1
|
Werner K, Hirner S, Offorjebe OA, Hosten E, Gordon J, Geduld H, Wallis LA, Risko N. A systematic review of cost-effectiveness of treating out of hospital cardiac arrest and the implications for resource-limited health systems. Int J Emerg Med 2024; 17:151. [PMID: 39385075 PMCID: PMC11465730 DOI: 10.1186/s12245-024-00727-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 09/28/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a prevalent condition with high mortality and poor outcomes even in settings where extensive emergency care resources are available. Interventions to address OHCA have had limited success, with survival rates below 10% in national samples of high-income countries. In resource-limited settings, where scarcity requires careful priority setting, more data is needed to determine the optimal allocation of resources. OBJECTIVE To establish the cost-effectiveness of OHCA care and assess the affordability of interventions across income settings. METHODS The authors conducted a systematic review of economic evaluations on interventions to address OHCA. Six databases (PubMed, EMBASE, Global Health, Cochrane, Global Index Medicus, and Tuft's Cost-Effectiveness Registry) were searched in September 2023. Included studies were (1) economic evaluations (beyond a simple costing exercise); and (2) assessed an intervention in the chain of survival for OHCA. Article quality was assessed using the CHEERs checklist and data summarised. Findings were reported by major themes identified by the reviewers. Based upon the results of the cost-effectiveness analyses we then conduct an analysis for the progressive realization of the OHCA chain of survival from the perspective of decision-makers facing resource constraints. RESULTS Four hundred and sixty-eight unique articles were screened, and 46 articles were included for final data abstraction. Studies predominantly used a healthcare sector perspective, modeled for all patients experiencing non-traumatic cardiac OHCA, were based in the US, and presented results in US Dollars. No studies reported results or used model inputs from low-income settings. Progressive realization of the chain of survival could likely begin with investments in termination of resuscitation protocols, professional prehospital defibrillator use, and CPR training followed by the distribution of AEDs in high-density public locations. Finally, other interventions such as indiscriminate defibrillator placement or adrenaline use, would be the lowest priority for early investment. CONCLUSION Our review found no high-quality evidence on the cost-effectiveness of treating OHCA in low-resource settings. Existing evidence can be utilized to develop a roadmap for the development of a cost-effective approach to OHCA care, however further economic evaluations using context-specific data are crucial to accurately inform prioritization of scarce resources within emergency care in these settings.
Collapse
Affiliation(s)
- Kalin Werner
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
- Institute of Health and Aging, University of California, San Francisco, San Francisco, CA, USA.
| | - Sarah Hirner
- University of Colorado School of Medicine, Aurora, CO, USA
| | - O Agatha Offorjebe
- Department of Emergency Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Edouard Hosten
- Département de Médecine d'Urgence, KU Leuven, Louvain, Belgium
| | - Julian Gordon
- University of Virginia Department of Neurology, Charlottesville, VA, USA
| | - Heike Geduld
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Nicholas Risko
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Werner K, Hirner S, Offorjebe OA, Hosten E, Gordon J, Geduld H, Wallis LA, Risko N. A Systematic Review of Cost-Effectiveness of Treating Out of Hospital Cardiac Arrest: Implications for Resource-limited Health Systems. RESEARCH SQUARE 2024:rs.3.rs-4402626. [PMID: 38883781 PMCID: PMC11177998 DOI: 10.21203/rs.3.rs-4402626/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a prevalent condition with high mortality and poor outcomes even in settings where extensive emergency care resources are available. Interventions to address OHCA have had limited success, with survival rates below 10% in national samples of high-income countries. In resource-limited settings, where scarcity requires careful priority setting, more data is needed to determine the optimal allocation of resources. Objective To establish the cost-effectiveness of OHCA care and assess the affordability of interventions across income settings. Methods The authors conducted a systematic review of economic evaluations on interventions to address OHCA. Included studies were (1) economic evaluations (beyond a simple costing exercise); and (2) assessed an intervention in the chain of survival for OHCA. Article quality was assessed using the CHEERs checklist and data summarised. Findings were reported by major themes identified by the reviewers. Based upon the results of the cost-effectiveness analyses we then conduct an analysis for the progressive realization of the OHCA chain of survival from the perspective of decision-makers facing resource constraints. Results 468 unique articles were screened, and 46 articles were included for final data abstraction. Studies predominantly used a healthcare sector perspective, modeled for all patients experiencing non-traumatic cardiac OHCA, were based in the US, and presented results in US Dollars. No studies reported results or used model inputs from low-income settings. Progressive realization of the chain of survival could likely begin with investments in TOR protocols, professional prehospital defibrillator use, and CPR training followed by distribution of AEDs in high-density public locations. Finally, other interventions such as indiscriminate defibrillator placement or adrenaline use, would be the lowest priority for early investment. Conclusion Our review found no high-quality evidence on the cost-effectiveness of treating OHCA in low-resource settings. Existing evidence can be utilized to develop a roadmap for the development of a cost-effective approach to OHCA care, however further economic evaluations using context-specific data are crucial to accurately inform prioritization of scarce resources within emergency care in these settings.
Collapse
|
3
|
Arabloo J, Ahmadizadeh E, Rezapour A, Ehsanzadeh SJ, Alipour V, Peighambari MM, Sarabi Asiabar A, Souresrafil A. Economic evaluation of automated external defibrillator deployment in public settings for out-of-hospital cardiac arrest: a systematic review. Expert Rev Med Devices 2024:1-18. [PMID: 38736307 DOI: 10.1080/17434440.2024.2354472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a major issue in aging populations. The use of automatic external defibrillators (AEDs) in public places improves cardiac arrest survival rates. The purpose of this study is to review economic evaluation studies of the use of AED technology in public settings for cardiac arrest resuscitation. METHODS Our search covered 1990-2021 and included PubMed, Cochrane Library, Embase, Scopus, and Web of Science. We included studies that analyzed cost-effectiveness, cost-utility and cost-benefit of the AED technology. Also, we performed the quality assessment of the studies through the checklist of quality assessment standard of health economic studies (QHES). RESULTS Our inclusion criteria were met by 25 studies. AEDs are found to be cost-effective in places with a high occurrence of cardiac arrest. In addition, proper integration of drones with AEDs into existing systems has the potential to significantly improve OHCA survival rates. CONCLUSION The present study found that putting AEDs in high-cardiac arrest and crowded areas reduces average costs. Despite this, the costs associated with acquiring and maintaining AEDs prevent their widespread use. Further research is needed to evaluate feasibility and explore innovative strategies for AED maintenance and accessibility.
Collapse
Affiliation(s)
- Jalal Arabloo
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Elaheh Ahmadizadeh
- Department of Management sciences and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Jafar Ehsanzadeh
- Department of English Language, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Alipour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Peighambari
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sarabi Asiabar
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aghdas Souresrafil
- Department of Health Services and Health Promotion, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| |
Collapse
|
4
|
Matinrad N, Reuter-Oppermann M. A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services. CENTRAL EUROPEAN JOURNAL OF OPERATIONS RESEARCH 2021; 30:251-302. [PMID: 34566490 PMCID: PMC8449697 DOI: 10.1007/s10100-021-00769-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 05/31/2023]
Abstract
Emergency services worldwide face increasing cost pressure that potentially limits their existing resources. In many countries, emergency services also face the issues of staff shortage-creating extra challenges and constraints, especially during crisis times such as the COVID-19 pandemic-as well as long distances to sparsely populated areas resulting in longer response times. To overcome these issues and potentially reduce consequences of daily (medical) emergencies, several countries, such as Sweden, Germany, and the Netherlands, have started initiatives using new types of human resources as well as equipment, which have not been part of the existing emergency systems before. These resources are employed in response to medical emergency cases if they can arrive earlier than emergency medical services (EMS). A good number of studies have investigated the use of these new types of resources in EMS systems, from medical, technical, and logistical perspectives as their study domains. Several review papers in the literature exist that focus on one or several of these new types of resources. However, to the best of our knowledge, no review paper that comprehensively considers all new types of resources in emergency medical response systems exists. We try to fill this gap by presenting a broad literature review of the studies focused on the different new types of resources, which are used prior to the arrival of EMS. Our objective is to present an application-based and methodological overview of these papers, to provide insights to this important field and to bring it to the attention of researchers as well as emergency managers and administrators.
Collapse
Affiliation(s)
- Niki Matinrad
- Department of Science and Technology, Linköping University, Norrköping, 60174 Sweden
| | - Melanie Reuter-Oppermann
- Information Systems - Software and Digital Business Group, Technical University of Darmstadt, 64289 Darmstadt, Germany
| |
Collapse
|
5
|
Goralnick E, Ezeibe C, Chaudhary MA, McCarty J, Herrera-Escobar JP, Andriotti T, de Jager E, Ospina-Delgado D, Goolsby C, Hunt R, Weissman JS, Haider A, Jacobs L, Andrade E, Brown J, Bulger EM, Butler FK, Callaway D, Caterson EJ, Choudhry NK, Davis MR, Eastman A, Eastridge BJ, Epstein JL, Evans CL, Gausche-Hill M, Gestring ML, Goldberg SA, Hanfling D, Holcomb JB, Jonson CO, King DR, Kivlehan S, Kotwal RS, Krohmer JR, Levy-Carrick N, Levy M, Meléndez Lugo JJ, Mooney DP, Neal MD, Niskanen R, O'Neill P, Park H, Pons PT, Prytz E, Rasmussen TE, Remley MA, Riviello R, Salim A, Shackelfold S, Smith ER, Stewart RM, Swaroop M, Ward K, Uribe-Leitz T, Jarman MP, Ortega G. Defining a Research Agenda for Layperson Prehospital Hemorrhage Control: A Consensus Statement. JAMA Netw Open 2020; 3:e209393. [PMID: 32663307 DOI: 10.1001/jamanetworkopen.2020.9393] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Trauma is the leading cause of death for US individuals younger than 45 years, and uncontrolled hemorrhage is a major cause of trauma mortality. The US military's medical advancements in the field of prehospital hemorrhage control have reduced battlefield mortality by 44%. However, despite support from many national health care organizations, no integrated approach to research has been made regarding implementation, epidemiology, education, and logistics of prehospital hemorrhage control by layperson immediate responders in the civilian sector. OBJECTIVE To create a national research agenda to help guide future work for prehospital hemorrhage control by laypersons. EVIDENCE REVIEW The 2-day, in-person, National Stop the Bleed (STB) Research Consensus Conference was conducted on February 27 to 28, 2019, to identify and achieve consensus on research gaps. Participants included (1) subject matter experts, (2) professional society-designated leaders, (3) representatives from the federal government, and (4) representatives from private foundations. Before the conference, participants were provided a scoping review on layperson prehospital hemorrhage control. A 3-round modified Delphi consensus process was conducted to determine high-priority research questions. The top items, with median rating of 8 or more on a Likert scale of 1 to 9 points, were identified and became part of the national STB research agenda. FINDINGS Forty-five participants attended the conference. In round 1, participants submitted 487 research questions. After deduplication and sorting, 162 questions remained across 5 a priori-defined themes. Two subsequent rounds of rating generated consensus on 113 high-priority, 27 uncertain-priority, and 22 low-priority questions. The final prioritized research agenda included the top 24 questions, including 8 for epidemiology and effectiveness, 4 for materials, 9 for education, 2 for global health, and 1 for health policy. CONCLUSIONS AND RELEVANCE The National STB Research Consensus Conference identified and prioritized a national research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage. Investigators and funding agencies can use this agenda to guide their future work and funding priorities.
Collapse
Affiliation(s)
- Eric Goralnick
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Chibuike Ezeibe
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Muhammad Ali Chaudhary
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Justin McCarty
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Juan P Herrera-Escobar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tomas Andriotti
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elzerie de Jager
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Craig Goolsby
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland
- National Center for Disaster Medicine and Public Health, Rockville, Maryland
| | - Richard Hunt
- National Health Care Preparedness Program, Department of Health and Human Services, Washington, DC
| | - Joel S Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adil Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Office of the Dean, Medical School, Aga Khan University, Karachi, Pakistan
| | - Lenworth Jacobs
- Department of Surgery, Hartford Hospital, Hartford, Connecticut
| | | | - Erin Andrade
- Department of Surgery, Washington University in St Louis, Missouri
| | - Jeremy Brown
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, DC
| | | | - Frank K Butler
- Defense Health Agency, Joint Trauma System, Joint Base San Antonio-Fort Sam Houston, Texas
| | - David Callaway
- Department of Emergency Medicine, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Edward J Caterson
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Niteesh K Choudhry
- Center for Healthcare Delivery Sciences, Harvard Medical School, Boston, Massachusetts
| | - Michael R Davis
- Combat Casualty Care Research Program Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Alex Eastman
- Countering Weapons of Mass Destruction Office Department of Homeland Security, Washington, DC
| | - Brian J Eastridge
- Department of Surgery, The University of Texas Health Science Center at San Antonio
| | - Jonathan L Epstein
- Training Services Division, American Red Cross, American Red Cross, Washington, DC
| | - Conor L Evans
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston
| | - Marianne Gausche-Hill
- Department of Emergency Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Mark L Gestring
- Department of Surgery, Rochester Medical Center, Rochester, New York
| | - Scott A Goldberg
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dan Hanfling
- Forum on Medical and Public Health Preparedness for Catastrophic Events, National Academies of Science, Washington, DC
| | | | - Carl-Oscar Jonson
- Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - David R King
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Sean Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Russ S Kotwal
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas
| | - Jon R Krohmer
- Office of Emergency Medical Services, National Highway Traffic Safety Administration, Washington, DC
| | - Nomi Levy-Carrick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew Levy
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - David P Mooney
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Matthew D Neal
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Habeeba Park
- Department of Surgery, University of Maryland Shock Trauma Center, Baltimore
| | - Peter T Pons
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver
| | - Erik Prytz
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Todd E Rasmussen
- Department of Surgery, F. Edward Hébert School of Medicine Uniformed Services University, Bethesda, Maryland
| | - Michael A Remley
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas
| | - Robert Riviello
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stacy Shackelfold
- Joint Trauma System, Defense Health Agency Combat Support, San Antonio, Texas
| | - E Reed Smith
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, DC
| | - Ronald M Stewart
- Department of Surgery, The University of Texas Health Science Center at San Antonio
| | - Mamta Swaroop
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kevin Ward
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Biomedical Engineering, University of Michigan, Ann Arbor
| | | | - Molly P Jarman
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gezzer Ortega
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
6
|
Hasselager A, Bohnstedt C, Østergaard D, Sønderskov C, Bihrmann K, Tolsgaard MG, Lauritsen TLB. Improving the cost-effectiveness of laypersons' paediatric basic life support skills training: A randomised non-inferiority study. Resuscitation 2019; 138:28-35. [PMID: 30836169 DOI: 10.1016/j.resuscitation.2019.02.032] [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: 11/09/2018] [Revised: 01/16/2019] [Accepted: 02/24/2019] [Indexed: 12/20/2022]
Abstract
AIM To compare dyad (training in pairs without an instructor) with resource-intensive instructor-led training for laypersons' paediatric resuscitation skills in a non-inferiority trial and examine cost-effectiveness of the training methods. METHODS In this randomised parallel group non-inferiority trial, 155 dyad and 175 instructor-led laypersons were trained in Basic Life Support and Foreign Body Airway Obstruction Management. Dyads were given instructional videos, hands-on exercises and provided feedback to their partner for 50 min. Instructor-led laypersons trained in groups of six for two hours. Learning were assessed in scenarios immediately after training and, subsequently, at 14 days, 1, and 3 months. Pass rates, cost-effectiveness of producing a competent layperson (passing both tests), and non-inferiority were analysed. RESULTS Sixty-eight (45.6%) dyad and 130 (74.3%) instructor-led laypersons passed the basic life support test (p < 0.001). For Foreign Body Airway Obstruction Management 77 (54.2%) dyad and 130 (79.3%) for instructor-led laypersons passed (p < 0.001). Skills decreased over three months for both groups. Forty-two (30.4%) dyad and ninety-eight (59.8%) for instructor-led laypersons were competent after training (p < 0.001). The lower effectiveness of dyad training had reduced costs (p < 0.001). For each 10,000 USD allocated to training, dyad training would result in 71 vs. 65 competent laypersons for instructor-led training. Non-inferiority of dyad training could not be established. CONCLUSION Instructor-led training was the most effective but also the most expensive training method, making it less cost-effective than dyad training. When the aim is to train for quantity rather than quality, dyad training would be the preferred choice of training method.
Collapse
Affiliation(s)
- Asbjørn Hasselager
- University of Copenhagen, Copenhagen Academy for Medical Education and Simulation (CAMES), RegionH, Denmark.
| | | | - Doris Østergaard
- University of Copenhagen, Copenhagen Academy for Medical Education and Simulation (CAMES), RegionH, Denmark
| | | | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Martin G Tolsgaard
- University of Copenhagen, Copenhagen Academy for Medical Education and Simulation (CAMES), RegionH, Denmark
| | - Torsten L B Lauritsen
- Department of Anaesthesia, The Juliane Marie Centre, Rigshospitalet University Hospital, Copenhagen, Denmark
| |
Collapse
|
7
|
Heidari M, Aryankhesal A, Khorasani-Zavareh D. Laypeople roles at road traffic crash scenes: a systematic review. Int J Inj Contr Saf Promot 2018; 26:82-91. [PMID: 29939119 DOI: 10.1080/17457300.2018.1481869] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This study aimed to identify the roles of laypeople at road traffic injuries (RTIs). A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words of 'laypeople', 'layman', 'layperson', 'bystander', 'first responder', 'lay first responder', 'road traffic', 'road traffic injury', 'crash injury', 'crash scene', 'emergency', 'trauma care', and 'prehospital trauma care' were used in combination with the Boolean operators OR and AND. We did electronic search on Google Scholar, PubMed, ISI Web of Science, CINAHL, Science Direct, Scopus, ProQuest. Based on the reviewed studies, some factors such as cultural conditions, knowledge, relief agencies, and demographic factors affect the interventions of laypeople at the crash scene in functional areas. Regarding the permanent presence of people at the crash scene, the present study can provide an opportunity to reduce different side effects of RTIs imposed on the society.
Collapse
Affiliation(s)
- Mohammad Heidari
- a Health Management and Economics Research Center, Iran University of Medical Sciences , Tehran , Iran.,b Department of Health in Emergency and Disaster, School of Health Management and Information Sciences , Iran University of Medical Sciences , Tehran , Iran
| | - Aidin Aryankhesal
- c Department of Health Services Management, School of Health Management and Information Sciences , Iran University of Medical Sciences , Tehran , Iran
| | - Davoud Khorasani-Zavareh
- d Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran.,e Department of Health in Disaster and Emergency, School of Health, Safety and Environment , Shahid Beheshti University of Medical Sciences , Tehran , Iran.,f Department of Clinical Science and Education , Karolinska Institute , Stockholm , Sweden
| |
Collapse
|
8
|
Lay persons alerted by mobile application system initiate earlier cardio-pulmonary resuscitation: A comparison with SMS-based system notification. Resuscitation 2017; 114:73-78. [PMID: 28268186 DOI: 10.1016/j.resuscitation.2017.03.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/01/2017] [Accepted: 03/02/2017] [Indexed: 11/22/2022]
Abstract
AIM We compared the time to initiation of cardiopulmonary resuscitation (CPR) by lay responders and/or first responders alerted either via Short Message Service (SMS) or by using a mobile application-based alert system (APP). METHODS The Ticino Registry of Cardiac Arrest collects all data about out-of-hospital cardiac arrests (OHCAs) occurring in the Canton of Ticino. At the time of a bystander's call, the EMS dispatcher sends one ambulance and alerts the first-responders network made up of police officers or fire brigade equipped with an automatic external defibrillator, the so called "traditional" first responders, and - if the scene was considered safe - lay responders as well. We evaluated the time from call to arrival of traditional first responders and/or lay responders when alerted either via SMS or the new developed mobile APP. RESULTS Over the study period 593 OHCAs have occurred. Notification to the first responders network was sent via SMS in 198 cases and via mobile APP in 134 cases. Median time to first responder/lay responder arrival on scene was significantly reduced by the APP-based system (3.5 [2.8-5.2]) compared to the SMS-based system (5.6 [4.2-8.5] min, p 0.0001). The proportion of lay responders arriving first on the scene significantly increased (70% vs. 15%, p<0.01) with the APP. Earlier arrival of a first responder or of a lay responder determined a higher survival rate. CONCLUSIONS The mobile APP system is highly efficient in the recruitment of first responders, significantly reducing the time to the initiation of CPR thus increasing survival rates.
Collapse
|
9
|
Bakke HK, Steinvik T, Angell J, Wisborg T. A nationwide survey of first aid training and encounters in Norway. BMC Emerg Med 2017; 17:6. [PMID: 28228110 PMCID: PMC5322636 DOI: 10.1186/s12873-017-0116-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 02/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background Bystander first aid can improve survival following out-of-hospital cardiac arrest or trauma. Thus, providing first aid education to laypersons may lead to better outcomes. In this study, we aimed to establish the prevalence and distribution of first aid training in the populace, how often first aid skills are needed, and self-reported helping behaviour. Methods We conducted a telephone survey of 1000 respondents who were representative of the Norwegian population. Respondents were asked where and when they had first aid training, if they had ever encountered situations where first aid was necessary, and stratified by occupation. First aid included cardio-pulmonary resuscitation (CPR) and basic life support (BLS). To test theoretical first aid knowledge, respondents were subjected to two hypothetical first aid scenarios. Results Among the respondents, 90% had received first aid training, and 54% had undergone first aid training within the last 5 years. The workplace was the most common source of first aid training. Of the 43% who had been in a situation requiring first aid, 89% had provided first aid in that situation. There were considerable variations among different occupations in first aid training, and exposure to situations requiring first aid. Theoretical first aid knowledge was not as good as expected in light of the high share who had first aid training. In the presented scenarios 42% of respondent would initiate CPR in an unconscious patient not breathing normally, and 46% would provide an open airway to an unconscious road traffic victim. First aid training was correlated with better theoretical knowledge, but time since first aid training was not. Conclusions A high proportion of the Norwegian population had first aid training, and interviewees reported high willingness to provide first aid. Theoretical first aid knowledge was worse than expected. While first aid is part of national school curriculum, few have listed school as the source for their first aid training. Electronic supplementary material The online version of this article (doi:10.1186/s12873-017-0116-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Håkon Kvåle Bakke
- Mo i Rana Hospital, Helgeland Hospital Trust, Mo i Rana, Norway. .,Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, 9037, Tromsø, Norway. .,Department of Anaesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway.
| | - Tine Steinvik
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, 9037, Tromsø, Norway
| | - Johan Angell
- Lawyers Leiros & Olsen AS, Tromsø, Norway.,Faculty of Law, University of Tromsø, Tromsø, Norway
| | - Torben Wisborg
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, 9037, Tromsø, Norway.,Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway.,Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
10
|
Ikeda DJ, Buckler DG, Li J, Agarwal AK, Di Taranti LJ, Kurtz J, Reis RD, Leary M, Abella BS, Blewer AL. Dissemination of CPR video self-instruction materials to secondary trainees: Results from a hospital-based CPR education trial. Resuscitation 2016; 100:45-50. [PMID: 26776900 DOI: 10.1016/j.resuscitation.2015.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/30/2015] [Accepted: 12/19/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) video self-instruction (VSI) materials have been promoted as a scalable approach to increase the prevalence of CPR skills among the lay public, in part due to the opportunity for secondary training (i.e., sharing of training materials). However, the motivations for, and barriers to, disseminating VSI materials to secondary trainees is poorly understood. METHODS This work represents an ancillary investigation of a prospective hospital-based CPR education trial in which family members of cardiac patients were trained using VSI. Mixed-methods surveys were administered to primary trainees six months after initial enrollment. Surveys were designed to capture motivations for, and barriers to, sharing VSI materials, the number of secondary trainees with whom materials were shared, and the settings, timing, and recipients of trainings. RESULTS Between 07/2012 and 05/2015, 653 study participants completed a six-month follow-up interview. Of those, 345 reported sharing VSI materials with 1455 secondary trainees. Materials were shared most commonly with family members. In a logistic regression analysis, participants in the oldest quartile (age >63 years) were less likely to share materials compared to those in the youngest quartile (age ≤ 44 years, OR 0.58, CI 0.37-0.90, p=0.02). Among the 308 participants who did not share their materials, time constraints was the most commonly cited barrier for not sharing. CONCLUSIONS VSI materials represent a strategy for secondary dissemination of CPR training, yet older individuals have a lower likelihood of sharing relative to younger individuals. Further work is warranted to remedy perceived barriers to CPR dissemination among the lay public using VSI approaches.
Collapse
Affiliation(s)
- Daniel J Ikeda
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David G Buckler
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jiaqi Li
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit K Agarwal
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura J Di Taranti
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James Kurtz
- Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - Ryan Dos Reis
- Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - Marion Leary
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin S Abella
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Audrey L Blewer
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
11
|
Ringh M, Rosenqvist M, Hollenberg J, Jonsson M, Fredman D, Nordberg P, Järnbert-Pettersson H, Hasselqvist-Ax I, Riva G, Svensson L. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest. N Engl J Med 2015; 372:2316-25. [PMID: 26061836 DOI: 10.1056/nejmoa1406038] [Citation(s) in RCA: 324] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) performed by bystanders is associated with increased survival rates among persons with out-of-hospital cardiac arrest. We investigated whether rates of bystander-initiated CPR could be increased with the use of a mobile-phone positioning system that could instantly locate mobile-phone users and dispatch lay volunteers who were trained in CPR to a patient nearby with out-of-hospital cardiac arrest. METHODS We conducted a blinded, randomized, controlled trial in Stockholm from April 2012 through December 2013. A mobile-phone positioning system that was activated when ambulance, fire, and police services were dispatched was used to locate trained volunteers who were within 500 m of patients with out-of-hospital cardiac arrest; volunteers were then dispatched to the patients (the intervention group) or not dispatched to them (the control group). The primary outcome was bystander-initiated CPR before the arrival of ambulance, fire, and police services. RESULTS A total of 5989 lay volunteers who were trained in CPR were recruited initially, and overall 9828 were recruited during the study. The mobile-phone positioning system was activated in 667 out-of-hospital cardiac arrests: 46% (306 patients) in the intervention group and 54% (361 patients) in the control group. The rate of bystander-initiated CPR was 62% (188 of 305 patients) in the intervention group and 48% (172 of 360 patients) in the control group (absolute difference for intervention vs. control, 14 percentage points; 95% confidence interval, 6 to 21; P<0.001). CONCLUSIONS A mobile-phone positioning system to dispatch lay volunteers who were trained in CPR was associated with significantly increased rates of bystander-initiated CPR among persons with out-of-hospital cardiac arrest. (Funded by the Swedish Heart-Lung Foundation and Stockholm County; ClinicalTrials.gov number, NCT01789554.).
Collapse
Affiliation(s)
- Mattias Ringh
- From the Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Solna (M. Ringh, J.H., M.J., D.F., P.N., I.H.-A., G.R., L.S.), the Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Danderyd (M. Rosenqvist), and the Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset (H.J.-P.) - all in Stockholm
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Bouland AJ, Risko N, Lawner BJ, Seaman KG, Godar CM, Levy MJ. The Price of a Helping Hand: Modeling the Outcomes and Costs of Bystander CPR. PREHOSP EMERG CARE 2015; 19:524-34. [PMID: 25665010 DOI: 10.3109/10903127.2014.995844] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Early, high-quality, minimally interrupted bystander cardio-pulmonary resuscitation (BCPR) is essential for out-of-hospital cardiac arrest survival. However, rates of bystander intervention remain low in many geographic areas. Community CPR programs have been initiated to combat these low numbers by teaching compression-only CPR to laypersons. This study examined bystander CPR and the cost-effectiveness of a countywide CPR program to improve out-of-hospital cardiac arrest survival. METHODS A 2-year retrospective review of emergency medical services (EMS) run reports for adult nontraumatic cardiac arrests was performed using existing prehospital EMS quality assurance data. The incidence and success of bystander CPR to produce prehospital return of spontaneous circulation and favorable neurologic outcomes at hospital discharge were analyzed. The outcomes were paired with cost data for the jurisdiction's community CPR program to develop a cost-effectiveness model. RESULTS During the 23-month study period, a total of 371 nontraumatic adult out-of-hospital cardiac arrests occurred, with a 33.4% incidence of bystander CPR. Incremental cost-effectiveness analysis for the community CPR program demonstrated a total cost of $22,539 per quality-adjusted life-year (QALY). A significantly increased proportion of those who received BCPR also had an automated external defibrillator (AED) applied. There was no correlation between witnessed arrest and performance of BCPR. A significantly increased proportion of those who received BCPR were found to be in a shockable rhythm when the initial ECG was performed. In the home setting, the chances of receiving BCPR were significantly smaller, whereas in the public setting a nearly equal number of people received and did not receive BCPR. Witnessed arrest, AED application, public location, and shockable rhythm on initial ECG were all significantly associated with positive ROSC and neurologic outcomes. A home arrest was significantly associated with worse neurologic outcome. CONCLUSIONS Cost-effectiveness analysis demonstrates that a community CPR outreach program is a cost-effective means for saving lives when compared to other healthcare-related interventions. Bystander CPR showed a clear trend toward improving the neurologic outcome of survivors. The findings of this study indicate a need for additional research into the economic effects of bystander CPR.
Collapse
|
13
|
Chiang WC, Ko PCI, Chang AM, Chen WT, Liu SSH, Huang YS, Chen SY, Lin CH, Cheng MT, Chong KM, Wang HC, Yang CW, Liao MW, Wang CH, Chien YC, Lin CH, Liu YP, Lee BC, Chien KL, Lai MS, Ma MHM. Bystander-initiated CPR in an Asian metropolitan: does the socioeconomic status matter? Resuscitation 2013; 85:53-8. [PMID: 24056397 DOI: 10.1016/j.resuscitation.2013.07.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the association of neighborhood socioeconomic status (SES) with bystander-initiated cardiopulmonary resuscitation (CPR) and patient outcomes of out of hospital cardiac arrests (OHCAs) in an Asian metropolitan area. METHODS We performed a retrospective study in a prospectively collected cohort from the Utstein registry of adult non-traumatic OHCAs in Taipei, Taiwan. Average real estate value was assessed as the first proxy of SES. Twelve administrative districts in Taipei City were categorized into low versus high SES areas to test the association. The primary outcome was bystander-initiated CPR, and the secondary outcome was patient survival status. Factors associated with bystander-initiated CPR were adjusted for in multivariate analysis. The mean household income was assessed as the second proxy of SES to validate the association. RESULTS From January 1, 2008 to December 30, 2009, 3573 OHCAs received prehospital resuscitation in the community. Among these, 617 (17.3%) cases received bystander CPR. The proportion of bystander CPR in low-SES vs. high-SES areas was 14.5% vs. 19.6% (p<0.01). Odds ratio of receiving bystander-initiated CPR in low-SES areas was 0.72 (95% confidence interval: [0.60-0.88]) after adjusting for age, gender, witnessed status, public collapse, and OHCA unrecognized by the online dispatcher. Survival to discharge rate was significantly lower in low-SES areas vs. high-SES areas (4.3% vs. 6.8%; p<0.01). All results above remained consistent in the analyses by mean household income. CONCLUSIONS Patients who experienced an OHCA in low-SES areas were less likely to receive bystander-initiated CPR, and demonstrated worse survival outcomes.
Collapse
Affiliation(s)
- Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Anna Marie Chang
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Wei-Ting Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Sot Shih-Hung Liu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Sheng Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shey-Ying Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chien-Hao Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tai Cheng
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kah-Meng Chong
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Chih Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Wei Yang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | - Chi-Hung Lin
- Department of Health, Taipei City Government, Taiwan
| | - Yueh-Ping Liu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Health, Taipei City Government, Taiwan
| | | | - Kuo-Long Chien
- Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mei-Shu Lai
- Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
14
|
Einav S, Kaufman N, Algur N, Strauss-Liviatan N, Kark JD. Brain biomarkers and management of uncertainty in predicting outcome of cardiopulmonary resuscitation: A nomogram paints a thousand words. Resuscitation 2013; 84:1083-8. [DOI: 10.1016/j.resuscitation.2013.01.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/28/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
|
15
|
Sund B, Svensson L, Rosenqvist M, Hollenberg J. Favourable cost-benefit in an early defibrillation programme using dual dispatch of ambulance and fire services in out-of-hospital cardiac arrest. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2012; 13:811-8. [PMID: 21739334 DOI: 10.1007/s10198-011-0338-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 06/28/2011] [Indexed: 05/07/2023]
Abstract
AIMS Out-of-hospital cardiac arrest is fatal without treatment, and time to defibrillation is an extremely important factor in relation to survival. We performed a cost-benefit analysis of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm, Sweden. METHODS AND RESULTS A cost-benefit analysis was performed to evaluate the effects of dual dispatch defibrillation. The increased survival rates were estimated from a real-world implemented intervention, and the monetary value of a life (<euro> 2.2 million) was applied to this benefit by using results from a recent stated-preference study. The estimated costs include defibrillators (including expendables/maintenance), training, hospitalisation/health care, fire service call-outs, overhead resources and the dispatch centre. The estimated number of additional saved lives was 16 per year, yielding a benefit-cost ratio of 36. The cost per quality-adjusted life years (QALY) was estimated to be <euro> 13,000, and the cost per saved life was <euro> 60,000. CONCLUSIONS The intervention of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm had positive economic effects. For the cost-benefit analysis, the return on investment was high and the cost-effectiveness showed levels below the threshold value for economic efficiency used in Sweden. The cost-utility analysis categorises the cost per QALY as medium.
Collapse
Affiliation(s)
- Björn Sund
- Swedish Business School, Örebro University, 702 82, Örebro, Sweden.
| | | | | | | |
Collapse
|
16
|
Mobile phone technology identifies and recruits trained citizens to perform CPR on out-of-hospital cardiac arrest victims prior to ambulance arrival. Resuscitation 2011; 82:1514-8. [DOI: 10.1016/j.resuscitation.2011.07.033] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 07/04/2011] [Accepted: 07/20/2011] [Indexed: 11/15/2022]
|
17
|
Mancini ME, Soar J, Bhanji F, Billi JE, Dennett J, Finn J, Ma MHM, Perkins GD, Rodgers DL, Hazinski MF, Jacobs I, Morley PT. Part 12: Education, implementation, and teams: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S539-81. [PMID: 20956260 DOI: 10.1161/circulationaha.110.971143] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
18
|
Soar J, Mancini ME, Bhanji F, Billi JE, Dennett J, Finn J, Ma MHM, Perkins GD, Rodgers DL, Hazinski MF, Jacobs I, Morley PT. Part 12: Education, implementation, and teams: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2010; 81 Suppl 1:e288-330. [PMID: 20956038 PMCID: PMC7184565 DOI: 10.1016/j.resuscitation.2010.08.030] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol,United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Public access defibrillation programs have increased dramatically over the past 15 years. This review will focus on their effectiveness and operational characteristics and discuss the characteristics of successful programs, which can improve outcomes. RECENT FINDINGS Automated external defibrillators increase survival from cardiac arrest when used by a bystander. Recent studies show that the best outcomes are achieved when devices are placed in areas with a high frequency of cardiac arrest and there is ongoing supervision with emergency plans and cardiopulmonary resuscitation training. Programs are cost-effective under these circumstances, but become very inefficient when placed in areas of low risk. There are few adverse events related to the public access defibrillation programs and volunteers are not harmed. Unguided placement results in devices not being used and a decline in organizational structure of the program. As most cardiac arrests occur in the home, the impact on overall survival remains low. SUMMARY Automated external defibrillators are highly effective at reducing death from ventricular fibrillation and easy access in public areas is most effective. Placement must be prioritized based on public health impact and characteristics of the community.
Collapse
|
20
|
Haukoos JS, Witt G, Gravitz C, Dean J, Jackson DM, Candlin T, Vellman P, Riccio J, Heard K, Kazutomi T, Luyten D, Pineda G, Gunter J, Biltoft J, Colwell C. Out-of-hospital cardiac arrest in denver, colorado: epidemiology and outcomes. Acad Emerg Med 2010; 17:391-8. [PMID: 20370778 PMCID: PMC3131153 DOI: 10.1111/j.1553-2712.2010.00707.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The annual incidence of out-of-hospital cardiac arrest (OOHCA) in the United States is approximately 6 per 10,000 population and survival remains low. Relatively little is known about the performance characteristics of a two-tiered emergency medical services (EMS) system split between fire-based basic life support (BLS) dispersed from fixed locations and hospital-based advanced life support (ALS) dispersed from nonfixed locations. The objectives of this study were to describe the incidence of OOHCA in Denver, Colorado, and to define the prevalence of survival with good neurologic function in the context of this particular EMS system. METHODS This was a retrospective cohort study using standardized abstraction methodology. A two-tiered hospital-based EMS system for the County of Denver and 10 receiving hospitals were studied. Consecutive adult patients who experienced nontraumatic OOHCA from January 1, 2003, through December 31, 2004, were enrolled. Demographic, prehospital arrest characteristics, treatment data, and survival data using the Utstein template were collected. Good neurologic survival was defined by a Cerebral Performance Categories (CPC) score of 1 or 2. RESULTS During the study period, 1,985 arrests occurred. Of these, 715 (36%) had attempted resuscitation by paramedics and constitute our study sample. The median age was 65 years (interquartile range = 52-78 years), 69% were male, 41% had witnessed arrest, 25% had bystander cardiopulmonary resuscitation (CPR) performed, and 30% had ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as their initial rhythm. Of the 715 patients, 545 (76%) were transported to a hospital, 223 (31%) had return of spontaneous circulation (ROSC), 175 (25%) survived to hospital admission, 58 (8%) survived to hospital discharge, and 42 (6%, 95% confidence interval [CI] = 4% to 8%) had a good neurologic outcome. CONCLUSIONS Out-of-hospital cardiac arrest survival in Denver, Colorado, is similar to that of other United States communities. This finding provides the basis for future epidemiologic and health services research in the out-of-hospital and ED settings in our community.
Collapse
Affiliation(s)
- Jason S Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Merchant RM, Becker LB, Abella BS, Asch DA, Groeneveld PW. Cost-Effectiveness of Therapeutic Hypothermia After Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2009; 2:421-8. [DOI: 10.1161/circoutcomes.108.839605] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Raina M. Merchant
- From the Robert Wood Johnson Foundation Clinical Scholars program (R.M.M.), the Center for Resuscitation Science and Department of Emergency Medicine (R.M.M., L.B.B., B.S.A.), and the Leonard Davis Institute of Health Economics (R.M.M., D.A.A., P.V.G.), University of Pennsylvania, Philadelphia, Pa; and the Philadelphia Veterans Affairs Medical Center (D.A.A., P.W.G.), Philadelphia, Pa
| | - Lance B. Becker
- From the Robert Wood Johnson Foundation Clinical Scholars program (R.M.M.), the Center for Resuscitation Science and Department of Emergency Medicine (R.M.M., L.B.B., B.S.A.), and the Leonard Davis Institute of Health Economics (R.M.M., D.A.A., P.V.G.), University of Pennsylvania, Philadelphia, Pa; and the Philadelphia Veterans Affairs Medical Center (D.A.A., P.W.G.), Philadelphia, Pa
| | - Benjamin S. Abella
- From the Robert Wood Johnson Foundation Clinical Scholars program (R.M.M.), the Center for Resuscitation Science and Department of Emergency Medicine (R.M.M., L.B.B., B.S.A.), and the Leonard Davis Institute of Health Economics (R.M.M., D.A.A., P.V.G.), University of Pennsylvania, Philadelphia, Pa; and the Philadelphia Veterans Affairs Medical Center (D.A.A., P.W.G.), Philadelphia, Pa
| | - David A. Asch
- From the Robert Wood Johnson Foundation Clinical Scholars program (R.M.M.), the Center for Resuscitation Science and Department of Emergency Medicine (R.M.M., L.B.B., B.S.A.), and the Leonard Davis Institute of Health Economics (R.M.M., D.A.A., P.V.G.), University of Pennsylvania, Philadelphia, Pa; and the Philadelphia Veterans Affairs Medical Center (D.A.A., P.W.G.), Philadelphia, Pa
| | - Peter W. Groeneveld
- From the Robert Wood Johnson Foundation Clinical Scholars program (R.M.M.), the Center for Resuscitation Science and Department of Emergency Medicine (R.M.M., L.B.B., B.S.A.), and the Leonard Davis Institute of Health Economics (R.M.M., D.A.A., P.V.G.), University of Pennsylvania, Philadelphia, Pa; and the Philadelphia Veterans Affairs Medical Center (D.A.A., P.W.G.), Philadelphia, Pa
| |
Collapse
|
22
|
Folke F, Lippert FK, Nielsen SL, Gislason GH, Hansen ML, Schramm TK, Sørensen R, Fosbøl EL, Andersen SS, Rasmussen S, Køber L, Torp-Pedersen C. Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations. Circulation 2009; 120:510-7. [PMID: 19635969 DOI: 10.1161/circulationaha.108.843755] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potential benefit and economic consequences of focused or unfocused AED deployment are unknown. METHODS AND RESULTS All cardiac arrests in public in Copenhagen, Denmark, from 1994 through 2005 were geographically located, as were 104 public AEDs placed by local initiatives. In accordance with European Resuscitation Council and American Heart Association (AHA) guidelines, areas with a high incidence of cardiac arrests were defined as those with 1 cardiac arrest every 2 or 5 years, respectively. There were 1274 cardiac arrests in public locations. According to the European Resuscitation Council or AHA guidelines, AEDs needed to be deployed in 1.2% and 10.6% of the city area, providing coverage for 19.5% (n=249) and 66.8% (n=851) of all cardiac arrests, respectively. The excessive cost of such AED deployments was estimated to be $33 100 or $41 000 per additional quality-adjusted life year, whereas unguided AED placement covering the entire city had an estimated cost of $108 700 per quality-adjusted life year. Areas with major train stations (1.8 arrests every 5 years per area), large public squares, and pedestrianized areas (0.6 arrests every 5 years per area) were main predictors of frequent cardiac arrests. CONCLUSIONS To achieve wide AED coverage, AEDs need to be more widely distributed than recommended by the European Resuscitation Council guidelines but consistent with the American Heart Association guidelines. Strategic placement of AEDs is pivotal for public-access defibrillation, whereas with unguided initiatives, AEDs are likely to be placed inappropriately.
Collapse
Affiliation(s)
- Fredrik Folke
- Research Fellow, Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Harve H, Jokela J, Tissari A, Saukko A, Okkolin T, Pettilä V, Silfvast T. Defibrillation and the quality of layperson cardiopulmonary resuscitation-dispatcher assistance or training? Resuscitation 2008; 80:275-7. [PMID: 19058896 DOI: 10.1016/j.resuscitation.2008.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 09/14/2008] [Accepted: 10/07/2008] [Indexed: 10/21/2022]
Abstract
AIMS OF THE STUDY To examine whether basic life support-defibrillation (BLS-D) training of laypersons enhances the speed of defibrillation and the quality of cardiopulmonary resuscitation (CPR) during a simulated ventricular fibrillation scenario compared with a situation where the care provider has no previous BLS-D training but receives dispatcher assistance with the use of an automated external defibrillator (AED) and the performance of CPR. METHODS Fifty-two military conscripts of the Finnish Defence Forces who without previous medical education had been tested in a simulated cardiac arrest scenario with dispatcher assistance and thereafter received a 4-h BLS-D training. Six months later they were randomly divided to form teams of two and again tested in a similar scenario but without dispatcher assistance. The time interval from collapse to first shock, hands-off time and the quality of CPR were compared between the two tests. RESULTS The quality of mouth-to-mouth ventilation was better after training, but there was only a minor improvement in the quality of compressions and the speed of defibrillation. CONCLUSIONS Training improved the quality of mouth-to-mouth ventilation performed by laypersons but had only a minor effect on defibrillation and the quality of compressions.
Collapse
Affiliation(s)
- Heini Harve
- The Finnish Defence Forces, Centre for Military Medicine, FIN-15701 Lahti, Finland.
| | | | | | | | | | | | | |
Collapse
|
24
|
Current World Literature. Curr Opin Anaesthesiol 2007; 20:605-9. [DOI: 10.1097/aco.0b013e3282f355c3] [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]
|
25
|
Maisch S, Friederich P, Goetz AE. [Public access defibrillation. Limited use by trained first responders and laymen]. Anaesthesist 2007; 55:1281-90. [PMID: 17021885 DOI: 10.1007/s00101-006-1098-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
As ventricular fibrillation is the most frequent initial heart rhythm causing out-of-hospital sudden cardiac arrest, defibrillation is of essential significance. Automated external defibrillators (AEDs) have been available for some years and as a result defibrillation can be carried out by individuals other than physicians and healthcare providers such as trained first responders and untrained lay rescuers. This so-called public access defibrillation nourished hope of progress in the treatment of sudden cardiac arrest. However, several limitations exist, such as low frequency of sudden cardiac arrest in public, rare use of publicly placed AEDs, low cost effectiveness, legal requirements and insufficient public willingness to help. Due to these restrictions of public access defibrillation other measures are more promising than the attempt at general distribution of AEDs. These measures are primary or secondary prophylaxis of sudden cardiac arrest, general knowledge of adequate activation of emergency medical services, implementation of first responder teams equipped with AEDs and particularly a better education in and application of the well-established principles of cardiopulmonary resuscitation.
Collapse
Affiliation(s)
- S Maisch
- Klinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg.
| | | | | |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW To discuss the clinical effectiveness, public health impact and cost-effectiveness of public access defibrillation. RECENT FINDINGS High rates of survival from prehospital ventricular fibrillation have been documented in patients treated by first responders using automated external defibrillators. The recent Public Access Defibrillation trial demonstrated a doubling of cardiac arrest survival in community units where volunteers trained in cardiopulmonary resuscitation were additionally equipped with automated external defibrillators. The cost-effectiveness analysis of the Public Access Defibrillation trial has not yet been published, and previous analyses have lacked full data on cost, outcome, or both. Data from many sources indicate that automated external defibrillator placement at sites with an expected rate of one cardiac arrest per defibrillator per 5 years, as recommended by the American Heart Association, addresses only around 1-2% of prehospital arrests, and will have a minimal impact on population survival. SUMMARY While highly targeted provision of automated external defibrillators in areas of greatest risk, such as casinos and airports, may be cost-effective, it will have little impact at a population level. Provision of more widespread public access defibrillation to sites with lower incidence of cardiac arrest is unlikely to be cost-effective, and may represent poorer value for money than alternative healthcare interventions in coronary artery disease.
Collapse
|
27
|
Current World Literature. Curr Opin Cardiol 2007; 22:49-53. [PMID: 17143045 DOI: 10.1097/hco.0b013e3280126b20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Affiliation(s)
- Jerry Potts
- ECC Programs, American Heart Association, Dallas, TX 75231, USA.
| | | |
Collapse
|
29
|
|