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Chen C, Lo CYZ, Ho MJC, Ng Y, Chan HCY, Wu WHK, Ong MEH, Siddiqui FJ. Global Sex Disparities in Bystander Cardiopulmonary Resuscitation After Out-of-Hospital Cardiac Arrest: A Scoping Review. J Am Heart Assoc 2024; 13:e035794. [PMID: 39248262 DOI: 10.1161/jaha.124.035794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
This scoping review collates evidence for sex biases in the receipt of bystander cardiopulmonary resuscitation (BCPR) among patients with out-of-hospital cardiac arrest patients globally. The MEDLINE, PsycINFO, CENTRAL, and Embase databases were screened for relevant literature, dated from inception to March 9, 2022. Studies evaluating the association between BCPR and sex/gender in patients with out-of-hospital cardiac arrest, except for pediatric populations and cardiac arrest cases with traumatic cause, were included. The review included 80 articles on BCPR in men and women globally; 58 of these studies evaluated sex differences in BCPR outcomes. Fifty-nine percent of the relevant studies (34/58) indicated that women are less likely recipients of BCPR, 36% (21/58) observed no significant sex differences, and 5% (3/58) reported that women are more likely to receive BCPR. In other studies, women were found to be less likely to receive BCPR in public but equally or more likely to receive BCPR in residential settings. The general reluctance to perform BCPR on women in the Western countries was attributed to perceived frailty of women, chest exposure, pregnancy, gender stereotypes, oversexualization of women's bodies, and belief that women are unlikely to experience a cardiac arrest. Most studies worldwide indicated that women were less likely to receive BCPR than men. Further research from non-Western countries is needed to understand the impact of cultural and socioeconomic settings on such biases and design customized interventions accordingly.
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Affiliation(s)
- Christina Chen
- Prehospital and Emergency Research Centre, Health Services and Systems Research Duke-NUS Medical School Singapore Singapore
| | | | - Maxz J C Ho
- National University Hospital Singapore Singapore
| | - Yaoyi Ng
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | | | - Wellington H K Wu
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Marcus E H Ong
- Department of Emergency Medicine Singapore General Hospital Singapore Singapore
| | - Fahad J Siddiqui
- Prehospital and Emergency Research Centre, Health Services and Systems Research Duke-NUS Medical School Singapore Singapore
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Blewer AL, Starks MA, Malta‐Hansen C, Sasson C, Ong MEH, Al‐Araji R, McNally BF, Viera AJ. Sex Differences in Receipt of Bystander Cardiopulmonary Resuscitation Considering Neighborhood Racial and Ethnic Composition. J Am Heart Assoc 2024; 13:e031113. [PMID: 38410966 PMCID: PMC10944027 DOI: 10.1161/jaha.123.031113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (B-CPR) and defibrillation for out-of-hospital cardiac arrest (OHCA) vary by sex, with women being less likely to receive these interventions in public. It is unknown whether sex differences persist when considering neighborhood racial and ethnic composition. We examined the odds of receiving B-CPR stratified by location and neighborhood. We hypothesized that women in predominantly Black neighborhoods will have a lower odds of receiving B-CPR. METHODS AND RESULTS We conducted a retrospective study using the Cardiac Arrest Registry to Enhance Survival (CARES). Neighborhoods were classified by census tract. We modeled the odds of receipt of B-CPR (primary outcome), automatic external defibrillation application, and survival to hospital discharge (secondary outcomes) by sex. CARES collected 457 621 arrests (2013-2019); after appropriate exclusion, 309 662 were included. Women who had public OHCA had a 14% lower odds of receiving B-CPR (odds ratio [OR], 0.86 [95% CI, 0.82-0.89]), but effect modification was not seen by neighborhood (P=not significant). In predominantly Black neighborhoods, women who had public OHCA had a 13% lower odds of receiving B-CPR (adjusted OR, 0.87 [95% CI, 0.76-0.98]) and 12% lower odds of receiving automatic external defibrillation application (adjusted OR, 0.88 [95% CI, 0.78-0.99]). In predominantly Hispanic neighborhoods, women who had public OHCA were less likely to receive B-CPR (adjusted OR, 0.83 [95% CI, 0.73-0.96]) and less likely to receive automatic external defibrillation application (adjusted OR, 0.74 [95% CI, 0.64-0.87]). CONCLUSIONS Women with public OHCA have a decreased likelihood of receiving B-CPR and automatic external defibrillation application. Findings did not differ significantly according to neighborhood composition. Despite this, our work has implications for considering strategies to reduce disparities around bystander response.
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Affiliation(s)
- Audrey L. Blewer
- Department of Family Medicine and Community HealthDuke UniversityDurhamNC
- Department of Population Health SciencesDuke UniversityDurhamNC
| | | | | | - Comilla Sasson
- Department of Emergency MedicineUniversity of ColoradoDenverCO
| | - Marcus Eng Hock Ong
- Health Services and Systems ResearchDuke–National University of Singapore Medical SchoolSingapore
- Department of Emergency MedicineSingapore General HospitalSingapore
| | - Rabab Al‐Araji
- Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Bryan F. McNally
- Rollins School of Public HealthEmory UniversityAtlantaGA
- Department of Emergency MedicineEmory University School of MedicineAtlantaGA
| | - Anthony J. Viera
- Department of Family Medicine and Community HealthDuke UniversityDurhamNC
- Department of Population Health SciencesDuke UniversityDurhamNC
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Paratz ED, Nehme E, Heriot N, Sundararajan V, Page G, Fahy L, Rowe S, Anderson D, Stub D, La Gerche A, Nehme Z. Sex disparities in bystander defibrillation for out-of-hospital cardiac arrest. Resusc Plus 2024; 17:100532. [PMID: 38188595 PMCID: PMC10770583 DOI: 10.1016/j.resplu.2023.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Background Previous studies have suggested that females experiencing out-of-hospital cardiac arrest (OHCA) receive lower rates of both bystander cardiopulmonary resuscitation (CPR) and defibrillation compared to males. Whether this disparity has improved over time is unknown. Methods A state-wide OHCA registry in Victoria, Australia collected data over twenty years (2002-2021) regarding rates of bystander interventions in OHCA. Characteristics and outcomes of each OHCA were compared with logistic regression according to sex and time (defined in two-year periods). Results 32,502 OHCAs were included (69.7% male). Both bystander CPR and defibrillation rates increased for females over time (p < 0.0001). There was no sex disparity in receipt of bystander CPR after adjustment for baseline differences. Females were less likely than males to receive bystander defibrillation, with sex disparity increasing from 2010 onwards (adjOR 0.26 (95%CI 0.09-0.80) in 2020-21 for females compared to males). Conclusion Initiatives to increase bystander CPR and defibrillation have resulted in higher overall rates of bystander interventions in the last two decades and no significant sex differences in provision of bystander CPR. However, females receive less bystander defibrillation than males, and sex disparity is increasing. Strategies to promote bystander defibrillation in females experiencing OHCA with a shockable rhythm should be a priority.
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Affiliation(s)
- Elizabeth D. Paratz
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
- Cardiology Department, Baker Heart & Diabetes Institute, 75 Commercial Rd., Prahran, VIC 3181, Australia
- Department of Medicine, St Vincent’s Hospital Melbourne, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Emily Nehme
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
| | - Natalie Heriot
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Vijaya Sundararajan
- Department of Medicine, St Vincent’s Hospital Melbourne, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia
| | | | - Louise Fahy
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Stephanie Rowe
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - David Anderson
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Dion Stub
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
- Department of Cardiology, Alfred Health, 55 Commercial Rd., Prahran, VIC 3181, Australia
| | - Andre La Gerche
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
- Cardiology Department, Baker Heart & Diabetes Institute, 75 Commercial Rd., Prahran, VIC 3181, Australia
| | - Ziad Nehme
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
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Gupta K, Nguyen DD, Kennedy KF, Chan PS. Time to bystander cardiopulmonary resuscitation by patient sex for out-of-hospital cardiac arrest. Resuscitation 2024; 196:110126. [PMID: 38280509 DOI: 10.1016/j.resuscitation.2024.110126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Delays in bystander cardiopulmonary resuscitation (CPR) are associated with worse out-of-hospital cardiac arrest (OHCA) outcomes. Whether disparities exist in time to CPR between women and men is unknown. METHODS We included witnessed OHCAs treated with bystander CPR from the Cardiac Arrest Registry Enhancing Survival between 2013-2021. The primary outcome was time to first bystander CPR, and secondary outcomes were survival to hospital discharge and favorable neurological survival. Hierarchical ordinal regression was used to model time to first CPR, which estimates the odds of having a 2-minute longer delay (from 0 to ≥10 minutes) in receiving bystander CPR. The model included sex, age, race, location of arrest, cardiac arrest etiology, day of week, and season as fixed effects and EMS agency as a random effect to account for clustering of patients within an agency. RESULTS Of 78,043 patients with a witnessed OHCA that received bystander CPR, 25,197 (32.3%) were women. The median [IQR] time to first bystander CPR was 2 [1,5] minutes for both women and men. In adjusted analysis, time to bystander CPR was similar in men and women (p = 0.26). Moreover, there was a statistically significantly graded inverse association between time to bystander CPR and survival. CONCLUSION For patients with witnessed OHCA that received bystander CPR, women and men had similar times to CPR, although 5-minute or greater delays in initiating CPR was not uncommon. Delays in bystander CPR in OHCA were associated with worse survival outcomes.
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Affiliation(s)
- Kashvi Gupta
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States.
| | - Dan D Nguyen
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
| | - Kevin F Kennedy
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
| | - Paul S Chan
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
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Hosomi S, Irisawa T, Nakao S, Zha L, Kiyohara K, Kitamura T, Ogura H, Oda J. Association of sex with post-arrest care and outcomes after out-of-hospital cardiac arrest of initial shockable rhythm: a nationwide cohort study. Front Cardiovasc Med 2024; 10:1269199. [PMID: 38239877 PMCID: PMC10794357 DOI: 10.3389/fcvm.2023.1269199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Background Research has described differences in the provision of prehospital treatment for women who experience out-of-hospital cardiac arrest. However, studies have reported conflicting results regarding survival outcomes or in-hospital interventions between sexes. Thus, this study aimed to investigate the association of sex with survival outcomes and in-hospital treatments in Japan. Methods We retrospectively analyzed data from the Japanese Association for Acute Medicine-Out-of-Hospital Cardiac Arrest Registry. Patients aged ≥18 years who presented with a shockable rhythm at the scene between June 2014 and December 2020 were included in our analysis. Outcome measures were 30-day survival and in-hospital interventions. We compared the outcomes between the sexes using multivariable logistic regression. Results In total, 5,926 patients (4,270 men; 1,026 women) with out-of-hospital cardiac arrest were eligible for our analysis. The proportions of patients with 30-day survival outcomes were 39.5% (1685/4,270) and 37.4% (384/1,026) in the male and female groups, respectively (crude odds ratio, 0.92; 95% confidence interval, 0.80-1.06). Although there were no significant differences, survival outcomes tended to be better in women than in men in the multiple regression analysis (adjusted odds ratio: 1.38; 95% confidence interval: 0.82-2.33). Furthermore, there was no significant difference between the sexes in terms of patients who received extracorporeal cardiopulmonary resuscitation (adjusted odds ratio: 0.81; 95% confidence interval: 0.49-1.33) or targeted temperature management (adjusted odds ratio: 0.99; 95% confidence interval: 0.68-1.46). Conclusions After adjusting for prognostic factors, there were no differences in survival rates and in-hospital interventions between men and women.
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Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kousuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Tokyo, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Böckler B, Preisner A, Bathe J, Rauch S, Ristau P, Wnent J, Gräsner JT, Seewald S, Lefering R, Fischer M. Gender-related differences in adults concerning frequency, survival and treatment quality after out-of-hospital cardiac arrest (OHCA): An observational cohort study from the German resuscitation registry. Resuscitation 2024; 194:110060. [PMID: 38013146 DOI: 10.1016/j.resuscitation.2023.110060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND In Germany approximately 20,500 women and 41,000 men were resuscitated after out-of-hospital cardiac arrest (OHCA) each year. We are currently experiencing a discussion about the possible undersupply of women in healthcare. The aim of the present study was to examine the prevalence of OHCA in Germany, as well as the outcome and quality of resuscitation care for both women and men. METHODS We present a cohort study from the German Resuscitation Registry (2006-2022). The quality of care was assessed for both EMS and hospital care based on risk-adjusted survival rates with the endpoints: "hospital admission with return of spontaneous circulation" (ROSCadmission) for all patients and "discharge with favourable neurological recovery" (CPC1/2discharge) for all admitted patients. Risk adjustment was performed using logistic regression analysis (LRA). If sex was significantly associated with survival, a matched-pairs-analysis (MPA) followed to explore the frequency of guideline adherence. RESULTS 58,798 patients aged ≥ 18 years with OHCA and resuscitation were included (men = 65.2%, women = 34.8%). In the prehospital phase the male gender was associated with lower ROSCadmission-rate (LRA: OR = 0.79, CI = 0.759-0.822). A total of 27,910 patients were admitted. During hospital care, men demonstrated a better prognosis (OR = 1.10; CI = 1.015-1.191). MPA revealed a more intensive therapy for men both during EMS and hospital care. Looking at the complete chain of survival, LRA revealed no difference for men and women concerning CPC1/2discharge (n = 58,798; OR = 0.95; CI = 0.888-1.024). CONCLUSION In Germany, 80% more men than women experience OHCA. The prognosis for CPC1/2discharge remains low (men = 10.5%, women = 7.1%), but comparable after risk adjustment. There is evidence of undersupply of care for women during hospital treatment, which could be associated with a worse prognosis. Further investigations are required to clarify these findings.
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Affiliation(s)
- Bastian Böckler
- Clinic for Anaesthesiology, Klinikum Großhadern/Innenstadt, Ludwig-Maximilians-Universität München, Munich, Germany; Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany
| | - Achim Preisner
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany; Women's Clinic with Gynaecology and Obstetrics, Alb Fils Kliniken, Göppingen, Germany
| | - Janina Bathe
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
| | - Stefan Rauch
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany
| | - Patrick Ristau
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
| | - Jan Wnent
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Jan-Thorsten Gräsner
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Stephan Seewald
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Rolf Lefering
- Universität Witten/Herdecke Institute for Research in Operative Medicine (IFOM), Cologne, Germany
| | - Matthias Fischer
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany.
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Kusumawati HI, Sutono, Alim S, Achmad BF, Putri AF. Factors associated with willingness to perform basic life support in the community setting in Yogyakarta, Indonesia. Australas Emerg Care 2023; 26:303-307. [PMID: 36964023 DOI: 10.1016/j.auec.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/25/2023] [Accepted: 03/08/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Cardiac arrest is one of the fatal medical emergencies which need to be treated immediately. Poor survival rates in the community settings are common because of limited and ineffective bystander basic life support (BLS). This study aimed to identify factors that are associated with the willingness to perform BLS in communities in Yogyakarta, Indonesia METHODS: A descriptive study was conducted with a cross-sectional design. Participants (n = 251) were enrolled from the general population consisting of teachers, security personnel, and police officers recruited through cluster random sampling. Data were gathered using both digital or printed questionnaires. Ordinal logistic regression with adjusted odds ratio (AOR) was used to analyze the association between BLS predictors and willingness to perform BLS. RESULTS Most participants were willing to perform BLS for all genders (55.55%). The inability to perform BLS and fear of causing harm were the main barriers to performing BLS accounting for 61.35% and 43.82%, respectively. Compared to other independent predictors, ages 40-59 were found to be the highest predictors of willingness to perform BLS (AOR:1.44) followed by experience of seeing real or simulation of the emergency case (AOR:1.38) CONCLUSIONS: More than half of the respondents were eager to perform BLS although some barriers were also found. This study provides some understanding of the predictor factors associated with BLS performance and shows respondents with some training or experience were more likely to perform BLS. The results inform policymakers to develop a strategic plan for increasing willingness to apply BLS in the community. WC:250.
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Affiliation(s)
- Happy Indah Kusumawati
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.
| | - Sutono
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Syahirul Alim
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Bayu Fandhi Achmad
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
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Shirakawa K, Matsuoka Y, Yamamoto Y, Inoue A, Takahashi R, Yamada Y, Ariyoshi K, Hifumi T, Sakamoto T, Kuroda Y. Neurologic outcome and location of cardiac arrest in out-of-hospital cardiac arrest patients who underwent extracorporeal cardiopulmonary resuscitation: A multicentre retrospective cohort in Japan. Resusc Plus 2023; 16:100468. [PMID: 37711681 PMCID: PMC10497793 DOI: 10.1016/j.resplu.2023.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
Aim We examined the association between the location of cardiac arrest and outcomes of patients with out-of-hospital cardiac arrest (OHCA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR). Methods This was a secondary analysis of SAVE-J II, a multicentre retrospective registry with 36 participating institutions across Japan, which enrolled adult patients with OHCA who underwent ECPR. The outcomes of interest were favourable neurologic outcome at discharge. We compared the outcome between OHCA cases that occurred at residential and public locations, using a multilevel logistic regression model allowing for the random effect of each hospital. Results Among 1,744 enrolled OHCAs, 809 and 935 occurred at residential (house: 603; apartment: 206) and public (street: 260; workplace: 210; others: 465) locations, respectively. The proportion of favourable neurologic outcomes was lower in OHCAs at residential locations than those at public locations (88/781 (11.3%) vs.131/891 (14.7%); adjusted odds ratio, 0.72 [95% confidence interval, 0.53-0.99]). However, subgroup analyses for patients with EMS aged <65 years call to hospital arrival within 30 minutes or during daytime revealed less difference between residential and public locations. Conclusion When cardiac arrests occurred at residential locations, lower proportions of favourable neurologic outcomes were exhibited among patients with OHCA who underwent ECPR. However, the event's location may not affect the prognosis among appropriate and select cases when transported within a limited timeframe.
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Affiliation(s)
- Kazuhiro Shirakawa
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Yoshinori Matsuoka
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohama-kaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Ryo Takahashi
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohama-kaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Yoshie Yamada
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Koichi Ariyoshi
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9‐1 Akashi‐cho, Chuo‐ku, Tokyo 104‐8560, Japan
| | - Tetsuya Sakamoto
- Teikyo University School of Medicine, Department of Emergency Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
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Awad E, Alinier G, Farhat H, Rumbolt N, Azizurrahman A, Mortada B, Shami R. Provision of bystander CPR for out-of-hospital cardiac arrest in the Middle East: a retrospective gender-based analysis. Int J Emerg Med 2023; 16:63. [PMID: 37752462 PMCID: PMC10523738 DOI: 10.1186/s12245-023-00537-6] [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: 05/13/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Previous studies conducted in North America, Europe, and East Asia (Liu et al., EClinicalMedicine 44:101293, 2022; Matsui et al., JAMA Netw Open 2:e195111, 2019; Awad et al., J Am Coll Emerg Physicians Open 4:e12957, 2023; Yoon et al., Prehosp Emerg Care :1-7, 2022) reported gender disparities in the provision of bystander CPR for patients with out-of-hospital cardiac arrest (OHCA). However, it remains unknown whether similar disparities exist in the Middle Eastern and Gulf regions. The primary objective of this study is to evaluate gender differences in the provision of bystander CPR for patients with OHCA in Qatar. METHODS Retrospective analysis of data obtained from Hamad Medical Corporation OHCA registry in the State of Qatar (2016-2022). We included adults with non-traumatic and EMS-attended OHCA. We used multilevel logistic regression to examine the association between gender and provision of bystander CPR. RESULTS In total, 4283 patients were included. Of those, 3414 (79.7%) were males, 1639 (38.3%) arrested in public locations, and 1463 (34.2%) received bystander CPR. Unadjusted comparisons showed that females were significantly older than males (mean age: 62.2 vs. 52.7). Females had a lower proportion of OHCA occurring in public locations (15.1% vs. 44.2%) and a lower proportion of shockable rhythm (11.9 vs. 27.5%). Regarding the outcome variable (provision of bystander CPR), the unadjusted analysis showed that the proportion of females who received bystander CPR was lower than that of males (29.2% vs. 35.4%, p < 0.001). However, after adjustment, we found no significant difference in provision of bystander CPR by gender (adjusted OR female vs. male 0.99, 95% CI 0.84-1.20, p = 0.97). In the subgroup who arrested in public locations, the analysis revealed females had greater odds of receiving bystander CPR (adjusted OR female vs. male 1.47, 95% CI 1.10-1.82, p = 0.04). CONCLUSIONS Overall, bystander CPR was less common in female gender; after adjustment for other covariates, including arrest location, we found no significant gender differences in provision of bystander CPR. We also observed that females were found to have a lower incidence of cardiac arrest in public locations. Nevertheless, if females were to experience cardiac arrest in a public location, they would be more likely to receive CPR. Further research is required to explain the observed differences in provision of bystander CPR.
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Affiliation(s)
- Emad Awad
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar.
- BC RESURECT: Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
- Department of Emergency Medicine, School of Medicine, University of Utah, Salt Lake, UT, USA.
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service (HMCAS), Hamad Medical Corporation, Doha, Qatar
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- Weill Cornell Medicine - Qatar, Doha, Qatar
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Hassan Farhat
- Hamad Medical Corporation Ambulance Service (HMCAS), Hamad Medical Corporation, Doha, Qatar
- Faculty of Medicine "Ibn El Jazzar", University of Sousse, Sousse, Tunisia
- Faculty of Sciences, University of Sfax, Sfax, Tunisia
| | - Niki Rumbolt
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar
| | - Adnaan Azizurrahman
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar
| | - Buthaina Mortada
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar
| | - Rakan Shami
- College of Health Science, University of Doha for Science and Technology, Doha, Qatar
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10
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Douma MJ, Picard CT, Brindley PG, Gibson J. The experience of online cardiac arrest video use for education and research: A qualitative interview study completed in partnership with survivors and co-survivors. Resusc Plus 2023; 14:100394. [PMID: 37215186 PMCID: PMC10197098 DOI: 10.1016/j.resplu.2023.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Background Swift recognition of cardiac arrest is required for survival, however failure to recognize (and delayed response) is common. Studying online cardiac arrest videos may aid recognition, however the ethical implications of this are unknown. We examined their use from the perspective of persons with lived experience of cardiac arrest, seeking to understand the experience of having one's cardiac arrest recorded and available online. Methods We gathered qualitative data using focused interviews of persons affected by cardiac arrest. Inductive thematic analysis was performed, as well as a deductive ethical analysis. Co-researcher survivors and co-survivors were involved in all stages of this project. Findings We identified themes of 'shock, hurt and helplessness' and 'surreality and reality' to describe the experience of having one's (or a family member's) cardiac arrest captured and distributed online. Participants provided guidance on the use of online videos for education and research, emphasising beneficence, autonomy, non-maleficence, and justice. Conclusions Finding one's own, or a family member's cardiac arrest video online is shocking and potentially harmful for families. If ethical principles are followed however, there may be acceptable procedures for the use of online videos of cardiac arrest for education or research purposes. The careful use of online videos of cardiac arrest for education and research may help improve recognition and response, though additional research is required to confirm or refute this claim.
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Affiliation(s)
- Matthew J Douma
- Nursing, Midwifery and Health Systems, University College Dublin, Ireland
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Peter G. Brindley
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Gibson
- Providence Health Care, Canada
- University of British Columbia Vancouver, British Columbia, Canada
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11
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Yoon H, Kim KH, Ro YS, Park JH, Shin SD, Song KJ, Hong KJ, Jeong J. Sex Disparities in Prehospital Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest in South Korea. PREHOSP EMERG CARE 2023; 27:170-176. [PMID: 34990298 DOI: 10.1080/10903127.2022.2025635] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Sex disparities have been reported in the prehospital and in-hospital care among patients with out-of-hospital cardiac arrest (OHCA). The aim of this study was to investigate the association between sex and prehospital advanced cardiac life support (ACLS) interventions provided by emergency medical services (EMS). METHODS This was a cross-sectional observational study using a nationwide OHCA registry in South Korea. The study included adult OHCAs with presumed cardiac etiology from January 2016 to December 2019. The main exposure was the sex of the victim, and the primary outcomes were prehospital ACLS interventions, including advanced airway management (AAM), intravenous access (IV), and epinephrine (EPI) administration. Multivariable logistic regression analysis accounted for age group, health insurance, comorbidities, place of arrest, urbanization level, witness status, bystander CPR and initial rhythm was performed to calculate adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs). RESULTS Among 71,154 eligible patients, females with OHCA received less prehospital ACLS interventions than males: risk difference, (95% CIs) -2.76 (-3.41;-2.11) for AAM, -6.03 (-6.79;-5.27) for IV, and -3.81 (-4.37;-3.25) for EPI. In multivariable logistic regression analysis, female sex was significantly associated with a lower probability of prehospital ACLS provision: AOR, (95% CIs) 0.87 (0.84-0.91) for AAM, 0.85 (0.82-0.88) for IV, and 0.81 (0.77-0.84) for EPI. CONCLUSION Compared to male patients, female patients were less likely to receive prehospital ACLS. This offers opportunities for EMS systems to reduce disparities and to improve compliance with OHCA resuscitation guidelines and outcomes through quality improvement and educational interventions.
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Affiliation(s)
- Hanna Yoon
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ki Hong Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Joo Jeong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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12
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Hosomi S, Zha L, Kiyohara K, Kitamura T, Irisawa T, Ogura H, Oda J. Sex disparities in prehospital advanced cardiac life support in out-of-hospital cardiac arrests in Japan. Am J Emerg Med 2023; 64:67-73. [PMID: 36442266 DOI: 10.1016/j.ajem.2022.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Sex disparities in out-of-hospital cardiac arrest (OHCA) care processes have been reported. This study aimed to investigate the association between sex and prehospital advanced cardiac life support (ACLS) interventions provided by emergency medical services in Japan. METHODS We analyzed data from January 1, 2013, to December 31, 2020, from the All-Japan Utstein Registry of patients with OHCA aged ≥18 years who were resuscitated by bystanders. The primary outcomes were prehospital ACLS interventions, including advanced airway management (AAM) and epinephrine administration. Sex-based disparities in receiving prehospital ACLS interventions were assessed via multivariable logistic regression analyses. RESULTS Among 314,460 eligible patients, females with OHCA received fewer prehospital ACLS interventions than males: 83,571/187,834 (44.5%) males vs. 55,086/126,626 (43.5%) females (adjusted odds ratio [AOR] = 0.94, 95% confidence interval [CI] = 0.93-0.96) for AAM and 60,097/187,834 (32.0%) males vs. 35,501/126,626 (28.0%) females (AOR = 0.84, 95% CI = 0.83-0.85) for epinephrine administration. Similar results were also obtained in the subgroup analysis (groups included patients aged 18-74 years and ≥75 years and those with cardiac origin, ventricular fibrillation (VF), non-VF, non-family member witnessed, and family member witnessed). CONCLUSION Compared with males, females were less likely to receive prehospital ACLS. Emergency medical service staff must be made aware of this disparity, and off-the-job training on intravenous cannulation or AAM replacement must be conducted. Investigation of the impact of sex disparity on OHCA care processes can facilitate planning of future public health policies to improve survival outcomes.
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Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan; Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Japan.
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan.
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan
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13
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Kwak J, Ok Ahn K, Chan PS. Sex difference in the association between type of bystander CPR and clinical outcomes in patients with out of hospital cardiac arrest. Resusc Plus 2022; 13:100342. [PMID: 36593881 PMCID: PMC9803815 DOI: 10.1016/j.resplu.2022.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background A recent study suggested that women with out-of-hospital cardiac arrest have a smaller survival benefit with bystander cardiopulmonary resuscitation than men. We evaluated whether this weaker association between bystander cardiopulmonary resuscitation and survival in women is related to dispatcher-assisted vs unassisted bystander cardiopulmonary resuscitation. Methods In a national registry in the Republic of Korea, we identified adult patients with out-of-hospital cardiac arrest during 2013-2018. The main exposure was type of bystander cardiopulmonary resuscitation (categorized as none, dispatcher-assisted, and unassisted). The primary outcome was favourable neurological survival. Multivariable logistic regression evaluated for an interaction between sex and type of bystander cardiopulmonary resuscitation. Results Of 93,245 patients with out-of-hospital cardiac arrest, there were 31,578 (33.9%) women and 61,667 (66.1%) men. Overall, both types of bystander cardiopulmonary resuscitation were associated with favourable neurological survival (unassisted: adjusted OR, 1.81 [95% CI: 1.66-1.98]; dispatcher-assisted: adjusted OR, 1.44 [95% CI: 1.33-1.56]). When unassisted cardiopulmonary resuscitation was administered, the association between bystander cardiopulmonary resuscitation and favourable neurological survival was similar between women and men: adjusted ORs of 1.59 (95% CI: 1.30-1.95) in women and 1.88 (95% CI: 1.71-2.08) in men; interaction p = 0.65). In contrast, when dispatcher-assisted cardiopulmonary resuscitation was administered, the association differed by sex: adjusted ORs of 1.08 (95% CI: 0.90-1.92) in women and 1.55 (95% CI: 1.42-1.69) in men; interaction p < 0.0002). Conclusions Dispatcher-assisted cardiopulmonary resuscitation was associated with favourable neurological survival in men but not in women whereas unassisted bystander cardiopulmonary resuscitation was associated with favourable neurological survival in women and men.
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Affiliation(s)
- Junyoung Kwak
- Department of Emergency Medicine, Myongji Hospital and Hanyang University College of Medicine, Goyang-si, South Korea
| | - Ki Ok Ahn
- Department of Emergency Medicine, Myongji Hospital and Hanyang University College of Medicine, Goyang-si, South Korea,Corresponding author at: 679-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, Gyeonggi-Do 412-270, South Korea.
| | - Paul S. Chan
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, MO, USA
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14
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Ahmed F, Khan UR, Soomar SM, Raheem A, Naeem R, Naveed A, Razzak JA, Khan NU. Acceptability of telephone-cardiopulmonary resuscitation (T-CPR) practice in a resource-limited country- a cross-sectional study. BMC Emerg Med 2022; 22:139. [PMID: 35918647 PMCID: PMC9347158 DOI: 10.1186/s12873-022-00690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND T-CPR has been shown to increase bystander CPR rates dramatically and is associated with improved patient survival. OBJECTIVE To evaluate the acceptability of T-CPR by the bystanders and identify baseline quality measures of T-CPR in Karachi, Pakistan. METHODS A cross-sectional study was conducted from January to December 2018 at the Aman foundation command and control center. Data was collected from audiotaped phone calls of patients who required assistance from the Aman ambulance and on whom the EMS telecommunicator recognized the need for CPR and provided instructions. Information was recorded using a structured questionnaire on demographics, the status of the patient, and different time variables involved in CPR performance. A One-way ANOVA was used to compare different time variables with recommended AHA guidelines. P-value ≤ 0.05 was considered significant. RESULTS There were 481 audiotaped calls in which CPR instruction was given, listened to, and recorded data. Out of which in 459(95.4%) of cases CPR was attempted Majority of the patients were males (n = 278; 57.8%) and most had witnessed cardiac arrest (n = 470; 97.7%) at home (n = 430; 89.3%). The mean time to recognize the need for CPR by an EMS telecommunicator was 4:59 ± 1:59(min), while the mean time to start CPR instruction by a bystander was 5:28 ± 2:24(min). The mean time to start chest compression was 6:04 ± 1:52(min.). CONCLUSION Our results show the high acceptability of T-CPR by bystanders. We also found considerable delays in recognizing cardiac arrest and initiation of CPR by telecommunicators. Further training of telecommunicators could reduce these delays.
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Affiliation(s)
- Fareed Ahmed
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Abid Naveed
- Sindh Rescue & Medical Services, Karachi, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.,Emergency Medicine, Weill Cornell Medicine, New York City, USA
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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15
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Factors Influencing Self-Confidence and Willingness to Perform Cardiopulmonary Resuscitation among Working Adults-A Quasi-Experimental Study in a Training Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148334. [PMID: 35886184 PMCID: PMC9322983 DOI: 10.3390/ijerph19148334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
Background: There is a potential relationship between the self-confidence and the willingness of bystanders to undertake resuscitation (CPR) and its training. The current guidelines increasingly focus on both the importance of the human factor and the fact that training programs should increase the willingness of bystanders to undertake resuscitation, which may have a direct impact on improving survival in out-of-hospital cardiac arrest (OHCA). Aim: The objective of the study was to analyze factors influencing the assessment of own skills crucial in basic life support (BLS) and the willingness to provide CPR to individual victims. Methods: A pre-test and post-test quasi-experimental design was used in this study. The data was collected from 4 December 2019 to 3 October 2020 in workplaces, during instructor-led BLS courses. Each intervention (training) consisted of a theoretical and a practical part. The program was focused both on the skills and the human factor. Results: Comparison of pre-test and post-test data concerning self-confidence scores of the ability to recognize OHCA among 967 participants demonstrated a significant difference (respectively, Me = 2.2, IQR [2−3] vs. Me = 3.4, IQR [3−4]; p = 0.000). Additionally, self-assessment scores for the ability to perform proper chest compressions between pre-test and post-test also differed significantly (respectively Me = 2.3, IQR [2−3] vs. Me = 3.3, IQR [3−4]; p = 0.000). A highly significant difference was found in the likelihood of changing the decision in favor of the willingness to undertake CPR for all types of victims, with the greatest difference found in relation to the willingness to conduct resuscitation on strangers (OR = 7.67, 95% CI 5.01−11.73; p < 0.01). Conclusions: Completing hands-on training has a highly significant, beneficial effect on the readiness to undertake resuscitation for all types of victims, strangers in particular. Training programs should place particular emphasis on developing readiness to undertake resuscitation for both those who have never been trained and those who had their last training more than one year ago.
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Abstract
PURPOSE OF REVIEW Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency in which a rapid response following the chain of survival is crucial to save life. Disparities in care can occur at each link in this pathway and hence produce health inequities. This review summarises the health inequities that exist for OHCA patients and suggests how they may be addressed. RECENT FINDINGS There is international evidence that the incidence of OHCA is increased with increasing deprivation and in ethnic minorities. These groups have lower rates of bystander CPR and bystander-initiated defibrillation, which may be due to barriers in accessing cardiopulmonary resuscitation training, provision of public access defibrillators, and language barriers with emergency call handlers. There are also disparities in the ambulance response and in-hospital care following resuscitation. These disadvantaged communities have poorer survival following OHCA. SUMMARY OHCA disproportionately affects deprived communities and ethnic minorities. These groups experience disparities in care throughout the chain of survival and this appears to translate into poorer outcomes. Addressing these inequities will require coordinated action that engages with disadvantaged communities.
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17
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Shida H, Nishiyama C, Okabayashi S, Yamamoto Y, Shimamoto T, Kawamura T, Sakamoto T, Iwami T. Laypersons' Psychological Barriers Against Rescue Actions in Emergency Situations - A Questionnaire Survey. Circ J 2022; 86:679-686. [PMID: 34759132 DOI: 10.1253/circj.cj-21-0341] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although bystanders' performance is important to improve outcomes of patients after cardiac arrests, few studies have investigated the barriers of bystanders, including those who could not perform cardiopulmonary resuscitation or any other rescue actions in emergency situations. This study aimed to assess the relationship between the psychological barriers of laypersons who encountered emergency situations and their rescue actions. METHODS AND RESULTS A questionnaire survey was conducted and this included laypersons who had encountered emergency situations during the last 5 years. Six questions were about the psychological barriers and 8 questions were about the laypersons' rescue actions. The primary outcome was any rescue actions performed by laypersons in an actual emergency situation. Overall, 7,827 (92.8%) of 8,430 laypersons responded; of them, 1,361 (16.1%) had encountered emergency situations during the last 5 years, and 1,220 (14.5%) were eligible for inclusion in the analyses. Of the 6 psychological barriers, "fear of approaching a collapsed person" (adjusted odds ratio [AOR] 0.50; 95% confidence interval [95% CI] 0.32-0.79) and "difficulties in judging whether to perform any rescue action" (AOR 0.63; 95% CI 0.40-0.99) were significantly associated with performing any rescue actions. CONCLUSIONS The fear of approaching a collapsed person and difficulties in judging whether to take any actions were identified as the psychological barriers in performing any rescue actions by laypersons who encountered emergency situations.
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Affiliation(s)
- Haruka Shida
- Department of Preventive Services, School of Public Health in the Graduate School of Medicine, Kyoto University
| | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science
| | | | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University
| | | | | | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine
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18
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Sex-related disparities in the in-hospital management of patients with out-of-hospital cardiac arrest. Resuscitation 2022; 173:47-55. [DOI: 10.1016/j.resuscitation.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/29/2022] [Accepted: 02/05/2022] [Indexed: 11/17/2022]
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19
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Liu N, Ning Y, Ong MEH, Saffari SE, Ryu HH, Kajino K, Lin CH, Karim SA, Rao GR, Ho AFW, Lim SL, Siddiqui FJ. Gender disparities among adult recipients of layperson bystander cardiopulmonary resuscitation by location of cardiac arrest in Pan-Asian communities: A registry-based study. EClinicalMedicine 2022; 44:101293. [PMID: 35198919 PMCID: PMC8850341 DOI: 10.1016/j.eclinm.2022.101293] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (BCPR) is a critical component of the 'chain of survival' in reducing mortality among out-of-hospital cardiac arrest (OHCA) victims. Inconsistent findings on gender disparities among adult recipients of layperson BCPR have been reported in the literature. We aimed to fill this knowledge gap by investigating the extent of gender disparities in a cross-national setting within Pan-Asian communities. METHODS We utilised data collected from the Pan-Asian Resuscitation Outcomes Study (PAROS), an international, multicentre, prospective study conducted between 2009 and 2018. We included all OHCA cases with non-traumatic arrest aetiology transported by emergency medical services and excluded study sites that did not consistently collect information about the location of cardiac arrest. Logistic regression was used to analyse the association between gender and BCPR, stratified by location. FINDINGS We analysed a cohort of 56,192 OHCA cases with an overall BCPR rate of 36.2% (20,329/56,192). At public locations, the BCPR rate was 31.2% (631/2022) for female and 36.4% (3235/8892) for male OHCA victims; while at home, the rate was 38.3% (6838/17,842) for females and 35.1% (9625/27,436) for males. Controlling for site differences and several factors in multivariable logistic regression, we found females less likely to receive BCPR than males in public locations (odds ratio [OR]=0.89, 95% confidence interval [CI]: 0.70-0.99), but more likely to receive BCPR at home (OR=1.16, 95% CI: 1.11-1.21). INTERPRETATION In Pan-Asian communities, gender differences exist in adult recipients of BCPR and differ between home and public locations. Future studies should account for additional information on bystanders and societal factors to identify targets for interventions. FUNDING The study was supported by grants from the National Medical Research Council (NMRC/CSA/0049/2013) and Laerdal Foundation (20040).
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Affiliation(s)
- Nan Liu
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore, Singapore
- Corresponding author at: Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
| | - Yilin Ning
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Seyed Ehsan Saffari
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Moriguchi, Osaka, Japan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sarah Abdul Karim
- Department of Emergency Medicine, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia
| | - G.V. Ramana Rao
- GVK Emergency Management and Research Institute (GVK EMRI), Secunderabad, Telangana, India
| | - Andrew Fu Wah Ho
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
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Butters A, Arnott C, Sweeting J, Winkel BG, Semsarian C, Ingles J. Sex Disparities in Sudden Cardiac Death. Circ Arrhythm Electrophysiol 2021; 14:e009834. [PMID: 34397259 DOI: 10.1161/circep.121.009834] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The overall incidence of sudden cardiac death is considerably lower among women than men, reflecting significant and often under-recognized sex differences. Women are older at time of sudden cardiac death, less likely to have a prior cardiac diagnosis, and less likely to have coronary artery disease identified on postmortem examination. They are more likely to experience their death at home, during sleep, and less likely witnessed. Women are also more likely to present in pulseless electrical activity or systole rather than ventricular fibrillation or ventricular tachycardia. Conversely, women are less likely to receive bystander cardiopulmonary resuscitation or receive cardiac intervention post-arrest. Underpinning sex disparities in sudden cardiac death is a paucity of women recruited to clinical trials, coupled with an overall lack of prespecified sex-disaggregated evidence. Thus, predominantly male-derived data form the basis of clinical guidelines. This review outlines the critical sex differences concerning epidemiology, cause, risk factors, prevention, and outcomes. We propose 4 broad areas of importance to consider: physiological, personal, community, and professional factors.
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Affiliation(s)
- Alexandra Butters
- Cardio Genomics Program at Centenary Institute (A.B., J.I.), The University of Sydney.,Faculty of Medicine and Health (A.B., C.S., J.I.), The University of Sydney
| | - Clare Arnott
- Department of Cardiology, Royal Prince Alfred Hospital (C.A., C.S., J.I.), Sydney, Australia.,The George Institute for Global Health (C.A.), Sydney, Australia
| | | | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Denmark (B.G.W.)
| | - Christopher Semsarian
- Faculty of Medicine and Health (A.B., C.S., J.I.), The University of Sydney.,Agnes Ginges Centre for Molecular Cardiology at Centenary Institute (C.S.), The University of Sydney.,Department of Cardiology, Royal Prince Alfred Hospital (C.A., C.S., J.I.), Sydney, Australia
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute (A.B., J.I.), The University of Sydney.,Faculty of Medicine and Health (A.B., C.S., J.I.), The University of Sydney.,Department of Cardiology, Royal Prince Alfred Hospital (C.A., C.S., J.I.), Sydney, Australia
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21
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Vogelsong MA, May T, Agarwal S, Cronberg T, Dankiewicz J, Dupont A, Friberg H, Hand R, McPherson J, Mlynash M, Mooney M, Nielsen N, O'Riordan A, Patel N, Riker RR, Seder DB, Soreide E, Stammet P, Xiong W, Hirsch KG. Influence of sex on survival, neurologic outcomes, and neurodiagnostic testing after out-of-hospital cardiac arrest. Resuscitation 2021; 167:66-75. [PMID: 34363853 DOI: 10.1016/j.resuscitation.2021.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/18/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
AIM Previous studies evaluating the relationship between sex and post-resuscitation care and outcomes following out-of-hospital cardiac arrest (OHCA) are conflicting. We investigated the association between sex and outcomes as well as neurodiagnostic testing in a prospective multicenter international registry of patients admitted to intensive care units following OHCA. METHODS OHCA survivors enrolled in the International Cardiac Arrest Registry (INTCAR) from 2012-2017 were included. We assessed the independent association between sex and survival to hospital discharge, good neurologic outcome (Cerebral Performance Category 1 or 2), neurodiagnostic testing, and withdrawal of life-sustaining therapy (WLST). RESULTS Of 2,407 eligible patients, 809 (33.6%) were women. Baseline characteristics differed by sex, with less bystander CPR and initial shockable rhythms among women. Women were less likely to survive to hospital discharge, however significance abated following adjusted analysis (30.1% vs 42.7%, adjusted OR 0.85, 95% CI 0.67-1.08). Women were less likely to have good neurologic outcome at discharge (21.4% vs 34.0%, adjusted OR 0.74, 95% CI 0.57-0.96) and at six months post-arrest (16.7% vs 29.4%, adjusted OR 0.73, 95% CI 0.54-0.98) that persisted after adjustment. Neuroimaging (75.5% vs 74.3%, p=0.54) and other neurophysiologic testing (78.8% vs 78.6%, p=0.91) was similar across sex. Women were more likely to undergo WLST (55.6% vs 42.8%, adjusted OR 1.35, 95% CI 1.09-1.66). CONCLUSIONS Women with cardiac arrest have lower odds of good neurologic outcomes and higher odds of WLST, despite comparable rates of neurodiagnostic testing and after controlling for baseline differences in clinical characteristics and cardiac arrest features.
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Affiliation(s)
- Melissa A Vogelsong
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States.
| | - Teresa May
- Department of Critical Care Services, Maine Medical Center, Portland, ME, United States
| | - Sachin Agarwal
- Department of Neurology, Columbia University Medical Center/New York Presbyterian Hospital, New York City, NY, United States Tobias Cronberg - Department of Clinical Sciences, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Josef Dankiewicz
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Allison Dupont
- Department of Cardiology, Northside Cardiovascular Institute, Atlanta, GA, United States
| | - Hans Friberg
- Department of Clinical Sciences, Intensive and Perioperative Care, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - John McPherson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Michael Mlynash
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael Mooney
- Department of Cardiology, Minneapolis Heart Institute, Abbot North-Western Hospital, Minneapolis, MN, United States
| | - Niklas Nielsen
- Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Andrea O'Riordan
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Nainesh Patel
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, United States
| | - Richard R Riker
- Department of Critical Care Services, Maine Medical Center, Portland, ME, United States
| | - David B Seder
- Department of Critical Care Services, Maine Medical Center, Portland, ME, United States
| | - Eldar Soreide
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway, Department Clinical Medicine, University of Bergen, Bergen, Norway
| | - Pascal Stammet
- Medical and Health Department, Luxembourg Fire and Rescue Corps, Luxembourg, Luxembourg
| | - Wei Xiong
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Karen G Hirsch
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
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22
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Ko SY, Ahn KO, Do Shin S, Park JH, Lee SY. Effects of telephone-assisted cardiopulmonary resuscitation on the sex disparity in provision of bystander cardiopulmonary resuscitation in public locations. Resuscitation 2021; 164:101-107. [PMID: 33774152 DOI: 10.1016/j.resuscitation.2021.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Telephone-assisted cardiopulmonary resuscitation (TA-CPR) is an effective community intervention to increase bystander CPR rates. This study evaluated the effect of TA-CPR on the provision of bystander CPR as a function of the patient's sex. METHODS Adult (aged ≥ 18 years) patients who collapsed in a public location between January 2013 and December 2017 and received emergency medical service (EMS) treatment for out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology were included in the study. The main exposures were TA-CPR and the patients' sex. The primary outcome was the implementation of bystander CPR by laypersons. Multivariable logistic regression analysis was conducted, stratified based on the provision of TA-CPR, to examine the effect on bystander CPR according to patient sex. RESULTS In the final analysis, 15,840 patients with OHCAs were included. Patients who received TA-CPR accounted for 32.6% (5167/15,840) of the sample. Overall, 84.4% (814/964) of the women and 86.9% (3653/4203) of the men received bystander CPR in the TA-CPR group (P < 0.001). In the non-TA-CPR group, 40.5% (912/2252) of women and 47.3% (3653/8421) of men received bystander CPR (P < 0.001). In the multivariable logistic regression analysis, there was no significant difference in the odds ratio (OR) of bystander CPR according to patient sex in the TA-CPR group (adjusted OR [AOR], 0.83; 95% confidence interval [CI], 0.68-1.01). Women were less likely to receive bystander CPR if the bystanders are not directed by TA-CPR (AOR: 0.79; 95% CI, 0.70-0.87). CONCLUSIONS TA-CPR attenuated the sex disparity in bystander CPR provided in public places.
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Affiliation(s)
- Seo Young Ko
- Department of Emergency Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju-si, Republic of Korea.
| | - Ki Ok Ahn
- Department of Emergency Medicine, MyongjiHospital, Hanyang University College of Medicine, Goyang, Republic of Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Sun Young Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea.
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23
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Matsuyama T, Scapigliati A, Pellis T, Greif R, Iwami T. Willingness to perform bystander cardiopulmonary resuscitation: A scoping review. Resusc Plus 2020; 4:100043. [PMID: 34223318 PMCID: PMC8244432 DOI: 10.1016/j.resplu.2020.100043] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
Background Despite the proven effectiveness of rapid initiation of cardiopulmonary resuscitation (CPR) for patients with out-of-hospital cardiac arrest (OHCA) by bystanders, fewer than half of the victims actually receive bystander CPR. We aimed to review the evidence of the barriers and facilitators for bystanders to perform CPR. Methods This scoping review was conducted as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. This review included studies assessing barriers or facilitators for the lay rescuers to perform CPR in actual emergency settings and excluded studies that overlapped with other ILCOR systematic reviews/scoping reviews (e.g. dispatcher instructed CPR etc). The key findings were classified into three kinds of factors: personal factors; CPR knowledge; and procedural issues. Results We identified 18 eligible studies. Of these studies addressing the reduced willingness to respond to cardiac arrest, 14 related to "personal factors", 3 to "CPR knowledge", and 2 to "procedural issues". On the other hand, we identified 5 articles assessing factors increasing bystanders' willingness to perform CPR. However, we observed significant heterogeneity among study populations, methodologies, factors definitions, outcome measures utilized and outcomes reported. Conclusions We found that a number of factors were present in actual settings which either inhibit or facilitate lay rescuers' performance of CPR. Interventional strategies to improve CPR performance of lay rescuers in the actual settings should be established, taking these factors into consideration.
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Affiliation(s)
- Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Andrea Scapigliati
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Robert Greif
- Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland.,Medical Education, School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
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24
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S222-S283. [PMID: 33084395 DOI: 10.1161/cir.0000000000000896] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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25
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Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham BL, Blewer AL, Dainty KN, Diederich E, Lin Y, Leary M, Mahgoub M, Mancini ME, Navarro K, Donoghue A. Part 6: Resuscitation Education Science: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S551-S579. [PMID: 33081527 DOI: 10.1161/cir.0000000000000903] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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26
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC, Baldi E, Beck S, Beckers SK, Blewer AL, Boulton A, Cheng-Heng L, Yang CW, Coppola A, Dainty KN, Damjanovic D, Djärv T, Donoghue A, Georgiou M, Gunson I, Krob JL, Kuzovlev A, Ko YC, Leary M, Lin Y, Mancini ME, Matsuyama T, Navarro K, Nehme Z, Orkin AM, Pellis T, Pflanzl-Knizacek L, Pisapia L, Saviani M, Sawyer T, Scapigliati A, Schnaubelt S, Scholefield B, Semeraro F, Shammet S, Smyth MA, Ward A, Zace D. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A188-A239. [PMID: 33098918 DOI: 10.1016/j.resuscitation.2020.09.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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27
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Matsuyama T, Komukai S, Izawa J, Gibo K, Okubo M, Kiyohara K, Kiguchi T, Iwami T, Ohta B, Kitamura T. Pre-Hospital Administration of Epinephrine in Pediatric Patients With Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol 2020; 75:194-204. [PMID: 31948649 DOI: 10.1016/j.jacc.2019.10.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND There is little evidence about pre-hospital advanced life support including epinephrine administration for pediatric out-of-hospital cardiac arrests (OHCAs). OBJECTIVES This study aimed to assess the effect of pre-hospital epinephrine administration by emergency-medical-service (EMS) personnel for pediatric OHCA. METHODS This nationwide population-based observational study in Japan enrolled pediatric patients age 8 to 17 years with OHCA between January 2007 and December 2016. Patients were sequentially matched with or without epinephrine during cardiac arrest using a risk-set matching based on time-dependent propensity score (probability of receiving epinephrine) calculated at each minute after initiation of cardiopulmonary resuscitation by EMS personnel. The primary endpoint was 1-month survival. Secondary endpoints were 1-month survival with favorable neurological outcome, defined as the cerebral performance category scale of 1 or 2, and pre-hospital return of spontaneous circulation (ROSC). RESULTS During the study period, a total of 1,214,658 OHCA patients were registered, and 3,961 pediatric OHCAs were eligible for analyses. Of these, 306 (7.7%) patients received epinephrine and 3,655 (92.3%) did not receive epinephrine. After time-dependent propensity score-sequential matching, 608 patients were included in the matched cohort. In the matched cohort, there were no significant differences between the epinephrine and no epinephrine groups in 1-month survival (epinephrine: 10.2% [31 of 304] vs. no epinephrine: 7.9% [24 of 304]; risk ratio [RR]: 1.13 [95% confidence interval (CI): 0.67 to 1.93]) and favorable neurological outcome (epinephrine: 3.6% [11 of 304] vs. no epinephrine: 2.6% [8 of 304]; RR: 1.56 [95% CI: 0.61 to 3.96]), whereas the epinephrine group had a higher likelihood of achieving pre-hospital ROSC (epinephrine: 11.2% [34 of 304] vs. no epinephrine: 3.3% [10 of 304]; RR: 3.17 [95% CI: 1.54 to 6.54]). CONCLUSIONS In this study, pre-hospital epinephrine administration was associated with ROSC, whereas there were no significant differences in 1-month survival and favorable neurological outcome between those with and without epinephrine.
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Affiliation(s)
- Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Junichi Izawa
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Koichiro Gibo
- Department of Emergency Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | | | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Services, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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28
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Shirakawa K, Kanao K, Saito Y, Doi K, Takuma K, Okamura T, Takebayashi T. Neurologically favourable outcomes of cardiogenic out-of-hospital cardiac arrest with relation to the type of witness in Japan. Resuscitation 2020; 152:97-104. [PMID: 32422239 DOI: 10.1016/j.resuscitation.2020.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/02/2020] [Accepted: 04/25/2020] [Indexed: 11/29/2022]
Abstract
AIM To assess the current situation and neurologically favourable outcomes after out-of-hospital cardiac arrest (OHCA) with respect to the type of witness. METHODS This retrospective observational study used data from the All-Japan Utstein Registry of the Fire and Disaster Management Agency collected between January 1, 2016, and December 31, 2016. Patients with cardiogenic OHCA aged ≥18 years who were witnessed by bystanders were included. The primary outcome measure was a neurologically favourable outcome 1 month after the OHCA. RESULTS Among the 123,554 patients with OHCA registered between January 1, 2016, and December 31, 2016, 24,856 patients were included. Of them, 15,139 were witnessed by family, and 9717 were witnessed by non-family (friends, 1306; colleagues, 951; passers-by, 997; others, 6463). When witnessed by family, the rate of neurologically favourable outcomes was significantly lower than that when witnessed by non-family (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.41-0.49, P < 0.001). After adjusting for potential confounders, the rate of neurologically favourable outcomes remained lower when OHCA was witnessed by family (OR = 0.88, 95% CI = 0.79-0.99, P = 0.03). However, in subgroup analysis, adjusted ORs for neurologically favourable outcomes were slightly greater for 65-84-year-old women and ≥85-year-old women with family witnesses than for those with non-family witnesses. For all other groups, non-family witnesses outperformed family witnesses. CONCLUSION Family-witnessed OHCA events had fewer neurologically favourable outcomes before and after adjusting for confounders. BLS education for family members may lead to improved prognosis of witnessed cardiogenic OHCAs.
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Affiliation(s)
- Kazuhiro Shirakawa
- Department of Emergency Medicine, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kanagawa 210-0013, Japan.
| | - Kunio Kanao
- Department of Emergency Medicine, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kanagawa 210-0013, Japan
| | - Yutaka Saito
- Department of Emergency Medicine, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kanagawa 210-0013, Japan
| | - Kenji Doi
- Department of Emergency Medicine, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kanagawa 210-0013, Japan
| | - Kiyotsugu Takuma
- Department of Emergency Medicine, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kanagawa 210-0013, Japan
| | - Tomonori Okamura
- Department of Emergency Medicine, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kanagawa 210-0013, Japan
| | - Toru Takebayashi
- Department of Emergency Medicine, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kanagawa 210-0013, Japan
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29
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Sato N, Matsuyama T, Kitamura T, Hirose Y. Disparities in Bystander Cardiopulmonary Resuscitation Performed by a Family Member and a Non-family Member. J Epidemiol 2020; 31:259-264. [PMID: 32307352 PMCID: PMC7940978 DOI: 10.2188/jea.je20200068] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Although bystander cardiopulmonary resuscitation (BCPR) plays an essential role in out-of-hospital cardiac arrest (OHCA) care, little is known about the bystander-patient relationship in the actual setting. This study aimed to assess the disparities in BCPR performed by a family member and that performed by a non-family member. Methods This population-based observational study involved all adult patients with witnessed OHCAs of medical origin in Niigata City, Japan, between January 2012 and December 2016, according to the Utstein style. We used logistic regression analysis to assess the association between the witnessing person and the probability of providing BCPR. Next, among those who received BCPR, we sought to investigate the difference between BCPR performed by family and that performed by non-family members in terms of whether those who witnessed the arrests actually performed BCPR. Results During the study period, 818 were eligible for this analysis, with 609 (74.4%) patients witnessed by family and 209 (25.6%) patients witnessed by non-family members. Multivariable logistic regression analysis showed that OHCA patients witnessed by family were less likely to receive BCPR compared to those witnessed by non-family members (260/609 [42.7%] versus 119/209 [56.9%], P = 0.017). Among the witnessed patients for whom BCPR was performed, the proportion of BCPR actually performed by a family member was lower than that performed by a non-family member (242/260 [93.1%] versus 116/119 [97.5%], P = 0.011). Conclusions In this community-based observational study, we found that a witnessing family member is less likely to perform BCPR than a witnessing non-family member.
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Affiliation(s)
- Nobuhiro Sato
- Department of Emergency and Critical Care Medicine, Niigata City General Hospital
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Services, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | - Yasuo Hirose
- Department of Emergency and Critical Care Medicine, Niigata City General Hospital
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30
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Kiyohara K, Katayama Y, Kitamura T, Kiguchi T, Matsuyama T, Ishida K, Sado J, Hirose T, Hayashida S, Nishiyama C, Iwami T, Shimazu T. Gender disparities in the application of public-access AED pads among OHCA patients in public locations. Resuscitation 2020; 150:60-64. [PMID: 32199903 DOI: 10.1016/j.resuscitation.2020.02.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/21/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Female out-of-hospital cardiac arrest (OHCA) patients have been reported to be less likely to receive cardiopulmonary resuscitation by bystanders compared with male patients in prehospital settings. However, no clinical studies have investigated gender disparities in the application of public-access automated external defibrillator (AED) pads among OHCA patients in public locations. METHODS OHCA data from 2011 to 2018 were obtained from the OHCA registry in Osaka City, Japan and OHCAs that occurred in public locations were included. Gender differences in receiving public-access AED pad application by bystanders were assessed according to the age of the OHCA patient (<15, 15-49, 50-74, and ≥75 years) after controlling confounders. RESULTS The analysis included 4358 OHCA patients (3313 male and 1045 female patients). The multivariable logistic regression analyses found no significant gender differences in the likelihood of public-access AED pad application among patients aged <15 years (5.3% in male patients vs 6.3% in female patients; adjusted OR = 1.00, p = 1.000), 50-74 years (16.8% vs 12.7%; adjusted OR = 0.96, p = 0.796), and ≥75 years (12.3% vs 14.8%; adjusted OR = 1.45, p = 0.098). In contrast, among patients aged 15-49 years, female patients were significantly less likely to receive public-access AED pad application compared with male patients (12.1% vs 5.2%; adjusted OR = 0.54, p = 0.032). CONCLUSION In this population, female OHCA patients of reproductive age (15-49 years) were less likely to receive public-access AED pad application compared with male patients of the same age group.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan.
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Junya Sado
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | - Taku Iwami
- Kyoto University Health Services, Kyoto, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Public access defibrillators: Gender-based inequities in access and application. Resuscitation 2020; 150:17-22. [PMID: 32126247 DOI: 10.1016/j.resuscitation.2020.02.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 11/22/2022]
Abstract
AIM While public access automated external defibrillator (AED) programs appear to improve outcomes in out-of-hospital cardiac arrest (OHCA) it is unclear if men and women benefit equally. We examined gender-based differences in OHCA location to determine what proportion were potentially eligible for public access AED application, and if patient gender was associated with AED utilization. METHODS We analyzed data from the Resuscitation Outcomes Consortium registry (2011-2015). We compared differences in OHCA locations by gender. We fit multivariate logistic regression models, restricted to public location OHCAs and public-location cases with bystander intervention, to calculate the association between gender and public access AED application. RESULTS Among 61 473 cases, 34% were female and 50% had bystander resuscitation. The incidence of public OHCA was 8.8% for women and 18% for men (risk difference 9.2%, 95% CI 8.7-9.7%). Women had significantly fewer OHCAs on roadways, in public buildings, places of recreation, and farms, but more in homes, non-acute healthcare facilities, and residential institutions. Female gender was associated with a lower odds of AED application in public OHCA (adjusted OR 0.76, 95% CI 0.64-0.90) and public-location cases with bystander interventions (adjusted OR 0.83, 95% CI 0.71-0.99). CONCLUSION Women had fewer OHCA in public locations that may have public access AEDs. Even among public location OHCA with bystander interventions, women were less likely to have public access AED applied. Initiatives to optimize AED locations and to engage the public with gender-specific resuscitation training may improve outcomes in women with OHCA.
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Sawyer KN. Reintegration & recovery after surviving cardiac arrest: Learning from the VACAR registry. Resuscitation 2020; 146:255-257. [DOI: 10.1016/j.resuscitation.2019.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 11/25/2022]
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Jentzer JC, Best PJM, White RD. Sex-Based Disparities in Cardiac Arrest Care: Time to Do Better! Mayo Clin Proc 2019; 94:561-563. [PMID: 30947826 DOI: 10.1016/j.mayocp.2019.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/25/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | | | - Roger D White
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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