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Allan KS, Mammarella B, Visanji M, Moglica E, Sadeghlo N, O'Neil E, Chan TT, Kishibe T, Aves T. Methods to teach schoolchildren how to perform and retain cardiopulmonary resuscitation (CPR) skills: A systematic review and meta-analysis. Resusc Plus 2023; 15:100439. [PMID: 37638097 PMCID: PMC10448218 DOI: 10.1016/j.resplu.2023.100439] [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: 06/05/2023] [Revised: 07/11/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023] Open
Abstract
Background Worldwide, bystander CPR rates are low; one effective way to increase these rates is to train schoolchildren; however, the most effective way to train them is currently unknown. Methods This systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies, evaluated whether CPR training for schoolchildren, using innovative teaching modalities (nonpractical, self, or peer-training) versus standard instructor-led training, resulted in higher quality CPR, self-confidence and short-term (≤3 months post-training) or long-term (>3 months post-training) retention of CPR skills. Results From 9793 citations, 96 studies published between 1975 and 2022 (44 RCTs and 52 before/after studies) were included. There were 43,754 students, average age of 11.5 ± 0.9 (range 5.9-17.6) and 49.2% male. Only 13 RCTs compared practical vs. nonpractical training (n = 5), self- vs. instructor-led training (n = 7) or peer- vs. instructor-led training (n = 5). The observed statistically significant differences in mean depth and rate of compressions between children with hands-on practical training and those without were not clinically relevant. Regardless of training modality, compression depth was consistently suboptimal. No differences were observed in CPR skills immediately or ≤ 3 months post-training, between children who were self- or peer-trained vs. instructor-led. Due to lack of data, we were unable to evaluate the impact of these novel training modalities on student self-confidence. Conclusion Although innovative training modalities are equally effective to instructor-led training when teaching schoolchildren CPR, compression depth was frequently suboptimal. Recommendations on standardized training and evaluation methods are necessary to understand the best ways to train children.
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Affiliation(s)
- Katherine S. Allan
- Division of Cardiology, Unity Health Toronto - St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Bianca Mammarella
- School of Interdisciplinary Science, McMaster University, Hamilton, Ontario, Canada
- Department of Biology, McMaster University, Hamilton, Ontario, Canada
| | - Mika'il Visanji
- Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Erinda Moglica
- Department of Chemical Engineering, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Negin Sadeghlo
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Emma O'Neil
- Division of Emergency Medicine, Unity Health Toronto - St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Tiffany T. Chan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Teruko Kishibe
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | - Theresa Aves
- Division of Cardiology, Unity Health Toronto - St. Michael’s Hospital, Toronto, Ontario, Canada
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Almiro A, AlQassab O, Alzeidan R, Binhaddab AS, Alkhorisi AM, Almalki HA, Ghouthalsayd MA, Kashour T, Hersi A, Alqarawi W. Characteristics of out-of-hospital cardiac arrest patients in Riyadh province, Saudi Arabia: a cross-sectional study. Front Cardiovasc Med 2023; 10:1192795. [PMID: 37283580 PMCID: PMC10239974 DOI: 10.3389/fcvm.2023.1192795] [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: 03/23/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Little work has been done on out-of-hospital cardiac arrest (OHCA) in Saudi Arabia. Our goal is to report the characteristics of OHCA patients and predictors of bystander cardiopulmonary resuscitation (CPR). Materials and methods This cross-sectional study utilized data from the Saudi Red Crescent Authority (SRCA), a governmental emergency medical service (EMS). A standardized data collection form based on the "Utstein-style" guidelines was developed. Data were retrieved from the electronic patient care reports that SRCA providers fill out for every case. OHCA cases that were attended by SRCA in Riyadh province between June 1st, 2020 and May 31st, 2021 were included. Multivariate regression analysis was performed to assess independent predictors of bystander CPR. Results A total of 1,023 OHCA cases were included. The mean age was 57.2 (±22.6). 95.7% (979/1,023) of cases were adults and 65.2% (667/1,023) were males. Home was the most common location of OHCA [784/1,011 (77.5%)]. The initial recorded rhythm was shockable in 131/742 (17.7%). The EMS mean response time was 15.9 min (±11.1). Bystander CPR was performed in 130/1,023 (12.7%) and was more commonly performed in children as compared to adults [12/44 (27.3%) vs. 118/979 (12.1%), p = 0.003]. Independent predictors of bystander CPR were being a child (OR = 3.26, 95% CI [1.21-8.82], p = 0.02) and having OHCA in a healthcare institution (OR = 6.35, 95% CI [2.15-18.72], p = 0.001). Conclusion Our study reported the characteristics of OHCA cases in Saudi Arabia using EMS data. We observed young age at presentation, low rates of bystander CPR, and long response time. These characteristics are distinctly different from other countries and call for urgent attention to OHCA care in Saudi Arabia. Lastly, being a child and having OHCA in a healthcare institution were found to be independent predictors of bystander CPR.
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Affiliation(s)
- Alyaman Almiro
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Osamah AlQassab
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rasmieh Alzeidan
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Ahmad M. Alkhorisi
- Operation Center, Public Health Agency, Saudi Ministry of Health, Riyadh, Saudi Arabia
| | - Hani A Almalki
- Operation Center, Public Health Agency, Saudi Ministry of Health, Riyadh, Saudi Arabia
| | | | - Tarek Kashour
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Hersi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wael Alqarawi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
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Farquharson B, Dixon D, Williams B, Torrens C, Philpott M, Laidlaw H, McDermott S. The psychological and behavioural factors associated with laypeople initiating CPR for out-of-hospital cardiac arrest: a systematic review. BMC Cardiovasc Disord 2023; 23:19. [PMID: 36639764 PMCID: PMC9840280 DOI: 10.1186/s12872-022-02904-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/17/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Prompt, effective CPR greatly increases the chances of survival in out-of-hospital c ardiac arrest. However, it is often not provided, even by people who have previously undertaken training. Psychological and behavioural factors are likely to be important in relation to CPR initiation by lay-people but have not yet been systematically identified. METHODS Aim: to identify the psychological and behavioural factors associated with CPR initiation amongst lay-people. DESIGN Systematic review Data sources: Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo and Google Scholar. STUDY ELIGIBILITY CRITERIA Primary studies reporting psychological or behavioural factors and data on CPR initiation involving lay-people published (inception to 31 Dec 2021). STUDY APPRAISAL AND SYNTHESIS METHODS Potential studies were screened independently by two reviewers. Study characteristics, psychological and behavioural factors associated with CPR initiation were extracted from included studies, categorised by study type and synthesised narratively. RESULTS One hundred and five studies (150,820 participants) comprising various designs, populations and of mostly weak quality were identified. The strongest and most ecologically valid studies identified factors associated with CPR initiation: the overwhelming emotion of the situation, perceptions of capability, uncertainty about when CPR is appropriate, feeling unprepared and fear of doing harm. Current evidence comprises mainly atheoretical cross-sectional surveys using unvalidated measures with relatively little formal testing of relationships between proposed variables and CPR initiation. CONCLUSIONS Preparing people to manage strong emotions and increasing their perceptions of capability are likely important foci for interventions aiming to increase CPR initiation. The literature in this area would benefit from more robust study designs. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42018117438.
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Affiliation(s)
- Barbara Farquharson
- grid.11918.300000 0001 2248 4331NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
| | - Diane Dixon
- grid.7107.10000 0004 1936 7291University of Aberdeen, Aberdeen, UK
| | - Brian Williams
- grid.23378.3d0000 0001 2189 1357University of Highlands and Islands, Inverness, UK
| | - Claire Torrens
- grid.11918.300000 0001 2248 4331University of Stirling, Stirling, UK
| | - Melanie Philpott
- grid.11918.300000 0001 2248 4331University of Stirling, Stirling, UK
| | - Henriette Laidlaw
- grid.23378.3d0000 0001 2189 1357University of Highlands and Islands, Inverness, UK
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Charlton K, Scott J, Blair L, Scott S, McClelland G, Davidson T, Burrow E, Mason A. Public attitudes towards bystander CPR and their association with social deprivation: Findings from a cross sectional study in North England. Resusc Plus 2022; 12:100330. [PMID: 36407569 PMCID: PMC9672441 DOI: 10.1016/j.resplu.2022.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Bystander cardiopulmonary resuscitation (BCPR) is undertaken in only 40% of out of hospital cardiac arrests (OHCAs) in the UK. Lower rates of BCPR and public access defibrillator (PAD) use have been correlated with lower socio-economic status (SES). The aim of this study was to examine knowledge and attitudes towards BCPR and PAD's using a study specific questionnaire, and to understand how these potentially interact with individual characteristics and SES. Methods Cross-sectional study between July-December 2021 across areas of varying SES in North England. Results Six hundred and one individuals completed the survey instrument (mean age = 51.9 years, 52.2 % female). Increased age was associated with being less willing to call 999 (p < 0.001) and follow call handler advice (p < 0.001). Female respondents were less comfortable performing BCPR than male respondents (p = 0.006). Individuals from least deprived areas were less likely to report comfort performing CPR, (p = 0.016) and less likely to know what a PAD is for, (p = 0.025). Higher education level was associated with increased ability to recognise OHCA (p = 0.005) and understanding of what a PAD is for (p < 0.001). Individuals with higher income were more likely to state they would follow advice regarding BCPR (p = 0.017) and report comfort using a PAD (p = 0.029). Conclusion Individual characteristics such as age and ethnicity, rather than SES, are indicators of knowledge, willingness, and perceived competency to perform BCPR. Policy makers should avoid using SES alone to target interventions. Future research should examine how cultural identity and social cohesion intersect with these characteristics to influence willingness to perform BCPR.
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Affiliation(s)
- Karl Charlton
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
- Corresponding author.
| | - Jason Scott
- Northumbria University, Sutherland Building, Northumberland Road, Newcastle upon Tyne NE1 8ST, UK
| | - Laura Blair
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Stephanie Scott
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 4LP, UK
| | - Graham McClelland
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Tom Davidson
- Centre of Excellence in Paramedic Practice, Institute of Health, University of Cumbria, Fusehill Street, Carlisle CA1 2HH, UK
| | - Emma Burrow
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Alex Mason
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
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Farquharson B, Calveley E, Clegg G, Williams B, Ramsay P, Macinnes L, Torrens C, Dixon D. Increasing lay-people's intentions to initiate CPR in out of hospital cardiac arrest: Results of a mixed-methods 'before and after' pilot study of a behavioural text-message intervention (BICeP). Resusc Plus 2022; 12:100312. [PMID: 36238584 PMCID: PMC9551210 DOI: 10.1016/j.resplu.2022.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Prompt, effective cardio-pulmonary resuscitation (CPR) increases survival in out-of-hospital cardiac arrest. However, CPR is often not provided, even by people with training. Low confidence, perceptions of risks and high emotion can prevent initiation of CPR. Behaviour-change techniques may be helpful in increasing CPR rates. Aim To pilot a text-message behavioural intervention designed to increase intentions to initiate CPR, explore participant responses and pilot methods for future randomised controlled trial of effectiveness. Methods A 'before and after' pilot study plus qualitative interviews was undertaken. Participants were lay-people who had undertaken CPR training in previous 2 years.Participants were sent an intervention, comprising 35 text-messages containing 14 behaviour-change techniques, to their mobile phone over 4-6 weeks.Primary outcome: intentions to initiate CPR assessed in response to 4 different scenarios.Secondary outcomes: theory-based determinants of intention (attitudes, subjective norms, perceived behavioural control and self-efficacy) and self-rated competence. Results 20 participants (6 female, 14 male), aged 20-84 provided baseline data. 17 received the full suite of 35 text messages.15 provided follow-up data. Intentions to perform CPR in scenarios where CPR was indicated were high at baseline and increased (18.1 ± 3.2-19.5 ± 1.8/21) after the intervention, as did self-efficacy and self-rated competency. Self-efficacy, attitudes, perceived behavioural control and subjective norms were positively correlated with intentions. Qualitative data suggest the intervention was perceived as useful. Additional options for delivery format and pace were suggested. Conclusions Pilot-testing suggests a text-message intervention delivered after CPR training is acceptable and may be helpful in increasing/maintaining intentions to perform CPR.
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Affiliation(s)
- Barbara Farquharson
- NMAHP Research Unit, University of Stirling, FK9 4LA, United Kingdom
- Corresponding author.
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Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study. Healthcare (Basel) 2022; 10:healthcare10101841. [PMID: 36292288 PMCID: PMC9601607 DOI: 10.3390/healthcare10101841] [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: 08/06/2022] [Revised: 09/10/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022] Open
Abstract
Out-of-hospital cardiac arrest resuscitation by non-emergency dedicated physicians may not be positively associated with survival, as these physicians have less experience and exposure than specialised dedicated personnel. The aim of this study was to compare the survival results of the teams led by emergency dedicated physicians (EDPhy) with those of the teams led by non-emergency dedicated physicians (N-EDPhy) and with a team of basic life support (BLS) emergency technicians (EMTs) used as the control group. A retrospective, multicentre study of emergency-medical-service-witnessed cardiac arrest from medical causes in adults was performed. The records from 2006 to 2016 in a database of a regional emergency system were analysed and updated up to 31 December 2021. Two groups were studied: initial shockable and non-shockable rhythms. In total, 1359 resuscitation attempts were analysed, 281 of which belonged to the shockable group, and 1077 belonged to the non-shockable rhythm group. Any onsite return of spontaneous circulation, patients admitted to the hospital alive, global survival, and survival with a cerebral performance category (CPC) of 1-2 (good and moderate cerebral performance) were studied, with both of the latter categories considered at 30 days, 1 year (primary outcome), and 5 years. The shockable and non-shockable rhythm group (and CPC 1-2) survivals at 1 year were, respectively, as follows: EDPhy, 66.7 % (63.4%) and 14.0% (12.3%); N-EDPhy, 16.0% (16.0%) and 1.96 % (1.47%); and EMTs 32.0% (29.7%) and 1.3% (0.84%). The crude ORs were EDPhy vs. N-EDPhy, 10.50 (5.67) and 8.16 (4.63) (all p < 0.05); EDPhy vs. EMTs, 4.25 (2.65) and 12.86 (7.80) (p < 0.05); and N-EDPhy vs. EMTs, 0.50 (0.76) (p < 0.05) and 1.56 (1.32) (p > 0.05). The presence of an EDPhy was positively related to all the survival and CPC rates.
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7
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Screening for neurocognitive impairment following out-of-hospital cardiac arrest: anyone for a MoCA? Resuscitation 2022; 172:137-138. [DOI: 10.1016/j.resuscitation.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/23/2022]
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Allan KS, O'Neil E, Currie MM, Lin S, Sapp JL, Dorian P. Responding to Cardiac Arrest in the Community in the Digital Age. Can J Cardiol 2021; 38:491-501. [PMID: 34954009 DOI: 10.1016/j.cjca.2021.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 01/25/2023] Open
Abstract
Sudden cardiac arrest (SCA) is a common event, affecting almost 400,000 individuals annually in North America. Initiation of cardiopulmonary resuscitation (CPR) and early defibrillation using an automated external defibrillator (AED) are critical for survival, yet many bystanders are reluctant to intervene. Digital technologies, including mobile devices, social media and crowdsourcing may help play a role to improve survival from SCA. In this article we review the current digital tools and strategies available to increase rates of bystander recognition of SCA, prompt immediate activation of Emergency Medical Services (EMS), initiate high quality CPR and to locate, retrieve and operate AEDs. Smartphones can help to both educate and connect bystanders with EMS dispatchers, through text messaging or video-calling, to encourage the initiation of CPR and retrieval of the closest AED. Wearable devices and household smartspeakers could play a future role in continuous vital signs monitoring in individuals at-risk of lethal arrhythmias and send an alert to either chosen contacts or EMS. Machine learning algorithms and mathematical modeling may aid EMS dispatchers with better recognition of SCA as well as policymakers with where to best place AEDs for optimal accessibility. There are challenges with the use of digital tech, including the need for government regulation and issues with data ownership, accessibility and interoperability. Future research will include smart cities, e-linkages, new technologies and using social media for mass education. Together or in combination, these emerging digital technologies may represent the next leap forward in SCA survival.
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Affiliation(s)
- Katherine S Allan
- Division of Cardiology, Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Emma O'Neil
- Department of Emergency Medicine, Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada
| | - Margaret M Currie
- Faculty of Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steve Lin
- Department of Emergency Medicine, Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - John L Sapp
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Paul Dorian
- Division of Cardiology, Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Stanley B, Burton T, Percival H, Beesley E, Coffin N, Hulme J, Owen A, Alderman J. Skill decay following Basic Life Support training: a systematic review protocol. BMJ Open 2021; 11:e051959. [PMID: 34903542 PMCID: PMC8672002 DOI: 10.1136/bmjopen-2021-051959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Survival from out of hospital cardiac arrest (OHCA) is lower in the UK than in several developed nations. Bystander cardiopulmonary resuscitation (CPR) is associated with increased rates of survival to hospital discharge following OHCA, prompting the introduction of several initiatives by the UK government to increase rates of bystander CPR, including the inclusion of Basic Life Support (BLS) teaching within the English national curriculum. While there is clear benefit in this, increasing evidence suggests poor retention of skills following BLS teaching. The aim of this systematic review is to summarise the literature regarding skill decay following BLS training, reporting particularly the time period over which this occurs, and which components of would-be rescuers' performance of the BLS algorithm are most affected. METHODS AND ANALYSIS A search will be conducted to identify studies in which individuals have received BLS training and received subsequent assessment of their skills at a later date. A search strategy comprising relevant Medical Subject Headings (MeSH) terms and keywords has been devised with assistance from an experienced librarian. Relevant databases will be searched with titles, abstract and full-text review conducted independently by two reviewers. Data will be extracted from included studies by two reviewers, with meta-analysis conducted if the appropriate preconditions (such as limited heterogeneity) are met. ETHIC AND DISSEMINATION No formal ethical approval is required for this systematic review. Results will be disseminated in the form of manuscript submission to a relevant journal and presentation at relevant meetings. To maximise the public's access to this review's findings, any scientific report will be accompanied by a lay summary posted via social media channels, and a press release disseminated to national and international news agencies. PROSPERO REGISTRATION NUMBER CRD42021237233.
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Affiliation(s)
- Benjamin Stanley
- Resuscitation for Medical Disciplines, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Thomas Burton
- Resuscitation for Medical Disciplines, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Harriet Percival
- Resuscitation for Medical Disciplines, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Emily Beesley
- Resuscitation for Medical Disciplines, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nicholas Coffin
- Resuscitation for Medical Disciplines, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Intensive Care Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Jonathan Hulme
- Resuscitation for Medical Disciplines, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Intensive Care Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Andrew Owen
- Resuscitation for Medical Disciplines, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joseph Alderman
- Resuscitation for Medical Disciplines, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Rees N, Howitt J, Breyley N, Geoghegan P, Powel C. A simulation study of drone delivery of Automated External Defibrillator (AED) in Out of Hospital Cardiac Arrest (OHCA) in the UK. PLoS One 2021; 16:e0259555. [PMID: 34780477 PMCID: PMC8592459 DOI: 10.1371/journal.pone.0259555] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background Drones are increasingly used in healthcare, and feasibility studies of deployment of Automated External Defibrillators (AED) in Out-of-hospital cardiac arrest (OHCA) have been conducted. Despite the potential contribution of drones to healthcare, regulatory barriers exist, including limits on flights beyond visual line-of-sight (BVLOS). The aim of this project was to deliver an AED BVLOS in Wales. Methods We developed of a Concept of Operations (CONOPS) to identify requirements, constraints, organisation and roles and responsibilities associated with deploying a drone to deliver an AED BVLOS. We equipped a Penguin B drone with satellite-enabled technology to enhance situational awareness and safety for the remote pilot. A BVLOS Operating Safety Case and three-week flight test programme was conducted with an AED attached directly to parachute for deployment to simulated OHCA. Results We completed six flights totalling 92km, 1:02.5 hours of flight time and four successful parachute payload drops. We conducted a successful end-to-end flight demonstration of an AED delivered via BVLOS by drone to a simulated OHCA and resuscitation by lay responder’s in a remote location; the final delivery of 4.5km was completed in 2:50 minutes. Conclusion We have delivered an AED by parachute, from fixed wing drone BVLOS in the UK in simulated OHCA. This project adds to the body of knowledge required for regulatory assurance on drone use BVLOS. Further research is needed before routine use of this technology.
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Affiliation(s)
- Nigel Rees
- Welsh Ambulance Services NHS Trust (WAST): Pre Hospital Emergency Research Unit (PERU), Institute of Life Sciences Swansea University Singleton Park, Swansea, Wales, United Kingdom
- * E-mail:
| | | | - Nigel Breyley
- Cyclops Air Cyclops Air Ltd, Lincoln, United Kingdom
| | | | - Carl Powel
- Welsh Ambulance Services NHS Trust (WAST): Pre Hospital Emergency Research Unit (PERU), Institute of Life Sciences Swansea University Singleton Park, Swansea, Wales, United Kingdom
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11
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Nikolovski SS, Lazic AD, Fiser ZZ, Obradovic IA, Randjelovic SS, Tijanic JZ, Raffay VI. Initial Outcomes and Survival of Out-of-Hospital Cardiac Arrest: EuReCa Serbia Multicenter Cohort Study. Cureus 2021; 13:e18555. [PMID: 34754697 PMCID: PMC8571513 DOI: 10.7759/cureus.18555] [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] [Accepted: 10/06/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Although the global survival rate of patients after out-of-hospital cardiac arrest (OHCA) has increased in the previous years, there still remain significant multifactorial public health challenges with many important aspects influencing the overall survival rate of these patients. The objective of this article is to analyze basic epidemiological parameters of OHCA in Serbia and to evaluate the influence of pre-hospitalization factors on the survival of OHCA patients. Methods Data on OHCA within the EuReCa Serbia Registry was collected according to the EuReCa Study protocol during the period October 1, 2014 - December 31, 2019, and included basic demographic data of the patients, data related to OHCA prior to hospital arrival, as well as data regarding subsequent hospitalization. Results The study included 6,266 EuReCa events (54% males), with a median age of 73 years [interquartile range (IQR) 63-82]. Cardiac arrest was witnessed in 3,111 out of 6,266 cases (49.6%), of which 2,725 cases (87.6%) were witnessed by bystanders and 286 cases (12.4%) by the emergency medical service (EMS) team. Resuscitation measures were attempted in 2,097 of 3,111 (67.4%) witnessed OHCA cases. Bystander cardiopulmonary resuscitation (CPR) was initiated in 288 cases within the bystander-witnessed group of 2,725 cases (10.6%). An initial shockable rhythm was detected in 323 out of 3,111 witnessed cases (10.4%). Any return of spontaneous circulation (ROSC) prior to hospital arrival was observed in 441 out of 2,097 cases where CPR was initiated (21.0%). Within the group of 2,097 events where CPR was initiated, in 287 cases the patient was transported to the hospital with ROSC (13.7%). An automated external defibrillator (AED) was used by bystanders in three cases. The collapse in locations other than the place of residence [p < 0.01; odds ratio (OR) 3.928], attempt to initiate CPR by a bystander (p < 0.01; OR 2.169), and presence of initial shockable rhythm (p = 0.01; OR 2.070) were observed as significant predictors of any ROSC in OHCA patients. Out of 287 patients hospitalized with ROSC, 54 (18.8%) were discharged alive. Conclusion Collapse outside of residence place, bystander CPR initiation, and initially detected shockable rhythm are important predictors of ROSC prior to hospital arrival and overall survival. Key factors of CPR-providing performance observed in this study were witnessing OHCA, CPR initiated by a bystander, presence of initial shockable rhythm, and any ROSC prior to hospital arrival.
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Affiliation(s)
| | | | - Zoran Z Fiser
- Emergency Department, Municipality Institute for Emergency Medicine Novi Sad, Novi Sad, SRB
| | - Ivana A Obradovic
- Anesthesiology, Resuscitation and Intensive Care Department, Hospital Sveti Vracevi, Bijeljina, BIH
| | - Suzana S Randjelovic
- Emergency Medical Service, University Clinical Center Kragujevac, Kragujevac, SRB
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12
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Abstract
OBJECTIVE The purpose of this study was to assess the trends in outcomes of out-of-hospital cardiac arrest (OHCA) in Beijing over 5 years. DESIGN Cross-sectional study. METHODS Adult patients with OHCA of all aetiologies who were treated by the Beijing emergency medical service (EMS) between January 2013 and December 2017 were analysed. Data were collected using the Utstein Style. Cases were followed up for 1 year. Descriptive statistics were used to characterise the sample and logistic regression was performed. RESULTS Overall, 5016 patients with OHCA underwent attempted resuscitation by the EMS in urban areas of Beijing during the study period. Survival to hospital discharge was 1.2% in 2013 and 1.6% in 2017 (adjusted rate ratio=1.0, p for trend=0.60). Survival to admission and neurological outcome at discharge did not significantly improve from 2013 to 2017. Patient characteristics and the aetiology and location of cardiac arrest were consistent, but there was a decrease in the initial shockable rhythm (from 6.5% to 5.6%) over the 5 years. The rate of bystander cardiopulmonary resuscitation (CPR) increased steadily over the years (from 10.4% to 19.4%). CONCLUSION Survival after OHCA in urban areas of Beijing did not improve significantly over 5 years, with long-term survival being unchanged, although the rate of bystander CPR increased steadily, which enhanced the outcomes of patients who underwent bystander CPR.
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Affiliation(s)
- Fei Shao
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Emergency Medicine, Hebei Yanda Hospital, Langfang, China
| | - Haibin Li
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shengkui Ma
- Department of Emergency Medicine, Beijing Red Cross Emergency Rescue Center, Beijing, China
| | - Dou Li
- Department of Emergency Medicine, Beijing Emergency Medical Center, Beijing, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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13
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Ali DM, Hisam B, Shaukat N, Baig N, Ong MEH, Epstein JL, Goralnick E, Kivela PD, McNally B, Razzak J. Cardiopulmonary resuscitation (CPR) training strategies in the times of COVID-19: a systematic literature review comparing different training methodologies. Scand J Trauma Resusc Emerg Med 2021; 29:53. [PMID: 33781299 PMCID: PMC8006111 DOI: 10.1186/s13049-021-00869-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Traditional, instructor led, in-person training of CPR skills has become more challenging due to COVID-19 pandemic. We compared the learning outcomes of standard in-person CPR training (ST) with alternative methods of training such as hybrid or online-only training (AT) on CPR performance, quality, and knowledge among laypersons with no previous CPR training. METHODS We searched PubMed and Google Scholar for relevant articles from January 1995 to May 2020. Covidence was used to review articles by two independent researchers. Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess quality of the manuscripts. RESULTS Of the 978 articles screened, twenty met the final inclusion criteria. All included studies had an experimental design and moderate to strong global quality rating. The trainees in ST group performed better on calling 911, time to initiate chest compressions, hand placement and chest compression depth. Trainees in AT group performed better in assessing scene safety, calling for help, response time including initiating first rescue breathing, adequate ventilation volume, compression rates, shorter hands-off time, confidence, willingness to perform CPR, ability to follow CPR algorithm, and equivalent or better knowledge retention than standard teaching methodology. CONCLUSION AT methods of CPR training provide an effective alternative to the standard in-person CPR for large scale public training.
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Affiliation(s)
- Daniyal Mansoor Ali
- Centre of Excellence Trauma and Emergencies, Aga Khan University, Karachi, Pakistan.
| | - Butool Hisam
- Centre of Excellence Trauma and Emergencies, Aga Khan University, Karachi, Pakistan
| | - Natasha Shaukat
- Centre of Excellence Trauma and Emergencies, Aga Khan University, Karachi, Pakistan.,Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Noor Baig
- Centre of Excellence Trauma and Emergencies, Aga Khan University, Karachi, Pakistan.,Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Jonathan L Epstein
- Emergency Care Safety Institute, Public Safety Group, Burlington, MA, USA
| | - Eric Goralnick
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Paul D Kivela
- Department of Emergency Medicine, University of Alabama, Birmingham, USA
| | - Bryan McNally
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
| | - Junaid Razzak
- Centre of Excellence Trauma and Emergencies, Aga Khan University, Karachi, Pakistan.,Centre of Global Emergency Care, Johns Hopkins University, Baltimore, USA
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14
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Ji C, Brown TP, Booth SJ, Hawkes C, Nolan JP, Mapstone J, Fothergill RT, Spaight R, Black S, Perkins GD. Risk prediction models for out-of-hospital cardiac arrest outcomes in England. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:198-207. [PMID: 32154865 DOI: 10.1093/ehjqcco/qcaa019] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 11/15/2022]
Abstract
AIMS The out-of-hospital cardiac arrest (OHCA) outcomes project is a national research registry. One of its aims is to explore sources of variation in OHCA survival outcomes. This study reports the development and validation of risk prediction models for return of spontaneous circulation (ROSC) at hospital handover and survival to hospital discharge. METHODS AND RESULTS The study included OHCA patients who were treated during 2014 and 2015 by emergency medical services (EMS) from seven English National Health Service ambulance services. The 2014 data were used to identify important variables and to develop the risk prediction models, which were validated using the 2015 data. Model prediction was measured by area under the curve (AUC), Hosmer-Lemeshow test, Cox calibration regression, and Brier score. All analyses were conducted using mixed-effects logistic regression models. Important factors included age, gender, witness/bystander cardiopulmonary resuscitation (CPR) combined, aetiology, and initial rhythm. Interaction effects between witness/bystander CPR with gender, aetiology and initial rhythm and between aetiology and initial rhythm were significant in both models. The survival model achieved better discrimination and overall accuracy compared with the ROSC model (AUC = 0.86 vs. 0.67, Brier score = 0.072 vs. 0.194, respectively). Calibration tests showed over- and under-estimation for the ROSC and survival models, respectively. A sensitivity analysis individually assessing Index of Multiple Deprivation scores and location in the final models substantially improved overall accuracy with inconsistent impact on discrimination. CONCLUSION Our risk prediction models identified and quantified important pre-EMS intervention factors determining survival outcomes in England. The survival model had excellent discrimination.
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Affiliation(s)
- Chen Ji
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Terry P Brown
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Scott J Booth
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Claire Hawkes
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Jerry P Nolan
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK.,Royal United Hospitals, Bath BA1 3NG, UK
| | | | - Rachael T Fothergill
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK.,London Ambulance Service NHS Trust, London SE1 8SD, UK
| | - Robert Spaight
- East Midlands Ambulance Service NHS Trust, Nottingham NG8 6PY, UK
| | - Sarah Black
- South Western Ambulance Service NHS Foundation Trust, Exeter EX2 7HY, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham B91 2JL, UK
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15
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Waldmann V, Karam N, Gaye B, Bougouin W, Dumas F, Sharifzadehgan A, Narayanan K, Kassim H, Beganton F, Jost D, Lamhaut L, Loeb T, Adnet F, Agostinucci JM, Deltour S, Revaux F, Ludes B, Voicu S, Megarbane B, Jabre P, Cariou A, Marijon E, Jouven X. Temporal Trends of Out-of-Hospital Cardiac Arrests Without Resuscitation Attempt by Emergency Medical Services. Circ Cardiovasc Qual Outcomes 2021; 14:e006626. [PMID: 33706541 DOI: 10.1161/circoutcomes.120.006626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Significant improvements in survival from out-of-hospital cardiac arrest (OHCA) have been reported; however, these are based only on data from OHCA in whom resuscitation is initiated by emergency medical services (EMS). We aimed to assess the characteristics and temporal trends of OHCA without resuscitation attempt by EMS. METHODS Prospective population-based study between 2011 and 2016 in the Greater Paris area (6.7 million inhabitants). All cases of OHCA were included in collaboration with EMS units, 48 different hospitals, and forensic units. RESULTS Among 15 207 OHCA (mean age 70.7±16.9 years, 61.6% male), 5486 (36.1%) had no resuscitation attempt by EMS. Factors that were independently associated with increase in likelihood of no resuscitation attempt included: age of patients (odds ratio, 1.06 per year [95% CI, 1.05-1.06], P<0.001), female sex (odds ratio, 1.21 [95% CI, 1.10-1.32], P=0.002), OHCA at home location (odds ratio, 3.38 [95%CI, 2.86-4.01], P<0.001), and absence of bystander (odds ratio, 1.94 [95% CI, 1.74-2.16], P<0.001). Overall, the annual number of OHCA increased by 9.1% (from 2923 to 3189, P=0.028). This increase was related to an increase of the annual number of OHCA without resuscitation attempt by EMS by 26.3% (from 993 to 1253, P=0.012), while the annual number of OHCA with resuscitation attempt by EMS did not significantly change (from 1930 to 1936, P=0.416). Considering only cases with resuscitation attempt, survival rate at hospital discharge increased (from 7.3% to 9.5%, P=0.02). However, when considering all OHCA, survival improvement did not reach statistical significance (from 4.8% to 5.7%, P=0.17). CONCLUSIONS We demonstrated an increase of the total number of OHCA related to an increase of the number of OHCA without resuscitation attempt by EMS. This increasing proportion of OHCA without resuscitation attempt attenuates improvement in survival rates achieved in EMS-treated patients.
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Affiliation(s)
- Victor Waldmann
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).,Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | - Nicole Karam
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).,Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | - Bamba Gaye
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | - Wulfran Bougouin
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.).,Ramsay Générale de Santé, Hôpital privé Jacques Cartier, Intensive Care Unit, Massy, France (W.B.)
| | - Florence Dumas
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.).,Emergency Department, Cochin Hospital, Paris, France (F.D.)
| | - Ardalan Sharifzadehgan
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).,Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | - Kumar Narayanan
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Cardiology Department, Medicover Hospitals, Hyderabad, India (K.N.)
| | - Haoiinda Kassim
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.)
| | - Frankie Beganton
- Ramsay Générale de Santé, Hôpital privé Jacques Cartier, Intensive Care Unit, Massy, France (W.B.)
| | | | | | | | | | | | - Sandrine Deltour
- Cerebrovascular Unit, La Pitié Salpêtrière Hospital, Paris, France (S.D.)
| | | | - Bertrand Ludes
- Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.).,Cerebrovascular Unit, La Pitié Salpêtrière Hospital, Paris, France (S.D.)
| | - Sebastian Voicu
- Intensive Care Unit, Lariboisière Hospital, Paris, France (S.V., B.M.)
| | - Bruno Megarbane
- Intensive Care Unit, Lariboisière Hospital, Paris, France (S.V., B.M.)
| | | | - Alain Cariou
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.).,Intensive Care Unit, Cochin Hospital, Paris, France (A.C.)
| | - Eloi Marijon
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).,Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | - Xavier Jouven
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).,Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
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Tangpaisarn T, Srinopparatanakul T, Artpru R, Kotruchin P, Ienghong K, Apiratwarakul K. Unrecognized Out of Hospital Cardiac Arrest Symptoms during Thailand’s Emergency Medical Services. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: To improve survival rate, the main focus of adult cardiac arrest management includes rapid recognition, prompt administration of cardiopulmonary resuscitation (CPR), defibrillation for shockable rhythms, post-return of spontaneous circulation (ROSC) care, and identification and treatment of underlying causes. This study aimed to identify the determinants of unrecognized cardiac arrest, and to study the recognition rate of out-of-hospital cardiac arrest (OHCA) by emergency medical services call handlers.
METHODS: We included OHCA patients who were transferred to hospital via Emergency Medical Services (EMS) of Srinagarind hospital, Khon Kaen, Thailand, from 1st January 2020 to 31st December 2020. The primary outcome was to identify symptoms that lead to an unrecognized cardiac arrest by the EMS call handlers. Secondary outcomes were to identify the recognition rate of OHCA by emergency medical services call handlers, and assess the outcome of CPR performed on OHCA patients.
RESULTS: There were a total of 58 patients in the present study, 26 patients (44.8%) and 32 patients (55.2%) belonged to the unrecognized and recognized cardiac arrest groups, respectively. The most common symptoms that led to unrecognized cardiac arrest were a state of unconsciousness (46.2%), major trauma (15.4%), and seizure-like activity (11.5%). The rate of ROSC was higher in the unrecognized cardiac arrest group (34.6% vs. 15.6%) but the rate of survival to hospital discharge was higher in the recognized cardiac arrest group (6.3% vs 0%).
CONCLUSIONS: Falling unconscious is the most common symptom of unrecognized OHCA cases seen by EMS in Thailand. Basic life support, especially an immediate assessment of a patient’s respiratory status should be taught in health programs in school or through public service channels.
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Watkins CL, Jones SP, Hurley MA, Benedetto V, Price CI, Sutton CJ, Quinn T, Bangee M, Chesworth B, Miller C, Doran D, Siriwardena AN, Gibson JME. Predictors of recognition of out of hospital cardiac arrest by emergency medical services call handlers in England: a mixed methods diagnostic accuracy study. Scand J Trauma Resusc Emerg Med 2021; 29:7. [PMID: 33407699 PMCID: PMC7789721 DOI: 10.1186/s13049-020-00823-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/13/2020] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to identify key indicator symptoms and patient factors associated with correct out of hospital cardiac arrest (OHCA) dispatch allocation. In previous studies, from 3% to 62% of OHCAs are not recognised by Emergency Medical Service call handlers, resulting in delayed arrival at scene. Methods Retrospective, mixed methods study including all suspected or confirmed OHCA patients transferred to one acute hospital from its associated regional Emergency Medical Service in England from 1/7/2013 to 30/6/2014. Emergency Medical Service and hospital data, including voice recordings of EMS calls, were analysed to identify predictors of recognition of OHCA by call handlers. Logistic regression was used to explore the role of the most frequently occurring (key) indicator symptoms and characteristics in predicting a correct dispatch for patients with OHCA. Results A total of 39,136 dispatches were made which resulted in transfer to the hospital within the study period, including 184 patients with OHCA. The use of the term ‘Unconscious’ plus one or more of symptoms ‘Not breathing/Ineffective breathing/Noisy breathing’ occurred in 79.8% of all OHCAs, but only 72.8% of OHCAs were correctly dispatched as such. ‘Not breathing’ was associated with recognition of OHCA by call handlers (Odds Ratio (OR) 3.76). The presence of key indicator symptoms ‘Breathing’ (OR 0.29), ‘Reduced or fluctuating level of consciousness’ (OR 0.24), abnormal pulse/heart rate (OR 0.26) and the characteristic ‘Female patient’ (OR 0.40) were associated with lack of recognition of OHCA by call handlers (p-values < 0.05). Conclusions There is a small proportion of calls in which cardiac arrest indicators are described but the call is not dispatched as such. Stricter adherence to dispatch protocols may improve call handlers’ OHCA recognition. The existing dispatch protocol would not be improved by the addition of further terms as this would be at the expense of dispatch specificity. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-020-00823-9.
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Affiliation(s)
- Caroline L Watkins
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Stephanie P Jones
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Margaret A Hurley
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Valerio Benedetto
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | | | | | - Tom Quinn
- Kingston University London and St George's, University of London, London, UK
| | - Munirah Bangee
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Brigit Chesworth
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Colette Miller
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Dawn Doran
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | | | - Josephine M E Gibson
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK.
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18
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Out-of-hospital cardiac arrest: comparing organised groups to individual first responders. Eur J Anaesthesiol 2020; 38:1096-1104. [DOI: 10.1097/eja.0000000000001335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Hawkes CA, Brown TP, Booth S, Fothergill RT, Siriwardena N, Zakaria S, Askew S, Williams J, Rees N, Ji C, Perkins GD. Attitudes to Cardiopulmonary Resuscitation and Defibrillator Use: A Survey of UK Adults in 2017. J Am Heart Assoc 2020; 8:e008267. [PMID: 30917733 PMCID: PMC6509714 DOI: 10.1161/jaha.117.008267] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Bystander cardiopulmonary resuscitation (CPR) and public access defibrillator (PAD) use can save the lives of people who experience out‐of‐hospital cardiac arrest. Little is known about the proportions of UK adults trained, their characteristics and willingness to act if witnessing an out‐of‐hospital cardiac arrest, or the public's knowledge regarding where the nearest PAD is located. Methods and Results An online survey was administered by YouGov to a nonprobabilistic purposive sample of UK adults, achieving 2084 participants, from a panel that was matched to be representative of the population. We used descriptive statistics and multivariate logistic regression modeling for analysis. Almost 52% were women, 61% were aged <55 years, and 19% had witnessed an out‐of‐hospital cardiac arrest. Proportions ever trained were 57% in chest‐compression‐only CPR, 59% in CPR, and 19.4% in PAD use. Most with training in any resuscitation technique had trained at work (54.7%). Compared with people not trained, those trained in PAD use said they were more likely to use one (odds ratio: 2.61), and those trained in CPR or chest‐compression‐only CPR were more likely to perform it (odds ratio: 5.39). Characteristics associated with being trained in any resuscitation technique included youth, female sex, higher social grade, and full‐time employment. Conclusions In the United Kingdom, training makes a difference in people's willingness to act in the event of a cardiac arrest. Although there is considerable opportunity to increase the proportion of the general population trained in CPR, consideration should be also given to encouraging training in PAD use and targeting training for those who are older or from lower social grades.
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Affiliation(s)
- Claire A Hawkes
- 1 Warwick Clinical Trials Unit Warwick Medical School University of Warwick Coventry United Kingdom
| | - Terry P Brown
- 1 Warwick Clinical Trials Unit Warwick Medical School University of Warwick Coventry United Kingdom
| | - Scott Booth
- 1 Warwick Clinical Trials Unit Warwick Medical School University of Warwick Coventry United Kingdom
| | - Rachael T Fothergill
- 3 Clinical Audit and Research London Ambulance Service NHS Trust London United Kingdom
| | | | - Sana Zakaria
- 9 Strategy and International Affairs British Heart Foundation London United Kingdom
| | - Sara Askew
- 5 Healthcare Innovation Directorate British Heart Foundation London United Kingdom
| | - Julia Williams
- 6 Research and Development Department South East Coast Ambulance Service NHS Foundation Trust Crawley United Kingdom
| | - Nigel Rees
- 7 School of Health and Social Work;University of Hertfordshire Hatfield United Kingdom.,8 Welsh Ambulance Service NHS Trust Research and Innovation Institute of Life Science Swansea University Wales United Kingdom
| | - Chen Ji
- 1 Warwick Clinical Trials Unit Warwick Medical School University of Warwick Coventry United Kingdom
| | - Gavin D Perkins
- 1 Warwick Clinical Trials Unit Warwick Medical School University of Warwick Coventry United Kingdom.,2 Intensive Care Medicine University Hospitals Birmingham NHS Foundation Trust Birmingham United Kingdom
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Tjelmeland IBM, Alm-Kruse K, Andersson LJ, Bratland S, Hafstad AK, Haug B, Langørgen J, Larsen AI, Lindner TW, Nilsen JE, Olasveengen TM, Soreide E, Skogvoll E, Kramer-Johansen J. Cardiac arrest as a reportable condition: a cohort study of the first 6 years of the Norwegian out-of-hospital cardiac arrest registry. BMJ Open 2020; 10:e038133. [PMID: 32641339 PMCID: PMC7348469 DOI: 10.1136/bmjopen-2020-038133] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The Norwegian Cardiac Arrest Registry (NorCAR) was established in 2013 when cardiac arrest became a mandatory reportable condition. The aim of this cohort study is to describe how the world's first mandatory, population-based cardiac arrest registry evolved during its first 6 years. SETTING Norway has a total population of 5.3 million inhabitants with a population density that varies considerably. All residents are assigned a unique identifier number, giving nationally approved registries access to information about all births and deaths in the country. Data in the registry are entered by data processors; public employees with close links to the emergency medical services. All data processors undergo a standardised training and meet for yearly retraining and updates. PARTICIPANTS All events of cardiac arrest where bystanders or healthcare professionals have started cardiopulmonary resuscitation or performed defibrillation are included into the NorCAR. PRIMARY AND SECONDARY OUTCOME MEASURES Since the establishment of the registry, the number of reporting health trusts, the number of reported events and the corresponding population at risk were followed year by year. Outcome is measured as changes in inclusion rate, incidence per 100 000 inhabitants and survival to 30 days after cardiac arrest. RESULTS In total, 14 849 cases were registered over 6 years, between 2013 and 2018. The number of health trusts reporting rose steadily from 2013. Within 3 years, all trusts reported to the registry with an increasing number of events reported; going from 1101 to 3400 per year. The prevalence of bystander cardiopulmonary resuscitation increased slightly, but the population incidence of survival did not change. CONCLUSION Declaring cardiac arrest as a reportable condition and close follow-up of all reporting areas is essential when building a national registry.
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Affiliation(s)
- Ingvild Beathe Myrhaugen Tjelmeland
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig Holstein, Kiel, Germany
| | - Kristin Alm-Kruse
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars-Jøran Andersson
- Clinic of Emergency Medicine, University Hospital of North Norway, Tromso, Norway
| | - Ståle Bratland
- Clinic of Emergency Medicine, University Hospital of North Norway, Tromso, Norway
| | | | - Bjørn Haug
- Department of Cardiology, Akershus University Hospital, Lorenskog, Norway
| | - Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Werner Lindner
- Regional Competency Center for Emergency Medicine (RAKOS), Stavanger University Hospital, Stavanger, Norway
| | - Jan Erik Nilsen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Theresa M Olasveengen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Development and Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - Eldar Soreide
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Hordaland, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St. Olav University Hospital, Trondheim, Norway
| | - Jo Kramer-Johansen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Recruiting Medical Students for a First Responder Project in the Social Age: Direct Contact Still Outperforms Social Media. Emerg Med Int 2020; 2020:9438560. [PMID: 32566309 PMCID: PMC7285391 DOI: 10.1155/2020/9438560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Efficient recruitment of first responders (FRs) is crucial for long-term success of any FR project. FRs are laypersons who are trained in cardiopulmonary resuscitation (CPR), medical professionals, and firemen, police officers, and other professions with a duty of help. As social media are widely used for rapid communication, we carried out a prospective observational study to test the hypothesis that recruitment of FRs via social media is more efficient than recruitment via direct face-to-face contact. Methods Following ethics committee agreement, we informed 600 medical students about becoming FRs when they attended a didactic lecture about the FR project or during their mandatory CPR-course. Furthermore, recruitment was opened to medical students through Facebook, which accessed ∼1,000 medical students to see if they expressed interest in becoming FRs. All of the recruited students successfully completed the FR training. We then used an online questionnaire to ask these students how they had been recruited. Results Out of 63 registered student FRs, 59 responded to the online questionnaire. Overall, 15.3% of these FR students were recruited via social media. The majority (78.0%) were recruited through direct contact. Conclusions Despite widespread use of social media, over three-quarters of these medical students were recruited to the FR project via direct personal contact. This suggests that the advantage of a larger reachable population using social media does not outweigh the impact of personal contact with experts.
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Bjørshol CA, Kramer-Johansen J. Survival and neurological outcome: Search for a low-hanging fruit. Resuscitation 2020; 148:269-270. [PMID: 32004665 DOI: 10.1016/j.resuscitation.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Conrad Arnfinn Bjørshol
- The Regional Centre for Emergency Medical Research and Development (RAKOS), Hillevågsveien 8, NO-4016 Stavanger, Norway; Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, P. O. Box 8100, NO-4068 Stavanger, Norway.
| | - Jo Kramer-Johansen
- Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway
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Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study. Resuscitation 2020; 148:218-226. [DOI: 10.1016/j.resuscitation.2019.12.042] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 12/07/2019] [Accepted: 12/22/2019] [Indexed: 11/22/2022]
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24
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Jänig C, Poplawski A, Sammito S, Liebler S, Schmidbauer W, Piepho T. [Effect of different training methods on the use of the i-gel laryngeal mask by lay persons on a manikin]. Med Klin Intensivmed Notfmed 2020; 116:238-244. [PMID: 32055866 DOI: 10.1007/s00063-020-00665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/10/2019] [Accepted: 12/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several studies have described the successful application of extraglottic airways by lay people to a phantom. OBJECTIVES This study examined the influence of the training method on the success of the application. METHODS A total of 150 visitors of a shopping mall were asked to place an i‑gel laryngeal mask (Intersurgical GmbH, Sankt Augustin, Germany) on a manikin. The short instruction was randomized and performed either as a practical demonstration or through the self-study of an illustrated manual. RESULTS Application success in the first attempt was 95.8 % for the practical demonstration group and 78.5 % for the written instruction group (p = 0.001). Placement times were also significantly different (median 11.5 s vs. 22.5 s, p < 0.001). CONCLUSIONS Learning success can be achieved with both training methods. Initially, a hands-on training should be carried out with a practical demonstration.
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Affiliation(s)
- C Jänig
- Klinik für Anästhesie und Intensivmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland.
| | - A Poplawski
- Institut für medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Abteilung für Biometrie und Bioinformatik, Universitätsmedizin Mainz der Johannes Gutenberg Universität Mainz, Mainz, Deutschland
| | - S Sammito
- Unterabteilung VI, Kommando Sanitätsdienst der Bundeswehr, Koblenz, Deutschland
| | - S Liebler
- Unterabteilung VI, Kommando Sanitätsdienst der Bundeswehr, Koblenz, Deutschland
| | - W Schmidbauer
- Klinik für Anästhesie und Intensivmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
| | - T Piepho
- Abteilung für Anästhesie, Krankenhaus der Barmherzigen Brüder, Trier, Deutschland
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Postresuscitation Care after Out-of-hospital Cardiac Arrest: Clinical Update and Focus on Targeted Temperature Management. Anesthesiology 2020; 131:186-208. [PMID: 31021845 DOI: 10.1097/aln.0000000000002700] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Out-of-hospital cardiac arrest is a major cause of mortality and morbidity worldwide. With the introduction of targeted temperature management more than a decade ago, postresuscitation care has attracted increased attention. In the present review, we discuss best practice hospital management of unconscious out-of-hospital cardiac arrest patients with a special focus on targeted temperature management. What is termed post-cardiac arrest syndrome strikes all organs and mandates access to specialized intensive care. All patients need a secured airway, and most patients need hemodynamic support with fluids and/or vasopressors. Furthermore, immediate coronary angiography and percutaneous coronary intervention, when indicated, has become an essential part of the postresuscitation treatment. Targeted temperature management with controlled sedation and mechanical ventilation is the most important neuroprotective strategy to take. Targeted temperature management should be initiated as quickly as possible, and according to international guidelines, it should be maintained at 32° to 36°C for at least 24 h, whereas rewarming should not increase more than 0.5°C per hour. However, uncertainty remains regarding targeted temperature management components, warranting further research into the optimal cooling rate, target temperature, duration of cooling, and the rewarming rate. Moreover, targeted temperature management is linked to some adverse effects. The risk of infection and bleeding is moderately increased, as is the risk of hypokalemia and magnesemia. Circulation needs to be monitored invasively and any deviances corrected in a timely fashion. Outcome prediction in the individual patient is challenging, and a self-fulfilling prophecy poses a real threat to early prognostication based on clinical assessment alone. Therefore, delayed and multimodal prognostication is now considered a key element of postresuscitation care. Finally, modern postresuscitation care can produce good outcomes in the majority of patients but requires major diagnostic and therapeutic resources and specific training. Hence, recent international guidelines strongly recommend the implementation of regional prehospital resuscitation systems with integrated and specialized cardiac arrest centers.
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26
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Resuscitation care bundles: The need to optimize individual care elements. Resuscitation 2020; 146:261-262. [DOI: 10.1016/j.resuscitation.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 11/24/2022]
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Xu Y, Li J, Wu Y, Yue P, Wu F, Xu Y. An audio-visual review model enhanced one-year retention of cardiopulmonary resuscitation skills and knowledge: A randomized controlled trial. Int J Nurs Stud 2019; 102:103451. [PMID: 31734218 DOI: 10.1016/j.ijnurstu.2019.103451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/08/2019] [Accepted: 10/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND As the majority of out-of-hospital cardiac arrest occur at patients' homes, implementing high-quality cardiopulmonary resuscitation by family members is critical in improving patient outcomes. However, the survival rate remains low due to low bystander cardiopulmonary resuscitation rate and rapid skill deterioration in individuals who complete the training. OBJECTIVES To evaluate the effectiveness of audio-visual review model and audio-visual-practice review model on cardiopulmonary resuscitation skill retention 12 months after training. DESIGN A randomized, double-blind, placebo controlled, and three-arm parallel study. PARTICIPANTS A total of 641 family members of patients at high risk of out-of-hospital cardiac arrest enrolled in the study and 448 participants completed the follow-up. METHODS Family members from Beijing, China were recruited. All families underwent initial cardiopulmonary resuscitation training. Their cardiopulmonary resuscitation skill and knowledge were assessed immediately after training. Trainees who were rated "adequate skill and knowledge" were assigned randomly into one of three groups. The control group was given a cardiopulmonary resuscitation instruction booklet and a placebo-DVD without any reminders. Both audio-visual and audio-visual-practice groups were reinforced by a telephone reminder every 3 months. The audio-visual-practice group was also asked to simultaneously practice the skills while watching the instructional-DVD. The trainees' cardiopulmonary resuscitation skills and knowledge were re-assessed 12 months after training. RESULTS The retention rates of cardiopulmonary resuscitation skills in both audio-visual-practice (N = 177) and audio-visual (N = 157) groups were higher than that in control group (N = 114) 12 months after training (all P-values < 0.001). The cardiopulmonary resuscitation skill retention rate in audio-visual-practice group was higher than that in audio-visual group (49.7% vs 36.9%, P = 0.019), but no difference was found in intention-to-treat analysis (32.1% vs 27.1%, P = 0.230). Both audio-visual-practice and audio-visual groups had higher correct rates on all skill elements than that in control group (all P-values < 0.05). The cardiopulmonary resuscitation knowledge scores in both audio-visual-practice and audio-visual groups were higher than that in control group (all P-values < 0.001). However, no significant difference was found between audio-visual-practice and audio-visual groups (P = 0.243). CONCLUSIONS Both audio-visual-practice and audio-visual review models demonstrated better long-term retention of cardiopulmonary resuscitation skills for families of people at higher risk of out-of-hospital cardiac arrest. (Registration number: chiCTR-TRC-12002149).
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Affiliation(s)
- Yimin Xu
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Fengtai District Beijing, 100069, China
| | - Jia Li
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Fengtai District Beijing, 100069, China
| | - Ying Wu
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Fengtai District Beijing, 100069, China.
| | - Peng Yue
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Fengtai District Beijing, 100069, China
| | - Fangqin Wu
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Fengtai District Beijing, 100069, China
| | - Yahong Xu
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Fengtai District Beijing, 100069, China
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González-Salvado V, Abelairas-Gómez C, Gude F, Peña-Gil C, Neiro-Rey C, González-Juanatey JR, Rodríguez-Núñez A. Targeting relatives: Impact of a cardiac rehabilitation programme including basic life support training on their skills and attitudes. Eur J Prev Cardiol 2019; 26:795-805. [DOI: 10.1177/2047487319830190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Training families of patients at risk for sudden cardiac death in basic life support (BLS) has been recommended, but remains challenging. This research aimed to determine the impact of embedding resuscitation training for patients in a cardiac rehabilitation programme on relatives' BLS skill retention at six months. Design Intervention community study. Methods Relatives of patients suffering acute coronary syndrome or revascularization enrolled on an exercise-based cardiac rehabilitation programme were included. BLS skills of relatives linked to patients in a resuscitation-retraining programme (G-CPR) were compared with those of relatives of patients in a standard programme (G-Stan) at baseline, following brief instruction and six months after. Differences in skill performance and deterioration and self-perceived preparation between groups over time were assessed. Results Seventy-nine relatives were included and complete data from 66 (G-Stan=33, G-CPR=33) was analysed. Baseline BLS skills were equally poor, improved irregularly following brief instruction and decayed afterwards. G-CPR displayed six-month better performance and lessened skill deterioration over time compared with G-Stan, including enhanced compliance with the BLS sequence ( p = 0.006 for group*time interaction) and global resuscitation quality ( p = 0.007 for group*time interaction). Self-perceived preparation was higher in G-CPR ( p = 0.002). Conclusions Relatives of patients suffering acute coronary syndrome or revascularization enrolled on a cardiac rehabilitation programme showed poor BLS skills. A resuscitation-retraining cardiac rehabilitation programme resulted in relatives' higher BLS awareness, skill retention and confidence at six months compared with the standard programme. This may suggest a significant impact of this formula on the family setting and support the active role of patients to enhance health education in their environment.
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Affiliation(s)
- Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago, CIBER-CV, Universidade de Santiago de Compostela, Spain
- Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain
- CLINURSID Research Group, Universidade de Santiago de Compostela, Spain
| | - Cristian Abelairas-Gómez
- Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain
- CLINURSID Research Group, Universidade de Santiago de Compostela, Spain
- Faculty of Education Sciences, Universidade de Santiago de Compostela, Spain
| | - Francisco Gude
- Clinical Epidemiology Unit, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Carlos Peña-Gil
- Cardiology Department, University Clinical Hospital of Santiago, CIBER-CV, Universidade de Santiago de Compostela, Spain
- Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain
| | - Carmen Neiro-Rey
- Cardiology Department, University Clinical Hospital of Santiago, CIBER-CV, Universidade de Santiago de Compostela, Spain
- Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Cardiology Department, University Clinical Hospital of Santiago, CIBER-CV, Universidade de Santiago de Compostela, Spain
- Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain
| | - Antonio Rodríguez-Núñez
- Institute of Health Research of Santiago (IDIS), Santiago de Compostela, Spain
- CLINURSID Research Group, Universidade de Santiago de Compostela, Spain
- Paediatric Emergency and Critical Care Division, University Clinical Hospital of Santiago, Universidade de Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, Spain
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Mathiesen WT, Birkenes TS, Lund H, Ushakova A, Søreide E, Bjørshol CA. Public knowledge and expectations about dispatcher assistance in out-of-hospital cardiac arrest. J Adv Nurs 2018; 75:783-792. [PMID: 30375018 DOI: 10.1111/jan.13886] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/22/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Abstract
AIM To assess the factors associated with the knowledge and expectations among the general public about dispatcher assistance in out-of-hospital cardiac arrest incidents. BACKGROUND In medical dispatch centres, emergency calls are frequently operated by specially trained nurses as dispatchers. In cardiac arrest incidents, efficient communication between the dispatcher and the caller is vital for prompt recognition and treatment of the cardiac arrest. DESIGN A cross-sectional observational survey containing six questions and seven demographic items. METHOD From January-June 2017 we conducted standardized interviews among 500 members of the general public in Norway. In addition to explorative statistical methods, we used multivariate logistic analysis. RESULTS Most participants expected cardiopulmonary resuscitation instructions, while few expected "help in deciding what to do." More than half regarded the bystanders present to be responsible for the decision to initiate cardiopulmonary resuscitation. Most participants were able to give the correct emergency medical telephone number. The majority knew that the emergency call would not be terminated until the ambulance arrived at the scene. However, only one-third knew that the emergency telephone number operator was a trained nurse. CONCLUSION The public expect cardiopulmonary resuscitation instructions from the emergency medical dispatcher. However, the majority assume it is the responsibility of the bystanders to make the decision to initiate cardiopulmonary resuscitation or not. Based on these findings, cardiopulmonary resuscitation training initiatives and public campaigns should focus more on the role of the emergency medical dispatcher as the team leader of the first resuscitation team in cardiac arrest incidents.
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Affiliation(s)
- Wenche T Mathiesen
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | | | - Helene Lund
- Emergency Medical Communication Centre, Division of Prehospital Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Anastasia Ushakova
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Eldar Søreide
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Conrad A Bjørshol
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.,The Regional Centre for Emergency Medical Research and Development (RAKOS), Clinic of Prehospital Medicine, Stavanger University Hospital, Stavanger, Norway
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30
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Song J, Guo W, Lu X, Kang X, Song Y, Gong D. The effect of bystander cardiopulmonary resuscitation on the survival of out-of-hospital cardiac arrests: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2018; 26:86. [PMID: 30309373 PMCID: PMC6182861 DOI: 10.1186/s13049-018-0552-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/24/2018] [Indexed: 11/16/2022] Open
Abstract
Background For many years, bystander cardiopulmonary resuscitation (BCPR) has been considered as a favorable factor to improve survival of out-of-hospital cardiac arrests (OHCAs). To examine the effect of BCPR on the survival of OHCAs and whether BCPR might also improve survival when the initial rhythm of OHCAs is limited, we performed a meta-analysis on published observational studies. Methods We did a systematic review to identify all studies published up to March, 2018, in any language, that reported the relation between BCPR and the survival of OHCAs. Using standard forms, two authors independently identified studies for inclusion and extracted information. The outcome was survival. Meta-regression was done to ascertain weighted factors for the outcomes. Results Data were extracted from 19 studies involving 232,703 patients. Firstly, pooled odds ratio (OR) from 16 cohort studies showed that BCPR was associated with improved chance of survival of OHCAs compared with NO-BCPR (OR 1.95, 95% confidence interval [CI]: 1.66–2.30). Secondly, from 8 cohort studies of OHCAs whose initial rhythm is limited, the pooled OR was 2.10 (95% CI, 1.68–2.63) of 6 articles for shockable rhythm and 1.07 (95% CI, 0.37–3.13) of 2 articles for non-shockable rhythm. Meta-regression showed a relation between the survival of OHCAs and BCPR was influenced by area (p < 0.05). Conclusions Based on currently available evidence, the findings of this meta-analysis suggest that BCPR increases the survival of OHCAs, and it also help OHCAs whose initial rhythm is shockable. That is to say BCPR is also helpful when emergency department response time is short. Therefore global priority should be given to increasing the incidence of BCPR by evidence-based best practice.
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Affiliation(s)
- Jianting Song
- Dalian Medical University, No. 9, west section, Lushun South road, Dalian city, Liaoning Province, China
| | - Wenxiu Guo
- Liaoning university of Traditional Chinese Medicine, No. 79, Chongshan road, Huanggu District, Shenyang city, Liaoning province, China
| | - Xiaoguang Lu
- Department of Emergency Medicine, Affiliated Zhongshan Hospital of Dalian University, No. 6th Jiefang Street, ZhongShan District, Dalian city, Liaoning Province, China.
| | - Xin Kang
- Department of Emergency Medicine, Affiliated Zhongshan Hospital of Dalian University, No. 6th Jiefang Street, ZhongShan District, Dalian city, Liaoning Province, China
| | - Yi Song
- Department of Emergency Medicine, Affiliated Zhongshan Hospital of Dalian University, No. 6th Jiefang Street, ZhongShan District, Dalian city, Liaoning Province, China
| | - Dianbo Gong
- Department of Emergency Medicine, Affiliated Zhongshan Hospital of Dalian University, No. 6th Jiefang Street, ZhongShan District, Dalian city, Liaoning Province, China
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Nadar SK, Mujtaba M, Al-Hadi H, Sadiq M, Al-Riyami A, Ali M, Al-Lawati H. Epidemiology, Outcomes and Coronary Angiography Findings of Patients Following Out-of-Hospital Cardiac Arrest: A single-centre experience from Oman. Sultan Qaboos Univ Med J 2018; 18:e155-e160. [PMID: 30210844 DOI: 10.18295/squmj.2018.18.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/07/2018] [Accepted: 03/01/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Out-of-hospital cardiac arrests (OHCAs) are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman. Methods This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. All adult patients who presented following an OHCA to the Emergency Department of SQUH during the study period were included. Demographic and clinical data were collected from electronic medical records. Results A total of 216 patients were included in the study. The majority (63.9%) presented after having collapsed, while 22.3% presented with chest pains. Asystole was the most frequent initial cardiac rhythm (62.5%), with only 10% having ventricular tachycardia/fibrillation. Very few patients (1.4%) had received cardiopulmonary resuscitation (CPR) prior to presentation. In total, 85 patients (39.4%) returned to spontaneous circulation (RSC); of these, post-RSC electrocardiography revealed an ST-segment elevation in 41.2% and normal findings in 23.5%. There were 63 patients who underwent coronary angiography, with 28 requiring stenting. Overall, 13% of patients survived and were discharged, although three survivors suffered permanent hypoxic brain damage. Conclusion The overall survival rate of patients who had experienced an OHCA was low. Education programmes should focus on the benefits of immediate CPR for individuals experiencing an OHCA, with more opportunities for CPR training to be made available to the general public in Oman.
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Affiliation(s)
- Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohammed Mujtaba
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hafidh Al-Hadi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Muhammed Sadiq
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adil Al-Riyami
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mehar Ali
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hatim Al-Lawati
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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Surviving out-of-hospital cardiac arrest: The neurological and functional outcome and health-related quality of life one year later. Resuscitation 2018; 129:19-23. [DOI: 10.1016/j.resuscitation.2018.05.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/15/2018] [Accepted: 05/09/2018] [Indexed: 11/23/2022]
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Outcomes and healthcare-associated costs one year after intensive care-treated cardiac arrest. Resuscitation 2018; 131:128-134. [PMID: 29958958 DOI: 10.1016/j.resuscitation.2018.06.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite the significant socioeconomic burden associated with cardiac arrest (CA), data on CA patients' long-term outcome and healthcare-associated costs are limited. The aim of this study was to determine one-year survival, neurological outcome and healthcare-associated costs for ICU-treated CA patients. METHODS This is a single-centre retrospective study on adult CA patients treated in Finnish tertiary hospital's ICUs between 2005 and 2013. Patients' personal identification number was used to crosslink data between several nationwide databases in order to obtain data on one-year survival, neurological outcome, and healthcare-associated costs. Healthcare-associated costs were calculated for every patient stratified by cardiac arrest location (OHCA = out-of-hospital cardiac arrest, IHCA = all in-hospital cardiac arrest, ICU-CA = in-ICU cardiac arrest) and initial cardiac rhythm. Cost-effectiveness was estimated by dividing total healthcare-associated costs for all patients from the respective group by the number of survivors and survivors with favourable neurological outcome. RESULTS The study population included 1,024 ICU-treated CA patients. The sum of costs for all patients was €50,847,540. At one-year after CA, 58% of OHCAs, 44% of IHCAs, and 39% of ICU-CAs were alive. Of one-year survivors 97% of OHCAs, 88% of IHCAs, and 93% of ICU-CAs had favourable neurological outcome. Effective cost per one-year survivor was €76,212 for OHCAs, €144,168 for IHCAs, and €239,468 for ICU-CAs. Effective cost per one-year survivor with favourable neurological outcome was €81,196 for OHCAs, €164,442 for IHCAs, and €257,207 for ICU-CAs. CONCLUSIONS In-ICU CA patients had the lowest one-year survival with the effective cost per survivor three times higher than for OHCAs.
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Mathiesen WT, Bjørshol CA, Kvaløy JT, Søreide E. Effects of modifiable prehospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:99. [PMID: 29669574 PMCID: PMC5907488 DOI: 10.1186/s13054-018-2017-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/21/2018] [Indexed: 11/20/2022]
Abstract
Background The modifiable prehospital system factors, bystander cardiopulmonary resuscitation (CPR), emergency medical services (EMS), response time, and EMS physician attendance, may affect short- and long-term survival for both rural and urban out-of-hospital cardiac arrest (OHCA) patients. We studied how such factors influenced OHCA survival in a mixed urban/rural region with a high survival rate after OHCA. Methods We analyzed the association between modifiable prehospital factors and survival to different stages of care in 1138 medical OHCA patients from an Utstein template-based cardiac arrest registry, using Kaplan-Meier type survival curves, univariable and multivariable logistic regression and mortality hazard plots. Results We found a significantly higher probability for survival to hospital admission (OR: 1.84, 95% CI 1.43–2.36, p < 0.001), to hospital discharge (OR: 1.51, 95% CI 1.08–2.11, p = 0.017), and at 1 year (OR: 1.58, 95% CI 1.11–2.26, p = 0.012) in the urban group versus the rural group. In patients receiving bystander CPR before EMS arrival, the odds of survival to hospital discharge increased more than threefold (OR: 3.05, 95% CI 2.00–4.65, p < 0.001). However, bystander CPR was associated with increased patient survival to discharge only in urban areas (survival probability 0.26 with CPR vs. 0.08 without CPR, p < 0.001). EMS response time ≥ 10 min was associated with decreased survival (OR: 0.61, 95% CI 0.45–0.83, p = 0.002), however, only in urban areas (survival probability 0.15 ≥ 10 min vs. 0.25 < 10 min, p < 0.001). In patients with prehospital EMS physician attendance, no significant differences were found in survival to hospital discharge (OR: 1.37, 95% CI 0.87–2.16, p = 0.17). In rural areas, patients with EMS physician attendance had an overall better survival to hospital discharge (survival probability 0.17 with EMS physician vs. 0.05 without EMS physician, p = 0.019). Adjusted for modifiable factors, the survival differences remained. Conclusions Overall, OHCA survival was higher in urban compared to rural areas, and the effect of bystander CPR, EMS response time and EMS physician attendance on survival differ between urban and rural areas. The effect of modifiable factors on survival was highest in the prehospital stage of care. In patients surviving to hospital admission, there was no significant difference in in-hospital mortality or in 1 year mortality between OHCA in rural versus urban areas.
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Affiliation(s)
- Wenche Torunn Mathiesen
- Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway. .,Norwegian Air Ambulance Foundation, Department of Research and Development, Drøbak, Norway. .,Stavanger University Hospital, Forskningens Hus, Armauer Hansensgate 2, P.O. box: 8100, 4068, Stavanger, Norway.
| | - Conrad Arnfinn Bjørshol
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Jan Terje Kvaløy
- Research Department, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Eldar Søreide
- Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Dobbie F, MacKintosh AM, Clegg G, Stirzaker R, Bauld L. Attitudes towards bystander cardiopulmonary resuscitation: Results from a cross-sectional general population survey. PLoS One 2018. [PMID: 29513722 PMCID: PMC5841784 DOI: 10.1371/journal.pone.0193391] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Survival from out-of-hospital cardiac arrest (OHCA) varies across the developed world. Although not all OHCA are recoverable, the survival rate in Scotland is lower than in comparable countries, with higher average survival rates of 7.9% in England and 9% across Europe. The purpose of this paper is to explore the barriers, facilitators and public attitudes to administering bystander cardiopulmonary resuscitation (CPR) which could inform future policy and initiatives to improve the rate of bystander CPR. Data was collected via a cross-sectional general population survey of 1027 adults in Scotland. 52% of respondents had been trained in CPR. Of those who were not trained, two fifths (42%) expressed a willingness to receive CPR training. Fewer than half (49%) felt confident administering CPR, rising to 82% if they were talked through it by a call handler. Multivariate analyses identified that people in social grade C2DE were less likely than those in social grade ABC1 to be CPR trained and less confident to administer CPR if talked through by a call handler. The older a person was, the less likely they were to be CPR trained, show willingness to be CPR trained or be confident to administer bystander CPR with or without instruction from an emergency call handler. These findings are particularly relevant considering that most OHCA happen in the homes of older people. In a developed country such as Scotland with widely available CPR training, only half of the adult population reported feeling confident about administering bystander CPR. Further efforts tailored specifically for people who are older, unemployed and have a lower social grade are required to increase knowledge, confidence and uptake of training in bystander CPR.
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Affiliation(s)
- Fiona Dobbie
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
- * E-mail:
| | - Anne Marie MacKintosh
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Gareth Clegg
- The University of Edinburgh, Resuscitation Research Group, Edinburgh, United Kingdom
| | - Rebecca Stirzaker
- Heriot Watt University, School of Social Sciences, Edinburgh, United Kingdom
| | - Linda Bauld
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
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Couper K, Kimani PK, Gale CP, Quinn T, Squire IB, Marshall A, Black JJM, Cooke MW, Ewings B, Long J, Perkins GD. Variation in outcome of hospitalised patients with out-of-hospital cardiac arrest from acute coronary syndrome: a cohort study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background
Each year, approximately 30,000 people have an out-of-hospital cardiac arrest (OHCA) that is treated by UK ambulance services. Across all cases of OHCA, survival to hospital discharge is less than 10%. Acute coronary syndrome (ACS) is a common cause of OHCA.
Objectives
To explore factors that influence survival in patients who initially survive an OHCA attributable to ACS.
Data source
Data collected by the Myocardial Ischaemia National Audit Project (MINAP) between 2003 and 2015.
Participants
Adult patients who had a first OHCA attributable to ACS and who were successfully resuscitated and admitted to hospital.
Main outcome measures
Hospital mortality, neurological outcome at hospital discharge, and time to all-cause mortality.
Methods
We undertook a cohort study using data from the MINAP registry. MINAP is a national audit that collects data on patients admitted to English, Welsh and Northern Irish hospitals with myocardial ischaemia. From the data set, we identified patients who had an OHCA. We used imputation to address data missingness across the data set. We analysed data using multilevel logistic regression to identify modifiable and non-modifiable factors that affect outcome.
Results
Between 2003 and 2015, 1,127,140 patient cases were included in the MINAP data set. Of these, 17,604 OHCA cases met the study inclusion criteria. Overall hospital survival was 71.3%. Across hospitals with at least 60 cases, hospital survival ranged from 34% to 89% (median 71.4%, interquartile range 60.7–76.9%). Modelling, which adjusted for patient and treatment characteristics, could account for only 36.1% of this variability. For the primary outcome, the key modifiable factors associated with reduced mortality were reperfusion treatment [primary percutaneous coronary intervention (pPCI) or thrombolysis] and admission under a cardiologist. Admission to a high-volume cardiac arrest hospital did not influence survival. Sensitivity analyses showed that reperfusion was associated with reduced mortality among patients with a ST elevation myocardial infarction (STEMI), but there was no evidence of a reduction in mortality in patients who did not present with a STEMI.
Limitations
This was an observational study, such that unmeasured confounders may have influenced study findings. Differences in case identification processes at hospitals may contribute to an ascertainment bias.
Conclusions
In OHCA patients who have had a cardiac arrest attributable to ACS, there is evidence of variability in survival between hospitals, which cannot be fully explained by variables captured in the MINAP data set. Our findings provide some support for the current practice of transferring resuscitated patients with a STEMI to a hospital that can deliver pPCI. In contrast, it may be reasonable to transfer patients without a STEMI to the nearest appropriate hospital.
Future work
There is a need for clinical trials to examine the clinical effectiveness and cost-effectiveness of invasive reperfusion strategies in resuscitated OHCA patients of cardiac cause who have not had a STEMI.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Keith Couper
- Warwick Medical School, University of Warwick, Coventry, UK
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Peter K Kimani
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- York Teaching Hospital NHS Foundation Trust, York, UK
| | - Tom Quinn
- Faculty of Health, Social Care and Education, Kingston University, London and St George’s, University of London, London, UK
| | - Iain B Squire
- University of Leicester and Leicester NIHR Cardiovascular Research Unit, Glenfield Hospital, Leicester, UK
| | | | - John JM Black
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | | | | | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK
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Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden – A population-based register study of more than 18,000 cases. Int J Cardiol 2018; 255:237-242. [DOI: 10.1016/j.ijcard.2017.12.068] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/12/2017] [Accepted: 12/19/2017] [Indexed: 11/21/2022]
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Cy CHAN, Ko HF, Tsui SY, Chan OY, Tang TH, Chu YC. Could Hong Kong Primary Schoolchildren be Taught to Perform Compression-Only CPR: A Pilot Study. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate whether Hong Kong primary schoolchildren could be taught to perform compression-only CPR. Design Prospective experimental trial Subjects Primary schoolchildren of age 9-12 years old from different Cub Scout packs attended a 2 hour voluntary compression-only CPR training session between late 2014 and mid-2015. Main outcome measures Cardiopulmonary resuscitation (CPR) knowledge in the format of pre- and post-test multiple choices questions (MCQ). Psychomotor skills assessment including correct hand position, compression depth, compression rate and chest wall recoil between each compression. Results A total of 112 primary schoolchildren attended the training session, in them 72% were boys. Pretest score and post-test score was 2.81/5 and 4.82/5, respectively. The difference was statistically significant (p<0.05). About 96% of subjects had correct hand position at all time during CPR. Mean compression rate was 119/minute. Mean compression depth was 3 cm. About 47% of subjects had 100% complete recoil of chest wall following compression. Conclusion Primary schoolchildren above 9 years old are able to acquire essential knowledge and skills in compression-only CPR. Their physical strength may limit their ability to perform effective chest compression; it is still worthwhile to advocate CO-CPR education in primary schoolchildren in Hong Kong in order to raise their interest in this life saving skills and to equip them with essential cognitive skills in emergency situations. To achieve optimal cost-effectiveness and a compression depth of at least 4 cm, body weight of 53 kg or above should be considered as a selection criterion.
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Affiliation(s)
| | | | - SY Tsui
- Prince of Wales Hospital, Department of Anaesthesia & Intensive Care, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
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Al-Dury N, Rawshani A, Israelsson J, Strömsöe A, Aune S, Agerström J, Karlsson T, Ravn-Fischer A, Herlitz J. Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age. Am J Emerg Med 2017. [DOI: 10.1016/j.ajem.2017.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Brown LE, Lynes C, Carroll T, Halperin H. CPR Instruction in U.S. High Schools. J Am Coll Cardiol 2017; 70:2688-2695. [DOI: 10.1016/j.jacc.2017.09.1101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/28/2022]
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Setälä P, Hoppu S, Virkkunen I, Yli-Hankala A, Kämäräinen A. Assessment of futility in out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2017; 61:1334-1344. [PMID: 28905989 DOI: 10.1111/aas.12966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/27/2017] [Accepted: 08/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our aim was to evaluate the impact of futile resuscitation attempts to the outcome calculations of attempted resuscitation in out-of-hospital cardiac arrest (OHCA). Defined as partial resuscitations, we focused on a subgroup of patients in whom cardiopulmonary resuscitation (CPR) was initiated, but further efforts were soon abandoned due to evidence of futility. METHODS We conducted this study using the Utstein template during a 12-month study period. We compared the event characteristics between full and partial resuscitation attempts and determined the incidence, survival and neurological outcome. RESULTS Emergency Medical Services (EMS) attended a total of 314 OHCA cases. In 34 cases, resuscitation was not attempted due to futility. Seventy-four cases were partial resuscitation attempts where resuscitation was soon discontinued due to dismal prognostic factors. Partial attempts were associated with an unwitnessed OHCA, prolonged downtime, end-stage malignant disease, multiple trauma, asystole or pulseless electrical activity as the initial rhythm, and a first responding unit being the first unit on the scene (P < 0.05, respectively). The calculation of survival to hospital discharge rate was 14% and increased 5% when partial resuscitation attempts were excluded from the analysis. Seventy-four percentage had a Cerebral Performance Category 1-2 at hospital discharge. Shockable initial rhythm, public location and bystander CPR had a positive impact on survival. CONCLUSIONS Resuscitative efforts were considered futile in 11% of cases and resuscitation was discontinued due to evidence of futility in additional 24% cases based on additional information. Terminating resuscitation should be identified as a separate subgroup of OHCA cases to better reflect the outcome.
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Affiliation(s)
- P. Setälä
- Emergency Medical Service; Tampere University Hospital; Tampere Finland
- FinnHEMS Research and Development Unit; FinnHEMS Ltd; Vantaa Finland
| | - S. Hoppu
- Emergency Medical Service; Tampere University Hospital; Tampere Finland
- Department of Intensive Care; Tampere University Hospital; Tampere Finland
| | - I. Virkkunen
- Emergency Medical Service; Tampere University Hospital; Tampere Finland
- FinnHEMS Research and Development Unit; FinnHEMS Ltd; Vantaa Finland
| | - A. Yli-Hankala
- Medical School; University of Tampere; Tampere Finland
- Department of Anaesthesia; Tampere University Hospital; Tampere Finland
| | - A. Kämäräinen
- Emergency Medical Service; Tampere University Hospital; Tampere Finland
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Bakke HK, Bakke HK, Schwebs R. First-aid training in school: amount, content and hindrances. Acta Anaesthesiol Scand 2017; 61:1361-1370. [PMID: 28832913 PMCID: PMC5659131 DOI: 10.1111/aas.12958] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/13/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
Abstract
Background To increase knowledge and competence about first aid in the population, first‐aid instruction is included in primary and secondary school curricula. This study aimed to establish how much time is spent on first‐aid training, which first‐aid measures are taught, and which factors prevent teachers from providing the quantity and quality of first‐aid training that they wish to give. Methods A questionnaire was distributed to teachers in physical education in primary and secondary schools and to teachers in vocational subjects in higher secondary schools. Results The teachers taught a median of two lessons in first aid per year. Cardiopulmonary resuscitation (CPR) was taught by 64% of teachers, free airway and recovery position by 69% and stopping severe bleeding by 51%. Recognising heart attack and stroke was taught by 25% and 23%, respectively. The main factors that the teachers perceived as limiting the amount and quality of first‐aid training were insufficient learning objective specifications in the curriculum, too many other competence aims, lack of CPR mannequins and lack of training as first‐aid instructors. Discussion Norwegian teachers provide an appreciable amount of first‐aid training to their students. However, several potential life‐saving measures are poorly covered. The curriculum needs to contain first aid but also should specify what first‐aid measures to be taught. First‐aid training of teachers should adequately prepare them to be first‐aid instructors.
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Affiliation(s)
- H. K. Bakke
- Mo i Rana Hospital; Helgeland Hospital Trust; Mo i Rana Norway
- Department of Anaesthesiology and Intensive Care; University Hospital of North Norway; Tromsø Norway
- Anaesthesia and Critical Care Research Group; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
| | | | - R. Schwebs
- Faculty of Education; Western Norway University of Applied Sciences; Bergen Norway
- Ortun School; Bergen Norway
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The use of trained volunteers in the response to out-of-hospital cardiac arrest - the GoodSAM experience. Resuscitation 2017; 121:123-126. [PMID: 29079507 DOI: 10.1016/j.resuscitation.2017.10.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 11/21/2022]
Abstract
In England, fewer than 1 in 10 out-of-hospital cardiac arrest victims survive to hospital discharge. This could be substantially improved by increasing bystander cardiopulmonary resuscitation and Automated External Defibrillator use. GoodSAM is a mobile-phone, app-based system alerting trained individuals to nearby cardiac arrests. 'Responders' can be notified by bystanders using the GoodSAM 'Alerter' function. In London, when a 999 call-handler identifies cardiac arrest, in addition to dispatching the usual professional resources, London Ambulance Service automatically activates nearby GoodSAM responders. This article discusses the development of GoodSAM, its integration with London Ambulance Service, and the plans for future expansion.
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Colwill M, Somerville C, Lindberg E, Williams C, Bryan J, Welman T. Cardiopulmonary resuscitation on television: are we miseducating the public? Postgrad Med J 2017; 94:71-75. [PMID: 28993522 DOI: 10.1136/postgradmedj-2017-135122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest survival rates in the UK are poor, and non-medically trained individuals have been identified to perform substandard cardiopulmonary resuscitation (CPR). Millions watch televised medical dramas and, for many, these comprise their only education on CPR. This study aims to investigate the quality of CPR portrayed on these programmes and whether this has an effect on public knowledge. METHODS Prospective observational study of 30 consecutive episodes of three popular medical dramas. Public knowledge of CPR and viewing habits were assessed with a survey of non-medically trained personnel. RESULTS 90 episodes were reviewed with 39 resuscitation attempts shown. Chest compression rates varied from 60 to 204 compressions per minute with a median of 122 (95% CI 113 to 132). Depth varied from 1.5 to 7.5 cm with a median of 3 (3.15-4.31). Rate and depth were significantly different from the UK Resuscitation Council Guidelines (2010) (p<0.05, t-test). Survey participants (n=160, 80% response rate) documented what they thought was the correct rate and depth of chest compressions and were scored accordingly. Those who documented watching medical dramas regularly scored significantly worse than those who watched occasionally (p<0.05, Mann-Whitney test). CONCLUSION Televised medical dramas depict CPR inaccurately and laypersons may be less well informed about the correct technique the more they tune into these programmes. While there may be other confounding variables, given the popularity of television medical dramas, the poor depiction may be significantly contributing to poor public CPR knowledge and represent a potential new avenue of public education.
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Affiliation(s)
- Michael Colwill
- Department of Emergency Medicine, Epsom and St Helier University Hospital Trust, Carshalton, UK
| | - Charlotte Somerville
- Department of Trauma and Orthopaedic Surgery, Heart of England NHS Foundation Trust, Heartlands Hospital, Bordesley Green East, Birmingham, UK
| | - Eric Lindberg
- Departments of Surgery and Anaesthesia, Ashford and St Peter's NHS Foundation Trust, Chertsey, Surrey, UK
| | - Caroline Williams
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London, UK
| | - James Bryan
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London, UK
| | - Ted Welman
- Departments of Surgery and Anaesthesia, Ashford and St Peter's NHS Foundation Trust, Chertsey, Surrey, UK.,Department of Emergency Medicine, St George's Hospital University Hospitals NHS Foundation Trust, London, UK
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["Kids Save Lives"-resuscitation training for schoolchildren : Systematic review]. Anaesthesist 2017; 66:589-597. [PMID: 28497243 DOI: 10.1007/s00101-017-0319-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Even in western developed countries, the probability of survival after out-of-hospital cardiac arrest (OHCA) is only 6-10%. In order to improve survival after OHCA, early initiation of cardiopulmonary resuscitation (CPR) by laypersons is essential. Introduction of CPR training in schoolchildren seems to be effective to increase lay-CPR rates. OBJECTIVE The objective of the present investigation was to elucidate educational aspects of teaching schoolchildren in CPR and to summarize campaigns related to a comprehensive establishment of lay-CPR worldwide. MATERIALS AND METHODS A literature research in PubMed was performed, the cutoff date was 27 February 2017. Overall, 192 abstracts were analyzed; 51 articles were considered relevant and included in the manuscript. An additional keyword research in Google revealed >230,000 entries, and 20 of those were included in the present manuscript. RESULTS A minimum age of 12-13 years is required to achieve a comparable quality of CPR to adult basic life support (BLS). Key issues are (i) the correct detection of a cardiac arrest, (ii) a correctly performed call for help, (iii) thoracic compressions and (iv) if applicable, the initiation of adequate mouth-to-mouth ventilation. Practical training showed a significantly higher CPR quality compared to theoretical training only or to the use of instruction or online videos only. Worldwide implementation of a 2-h BLS training per year in children from the age of 12 or younger is recommended by the "Kids Save Lives"- statement since 2015. In Germany, implementation at the level of the federal states has progressed to different degrees.
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Bakke HK, Wisborg T. We need to include bystander first aid in trauma research. Scand J Trauma Resusc Emerg Med 2017; 25:32. [PMID: 28335785 PMCID: PMC5364713 DOI: 10.1186/s13049-017-0372-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/27/2017] [Indexed: 12/02/2022] Open
Abstract
Background The chain of trauma survival is a concept that originated in the area of out-of-hospital cardiac arrest (OHCA) and was adapted to the treatment of trauma. In out-of-hospital cardiac arrest research into bystander first aid has resulted in improved outcome. Whereas, in trauma research the first link of the chain of survival is almost ignored. Methods In OHCA, cardiopulmonary resuscitation (CPR) from bystanders has been subject of a vast amount of research, as well as measures and programs to raise the rate of bystander CPR to cardiac arrest victims. These efforts have resulted in improved survival. The research effort has been well grounded in the research community, as demonstrated by its natural inclusion in the uniform reporting template (Utstein) for the treatment of OHCA. In trauma the bystander may contribute by providing an open airway, staunch bleedings, or prevent hypothermia. In trauma however, while the chain of survival has been adopted along with it distinct links, including bystander first aid, the consensus-based uniform reporting template for trauma (the Utstein template) does not include the bystander first aid efforts. There is extremely little research on what first aid measures bystanders provide to trauma victims, and on what impact such measures have on outcome. An important step to improve research on bystander first aid in trauma would be to include this as part of the uniform reporting template for trauma Conclusion The lack of research on bystander first aid makes the first link in the trauma chain of survival the weakest link. We, the trauma research community, should either improve our research and knowledge in this area, or remove the link from the chain of survival
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Affiliation(s)
- Håkon Kvåle Bakke
- Mo i Rana Hospital, Helgeland Hospital Trust, Mo i Rana, Norway. .,Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, Tromsø, Norway. .,Department of Anaesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway.
| | - Torben Wisborg
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, Tromsø, Norway.,Department of Anaesthesiology and Intensive Care, Hammerfest Hospital, Finnmark Health Trust, Hammerfest, Norway.,Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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von Vopelius-Feldt J, Brandling J, Benger J. Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest. Resuscitation 2017; 114:40-46. [PMID: 28253479 DOI: 10.1016/j.resuscitation.2017.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/28/2016] [Accepted: 02/21/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Improving survival after out-of-hospital cardiac arrest (OHCA) is a priority for modern emergency medical services (EMS) and prehospital research. Advanced life support (ALS) is now the standard of care in most EMS. In some EMS, prehospital critical care providers are also dispatched to attend OHCA. This systematic review presents the evidence for prehospital critical care for OHCA, when compared to standard ALS care. METHODS We searched the following electronic databases: PubMed, EmBASE, CINAHL Plus and AMED (via EBSCO), Cochrane Database of Systematic Reviews, DARE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, NIHR Health Technology Assessment Database, Google Scholar and ClinicalTrials.gov. Search terms related to cardiac arrest and prehospital critical care. All studies that compared patient-centred outcomes between prehospital critical care and ALS for OHCA were included. RESULTS The review identified six full text publications that matched the inclusion criteria, all of which are observational studies. Three studies showed no benefit from prehospital critical care but were underpowered with sample sizes of 1028-1851. The other three publications showed benefit from prehospital critical care delivered by physicians. However, an imbalance of prognostic factors and hospital treatment in these studies systematically favoured the prehospital critical care group. CONCLUSION Current evidence to support prehospital critical care for OHCA is limited by the logistic difficulties of undertaking high quality research in this area. Further research needs an appropriate sample size with adjustments for confounding factors in observational research design.
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Affiliation(s)
- Johannes von Vopelius-Feldt
- Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom.
| | - Janet Brandling
- Faculty of Health & Applied Sciences, University of the West of England, Glenside Campus, BS16 1QY Bristol, United Kingdom
| | - Jonathan Benger
- Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom; Emergency Care, University of the West of England, Bristol, United Kingdom
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Bakke HK, Steinvik T, Angell J, Wisborg T. A nationwide survey of first aid training and encounters in Norway. BMC Emerg Med 2017; 17:6. [PMID: 28228110 PMCID: PMC5322636 DOI: 10.1186/s12873-017-0116-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 02/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background Bystander first aid can improve survival following out-of-hospital cardiac arrest or trauma. Thus, providing first aid education to laypersons may lead to better outcomes. In this study, we aimed to establish the prevalence and distribution of first aid training in the populace, how often first aid skills are needed, and self-reported helping behaviour. Methods We conducted a telephone survey of 1000 respondents who were representative of the Norwegian population. Respondents were asked where and when they had first aid training, if they had ever encountered situations where first aid was necessary, and stratified by occupation. First aid included cardio-pulmonary resuscitation (CPR) and basic life support (BLS). To test theoretical first aid knowledge, respondents were subjected to two hypothetical first aid scenarios. Results Among the respondents, 90% had received first aid training, and 54% had undergone first aid training within the last 5 years. The workplace was the most common source of first aid training. Of the 43% who had been in a situation requiring first aid, 89% had provided first aid in that situation. There were considerable variations among different occupations in first aid training, and exposure to situations requiring first aid. Theoretical first aid knowledge was not as good as expected in light of the high share who had first aid training. In the presented scenarios 42% of respondent would initiate CPR in an unconscious patient not breathing normally, and 46% would provide an open airway to an unconscious road traffic victim. First aid training was correlated with better theoretical knowledge, but time since first aid training was not. Conclusions A high proportion of the Norwegian population had first aid training, and interviewees reported high willingness to provide first aid. Theoretical first aid knowledge was worse than expected. While first aid is part of national school curriculum, few have listed school as the source for their first aid training. Electronic supplementary material The online version of this article (doi:10.1186/s12873-017-0116-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Håkon Kvåle Bakke
- Mo i Rana Hospital, Helgeland Hospital Trust, Mo i Rana, Norway. .,Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, 9037, Tromsø, Norway. .,Department of Anaesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway.
| | - Tine Steinvik
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, 9037, Tromsø, Norway
| | - Johan Angell
- Lawyers Leiros & Olsen AS, Tromsø, Norway.,Faculty of Law, University of Tromsø, Tromsø, Norway
| | - Torben Wisborg
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, 9037, Tromsø, Norway.,Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway.,Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Exploring How Lay Rescuers Overcome Barriers to Provide Cardiopulmonary Resuscitation: A Qualitative Study. Prehosp Disaster Med 2016; 32:27-32. [PMID: 27964771 DOI: 10.1017/s1049023x16001278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Survival rates after out-of-hospital cardiac arrest (OHCA) vary considerably among regions. The chance of survival is increased significantly by lay rescuer cardiopulmonary resuscitation (CPR) before Emergency Medical Services (EMS) arrival. It is well known that for bystanders, reasons for not providing CPR when witnessing an OHCA incident may be fear and the feeling of being exposed to risk. The aim of this study was to gain a better understanding of why barriers to providing CPR are overcome. METHODS Using a semi-structured interview guide, 10 lay rescuers were interviewed after participating in eight OHCA incidents. Qualitative content analysis was used. The lay rescuers were questioned about their CPR-knowledge, expectations, and reactions to the EMS and from others involved in the OHCA incident. They also were questioned about attitudes towards providing CPR in an OHCA incident in different contexts. RESULTS The lay rescuers reported that they were prepared to provide CPR to anybody, anywhere. Comprehending the severity in the OHCA incident, both trained and untrained lay rescuers provided CPR. They considered CPR provision to be the expected behavior of any community citizen and the EMS to act professionally and urgently. However, when asked to imagine an OHCA in an unclear setting, they revealed hesitation about providing CPR because of risk to their own safety. CONCLUSION Mutual trust between community citizens and towards social institutions may be reasons for overcoming barriers in providing CPR by lay rescuers. A normative obligation to act, regardless of CPR training and, importantly, without facing any adverse legal reactions, also seems to be an important factor behind CPR provision. Mathiesen WT , Bjørshol CA , Høyland S , Braut GS , Søreide E . Exploring how lay rescuers overcome barriers to provide cardiopulmonary resuscitation: a qualitative study. Prehosp Disaster Med. 2017;32(1):27-32.
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Epidemiology and outcomes from out-of-hospital cardiac arrests in England. Resuscitation 2016; 110:133-140. [PMID: 27865775 DOI: 10.1016/j.resuscitation.2016.10.030] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION This study reports the epidemiology and outcomes from out-of-hospital cardiac arrest (OHCA) in England during 2014. METHODS Prospective observational study from the national OHCA registry. The incidence, demographic and outcomes of patients who were treated for an OHCA between 1st January 2014 and 31st December 2014 in 10 English ambulance service (EMS) regions, serving a population of almost 54 million, are reported in accordance with Utstein recommendations. RESULTS 28,729 OHCA cases of EMS treated cardiac arrests were reported (53 per 100,000 of resident population). The mean age was 68.6 (SD=19.6) years and 41.3% were female. Most (83%) occurred in a place of residence, 52.7% were witnessed by either the EMS or a bystander. In non-EMS witnessed cases, 55.2% received bystander CPR whilst public access defibrillation was used rarely (2.3%). Cardiac aetiology was the leading cause of cardiac arrest (60.9%). The initial rhythm was asystole in 42.4% of all cases and was shockable (VF or pVT) in 20.6%. Return of spontaneous circulation at hospital transfer was evident in 25.8% (n=6302) and survival to hospital discharge was 7.9%. CONCLUSION Cardiac arrest is an important cause of death in England. With less than one in ten patients surviving, there is scope to improve outcomes. Survival rates were highest amongst those who received bystander CPR and public access defibrillation.
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