thomas D Rea
- University of Washington and King County Emergency Medical Services, 401 5th Ave, Suite 1200, 98104, United States.
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95
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Hardeland C, Sunde K, Ramsdal H, Hebbert SR, Soilammi L, Westmark F, Nordum F, Hansen AE, Steen-Hansen JE, Olasveengen TM. Factors impacting upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients. Resuscitation 2016; 109:56-63. [PMID: 27768861 DOI: 10.1016/j.resuscitation.2016.09.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/01/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
AIM Explore, understand and address issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to out-of-hospital cardiac arrest (OHCA) patients. METHODS Mixed-methods design obtaining data for one year in three emergency medical communication centres (EMCC); Oslo-Akershus (OA), Vestfold-Telemark (VT) and Østfold (Ø). Data collection included quantitative data from analysis of dispatch logs, ambulance records and audio files. Qualitative data were collected through in-depth interviews and non-participant observations. RESULTS OA-, VT- and Ø-EMCC responded to 1095 OHCAs and 579 of these calls were included for further analysis (333, 143 and 103, respectively). There were significant site differences in their recognition of OHCA (89, 94 and 78%, respectively, p<0.001), provision of CPR instructions (83, 83 and 61%, respectively, p<0.001), time from call answered to initial CPR instructions (1.4min (1.2, 1.6), 1.1min (0,9, 1.2) and 1.3 (1.2, 1.7) respectively, p=0.002). The most frequent reason for delayed or failed recognition of OHCA was misinterpretation of agonal breathing. Interviews and observations revealed individual differences in protocol use, interrogation strategy and assessment of breathing. Use of protocol was only part of decision making, dispatchers trusted their own clinical experience and intuition, and used assumptions about the patient and the situation as part of decision making. CONCLUSION Agonal breathing continues to be the main barrier to recognition of cardiac arrest. Individual differences among dispatchers' strategies can directly impact on performance, mainly due to the wide definition of cardiac arrest and lack of uniform tools for assessment of breathing.
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Affiliation(s)
- Camilla Hardeland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PB 1171 Blindern, N-0318 Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway.
| | - Kjetil Sunde
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PB 1171 Blindern, N-0318 Oslo, Norway; Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway
| | - Helge Ramsdal
- Department of Health and Social Studies, Østfold University College, PB 700, 1757 Halden, Norway
| | - Susan R Hebbert
- Prehospital Clinic, Vestfold and Telemark Emergency Medical Communication Centre, Vestfold Hospital Trust, PB 2168, NO-3103 Tønsberg, Norway
| | - Linda Soilammi
- Prehospital clinic, Oslo Emergency Medical Communication Centre, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway
| | - Fredrik Westmark
- Prehospital Clinic, Østfold HF Hospital Trust, PB 300, NO-1714 Sarpsborg, Norway
| | - Fredrik Nordum
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway; Prehospital clinic, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway
| | - Andreas E Hansen
- Prehospital clinic, Oslo Emergency Medical Communication Centre, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway
| | - Jon E Steen-Hansen
- Prehospital Clinic, Vestfold and Telemark Emergency Medical Communication Centre, Vestfold Hospital Trust, PB 2168, NO-3103 Tønsberg, Norway
| | - Theresa M Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway; Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, PB 4956 Nydalen, N-0424 Oslo, Norway
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96
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Ro YS, Shin SD, Lee YJ, Lee SC, Song KJ, Ryoo HW, Ong MEH, McNally B, Bobrow B, Tanaka H, Myklebust H, Birkenes TS. Effect of Dispatcher-Assisted Cardiopulmonary Resuscitation Program and Location of Out-of-Hospital Cardiac Arrest on Survival and Neurologic Outcome. Ann Emerg Med 2016; 69:52-61.e1. [PMID: 27665488 DOI: 10.1016/j.annemergmed.2016.07.028] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/21/2016] [Accepted: 07/19/2016] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVE We study the effect of a nationwide dispatcher-assisted cardiopulmonary resuscitation (CPR) program on out-of-hospital cardiac arrest outcomes by arrest location (public and private settings). METHODS All emergency medical services (EMS)-treated adults in Korea with out-of-hospital cardiac arrests of cardiac cause were enrolled between 2012 and 2013, excluding cases witnessed by EMS providers and those with unknown outcomes. Exposure was bystander CPR categorized into 3 groups: bystander CPR with dispatcher assistance, bystander CPR without dispatcher assistance, and no bystander CPR. The endpoint was good neurologic recovery at discharge. Multivariable logistic regression analysis was performed. The final model with an interaction term was evaluated to compare the effects across settings. RESULTS A total of 37,924 patients (31.1% bystander CPR with dispatcher assistance, 14.3% bystander CPR without dispatcher assistance, and 54.6% no bystander CPR) were included in the final analysis. The total bystander CPR rate increased from 30.9% in quarter 1 (2012) to 55.7% in quarter 4 (2014). Bystander CPR with and without dispatcher assistance was more likely to result in higher survival with good neurologic recovery (4.8% and 5.2%, respectively) compared with no bystander CPR (2.1%). The adjusted odds ratios for good neurologic recovery were 1.50 (95% confidence interval [CI] 1.30 to 1.74) in bystander CPR with dispatcher assistance and 1.34 (95% CI 1.12 to 1.60) in bystander CPR without it compared with no bystander CPR. For arrests in private settings, the adjusted odds ratios were 1.58 (95% CI 1.30 to 1.92) in bystander CPR with dispatcher assistance and 1.28 (95% CI 0.98 to 1.67) in bystander CPR without it; in public settings, the adjusted odds ratios were 1.41 (95% CI 1.14 to 1.75) and 1.37 (95% CI 1.08 to 1.72), respectively. CONCLUSION Bystander CPR regardless of dispatcher assistance was associated with improved neurologic recovery after out-of-hospital cardiac arrest. However, for out-of-hospital cardiac arrest cases in private settings, bystander CPR was associated with improved neurologic recovery only when dispatcher assistance was provided.
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Affiliation(s)
- Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Yu Jin Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Chul Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Dongkuk University Ilsan Hospital
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Wook Ryoo
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Kyoungpook National University Hospital
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, and Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Bryan McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Bentley Bobrow
- Bureau of EMS and Trauma System, Arizona State Department of Health Service, Phoenix, AZ
| | - Hideharu Tanaka
- Department of Emergency Medical System, Kokushikan University, Tokyo, Japan
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97
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Rasmussen SE, Nebsbjerg MA, Krogh LQ, Bjørnshave K, Krogh K, Povlsen JA, Riddervold IS, Grøfte T, Kirkegaard H, Løfgren B. A novel protocol for dispatcher assisted CPR improves CPR quality and motivation among rescuers-A randomized controlled simulation study. Resuscitation 2016; 110:74-80. [PMID: 27658651 DOI: 10.1016/j.resuscitation.2016.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/14/2016] [Accepted: 09/09/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Emergency dispatchers use protocols to instruct bystanders in cardiopulmonary resuscitation (CPR). Studies changing one element in the dispatcher's protocol report improved CPR quality. Whether several changes interact is unknown and the effect of combining multiple changes previously reported to improve CPR quality into one protocol remains to be investigated. We hypothesize that a novel dispatch protocol, combining multiple beneficial elements improves CPR quality compared with a standard protocol. METHODS A novel dispatch protocol was designed including wording on chest compressions, using a metronome, regular encouragements and a 10-s rest each minute. In a simulated cardiac arrest scenario, laypersons were randomized to perform single-rescuer CPR guided with the novel or the standard protocol. PRIMARY OUTCOME a composite endpoint of time to first compression, hand position, compression depth and rate and hands-off time (maximum score: 22 points). Afterwards participants answered a questionnaire evaluating the dispatcher assistance. RESULTS The novel protocol (n=61) improved CPR quality score compared with the standard protocol (n=64) (mean (SD): 18.6 (1.4)) points vs. 17.5 (1.7) points, p<0.001. The novel protocol resulted in deeper chest compressions (mean (SD): 58 (12)mm vs. 52 (13)mm, p=0.02) and improved rate of correct hand position (61% vs. 36%, p=0.01) compared with the standard protocol. In both protocols hands-off time was short. The novel protocol improved motivation among rescuers compared with the standard protocol (p=0.002). CONCLUSIONS Participants guided with a standard dispatch protocol performed high quality CPR. A novel bundle of care protocol improved CPR quality score and motivation among rescuers.
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Affiliation(s)
- Stinne Eika Rasmussen
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Mette Amalie Nebsbjerg
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Lise Qvirin Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Katrine Bjørnshave
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Kristian Krogh
- Center for Health Sciences Education, Aarhus University, Palle Juul-Jensens Boulevard 82, Building B, 8200 Aarhus N, Denmark; Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jonas Agerlund Povlsen
- Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 9, 8200 Aarhus N, Denmark
| | - Ingunn Skogstad Riddervold
- Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 1st floor, 8200 Aarhus N, Denmark
| | - Thorbjørn Grøfte
- Department of Anaesthesiology and Intensive Care, Regional Hospital of Randers, Skovlyvej 1, 8930 Randers, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark; Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Internal Medicine, Regional Hospital of Randers, Skovlyvej 1, 8930 Randers, Denmark.
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98
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Møller TP, Andréll C, Viereck S, Todorova L, Friberg H, Lippert FK. Recognition of out-of-hospital cardiac arrest by medical dispatchers in emergency medical dispatch centres in two countries. Resuscitation 2016; 109:1-8. [PMID: 27658652 DOI: 10.1016/j.resuscitation.2016.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/21/2016] [Accepted: 09/09/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Survival after out-of-hospital cardiac arrest (OHCA) remains low. Early recognition by emergency medical dispatchers is essential for an effective chain of actions, leading to early cardiopulmonary resuscitation, use of an automated external defibrillator and rapid dispatching of the emergency medical services. AIM To analyse and compare the accuracy of OHCA recognition by medical dispatchers in two countries. METHOD An observational register-based study collecting data from national cardiac arrest registers in Denmark and Sweden during a six-month period in 2013. Data were analysed in two steps; registry data were merged with electronically registered emergency call data from the emergency medical dispatch centres in the two regions. Cases with missing or non-OHCA dispatch codes were analysed further by auditing emergency call recordings using a uniform data collection template. RESULTS The sensitivity for recognition of OHCA was 40.9% (95% CI: 37.1-44.7%) in the Capital Region of Denmark and 78.4% (95% CI: 73.2-83.0%) in the Skåne Region in Sweden (p<0.001). With additional data from the emergency call recordings, the sensitivity was 80.7% (95% CI: 77.7-84.3%) and 86.0% (95% CI: 81.3-89.8%) for the two regions (p=0.06). The majority of the non-recognised OHCA were dispatched with the highest priority. CONCLUSION The accuracy of OHCA recognition was high and comparable. We identified large differences in data registration practices despite the use of similar dispatch tools. This raises a discussion of definitions and transparency in general in scientific reporting of OHCA recognition, which is essential if used as quality indicator in emergency medical services.
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Affiliation(s)
- Thea Palsgaard Møller
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark.
| | - Cecilia Andréll
- Center for Cardiac Arrest, Lund University, Barngatan 2A, S-221 85 Lund, Sweden; Anesthesiology and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Søren Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
| | - Lizbet Todorova
- Center for Cardiac Arrest, Lund University, Barngatan 2A, S-221 85 Lund, Sweden; Section of Ambulance, Crisis Management and Security, Region Skane Prehospital Unit, Lund, Sweden
| | - Hans Friberg
- Center for Cardiac Arrest, Lund University, Barngatan 2A, S-221 85 Lund, Sweden; Anesthesiology and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Freddy K Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
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99
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Mawani M, Kadir MM, Azam I, Mehmood A, McNally B, Stevens K, Nuruddin R, Ishaq M, Razzak JA. Epidemiology and outcomes of out-of-hospital cardiac arrest in a developing country-a multicenter cohort study. BMC Emerg Med 2016; 16:28. [PMID: 27465304 PMCID: PMC4963996 DOI: 10.1186/s12873-016-0093-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 07/21/2016] [Indexed: 12/04/2022] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death and disability worldwide. Overall survival after an OHCA has been reported to be poor and limited studies have been conducted in developing countries. We aimed to investigate the rates of survival from OHCA and explore components of the chain of survival in a developing country. Methods We conducted a multicenter prospective cohort study in the emergency departments (ED) of five major public and private sector hospitals of Karachi, Pakistan from January 2013 to April 2013. Twenty-four hour data collection was performed by trained data collectors, using a structured questionnaire. All patients ≥18 years of age, presenting with OHCA of cardiac origin, were included. Patients with do-not-resuscitate status or referred from other hospitals were excluded. Our primary outcome was survival of OHCA patients at the end of ED stay. Results During the three month period, data was obtained from 310 OHCA patients. The overall survival to ED discharge was 1.6 % which decreased to 0 % at 2-months after discharge. More than half (58.3 %) of these OHCA patients were brought to the hospital in a non-EMS (emergency medical service) vehicle i.e. public or private transportation. Patients utilizing non-EMS transportation reached the hospital earlier with a median time of 23 min compared to patients utilizing any type of ambulances which had a delay of 7 min hospital reaching time (median time 30 min). However, patients utilizing ambulances with life-support facilities, as compared to all other types of pre-hospital transportation, had the shortest time to first life-support intervention (15 min). Most of the patients (92.9 %) had a witnessed cardiac arrest out of which only a small percentage (2.3 %) received bystander CPR (cardio pulmonary resuscitation). Median time from arrest to receiving first CPR was 20 min. Only 1 % of patients were found to have a shockable rhythm on first assessment. Conclusion This study showed that the overall survival of OHCA is null in this population. Lack of bystander CPR and weaker emergency medical services (EMS) leading to a delay in receiving life-support interventions were some of the important observations. Poor survival emphasizes the need to standardize EMS systems, initiate public awareness programs and strengthen links in the chain of survival. Electronic supplementary material The online version of this article (doi:10.1186/s12873-016-0093-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Minaz Mawani
- Department of Medicine, Aga Khan University, First floor, Faculty Offices Building, Stadium road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | | | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Amber Mehmood
- International Health Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan McNally
- Emory University School of Medicine & Rollins School of Public Health, Atlanta, GA, USA
| | - Kent Stevens
- Department of Surgery Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rozina Nuruddin
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Mohammad Ishaq
- Department of Medicine, Aga Khan University, First floor, Faculty Offices Building, Stadium road, P.O. Box 3500, Karachi, 74800, Pakistan.,Karachi Institute of Heart Diseases, Karachi, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University & Aman Health, Aman Foundation, Karachi, Pakistan
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100
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Ho AFW, Sim ZJ, Shahidah N, Hao Y, Ng YY, Leong BSH, Zarinah S, Teo WKL, Goh GSY, Jaafar H, Ong MEH. Barriers to dispatcher-assisted cardiopulmonary resuscitation in Singapore. Resuscitation 2016; 105:149-55. [PMID: 27288652 DOI: 10.1016/j.resuscitation.2016.05.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/31/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is effective in increasing bystander CPR in out-of-hospital cardiac arrests (OHCA). Singapore has recently implemented a DA-CPR program. We aimed to characterize barriers to commencement of chest compressions by callers in Singapore. METHODS We analyzed dispatch recordings of OHCA cases received by the ambulance call center between July 2012 and March 2015. Audio recordings of poor quality were excluded. Trained reviewers noted the sequential stages of the dispatcher's recognition of CPR, delivering CPR instructions and caller performing CPR. Time taken to reach these milestones was noted. Barriers to chest compressions were identified. RESULTS A total of 4897 OHCA occurred during the study period, overall bystander CPR rate was 45.7%. 1885 dispatch recordings were reviewed with 1157 cases qualified for dispatcher CPR. In 1128 (97.5%) cases, the dispatcher correctly recognized the need for CPR. CPR instructions were delivered in 1056 (91.3%) cases. Of these, 1007 (87.0%) callers performed CPR to instruction. One or more barriers to chest compressions were identified in 430 (37.2%) cases. The commonest barrier identified was "could not move patient" (27%). Cases where barriers were identified were less likely to have the need for CPR recognized by the dispatcher (94.9% vs. 99.0%, p<0.001), CPR instructions given (79.3% vs. 98.3%, p<0.001) and CPR started (67.9% vs. 98.3%, p<0.001), while the time taken to reach each of these stages were significantly longer (p<0.001). CONCLUSION Barriers were present in 37% of cases. They were associated with lower proportion of CPR started and longer delay to CPR.
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Affiliation(s)
- Andrew Fu Wah Ho
- Emergency Medicine Residency, Singapore Health Services, Singapore, Singapore.
| | - Zariel Jiaying Sim
- Barts and the London School of Medicine and Dentistry, Greater London, United Kingdom
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Ying Hao
- Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Benjamin S H Leong
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | - Siti Zarinah
- Operations Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Winston K L Teo
- Operations Department, Singapore Civil Defence Force, Singapore, Singapore
| | | | - Hamizah Jaafar
- Operations Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Marcus E H Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
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