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Ganter J, Ruf A, Oppermann J, Feilhauer J, Brucklacher T, Busch HJ, Müller MP. Automatic measurement of departing times in smartphone alerting systems: A pilot study. Resusc Plus 2024; 17:100510. [PMID: 38076389 PMCID: PMC10701107 DOI: 10.1016/j.resplu.2023.100510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
AIM Smartphone alerting systems (SAS) alert volunteers in close vicinity of suspected out-of-hospital cardiac arrest. Some systems use sophisticated algorithms to select those who will probably arrive first. Precise estimation of departing times and travel times may help to further improve algorithms. We developed a global positioning system (GPS) based method for automatic measurements of departing times. The aim of this pilot study was to evaluate feasibility and precision of the method. METHODS Region of Lifesavers alerting app (iOS/ Android, version 3.0, FirstAED ApS, Denmark) was used in this study. 27 experiments were performed with 9 students, who were instructed to stay in their flats during the study days. A geofence was set for each alarm in the alerting system with a radius of 10 m (8 cases), 15 m (10 cases), and 20 m (9 cases) around the GPS position at which the alarm was accepted in the app. The system logged responders as being departed when the smartphone position was registered outside the geofence. The students were instructed to manually start a stopwatch at the time of the alert and to stop the stopwatch once they had entered the street in front of their flat. RESULTS The median difference between automatically and manually retrieved times were -16 seconds [interquartile range IQR 50 seconds] (geofence 10 m), 30 seconds [IQR 25 seconds] (15 m), and 20 seconds [IQR 13 seconds] (20 m), respectively. The 20 m geofence was associated with the smallest interquartile range. CONCLUSION Departing times of volunteer responders in SAS can be retrieved automatically using GPS and a geofence.
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Affiliation(s)
- Julian Ganter
- Department of Anaesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Region of Lifesavers, Freiburg, Germany
| | - Alexander Ruf
- Health Care Lab, Karlsruhe Service Research Institute (KSRI), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Julian Oppermann
- Health Care Lab, Karlsruhe Service Research Institute (KSRI), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Joschka Feilhauer
- Health Care Lab, Karlsruhe Service Research Institute (KSRI), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | | | - Hans-Jörg Busch
- Region of Lifesavers, Freiburg, Germany
- Department of Emergency Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Freiburg, Germany
| | - Michael Patrick Müller
- Region of Lifesavers, Freiburg, Germany
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefs Hospital, Freiburg, Germany
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2
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Nassal MM, Wang HE, Benoit JL, Kuhn A, Powell JR, Keseg D, Sauto J, Panchal AR. Statewide implementation of the cardiac arrest registry to enhance survival in Ohio. Resusc Plus 2024; 17:100528. [PMID: 38178963 PMCID: PMC10765104 DOI: 10.1016/j.resplu.2023.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Objective Public health surveillance is essential for improving community health. The Cardiac Arrest Registry to Enhance Survival (CARES) is a surveillance system for out-of-hospital cardiac arrest (OHCA). We describe results of the organized statewide implementation of Ohio CARES. Methods We performed a retrospective analysis of CARES enactment in Ohio. Key elements included: establishment of statewide leadership, appointment of a dedicated coordinator, conversion to a statewide subscription, statewide dissemination of information, fundraising from internal and external stakeholders, and conduct of resuscitation academies. We identified all adult (≥18 years) OHCA reported in the registry during 2013-2020. We evaluated OHCA characteristics before (2013-2015) and after (2016-2019) statewide implementation using chi-square test. We evaluated trends in OHCA outcomes using the Cochran-Armitage test of trend. Results Statewide CARES promotion increased participation from 2 (urban) to 136 (129 urban, 7 rural) EMS agencies. Covered population increased from 1.2 M (10% of state) to 4.8 M (41% of state). After statewide implementation, OHCA populations increased male (58.1% vs 60.8%, p < 0.01), white (50.1% vs 63.7%, p < 0.01), bystander witnessed (26.9% vs 32.9%, p < 0.01) OHCAs. Bystander CPR (34.7% vs 33.2%, p = 0.22), bystander AED (13.5% vs 12.3%, p = 0.55) and initial rhythm (shockable 18.0% vs 18.3%, p = 0.32) did not change. From 2013 to 2019 there were temporal increases in ROSC (29.7% to 31.9%, p-trend = 0.028), survival (7.4% to 12.3%, p-trend < 0.001) and survival with good neurologic outcome (5.6% to 8.6%, p-trend = 0.047). Conclusion The organized statewide implementation of CARES in Ohio was associated with marked increases in community uptake and concurrent observed improvements in patient outcomes. These results highlight key lessons for community-wide fostering of OHCA surveillance.
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Affiliation(s)
- Michelle M.J. Nassal
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - Henry E. Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - Justin L. Benoit
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States
| | | | - Jonathan R. Powell
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - David Keseg
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - James Sauto
- Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Ashish R. Panchal
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
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Müller MP, Jonsson M, Böttiger BW, Rott N. Telephone cardiopulmonary resuscitation, first responder systems, cardiac arrest centers, and global campaigns to save lives. Curr Opin Crit Care 2023; 29:621-627. [PMID: 37861192 DOI: 10.1097/mcc.0000000000001112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW The latest resuscitation guidelines contain a new chapter, which focuses on systems improving care for patients with out-of-hospital cardiac arrest (OHCA). In this article, we describe recent developments regarding telephone cardiopulmonary resuscitation (CPR), first responder systems, cardiac arrest centers, and global campaigns. RECENT FINDINGS Telephone CPR has been implemented in many countries, and recent developments include artificial intelligence and video calls to improve dispatch assisted CPR. However, the degree of implementation is not yet satisfying. Smartphone alerting systems are effective in reducing the resuscitation-free interval, but many regions do not yet use this technology. Further improvements are needed to reduce response times. Cardiac arrest centers increase the survival chance after OHCA. Specific criteria need to be defined and professional societies should establish a certification process. Global campaigns are effective in reaching people around the world. However, we need to evaluate the effects of the campaigns. SUMMARY Telephone CPR, first responder systems, cardiac arrest centers, and global campaigns are highlighted in the recent resuscitation guidelines. However, the degree of implementation is not yet sufficient. We do not only need to implement these measures, but we should also aim to monitor the systems regarding their performance and further improve them.
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Affiliation(s)
- Michael P Müller
- Department of Anesthesiology, Intensive Care, and Emergency Medicine, Artemed St. Josef's Hospital, Freiburg, Germany
| | - Martin Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet. Stockholm, Sweden
| | - Bernd W Böttiger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Nadine Rott
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany
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Berglund E, Hollenberg J, Jonsson M, Svensson L, Claesson A, Nord A, Nordberg P, Forsberg S, Rosenqvist M, Lundgren P, Högstedt Å, Riva G, Ringh M. Effect of Smartphone Dispatch of Volunteer Responders on Automated External Defibrillators and Out-of-Hospital Cardiac Arrests: The SAMBA Randomized Clinical Trial. JAMA Cardiol 2023; 8:81-88. [PMID: 36449309 PMCID: PMC9713680 DOI: 10.1001/jamacardio.2022.4362] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022]
Abstract
Importance Smartphone dispatch of volunteer responders to nearby out-of-hospital cardiac arrests (OHCAs) has emerged in several emergency medical services, but no randomized clinical trials have evaluated the effect on bystander use of automated external defibrillators (AEDs). Objective To evaluate if bystander AED use could be increased by smartphone-aided dispatch of lay volunteer responders with instructions to collect nearby AEDs compared with instructions to go directly to patients with OHCAs to start cardiopulmonary resuscitation (CPR). Design, Setting, and Participants This randomized clinical trial assessed a system for smartphone dispatch of volunteer responders to individuals experiencing OHCAs that was triggered at emergency dispatch centers in response to suspected OHCAs and randomized 1:1. The study was conducted in 2 main Swedish regions: Stockholm and Västra Götaland between December 2018 and January 2020. At study start, there were 3123 AEDs in Stockholm and 3195 in Västra Götaland and 24 493 volunteer responders in Stockholm and 19 117 in Västra Götaland. All OHCAs in which the volunteer responder system was activated by dispatchers were included. Excluded were patients with no OHCAs, those with OHCAs not treated by the emergency medical services, and those with OHCAs witnessed by the emergency medical services. Interventions Volunteer responders were alerted through the volunteer responder system smartphone application and received map-aided instructions to retrieve nearest available public AEDs on their way to the OHCAs. The control arm included volunteer responders who were instructed to go directly to the OHCAs to perform CPR. Main Outcomes and Measures Overall bystander AED attachment, including those attached by volunteer responders and lay volunteers who did not use the smartphone application. Results Volunteer responders were activated for 947 patients with OHCAs. Of those, 461 were randomized to the intervention group (median [IQR] age of patients, 73 [61-81] years; 295 male patients [65.3%]) and 486 were randomized to the control group (median [IQR] age of patients, 73 [63-82] years; 312 male patients [65.3%]). Primary outcome of AED attachment occurred in 61 patients (13.2%) in the intervention arm vs 46 patients (9.5%) in the control arm (difference, 3.8% [95% CI, -0.3% to 7.9%]; P = .08). The majority of AEDs were attached by lay volunteers who were not using the smartphone application (37 in intervention arm, 28 in control). There were no significant differences in secondary outcomes. Among the volunteer responders using the application, crossover was 11% and compliance to instructions was 31%. Volunteer responders attached 38% (41 of 107) of all AEDs and provided 45% (16 of 36) of all defibrillations and 43% (293 of 666) of all CPR. Conclusions and Relevance In this study, smartphone dispatch of volunteer responders to OHCAs to retrieve nearby AEDs vs instructions to directly perform CPR did not significantly increase volunteer AED use. High baseline AED attachement rate and crossover may explain why the difference was not significant. Trial Registration ClinicalTrials.gov Identifier: NCT02992873.
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Affiliation(s)
- Ellinor Berglund
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Anette Nord
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Sune Forsberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Mårten Rosenqvist
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Peter Lundgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Prehospen–Centre for Prehospital Research, University of Borås, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Åsa Högstedt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Prehospen–Centre for Prehospital Research, University of Borås, Sweden
| | - Gabriel Riva
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
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Abstract
PURPOSE OF REVIEW Technology is being increasingly implemented in the fields of cardiac arrest and cardiopulmonary resuscitation. In this review, we describe how recent technological advances have been implemented in the chain of survival and their impact on outcomes after cardiac arrest. Breakthrough technologies that are likely to make an impact in the future are also presented. RECENT FINDINGS Technology is present in every link of the chain of survival, from prediction, prevention, and rapid recognition of cardiac arrest to early cardiopulmonary resuscitation and defibrillation. Mobile phone systems to notify citizen first responders of nearby out-of-hospital cardiac arrest have been implemented in numerous countries with improvement in bystanders' interventions and outcomes. Drones delivering automated external defibrillators and artificial intelligence to support the dispatcher in recognising cardiac arrest are already being used in real-life out-of-hospital cardiac arrest. Wearables, smart speakers, surveillance cameras, and artificial intelligence technologies are being developed and studied to prevent and recognize out-of-hospital and in-hospital cardiac arrest. SUMMARY This review highlights the importance of technology applied to every single step of the chain of survival to improve outcomes in cardiac arrest. Further research is needed to understand the best role of different technologies in the chain of survival and how these may ultimately improve outcomes.
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Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Lorenzo Gamberini
- Department of Anaesthesia and Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
| | - Federico Semeraro
- Department of Anaesthesia and Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
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Scquizzato T, Belloni O, Semeraro F, Greif R, Metelmann C, Landoni G, Zangrillo A. Dispatching citizens as first responders to out-of-hospital cardiac arrests: a systematic review and meta-analysis. Eur J Emerg Med 2022; 29:163-172. [PMID: 35283448 DOI: 10.1097/mej.0000000000000915] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mobile phone technologies to alert citizen first responders to out-of-hospital cardiac arrests (OHCAs) were implemented in numerous countries. This systematic review and meta-analysis aim to investigate whether activating citizen first responders increases bystanders' interventions and improves outcomes. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to 24 November 2021, for studies comparing citizen first responders' activation versus standard emergency response in the case of OHCA. The primary outcome was survival at hospital discharge or 30 days. Secondary outcomes were discharge with favourable neurological outcome, bystander-initiated cardiopulmonary resuscitation (CPR), and the use of automated external defibrillators (AEDs) before ambulance arrival. Evidence certainty was evaluated with GRADE. Our search strategy yielded 1215 articles. After screening, we included 10 studies for a total of 23 351 patients. OHCAs for which citizen first responders were activated had higher rates of survival at hospital discharge or 30 days compared with standard emergency response [nine studies; 903/9978 (9.1%) vs. 1104/13 247 (8.3%); odds ratio (OR), 1.45; 95% confidence interval (CI), 1.21-1.74; P < 0.001], return of spontaneous circulation [nine studies; 2575/9169 (28%) vs. 3445/12 607 (27%); OR, 1.40; 95% CI, 1.07-1.81; P = 0.01], bystander-initiated CPR [eight studies; 5876/9074 (65%) vs. 6384/11 970 (53%); OR, 1.75; 95% CI, 1.43-2.15; P < 0.001], and AED use [eight studies; 654/9132 (7.2%) vs. 624/14 848 (4.2%); OR, 1.82; 95% CI, 1.31-2.53; P < 0.001], but similar rates of neurological intact discharge [three studies; 316/2685 (12%) vs. 276/2972 (9.3%); OR, 1.37; 95% CI, 0.81-2.33; P = 0.24]. Alerting citizen first responders to OHCA patients is associated with higher rates of bystander-initiated CPR, use of AED before ambulance arrival, and survival at hospital discharge or 30 days.
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Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Olivia Belloni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Camilla Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation. Circulation 2022; 145:e776-e801. [PMID: 35164535 DOI: 10.1161/cir.0000000000001013] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
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8
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Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation. Resuscitation 2022; 172:204-228. [PMID: 35181376 DOI: 10.1016/j.resuscitation.2021.11.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
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9
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Mottlau KH, Andelius LC, Gregersen R, Malta Hansen C, Folke F. Citizen Responder Activation in Out-of-Hospital Cardiac Arrest by Time of Day and Day of Week. J Am Heart Assoc 2022; 11:e023413. [PMID: 35060395 PMCID: PMC9238482 DOI: 10.1161/jaha.121.023413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background We aim to examine diurnal and weekday variations in citizen responder availability and intervention at out‐of‐hospital cardiac arrest (OHCA) resuscitation. Methods and Results We included confirmed OHCAs where citizen responders were activated by a smartphone application in the Capital Region of Denmark between September 1, 2017 and August 31, 2018. OHCAs were analyzed by time of day (daytime: 07:00 am–03:59 pm, evening: 4:00–11:59 pm, and nighttime: 12:00–06:59 am) and day of week (Monday–Friday or Saturday–Sunday/public holidays). We included 438 OHCAs where 6836 citizen responders were activated. More citizen responders accepted alarms in the evening (mean 4.8 [95% CI, 4.4–5.3]) compared with daytime (3.7 [95% CI, 3.4–4.4]) and nighttime (1.8 [95% CI, 1.5–2.2]) (P<0.001), and more accepted alarms during weekends (4.3 [95% CI, 3.8–4.9]) compared with weekdays (3.4 [95% CI, 3.2–3.7]) (P<0.001). Proportion of OHCAs where at least 1 citizen responder arrived before Emergency Medical Services were significantly different between day (42.9%), evening (50.3%), and night (26.1%) (P<0.001), and between weekdays (37.2%) and weekends (53.5%) (P=0.002). When responders arrived before Emergency Medical Services, there was no difference of bystander cardiopulmonary resuscitation or defibrillation between daytime, evening, and nighttime (P=0.75 and P=0.22, respectively) or between weekend and weekdays (P=0.29 and P=0.12, respectively). Conclusions Citizen responders were more likely to accept OHCA alarms during evening and weekends, with the highest proportion of responders arriving before Emergency Medical Services in the evening. However, there was no significant difference in delivering cardiopulmonary resuscitation or early defibrillation among cases where citizen responders arrived before Emergency Medical Services. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03835403.
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Affiliation(s)
- Katarina Høgh Mottlau
- Copenhagen University Hospital - Copenhagen Emergency Medical Services Copenhagen Denmark
| | - Linn Charlotte Andelius
- Copenhagen University Hospital - Copenhagen Emergency Medical Services Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Denmark
| | - Rasmus Gregersen
- Department of Emergency Medicine Copenhagen University Hospital - Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Carolina Malta Hansen
- Copenhagen University Hospital - Copenhagen Emergency Medical Services Copenhagen Denmark
| | - Fredrik Folke
- Copenhagen University Hospital - Copenhagen Emergency Medical Services Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Denmark.,Department of Cardiology Copenhagen University Hospital - Herlev and Gentofte Copenhagen Denmark
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10
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Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Tijssen JGP, Zwinderman AH, Blom MT, Koster RW. Alert system-supported lay defibrillation and basic life-support for cardiac arrest at home. Eur Heart J 2021; 43:1465-1474. [PMID: 34791171 PMCID: PMC9009403 DOI: 10.1093/eurheartj/ehab802] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/17/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Aims Automated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home. Methods and results In residential areas, 785 AEDs were placed and 5735 volunteer responders were recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient. We analysed survival (primary outcome) and neurologically favourable survival to discharge, time to first defibrillation shock, and cardiopulmonary resuscitation (CPR) before Emergency Medical Service (EMS) arrival of patients in residences found with ventricular fibrillation (VF), before and after introduction of this text-message alert system. Survival from OHCAs in residences increased from 26% to 39% {adjusted relative risk (RR) 1.5 [95% confidence interval (CI): 1.03–2.0]}. RR for neurologically favourable survival was 1.4 (95% CI: 0.99–2.0). No CPR before ambulance arrival decreased from 22% to 9% (RR: 0.5, 95% CI: 0.3–0.7). Text-message-responders with AED administered shocks to 16% of all patients in VF in residences, while defibrillation by EMS decreased from 73% to 39% in residences (P < 0.001). Defibrillation by first responders in residences increased from 22 to 40% (P < 0.001). Use of public AEDs in residences remained unchanged (6% and 5%) (P = 0.81). Time from emergency call to defibrillation decreased from median 11.7 to 9.3 min; mean difference –2.6 (95% CI: –3.5 to –1.6). Conclusion Introducing volunteer responders directed to AEDs, dispatched by text-message was associated with significantly reduced time to first defibrillation, increased bystander CPR and increased overall survival for OHCA patients in residences found with VF.
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Affiliation(s)
- Remy Stieglis
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | - Jolande A Zijlstra
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | | | | | | | - Jan G P Tijssen
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | | | - Marieke T Blom
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | - Rudolph W Koster
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
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Matinrad N, Reuter-Oppermann M. A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services. CENTRAL EUROPEAN JOURNAL OF OPERATIONS RESEARCH 2021; 30:251-302. [PMID: 34566490 PMCID: PMC8449697 DOI: 10.1007/s10100-021-00769-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 05/31/2023]
Abstract
Emergency services worldwide face increasing cost pressure that potentially limits their existing resources. In many countries, emergency services also face the issues of staff shortage-creating extra challenges and constraints, especially during crisis times such as the COVID-19 pandemic-as well as long distances to sparsely populated areas resulting in longer response times. To overcome these issues and potentially reduce consequences of daily (medical) emergencies, several countries, such as Sweden, Germany, and the Netherlands, have started initiatives using new types of human resources as well as equipment, which have not been part of the existing emergency systems before. These resources are employed in response to medical emergency cases if they can arrive earlier than emergency medical services (EMS). A good number of studies have investigated the use of these new types of resources in EMS systems, from medical, technical, and logistical perspectives as their study domains. Several review papers in the literature exist that focus on one or several of these new types of resources. However, to the best of our knowledge, no review paper that comprehensively considers all new types of resources in emergency medical response systems exists. We try to fill this gap by presenting a broad literature review of the studies focused on the different new types of resources, which are used prior to the arrival of EMS. Our objective is to present an application-based and methodological overview of these papers, to provide insights to this important field and to bring it to the attention of researchers as well as emergency managers and administrators.
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Affiliation(s)
- Niki Matinrad
- Department of Science and Technology, Linköping University, Norrköping, 60174 Sweden
| | - Melanie Reuter-Oppermann
- Information Systems - Software and Digital Business Group, Technical University of Darmstadt, 64289 Darmstadt, Germany
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Ganter J, Damjanovic D, Trummer G, Busch HJ, Baldas K, Hänsel M, Müller MP. Smartphone based alerting of first responders during the corona virus disease-19 pandemic: An observational study. Medicine (Baltimore) 2021; 100:e26526. [PMID: 34232186 PMCID: PMC8270573 DOI: 10.1097/md.0000000000026526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/13/2021] [Indexed: 01/04/2023] Open
Abstract
Smartphone alerting systems (SAS) for first responders potentially shorten the resuscitation-free interval of patients with acute cardiac arrest. During the corona virus disease-19 (COVID-19) pandemic, many systems are suspended due to potential risks for the responders.Objective of the study was to establish a concept for SAS during the COVID-19 pandemic and to evaluate whether a SAS can safely be operated in pandemic conditions.A SAS had been implemented in Freiburg (Germany) in 2018 alerting nearby registered first responders in case of emergencies with suspected cardiac arrest. Due to the pandemic, SAS was stopped in March 2020. A concept for a safe restart was elaborated with provision of a set with ventilation bag/mask, airway filter, and personal protective equipment (PPE) for every volunteer. A standard operating procedure was elaborated following the COVID-19 guidelines of the European Resuscitation Council.Willingness of the participants to respond alarms during the pandemic was investigated using an online survey. The response rates of first responders were monitored before and after deactivation, and during the second wave of the pandemic.The system was restarted in May 2020. The willingness to respond to alarms was lower during the pandemic without PPE. It remained lower than before the pandemic when the volunteers had been equipped with PPE, but the alarm response rate remained at approximately 50% during the second wave of the pandemic.When volunteers are equipped with PPE, the operation of a SAS does not need to be paused, and the willingness to respond remains high among first responders.
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Affiliation(s)
- Julian Ganter
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine
| | - Domagoj Damjanovic
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine
- ERC Research NET, European Resuscitation Council, Niel, Belgium
| | - Georg Trummer
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine
- ERC Research NET, European Resuscitation Council, Niel, Belgium
- German Resuscitation Council (GRC), Ulm, Germany
| | - Hans-Jörg Busch
- German Resuscitation Council (GRC), Ulm, Germany
- Department of Emergency Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg
| | - Klemens Baldas
- Department of Anaesthesiology, Intensive Care, and Emergency Medicine, St. Josef's Hospital, Freiburg
| | - Mike Hänsel
- Carl Gustav Carus Faculty of Medicine, Carus Teaching Center, Technische Universität Dresden, Dresden, Germany
| | - Michael Patrick Müller
- ERC Research NET, European Resuscitation Council, Niel, Belgium
- German Resuscitation Council (GRC), Ulm, Germany
- Department of Anaesthesiology, Intensive Care, and Emergency Medicine, St. Josef's Hospital, Freiburg
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Lee MJ, Shin TY, Lee CH, Moon JD, Roh SG, Kim CW, Park HE, Woo SH, Lee SJ, Shin SL, Oh YT, Lim YS, Choe JY, Na SH, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 9. Education and system implementation for enhanced chain of survival. Clin Exp Emerg Med 2021; 8:S116-S124. [PMID: 34034453 PMCID: PMC8171173 DOI: 10.15441/ceem.21.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/28/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Mi Jin Lee
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae-Yong Shin
- Department of Emergency Medicine, Asan Chungmu General Hospital, Asan, Korea
| | - Chang Hee Lee
- Department of Emergency Medical Technician, Namseoul University, Cheonan, Korea
| | - Jun Dong Moon
- Department of Emergency Medical Service, College of Health & Nursing, Kongju National University, Gongju, Korea
| | - Sang Gyun Roh
- Department of Emergency Medical Services, Sun Moon University, Asan, Korea
| | - Chan Woong Kim
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyo Eun Park
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Seon Hee Woo
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seung Joon Lee
- National Medical Emergency Center, National Medical Center, Seoul, Korea
| | - Seung Lyul Shin
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Young Taeck Oh
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Su Lim
- Department of Emergency Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Jae Young Choe
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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14
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Metelmann C, Metelmann B, Kohnen D, Brinkrolf P, Andelius L, Böttiger BW, Burkart R, Hahnenkamp K, Krammel M, Marks T, Müller MP, Prasse S, Stieglis R, Strickmann B, Thies KC. Smartphone-based dispatch of community first responders to out-of-hospital cardiac arrest - statements from an international consensus conference. Scand J Trauma Resusc Emerg Med 2021; 29:29. [PMID: 33526058 PMCID: PMC7852085 DOI: 10.1186/s13049-021-00841-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background Over the past decade Smartphone-based activation (SBA) of Community First Responders (CFR) to out-of-hospital cardiac arrests (OHCA) has gained much attention and popularity throughout Europe. Various programmes have been established, and interestingly there are considerable differences in technology, responder spectrum and the degree of integration into the prehospital emergency services. It is unclear whether these dissimilarities affect outcome. This paper reviews the current state in five European countries, reveals similarities and controversies, and presents consensus statements generated in an international conference with the intention to support public decision making on future strategies for SBA of CFR. Methods In a consensus conference a three-step approach was used: (i) presentation of current research from five European countries; (ii) workshops discussing evidence amongst the audience to generate consensus statements; (iii) anonymous real-time voting applying the modified RAND-UCLA Appropriateness method to adopt or reject the statements. The consensus panel aimed to represent all stakeholders involved in this topic. Results While 21 of 25 generated statements gained approval, consensus was only found for 5 of them. One statement was rejected but without consensus. Members of the consensus conference confirmed that CFR save lives. They further acknowledged the crucial role of emergency medical control centres and called for nationwide strategies. Conclusions Members of the consensus conference acknowledged that smartphone-based activation of CFR to OHCA saves lives. The statements generated by the consensus conference may assist the public, healthcare services and governments to utilise these systems to their full potential, and direct the research community towards fields that still need to be addressed. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00841-1.
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Affiliation(s)
- Camilla Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany.
| | - Bibiana Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Dorothea Kohnen
- zeb.business school, Steinbeis University Berlin, Münster, Germany
| | - Peter Brinkrolf
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - Klaus Hahnenkamp
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Mario Krammel
- Emergency Medical Service Vienna, Vienna, Austria.,PULS Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Tore Marks
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Michael P Müller
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefskrankenhaus, Freiburg im Breisgau, Germany
| | | | - Remy Stieglis
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernd Strickmann
- Emergency Medical Service, City and District of Gütersloh, Gütersloh, Germany
| | - Karl Christian Thies
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany.,Klinik für Anaesthesiologie, EvKB, Universitätsklinikum OWL der Universitaet Bielefeld, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany
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15
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Ganter J, Damjanovic D, Trummer G, Busch HJ, Baldas K, Steuber T, Niechoj J, Müller MP. [Implementation of a smartphone-based first-responder alerting system]. Notf Rett Med 2021; 25:177-185. [PMID: 33469407 PMCID: PMC7809537 DOI: 10.1007/s10049-020-00835-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/25/2022]
Abstract
Hintergrund Die Verkürzung des reanimationsfreien Intervalls beim Herz-Kreislauf-Stillstand erhöht die Überlebensrate. Smartphone-basierte Systeme können Ersthelfer in der Nähe des Notfallorts orten und alarmieren. Ziel Etablierung eines Ersthelferalarmierungssystems, technische Weiterentwicklung und Anpassung an regionale Strukturen. Material und Methoden Das System „Region der Lebensretter“ wurde im Juli 2018 in Freiburg etabliert. Mittels halbjährlicher Evaluation wurde der Bedarf für Optimierungen festgestellt und im Sinne eines PDCA(plan-do-check-act)-Zyklus umgesetzt. Die nötigen Funktionen wurden spezifiziert („plan“), programmiert, getestet und freigegeben („do“). Anschließend wurden die Änderungen evaluiert („check“) und bei Bedarf weitere Optimierungen durchgeführt („act“). Ergebnisse Die Zahl der Ersthelfer stieg von 276 (2. Halbjahr 2018) auf 794 Helfer (1. Halbjahr 2020). Die Einsatzübernahmen stiegen von 30 % (2. Halbjahr 2018) bis auf 49 % (1. Halbjahr 2020). Folgende Funktionen wurden programmiert und umgesetzt: dynamischer Alarmierungsradius in Abhängigkeit der voraussichtlichen Eintreffzeit des Rettungsdiensts, lauter Alarm trotz Stummschaltung, Anbindung an AED-Datenbank, Ersthelferausweis, Statusmeldung „eingetroffen“, Angabe des Verkehrsmittels zur Optimierung des Algorithmus. Die Anzahl der vorhandenen AED nahm von 190 auf 270 zu. Diskussion Smartphone-basierte Alarmierungssysteme können das reanimationsfreie Intervall verkürzen. Neben der Gesamtzahl von Ersthelfern ist die technische Umsetzung entscheidend. Weitere Studien sollten auf der Basis valider Daten untersuchen, ob die Überlebensrate nach außerklinischem Herz-Kreislauf-Stillstand gesteigert werden kann. Die Anbindung der Systeme an Datenbanken der Qualitätssicherung im Rettungsdienst bzw. Reanimationsregister erscheint sinnvoll.
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Affiliation(s)
- Julian Ganter
- Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg – Bad Krozingen, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
- c/o Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, St. Josefskrankenhaus, Region der Lebensretter e. V., Sautierstr. 1, 79104 Freiburg, Deutschland
- Deutscher Rat für Wiederbelebung e. V. – German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Deutschland
| | - Domagoj Damjanovic
- Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg – Bad Krozingen, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
- c/o Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, St. Josefskrankenhaus, Region der Lebensretter e. V., Sautierstr. 1, 79104 Freiburg, Deutschland
- Deutscher Rat für Wiederbelebung e. V. – German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Deutschland
| | - Georg Trummer
- Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg – Bad Krozingen, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
- c/o Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, St. Josefskrankenhaus, Region der Lebensretter e. V., Sautierstr. 1, 79104 Freiburg, Deutschland
- Deutscher Rat für Wiederbelebung e. V. – German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Deutschland
| | - Hans-Jörg Busch
- c/o Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, St. Josefskrankenhaus, Region der Lebensretter e. V., Sautierstr. 1, 79104 Freiburg, Deutschland
- Deutscher Rat für Wiederbelebung e. V. – German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Deutschland
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Klemens Baldas
- c/o Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, St. Josefskrankenhaus, Region der Lebensretter e. V., Sautierstr. 1, 79104 Freiburg, Deutschland
- Deutscher Rat für Wiederbelebung e. V. – German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Deutschland
- Klinik f. Anästhesiologie, Intensiv- und Notfallmedizin, St. Josefskrankenhaus, Freiburg, Deutschland
| | - Thomas Steuber
- c/o Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, St. Josefskrankenhaus, Region der Lebensretter e. V., Sautierstr. 1, 79104 Freiburg, Deutschland
| | - Jan Niechoj
- c/o Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, St. Josefskrankenhaus, Region der Lebensretter e. V., Sautierstr. 1, 79104 Freiburg, Deutschland
- Kreisverband Freiburg e. V., Deutsches Rotes Kreuz, Freiburg, Deutschland
| | - Michael P. Müller
- c/o Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, St. Josefskrankenhaus, Region der Lebensretter e. V., Sautierstr. 1, 79104 Freiburg, Deutschland
- Deutscher Rat für Wiederbelebung e. V. – German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Deutschland
- Klinik f. Anästhesiologie, Intensiv- und Notfallmedizin, St. Josefskrankenhaus, Freiburg, Deutschland
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Valeriano A, Van Heer S, de Champlain F, C Brooks S. Crowdsourcing to save lives: A scoping review of bystander alert technologies for out-of-hospital cardiac arrest. Resuscitation 2020; 158:94-121. [PMID: 33188832 DOI: 10.1016/j.resuscitation.2020.10.035] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Abstract
AIM Out-of-hospital cardiac arrest (OHCA) constitutes a significant global health burden, with a survival rate of only 10-12%. Mobile phone technologies have been developed that crowdsource citizen volunteers to nearby OHCAs in order to initiate resuscitation prior to ambulance arrival. We performed a scoping review to map the available literature on these crowdsourcing technologies and compared their technical specifications. METHODS A search strategy was developed for five online databases. Two reviewers independently assessed all articles for inclusion and extracted relevant study information. Subsequently, we performed a supplementary internet search and consulted experts to identify all available bystander alert technologies and their specifications. RESULTS We included 65 articles examining bystander alerting technologies from more than 15 countries. We also identified 25 unique technologies, of which 18 were described in the included literature. Technologies were text message-based systems (n = 3) or mobile phone applications (n = 22). Most (21/25) used global positioning systems to direct bystanders to victims and nearby AEDs. Response radii for alerts varied widely from 200 m to 10 km. Some technologies incorporated advanced features such as video-conferencing with ambulance dispatch and detailed alert settings. Not all systems required volunteers to have training in cardiopulmonary resuscitation. Only ten studies assessed impact on clinical outcomes. Key barriers discussed included false positive alerts, legal liability, and potential psychological impact on volunteers. CONCLUSION Our review provides a comprehensive overview of crowdsourcing technologies for bystander intervention in out-of-hospital cardiac arrest. Future work should focus on clinical outcomes and methods of addressing barriers to implementation.
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Affiliation(s)
| | - Shyan Van Heer
- School of Medicine, Queen's University, Kingston, Canada
| | | | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, Canada.
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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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Abstract
Cardiac electrical stimulation is a rarely used but required skill for pediatric emergency physicians. Children who are in cardiac arrest or who demonstrate evidence of hypoperfusion because of cardiac reasons require rapid diagnosis and intervention to minimize patient morbidity and mortality. Both hospital- and community-based personnel must have sufficient access to, and knowledge of, appropriate equipment to provide potentially lifesaving defibrillation, cardioversion, or cardiac pacing. In this review, we will discuss the primary clinical indications for cardioelectrical stimulation in pediatric patients, including the use of automated external defibrillators, internal defibrillators, and pacemakers. We discuss the types of devices that are currently available, emergency management of internal defibrillation and pacemaker devices, and the role of advocacy in improving delivery of emergency cardiovascular care of pediatric patients in the community.
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Enhancing citizens response to out-of-hospital cardiac arrest: A systematic review of mobile-phone systems to alert citizens as first responders. Resuscitation 2020; 152:16-25. [PMID: 32437783 PMCID: PMC7211690 DOI: 10.1016/j.resuscitation.2020.05.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/16/2020] [Accepted: 05/03/2020] [Indexed: 12/19/2022]
Abstract
Introduction Involving laypersons in response to out-of-hospital cardiac arrest through mobile-phone technology is becoming widespread in numerous countries, and different solutions were developed. We performed a systematic review on the impact of alerting citizens as first responders and to provide an overview of different strategies and technologies used. Methods We searched electronic databases up to October 2019. Eligible studies described systems to alert citizens first responders to out-of-hospital cardiac arrest through text messages or apps. We analyzed the implementation and performance of these systems and their impact on patients’ outcomes. Results We included 28 manuscripts describing 12 different systems. The first text message system was implemented in 2006 and the first app in 2010. First responders accepted to intervene in median (interquartile) 28.7% (27–29%) of alerts and reached the scene after 4.6 (4.4–5.5) minutes for performing CPR. First responders arrived before ambulance, started CPR and attached a defibrillator in 47% (34–58%), 24% (23–27%) and 9% (6–14%) of cases, respectively. Pooled analysis showed that first responders activation increased layperson-CPR rates (1463/2292 [63.8%] in the intervention group vs. 1094/1989 [55.0%] in the control group; OR = 1.70; 95% CI, 1.11–2.60; p = 0.01) and survival to hospital discharge or at 30 days (327/2273 [14.4%] vs. 184/1955 [9.4%]; OR = 1.51; 95% CI, 1.24–1.84; p < 0.001). Conclusions Alerting citizens as first responders in case of out-of-hospital cardiac arrest may reduce the intervention-free time and improve patients’ outcomes.
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Chien SC, Islam MM, Yeh CA, Chien PH, Chen CY, Chin YP, Lin MC. Mutual-Aid Mobile App for Emergency Care: Feasibility Study. JMIR Form Res 2020; 4:e15494. [PMID: 32191212 PMCID: PMC7118550 DOI: 10.2196/15494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/28/2019] [Accepted: 12/16/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Improving the quality of patient care through the use of mobile devices is one of the hot topics in the health care field. In unwanted situations like an accident, ambulances and rescuers often require a certain amount of time to arrive at the scene. Providing immediate cardiopulmonary resuscitation (CPR) to patients might improve survival. OBJECTIVE The primary objective of this study was to evaluate the feasibility of an emergency and mutual-aid app model in Taiwan and to provide a reference for government policy. METHODS A structured questionnaire was developed as a research tool. All questionnaires were designed according to the technology acceptance model, and a Likert scale was used to measure the degree of agreement or disagreement. Moreover, in-depth interviews were conducted with six experts from medical, legal, and mobile app departments. Each expert was interviewed once to discuss feasible countermeasures and suggestions. Statistical Package for the Social Sciences (SPSS version 19; IBM Corp, Armonk, New York) was used to perform all statistical analyses, including descriptive statistics, independent sample t-tests, variance analysis, and Pearson correlation analysis. RESULTS We conducted this study between October 20, 2017, and November 10, 2017, at the Taipei Medical University Hospital. Questionnaires were distributed to medical personnel, visiting guests, family members, and volunteers. A total of 113 valid questionnaires were finally obtained after the exclusion of incomplete questionnaires. Cronbach α values for self-efficacy (perceived ease of use), use attitude (perceived usefulness), and use willingness and frequency were above .85, meeting the criterion of greater than .70. We observed that the reliability of each subquestion was acceptable and the values for use attitude (perceive usefulness) and use willingness and frequency were more than .90. CONCLUSIONS The findings suggest that perceived ease of use and perceived usefulness of the app model affect use willingness. However, perceived usefulness had an intermediary influence on use willingness. Experts in law, medical, and technology fields consider that an emergency and mutual-aid model can be implemented in Taiwan. Along with the development of an emergency and mutual-aid app model, we recommend an increase in the number of automated external defibrillators per region and promotion of correct knowledge about CPR in order to decrease morbidity and mortality.
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Affiliation(s)
- Shuo-Chen Chien
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Md Mohaimenul Islam
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chen-An Yeh
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Po-Han Chien
- Business Administration, National Taiwan University, Taipei, Taiwan
| | - Chun You Chen
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Yen-Po Chin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chin Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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Smith CM, Griffiths F, Fothergill RT, Vlaev I, Perkins GD. Identifying and overcoming barriers to automated external defibrillator use by GoodSAM volunteer first responders in out-of-hospital cardiac arrest using the Theoretical Domains Framework and Behaviour Change Wheel: a qualitative study. BMJ Open 2020; 10:e034908. [PMID: 32161161 PMCID: PMC7066637 DOI: 10.1136/bmjopen-2019-034908] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES GoodSAM is a mobile phone app that integrates with UK ambulance services. During a 999 call, if a call handler diagnoses cardiac arrest, nearby volunteer first responders registered with the app are alerted. They can give cardiopulmonary resuscitation (CPR) and/or use a public access automated external defibrillator (AED). We aimed to identify means of increasing AED use by GoodSAM first responders. METHODS We conducted semistructured telephone interviews, using the Theoretical Domains Framework to identify and classify barriers to AED use. We analysed findings using the Capability, Opportunity, Motivation, Behaviour (COM-B) model and subsequently used the Behaviour Change Wheel to develop potential interventions to improve AED use. SETTING London, UK. PARTICIPANTS GoodSAM first responders alerted in the previous 7 days about a cardiac arrest. RESULTS We conducted 30 telephone interviews in two batches in July and October 2018. A public access AED was taken to scene once, one had already been attached on scene another time and three participants took their own AEDs when responding. Most first responders felt capable and motivated to use public access AEDs but were concerned about delaying CPR if they retrieved one and frustrated when arriving after the ambulance service. They perceived lack of opportunities due to unavailable and inaccessible AEDs, particularly out of hours. We subsequently developed 13 potential interventions to increase AED use for future testing. CONCLUSIONS GoodSAM first responders used AEDs occasionally, despite a capability and motivation to do so. Those operating volunteer first responder systems should consider our proposed interventions to improve AED use. Of particular clinical importance are: highlighting AED location and providing route/time estimates to the patient via the nearest AED. This would help single responders make appropriate decisions about AED retrieval. As AED collection may extend time to reach the patient, where there is sufficient density of potential responders, systems could send one responder to initiate CPR and another to collect an AED.
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Affiliation(s)
| | | | - Rachael T Fothergill
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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22
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Crowdsourcing in health and medical research: a systematic review. Infect Dis Poverty 2020; 9:8. [PMID: 31959234 PMCID: PMC6971908 DOI: 10.1186/s40249-020-0622-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 01/07/2020] [Indexed: 12/31/2022] Open
Abstract
Background Crowdsourcing is used increasingly in health and medical research. Crowdsourcing is the process of aggregating crowd wisdom to solve a problem. The purpose of this systematic review is to summarize quantitative evidence on crowdsourcing to improve health. Methods We followed Cochrane systematic review guidance and systematically searched seven databases up to September 4th 2019. Studies were included if they reported on crowdsourcing and related to health or medicine. Studies were excluded if recruitment was the only use of crowdsourcing. We determined the level of evidence associated with review findings using the GRADE approach. Results We screened 3508 citations, accessed 362 articles, and included 188 studies. Ninety-six studies examined effectiveness, 127 examined feasibility, and 37 examined cost. The most common purposes were to evaluate surgical skills (17 studies), to create sexual health messages (seven studies), and to provide layperson cardio-pulmonary resuscitation (CPR) out-of-hospital (six studies). Seventeen observational studies used crowdsourcing to evaluate surgical skills, finding that crowdsourcing evaluation was as effective as expert evaluation (low quality). Four studies used a challenge contest to solicit human immunodeficiency virus (HIV) testing promotion materials and increase HIV testing rates (moderate quality), and two of the four studies found this approach saved money. Three studies suggested that an interactive technology system increased rates of layperson initiated CPR out-of-hospital (moderate quality). However, studies analyzing crowdsourcing to evaluate surgical skills and layperson-initiated CPR were only from high-income countries. Five studies examined crowdsourcing to inform artificial intelligence projects, most often related to annotation of medical data. Crowdsourcing was evaluated using different outcomes, limiting the extent to which studies could be pooled. Conclusions Crowdsourcing has been used to improve health in many settings. Although crowdsourcing is effective at improving behavioral outcomes, more research is needed to understand effects on clinical outcomes and costs. More research is needed on crowdsourcing as a tool to develop artificial intelligence systems in medicine. Trial registration PROSPERO: CRD42017052835. December 27, 2016.
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Smida T, Willson C, Salerno J, Weiss L, Salcido DD. Can you get there from here? An analysis of walkability among PulsePoint CPR alert dispatches. Resuscitation 2020; 148:135-139. [PMID: 31962177 DOI: 10.1016/j.resuscitation.2019.12.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/05/2019] [Accepted: 12/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bystander CPR before the arrival of EMS is a major factor in out of hospital cardiac arrest (OHCA) survival. To recruit trained bystanders, mobile phone-based alert systems have been developed, but their limitations are not well understood. OBJECTIVE We investigated the effects of landscape features on the capabilities of the PulsePoint CPR dispatch platform in Allegheny County, Pennsylvania. We hypothesized that landscape features would reduce walkable area within dispatch zones and that larger alert radii could mitigate these effects. METHODS CPR alert location data were obtained from the Allegheny County 911 PulsePoint deployment from July 2016-2019 (n = 1100). PulsePoint, a smartphone-based citizen CPR dispatch platform, alerts volunteers to public OHCAs within 400 m. Digital maps of alerts were generated for walkability analysis using the image Labeler MATLAB polygon tool. Unwalkable areas were labeled, classified into five categories, and quantified. RESULTS Of the 1100 events analyzed, encompassing 212 mi2, 357 (32.45%) had no impediments to walkability. Within a 400 m radius of partially impeded events, the median proportion of obstructed area was 0.2250 (Min: 0.0005, Max: 0.8338, IQR: 0.3004, Sx: 0.1923). When the alert radius was expanded to 468 m, the median increased to 0.2336 (Min: 0.0016, Max: 0.8597, IQR: 0.3064, Sx: 0.1950). The percentages of total unwalkable area by each category were: terrain (54.286%), water (24.674%), road w/o crosswalk (11.3197%), railroad (7.4100%), private property (2.3102%). CONCLUSIONS In this region, most PulsePoint alerts had unwalkable areas, mostly from terrain and water. Contrary to our initial hypotheses, moderately increasing dispatch radius did not improve walkability.
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Affiliation(s)
- Tanner Smida
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
| | - Connor Willson
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Jessica Salerno
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Leonard Weiss
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - David D Salcido
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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24
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Sudden cardiac arrest survival in HEARTSafe communities. Resuscitation 2020; 146:13-18. [DOI: 10.1016/j.resuscitation.2019.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/23/2022]
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25
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Stroop R, Kerner T, Strickmann B, Hensel M. Mobile phone-based alerting of CPR-trained volunteers simultaneously with the ambulance can reduce the resuscitation-free interval and improve outcome after out-of-hospital cardiac arrest: A German, population-based cohort study. Resuscitation 2019; 147:57-64. [PMID: 31887366 DOI: 10.1016/j.resuscitation.2019.12.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
Abstract
AIM To test the hypothesis that simultaneous mobile phone-based alerting of CPR-trained volunteers (Mobile-Rescuers) with Emergency Medical Service (EMS) teams leads to better outcomes in out-of-hospital cardiac arrest (OHCA) victims than EMS alerting alone. METHODS The outcomes of 730 OHCA patients were retrospectively analysed, depending on who initiated CPR: Mobile-Rescuer-initiated-CPR (n = 94), EMS-initiated-CPR (n = 359), lay bystander-initiated-CPR (n = 277). An adjusted analysis of the intervention and their main outcomes (emergency response time, return of spontaneous circulation, hospital discharge rate, neurological outcomes) was performed (Propensity Score Method with patient matching). RESULTS Recruited and trained Mobile-Rescuers (n = 740) arrived at the scene in 46% of all triggered alarms. There was a significant difference in response time between Mobile-Rescuers (4 min) and EMS teams (7 min), (p < 0.001). Compared to EMS-initiated-CPR, Mobile-Rescuer-initiated-CPR patients more frequently showed a return of spontaneous circulation, but statistical significance was narrowly missed (p = 0.056). The hospital discharge rate was significantly higher with the Mobile-Rescuer (18%) vs. EMS (7%), (p = 0.049). Good neurological outcomes (Cerebral Performance Categories Score 1 and 2) were seen in 11% of Mobile-Rescuer patients and 4% of EMS patients (p = 0.165). There were no significant differences compared with lay bystander-initiated-CPR. CONCLUSION Simultaneous alerting of nearby CPR-trained volunteers complementary to professional EMS teams can reduce both the response time and resuscitation-free interval and might improve hospital discharge rate and neurological outcomes after OHCA.
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Affiliation(s)
- Ralf Stroop
- Department of Stereotactic Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Am Heessener Wald 1, 59073 Hamm, Germany.
| | - Thoralf Kerner
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany.
| | - Bernd Strickmann
- Medical Director, Emergency Medical Service, City and District of Gütersloh, Herzebrocker Strasse 140, 33324 Gütersloh, Germany.
| | - Mario Hensel
- Department of Anaesthesiology and Intensive Care Medicine, Park-Klinik-Weissensee, Schönstrasse 80, 13086 Berlin, Germany.
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26
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Del Pozo A, Villalobos F, Rey-Reñones C, Granado E, Sabaté D, Poblet C, Calvet A, Basora J, Castro A, Flores G. Effectiveness of a network of automatically activated trained volunteers on the reduction of cardiopulmonary resuscitation manoueuvers initiation time: study protocol. BMC Public Health 2019; 19:572. [PMID: 31088520 PMCID: PMC6518759 DOI: 10.1186/s12889-019-6896-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/25/2019] [Indexed: 11/28/2022] Open
Abstract
Background Cardiorespiratory arrest (CRA) is a health emergency with high mortality. Mortality depends on time of initiation and quality of cardiopulmonary resuscitation (CPR) manoeuvres and the use of the automated external defibrillator (AED). Methods The aim of the study is to determine the effectiveness of an automatically activated network of volunteers using smartwatch and smartphone applications on the reduction of time of initiation of cardiopulmonary resuscitation manoeuvres. The protocol will be developed in four phases: 1) validation of an application (App) for smartwatch that automatically generates a health alert in case of out-of-hospital cardiorespiratory arrest (OHCA); 2) training course for laypersons on CPR manoeuvres and AED use; 3) creation of a network of volunteers trained in CPR and AED use that covers our city; and 4) simulation in which the network of volunteers is automatically activated via smartphone to attend simulated OHCAs. A total of 134 health alerts will be generated; on 67 occasions the alert will be directed to the emergency health services and to the network of trained volunteers (Intervention Group) and on 67 occasions the alert will be solely directed to the emergency health services (Control Group). The arrival time of the first rescuer, category of first rescuer (emergency services versus network of volunteers), initiation time of manoeuvres and competence will be recorded. Discussion CPR training for laypersons is advised, especially for relatives and people close to patients with heart disease, to reduce time of initiation of CPR and to improve OHCA survival rates. This study aims to verify that the initiation time of CPR manoeuvres and AED use is shorter in the intervention than in the control group. Trial registration Clinicaltrials.gov ID NCT03828305. Trial registered on February 1, 2019 (retrospective register).
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Affiliation(s)
- Albert Del Pozo
- Research Group in Primary Care Research Technologies (TICS-AP), Primary Care Research Institute IDIAP Jordi Gol, Reus, Spain.,Primary Care Centre Falset. Primary Care Management Camp de Tarragona, Catalan Institute of Health, Tarragona, Spain
| | - Felipe Villalobos
- Research Support Unit Camp de Tarragona, Primary Care Research Institute IDIAP Jordi Gol, Camí de Riudoms 53-55, 43202, Reus, Tarragona, Spain
| | - Cristina Rey-Reñones
- Research Group in Primary Care Research Technologies (TICS-AP), Primary Care Research Institute IDIAP Jordi Gol, Reus, Spain. .,Research Support Unit Camp de Tarragona, Primary Care Research Institute IDIAP Jordi Gol, Camí de Riudoms 53-55, 43202, Reus, Tarragona, Spain. .,University Rovira i Virgili, Tarragona, Spain.
| | - Ester Granado
- Research Group in Primary Care Research Technologies (TICS-AP), Primary Care Research Institute IDIAP Jordi Gol, Reus, Spain.,Primary Care Centre Reus-4, Primary Care Management Camp de Tarragona. Catalan Institute of Health, Tarragona, Spain
| | - David Sabaté
- Primary Care Centre CUAP Reus, Primary Care Management Camp de Tarragona, Catalan Institute of Health, Tarragona, Spain
| | - Carme Poblet
- Primary Care Centre Reus-4, Primary Care Management Camp de Tarragona. Catalan Institute of Health, Tarragona, Spain
| | - Angels Calvet
- Mobility Office, Catalan Institute of Health, Barcelona, Spain.,Open University of Catalonia, Barcelona, Spain
| | - Josep Basora
- Research Support Unit Camp de Tarragona, Primary Care Research Institute IDIAP Jordi Gol, Camí de Riudoms 53-55, 43202, Reus, Tarragona, Spain.,University Rovira i Virgili, Tarragona, Spain
| | - Antoni Castro
- University Rovira i Virgili, Tarragona, Spain.,Internal Medicine Department, Sant Joan de Reus University Hospital, Reus, Spain
| | - Gemma Flores
- Research Group in Primary Care Research Technologies (TICS-AP), Primary Care Research Institute IDIAP Jordi Gol, Reus, Spain.,Analysis and Quality Unit, Health and Social Network Santa Tecla, Tarragona, Spain
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Smart Technology – a Future Field in Acute Cardiac Care. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lee SY, Shin SD, Lee YJ, Song KJ, Hong KJ, Ro YS, Lee EJ, Kong SY. Text message alert system and resuscitation outcomes after out-of-hospital cardiac arrest: A before-and-after population-based study. Resuscitation 2019; 138:198-207. [DOI: 10.1016/j.resuscitation.2019.01.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/27/2018] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
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29
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Sondergaard KB, Hansen SM, Pallisgaard JL, Gerds TA, Wissenberg M, Karlsson L, Lippert FK, Gislason GH, Torp-Pedersen C, Folke F. Out-of-hospital cardiac arrest: Probability of bystander defibrillation relative to distance to nearest automated external defibrillator. Resuscitation 2018; 124:138-144. [DOI: 10.1016/j.resuscitation.2017.11.067] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/30/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
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30
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Rao P, Kern KB. Improving Community Survival Rates from Out-of-Hospital Cardiac Arrest. Curr Cardiol Rev 2018; 14:79-84. [PMID: 29737258 PMCID: PMC6088442 DOI: 10.2174/1573403x14666180507160555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/31/2018] [Accepted: 04/25/2018] [Indexed: 12/24/2022] Open
Abstract
Out of hospital cardiac arrest affects 350,000 Americans yearly and is associated with a high mortality rate. Improving survival rates in this population rests on the prompt and effective implementation of four key principles. These include 1) early recognition of cardiac arrest 2) early use of chest compressions 3) early defibrillation, which in turn emphasizes the importance of public access defibrillation programs and potential for drone technology to allow for early defibrillation in private or rural settings 4) early and aggressive post-arrest care including the consideration of therapeutic hypothermia, early coronary angiography +/- percutaneous coronary intervention and a hyper-invasive approach to out-of-hospital refractory cardiac arrest.
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Affiliation(s)
- Prashant Rao
- University of Arizona, College of Medicine, Sarver Heart Center, Tucson, Arizona, USA
| | - Karl B. Kern
- University of Arizona, College of Medicine, Sarver Heart Center, Tucson, Arizona, USA
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31
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Agerskov M, Hansen MB, Nielsen AM, Møller TP, Wissenberg M, Rasmussen LS. Return of spontaneous circulation and long-term survival according to feedback provided by automated external defibrillators. Acta Anaesthesiol Scand 2017; 61:1345-1353. [PMID: 28901546 PMCID: PMC5698742 DOI: 10.1111/aas.12992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 01/23/2023]
Abstract
Background We aimed to investigate the effect of automated external defibrillator (AED) feedback mechanisms on survival in out‐of‐hospital cardiac arrest (OHCA) victims. In addition, we investigated converting rates in patients with shockable rhythms according to AED shock waveforms and energy levels. Methods We collected data on OHCA occurring between 2011 and 2014 in the Capital Region of Denmark where an AED was applied prior to ambulance arrival. Patient data were obtained from the Danish Cardiac Arrest Registry and medical records. AED data were retrieved from the Emergency Medical Dispatch Centre (EMDC) and information on feedback mechanisms, energy waveform and energy level was downloaded from the applied AEDs. Results A total of 196 OHCAs had an AED applied prior to ambulance arrival; 62 of these (32%) provided audio visual (AV) feedback while no feedback was provided in 134 (68%). We found no difference in return of spontaneous circulation (ROSC) at hospital arrival according to AV‐feedback; 34 (55%, 95% confidence interval (CI) [13–67]) vs. 72 (54%, 95% CI [45–62]), P = 1 (odds ratio (OR) 1.1, 95% CI [0.6–1.9]) or 30‐day survival; 24 (39%, 95% CI [28–51]) vs. 53 (40%, 95% CI [32–49]), P = 0.88 (OR 1.1 (95% CI [0.6–2.0])). Moreover, we found no difference in converting rates among patients with initial shockable rhythm receiving one or more shocks according to AED energy waveform and energy level. Conclusions No difference in survival after OHCA according to AED feedback mechanisms, nor any difference in converting rates according to AED waveform or energy levels was detected.
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Affiliation(s)
- M. Agerskov
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. B. Hansen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - A. M. Nielsen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Emergency Medical Services, Copenhagen; University of Copenhagen; Copenhagen Denmark
| | - T. P. Møller
- Emergency Medical Services, Copenhagen; University of Copenhagen; Copenhagen Denmark
| | - M. Wissenberg
- Emergency Medical Services, Copenhagen; University of Copenhagen; Copenhagen Denmark
- Department of Cardiology; Gentofte Hospital; University of Copenhagen; Copenhagen Denmark
| | - L. S. Rasmussen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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Fredman D, Haas J, Ban Y, Jonsson M, Svensson L, Djarv T, Hollenberg J, Nordberg P, Ringh M, Claesson A. Use of a geographic information system to identify differences in automated external defibrillator installation in urban areas with similar incidence of public out-of-hospital cardiac arrest: a retrospective registry-based study. BMJ Open 2017; 7:e014801. [PMID: 28576894 PMCID: PMC5623355 DOI: 10.1136/bmjopen-2016-014801] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Early defibrillation in out-of-hospital cardiac arrest (OHCA) is of importance to improve survival. In many countries the number of automated external defibrillators (AEDs) is increasing, but the use is low. Guidelines suggest that AEDs should be installed in densely populated areas and in locations with many visitors. Attempts have been made to identify optimal AED locations based on the incidence of OHCA using geographical information systems (GIS), but often on small datasets and the studies are seldom reproduced. The aim of this paper is to investigate if the distribution of public AEDs follows the incident locations of public OHCAs in urban areas of Stockholm County, Sweden. METHOD OHCA data were obtained from the Swedish Register for Cardiopulmonary Resuscitation and AED data were obtained from the Swedish AED Register. Urban areas in Stockholm County were objectively classified according to the pan-European digital mapping tool, Urban Atlas (UA). Furthermore, we reclassified and divided the UA land cover data into three classes (residential, non-residential and other areas). GIS software was used to spatially join and relate public AED and OHCA data and perform computations on relations and distance. RESULTS Between 1 January 2012 and 31 December 2014 a total of 804 OHCAs occurred in public locations in Stockholm County and by December 2013 there were 1828 AEDs available. The incidence of public OHCAs was similar in residential (47.3%) and non-residential areas (43.4%). Fewer AEDs were present in residential areas than in non-residential areas (29.4% vs 68.8%). In residential areas the median distance between OHCAs and AEDs was significantly greater than in non-residential areas (288 m vs 188 m, p<0.001). CONCLUSION The majority of public OHCAs occurred in areas classified in UA as 'residential areas' with limited AED accessibility. These areas need to be targeted for AED installation and international guidelines need to take geographical location into account when suggesting locations for AED installation.
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Affiliation(s)
- David Fredman
- Department of Medicine, Karolinska Institutet, Center for Resuscitation Science, Solna, Sweden
| | - Jan Haas
- Division of Geoinformatics, Kungliga Tekniska Hogskolan (KTH), Stockholm, Sweden
| | - Yifang Ban
- Division of Geoinformatics, Kungliga Tekniska Hogskolan (KTH), Stockholm, Sweden
| | - Martin Jonsson
- Department of Medicine, Karolinska Institutet, Center for Resuscitation Science, Solna, Sweden
| | - Leif Svensson
- Department of Medicine, Karolinska Institutet, Center for Resuscitation Science, Solna, Sweden
| | - Therese Djarv
- Department of Medicine, Karolinska Institutet, Function of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Medicine, Karolinska Institutet, Center for Resuscitation Science, Solna, Sweden
| | - Per Nordberg
- Department of Medicine, Karolinska Institutet, Center for Resuscitation Science, Solna, Sweden
| | - Mattias Ringh
- Department of Medicine, Karolinska Institutet, Center for Resuscitation Science, Solna, Sweden
| | - Andreas Claesson
- Department of Medicine, Karolinska Institutet, Center for Resuscitation Science, Solna, Sweden
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Pijls RW, Nelemans PJ, Rahel BM, Gorgels AP. Factors modifying performance of a novel citizen text message alert system in improving survival of out-of-hospital cardiac arrest. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017. [PMID: 28635305 PMCID: PMC6058405 DOI: 10.1177/2048872617694675] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Recently we found that the text message alert system increases survival of sudden out-of-hospital cardiac arrest. The aim of the present study is to explore the contribution of the system to survival specifically in resuscitation settings with prolonged delay of start of resuscitation. METHODS AND RESULTS Data were used from consecutive patients resuscitated for out-of-hospital cardiac arrest during a two-year period in the Dutch province Limburg. Survival of 291 cases with out-of-hospital cardiac arrest where one or more volunteers attended (Scenario 2) was compared with survival of 131 cases with out-of-hospital cardiac arrest where no volunteers attended and only standard care was given (Scenario 1). Multivariable logistic regression models including terms for interaction between scenario and the covariate coding for resuscitation setting were used to test for effect modification. The highest impact on survival of the alert system was observed in cases of (a) witnessed arrests (odds ratio=2.25; 95% confidence interval: 1.27-4.00; p=0.005); (b) arrests that occurred in the home (odds ratio=2.28; 95% confidence interval: 1.21-4.28; p=0.011); (c) arrival of the ambulance with a delay of 7-10 min (odds ratio=2.63; 95% confidence interval: 1.09-6.35; p=0.032); and (d) arrests at evening/night (odds ratio=3.07; 95% confidence interval: 1.34-7.03; p=0.008). Due to the low sample size, p-values from tests for interaction were non-significant. CONCLUSION The contribution of the alert system to survival is most substantial in cases of witnessed arrest, in the home situation, at slightly delayed arrival of the first ambulance and during the evening/night.
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Affiliation(s)
- Ruud Wm Pijls
- 1 Department of Cardiology, CAPHRI school for Public Health and Primary Care, Maastricht University Medical Centre+, the Netherlands
| | - Patty J Nelemans
- 2 Department of Epidemiology, CAPHRI school for Public Health and Primary Care, Maastricht University Medical Centre+, the Netherlands
| | - Braim M Rahel
- 3 VieCuri Medical Centre for Northern Limburg, the Netherlands
| | - Anton Pm Gorgels
- 1 Department of Cardiology, CAPHRI school for Public Health and Primary Care, Maastricht University Medical Centre+, the Netherlands
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Expanding the first link in the chain of survival – Experiences from dispatcher referral of callers to AED locations. Resuscitation 2016; 107:129-34. [DOI: 10.1016/j.resuscitation.2016.06.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/12/2016] [Accepted: 06/08/2016] [Indexed: 11/19/2022]
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35
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Rumsfeld JS, Brooks SC, Aufderheide TP, Leary M, Bradley SM, Nkonde-Price C, Schwamm LH, Jessup M, Ferrer JME, Merchant RM. Use of Mobile Devices, Social Media, and Crowdsourcing as Digital Strategies to Improve Emergency Cardiovascular Care. Circulation 2016; 134:e87-e108. [DOI: 10.1161/cir.0000000000000428] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Pijls RW, Nelemans PJ, Rahel BM, Gorgels AP. A text message alert system for trained volunteers improves out-of-hospital cardiac arrest survival. Resuscitation 2016; 105:182-7. [DOI: 10.1016/j.resuscitation.2016.06.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/12/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
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Brooks SC, Simmons G, Worthington H, Bobrow BJ, Morrison LJ. The PulsePoint Respond mobile device application to crowdsource basic life support for patients with out-of-hospital cardiac arrest: Challenges for optimal implementation. Resuscitation 2016; 98:20-6. [DOI: 10.1016/j.resuscitation.2015.09.392] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/04/2015] [Accepted: 09/15/2015] [Indexed: 11/30/2022]
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Lijovic M, Bernard S, Nehme Z, Walker T, Smith K. Public access defibrillation—results from the Victorian Ambulance Cardiac Arrest Registry. Resuscitation 2015; 85:1739-44. [PMID: 25449346 DOI: 10.1016/j.resuscitation.2014.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/12/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
AIM To assess the impact of automated external defibrillator (AED) use by bystanders in Victoria, Australia on survival of adults suffering an out-of-hospital cardiac arrest (OHCA) in a public place compared to those first defibrillated by emergency medical services (EMS). METHODS We analysed data from the Victorian Ambulance Cardiac Arrest Registry for individuals aged >15 years who were defibrillated in a public place between 1 July 2002 and 30 June 2013, excluding events due to trauma or witnessed by EMS. RESULTS Of 2270 OHCA cases who arrested in a public place, 2117 (93.4%) were first defibrillated by EMS and 153 (6.7%) were first defibrillated by a bystander using a public AED. Use of public AEDs increased almost 11-fold between 2002/2003 and 2012/2013, from 1.7% to 18.5%, respectively (p < 0.001). First defibrillation occurred sooner in bystander defibrillation (5.2 versus 10.0 min, p < 0.001). Unadjusted survival to hospital discharge for bystander defibrillated patients was significantly higher than for those first defibrillated by EMS (45% versus 31%, p < 0.05). Multivariable logistic regression analysis showed that first defibrillation by a bystander using an AED was associated with a 62% increase in the odds of survival to hospital discharge (adjusted odds ratio 1.62, 95% CI: 1.12–2.34, p = 0.010) compared to first defibrillation by EMS. CONCLUSION Survival to hospital discharge is improved in patients first defibrillated using a public AED prior to EMS arrival in Victoria, Australia. Encouragingly, bystander AED use in Victoria has increased over time. More widespread availability of AEDs may further improve outcomes of OHCA in public places.
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Greif R, Lockey A, Conaghan P, Lippert A, De Vries W, Monsieurs K. Ausbildung und Implementierung der Reanimation. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0092-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, Cabanas JG, Cone DC, Diercks DB, Foster J(J, Meeks RA, Travers AH, Welsford M. Part 4: Systems of Care and Continuous Quality Improvement. Circulation 2015; 132:S397-413. [DOI: 10.1161/cir.0000000000000258] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Agerskov M, Nielsen AM, Hansen CM, Hansen MB, Lippert FK, Wissenberg M, Folke F, Rasmussen LS. Public Access Defibrillation: Great benefit and potential but infrequently used. Resuscitation 2015; 96:53-8. [DOI: 10.1016/j.resuscitation.2015.07.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/18/2015] [Accepted: 07/22/2015] [Indexed: 11/30/2022]
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Hansen SM, Brøndum S, Thomas G, Rasmussen SR, Kvist B, Christensen A, Lyng C, Lindberg J, Lauritsen TLB, Lippert FK, Torp-Pedersen C, Hansen PA. Home Care Providers to the Rescue: A Novel First-Responder Programme. PLoS One 2015; 10:e0141352. [PMID: 26509532 PMCID: PMC4625014 DOI: 10.1371/journal.pone.0141352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022] Open
Abstract
AIM To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA). METHODS We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark. RESULTS Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED. CONCLUSION Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival.
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Affiliation(s)
- Steen M. Hansen
- Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stig Brøndum
- Hjerteforeningen, Danish Heart Foundation, Copenhagen, Denmark
| | - Grethe Thomas
- The Danish Foundation TrygFonden, Copenhagen, Denmark
| | - Susanne R. Rasmussen
- KORA, Danish Institute for Local and Regional Government Research, Aarhus, Denmark
| | - Birgitte Kvist
- Department of Health and Nursing, Municipality of Frederikshavn, North Denmark Region, Frederikshavn, Denmark
| | | | - Charlotte Lyng
- Home Care Organization, Municipality of Frederikshavn, North Denmark Region, Frederikshavn, Denmark
| | - Jan Lindberg
- Prehospital Care Organization, North Denmark Region, Aalborg, Denmark
| | - Torsten L. B. Lauritsen
- Department of Anaesthesia, The Juliane Marie Centre, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | | | - Poul A. Hansen
- Prehospital Care Organization, North Denmark Region, Aalborg, Denmark
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Greif R, Lockey AS, Conaghan P, Lippert A, De Vries W, Monsieurs KG, Ballance JH, Barelli A, Biarent D, Bossaert L, Castrén M, Handley AJ, Lott C, Maconochie I, Nolan JP, Perkins G, Raffay V, Ringsted C, Soar J, Schlieber J, Van de Voorde P, Wyllie J, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:288-301. [DOI: 10.1016/j.resuscitation.2015.07.032] [Citation(s) in RCA: 272] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Beckers SK, Bergrath S. [Comments on: Layperson warning system for cardiac arrest]. Anaesthesist 2015; 64:709-10. [PMID: 26227788 DOI: 10.1007/s00101-015-0064-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S K Beckers
- Klinik für Anästhesiologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - S Bergrath
- Klinik für Anästhesiologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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Ringh M, Rosenqvist M, Hollenberg J, Jonsson M, Fredman D, Nordberg P, Järnbert-Pettersson H, Hasselqvist-Ax I, Riva G, Svensson L. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest. N Engl J Med 2015; 372:2316-25. [PMID: 26061836 DOI: 10.1056/nejmoa1406038] [Citation(s) in RCA: 322] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) performed by bystanders is associated with increased survival rates among persons with out-of-hospital cardiac arrest. We investigated whether rates of bystander-initiated CPR could be increased with the use of a mobile-phone positioning system that could instantly locate mobile-phone users and dispatch lay volunteers who were trained in CPR to a patient nearby with out-of-hospital cardiac arrest. METHODS We conducted a blinded, randomized, controlled trial in Stockholm from April 2012 through December 2013. A mobile-phone positioning system that was activated when ambulance, fire, and police services were dispatched was used to locate trained volunteers who were within 500 m of patients with out-of-hospital cardiac arrest; volunteers were then dispatched to the patients (the intervention group) or not dispatched to them (the control group). The primary outcome was bystander-initiated CPR before the arrival of ambulance, fire, and police services. RESULTS A total of 5989 lay volunteers who were trained in CPR were recruited initially, and overall 9828 were recruited during the study. The mobile-phone positioning system was activated in 667 out-of-hospital cardiac arrests: 46% (306 patients) in the intervention group and 54% (361 patients) in the control group. The rate of bystander-initiated CPR was 62% (188 of 305 patients) in the intervention group and 48% (172 of 360 patients) in the control group (absolute difference for intervention vs. control, 14 percentage points; 95% confidence interval, 6 to 21; P<0.001). CONCLUSIONS A mobile-phone positioning system to dispatch lay volunteers who were trained in CPR was associated with significantly increased rates of bystander-initiated CPR among persons with out-of-hospital cardiac arrest. (Funded by the Swedish Heart-Lung Foundation and Stockholm County; ClinicalTrials.gov number, NCT01789554.).
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Affiliation(s)
- Mattias Ringh
- From the Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Solna (M. Ringh, J.H., M.J., D.F., P.N., I.H.-A., G.R., L.S.), the Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Danderyd (M. Rosenqvist), and the Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset (H.J.-P.) - all in Stockholm
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Ringh M, Jonsson M, Nordberg P, Fredman D, Hasselqvist-Ax I, Håkansson F, Claesson A, Riva G, Hollenberg J. Survival after Public Access Defibrillation in Stockholm, Sweden – A striking success. Resuscitation 2015; 91:1-7. [DOI: 10.1016/j.resuscitation.2015.02.032] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/10/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
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Zijlstra JA, Beesems SG, De Haan RJ, Koster RW. Psychological impact on dispatched local lay rescuers performing bystander cardiopulmonary resuscitation. Resuscitation 2015; 92:115-21. [PMID: 25957944 DOI: 10.1016/j.resuscitation.2015.04.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/14/2015] [Accepted: 04/23/2015] [Indexed: 11/25/2022]
Abstract
AIM We studied the short-term psychological impact and post-traumatic stress disorder (PTSD)-related symptoms in lay rescuers performing cardiopulmonary resuscitation (CPR) after a text message (TM)-alert for out-of-hospital-cardiac arrest, and assessed which factors contribute to a higher level of PTSD-related symptoms. METHODS The lay rescuers received a TM-alert and simultaneously an email with a link to an online questionnaire. We analyzed all questionnaires from February 2013 until October 2014 measuring the short-term psychological impact. We interviewed by telephone all first arriving lay rescuers performing bystander CPR and assessed PTSD-related symptoms with the Impact of Event Scale (IES) 4-6 weeks after the resuscitation. IES-scores 0-8 reflected no stress, 9-25 mild, 26-43 moderate, and 44-75 severe stress. A score ≥ 26 indicated PTSD symptomatology. RESULTS Of all alerted lay rescuers, 6572 completed the online questionnaire. Of these, 1955 responded to the alert and 507 assisted in the resuscitation. We interviewed 203 first arriving rescuers of whom 189 completed the IES. Of these, 41% perceived no/mild short-term impact, 46% bearable impact and 13% severe impact. On the IES, 81% scored no stress and 19% scored mild stress. None scored moderate or severe stress. Using a multivariable logistic regression model we identified three factors with an independent impact on mild stress level: no automated external defibrillator connected by the lay rescuer, severe short-term impact, and no (very) positive experience. CONCLUSION Lay rescuers alerted by text messages, do not show PTSD-related symptoms 4-6 weeks after performing bystander CPR, even if they perceive severe short-term psychological impact.
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Affiliation(s)
- Jolande A Zijlstra
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Stefanie G Beesems
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rob J De Haan
- Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
Real progress has been made in improving long-term outcome after out-of-hospital cardiac arrest in the past 10 years. Many communities have doubled their survival-to-hospital-discharge rate during this period. Common features of such successful programs include the following: (1) 911 dispatcher-assisted cardiopulmonary resuscitation (CPR) instruction, (2) bystander chest compression-only CPR program, (3) public access defibrillation, including targeted automated external defibrillator programs, (4) renewed emphasis on minimally interrupted chest compressions by emergency medical services responders, and (5) aggressive postresuscitation care, including targeted temperature management and early coronary angiography and intervention. An important lesson from these successful community efforts is that multiple, simultaneous changes to the local cardiac arrest response system are necessary to improve survival. The next exciting step in this quest appears to be the treatment of refractory cardiac arrest with the combination of mechanical CPR, intra-arrest hypothermia, extracorporeal CPR with mechanical circulatory support devices, and early coronary intervention.
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