Direction of first bystander call for help is associated with outcome from out-of-hospital cardiac arrest

The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand

INTRODUCTION

The aim of this study was to develop a risk adjustment strategy, including effect modifiers, for benchmarking emergency medical service (EMS) performance for out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand.

METHOD

Using 2017-2019 data from the Australasian Resuscitation Outcomes Consortium (Aus-ROC) OHCA Epistry, we included adults who received an EMS attempted resuscitation for a presumed medical OHCA. Logistic regression was applied to develop risk adjustment models for event survival (return of spontaneous circulation at hospital handover) and survival to hospital discharge/30 days. We examined potential effect modifiers, and assessed model discrimination and validity.

RESULTS

Both OHCA survival outcome models included EMS agency and the Utstein variables (age, sex, location of arrest, witnessed arrest, initial rhythm, bystander cardiopulmonary resuscitation, defibrillation prior to EMS arrival, and EMS response time). The model for event survival had good discrimination according to the concordance statistic (0.77) and explained 28% of the variation in survival. The corresponding figures for survival to hospital discharge/30 days were 0.87 and 49%. The addition of effect modifiers did little to improve the performance of either model.

CONCLUSION

The development of risk adjustment models with good discrimination is an important step in benchmarking EMS performance for OHCA. The Utstein variables are important in risk-adjustment, but only explain a small proportion of the variation in survival. Further research is required to understand what factors contribute to the variation in survival between EMS.

Impact of Awareness Time Interval on the Effect of Bystander Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest: A Nationwide Study

PURPOSE

The awareness time interval (ATI), the time from the witnessed event to emergency medical service (EMS) activation, is an important factor influencing out-of-hospital cardiac arrest (OHCA) outcomes. Since bystander cardiopulmonary resuscitation (BCPR) is provided after cardiac arrest is recognized, the effect of BCPR may vary depending on ATI delay. We aimed to investigate whether ATI modifies the effect of BCPR on OHCA outcomes.

MATERIALS AND METHODS

A population-based observational study was conducted with EMS-treated witnessed adult (≥18 years) OHCAs between 2013 and 2018. The exposure variable was provision of BCPR. The primary outcome was a good neurological outcome defined as cerebral performance category scale 1or 2 (good CPC). Multivariable logistic regression analysis was conducted using the ATI group (-1, 1-5, 5- min) as the interaction term.

RESULTS

Of 34366 eligible OHCAs, 65.5% received BCPR. EMS was activated within 1 min in 45.9%, within 1-5 min in 29.2%, and after 5 min in 24.9% cases. In the adjusted interaction model, compared with no BCPR, a longer ATI resulted in smaller adjusted odds ratios for good CPC in the BCPR group [5.33 (4.17-6.82) for ATI ≤1 min, 5.14 (4.00-6.60) for 1-5 min, and 2.14 (1.63-2.81) for ATI >5 min].

CONCLUSION

The effect of BCPR on improving the chances for a good neurological outcome decreased as time from collapse to EMS activation increased. The importance of early recognition of OHCA and EMS activation should be emphasized in BCPR training.

Location of out-of-hospital cardiac arrest and the awareness time interval: a nationwide observational study

AIMS

A short awareness time interval (ATI, time from witnessing the arrest to calling for help) and bystander cardiopulmonary resuscitation (CPR) are important factors affecting neurological recovery after out-of-hospital cardiac arrest (OHCA). This study investigated the association of the location of OHCA with the length of ATI and bystander CPR.

METHODS

This population-based observational study used the nationwide Korea OHCA database and included all adults with layperson-witnessed OHCA with presumed cardiac aetiology between 2013 and 2017. The exposure was the location of OHCA (public places, private housing and nursing facilities). The primary outcome was short ATI, defined as <4 min from witnessing to calling for emergency medical service (EMS). The secondary outcome was the frequency of provision of bystander CPR. Multivariable logistic regression analysis was performed to evaluate the association of location of OHCA with study outcomes.

RESULTS

Of 30 373 eligible OHCAs, 66.6% occurred in private housing, 24.0% occurred in public places and 9.4% occurred in nursing facilities. In 67.3% of the cases, EMS was activated within 4 min of collapse, most frequently in public places (public places 77.0%, private housing 64.2% and nursing facilities 64.8%; p<0.01). The overall rate of bystander CPR was 65.5% with highest in nursing facilities (77.0%), followed by public places (70.1%) and private housing 62.3%; p<0.01). Compared with public places, the adjusted ORs (AORs) (95% CIs) for a short ATI were 0.58 (0.54 to 0.62) in private housing and 0.62 (0.56 to 0.69) in nursing facilities. The AORs (95% CIs) for bystander CPR were 0.75 (0.71 to 0.80) in private housing and 1.57 (1.41 to 1.75) in nursing facilities.

CONCLUSION

OHCAs in private housing and nursing facilities were less likely to have immediate EMS activation after collapse than in public places. A public education is needed to increase the awareness of necessity of prompt EMS activation.

Proposing an International Standard Accident Number for Interconnecting Information and Communication Technology Systems of the Rescue Chain

BACKGROUND

The rapid dissemination of smart devices within the internet of things (IoT) is developing toward automatic emergency alerts which are transmitted from machine to machine without human interaction. However, apart from individual projects concentrating on single types of accidents, there is no general methodology of connecting the standalone information and communication technology (ICT) systems involved in an accident: systems for alerting (e.g., smart home/car/wearable), systems in the responding stage (e.g., ambulance), and in the curing stage (e.g., hospital).

OBJECTIVES

We define the International Standard Accident Number (ISAN) as a unique token for interconnecting these ICT systems and to provide embedded data describing the circumstances of an accident (time, position, and identifier of the alerting system).

MATERIALS AND METHODS

Based on the characteristics of processes and ICT systems in emergency care, we derive technological, syntactic, and semantic requirements for the ISAN, and we analyze existing standards to be incorporated in the ISAN specification.

RESULTS

We choose a set of formats for describing the embedded data and give rules for their combination to generate an ISAN. It is a compact alphanumeric representation that is generated easily by the alerting system. We demonstrate generation, conversion, analysis, and visualization via representational state transfer (REST) services. Although ISAN targets machine-to-machine communication, we give examples of graphical user interfaces.

CONCLUSION

Created either locally by the alerting IoT system or remotely using our RESTful service, the ISAN is a simple and flexible token that enables technological, syntactic, and semantic interoperability between all ICT systems in emergency care.

Out-of-hospital cardiac arrest in the Pilsen Region in 2018

AIMS

To acquire epidemiological data on pre-hospital cardiac arrest incidents occurring in the Pilsen Region of the Czech Republic in 2018, and the results of subsequent cardiopulmonary resuscitation Methods. A prospective observational study of the survival rate of out-of-hospital cardiac arrest (OHCA) in patients undergoing CPR carried out by emergency medical service personnel. The observed time period was from January 1^st, 2018 until December 31^st, 2018. The data were acquired from patients' records in paper and electronic forms.

RESULTS

In the monitored period 707 patients with signs of cardiac arrest were recorded in the Pilsen Region with an incidence rate of 128.9 per 100,000 inhabitants. Emergency medical units performed CPR in 484 cases. The incidence rate of pre-hospital CPR was 88.2 cases per 100,000 inhabitants. Spontaneous blood circulation was temporarily or permanently restored in 276 patients (57.0%), 203 (41.9%) patients were transferred to a hospital, and there were 61 (12.6%) cases of survival with Cerebral Performance Category (CPC) score of 1 or 2. The first monitored rhythm was a shockable in 134 (27.7%) cases. In this sub-group ROSC was achieved in 94 (70.1%) cases and 58 (43.3%) of those were subsequently transferred to a hospital. A good CPC result was achieved in 41 (30.6%) patients of this sub group.

CONCLUSION

The study has provided valuable epidemiological data on OHCA and prehospital CPR in the area of the Pilsen Region in 2018. The collected data, compared to international results, show a higher survival rate with good neurological score in 12.6% of cases.

A randomised controlled comparison of video versus instructor-based compression only life support training

Background and Aims:

Sudden cardiac deaths remain a major health problem worldwide. Most of these cases generally involve out of hospital cardiac arrest, making the role of bystander resuscitation very crucial. In the developing countries, illiteracy and scarcity of health professionals is a great barrier to cardiopulmonary resuscitation (CPR) training. Video-based CPR training can offer an easily accessible modality in these situations. Hence, this study was conducted with an aim to assess the efficacy of video-based training in comparison to the traditional instructor-based CPR training in layman.

Methods:

This prospective cross-over observational study included 109 undergraduate university students attending voluntary resuscitation training and were randomly divided into two groups of video-based demonstration (VBD) and instructor-based demonstration (IBD) of compression only life support (COLS). They were then assessed for psychomotor skill development (Laerdal Simpad Plus Q-CPR) and perception about the quality of training methodology as primary and secondary objectives, respectively.

Results:

Population characteristics were similar in both the groups. In the VBD, scene safety was performed by 95.2% and call for help by 97.6%, and by 76.1% each in the IBD group (P < 0.05). Response to compression time (RCT) was significantly shorter in VBD (35 ± 9 sec) as compared to IBD (54 ± 14 sec) (P < 0.001). However, the proportion of participants performing response check, correct site identification, and other parameters were comparable.

Conclusion:

Video-based COLS training significantly decreased the RCT by 35% compared to traditional instructor-based training. However, other features of high-quality CPR remain comparable.

Cardiopulmonary arrest in primary care clinics: more holes than cheese: a survey of the knowledge and attitudes of primary care physicians regarding resuscitation

BACKGROUND

Patients experiencing pre-arrest symptoms may first refer to their primary care physician. The study's aim was to determine the likelihood that a patient undergoing out-of-hospital cardiac arrest will receive appropriate resuscitation efforts in a primary care clinic in a country with a directive that clinics maintain resuscitation equipment and physicians undergo periodic resuscitation training.

METHODS

An anonymous, 23-question online cross-sectional survey was created and administered to primary care physicians working in community clinics (10/1/2015-5/3/2015). Recruitment was accomplished by posting a link to the survey to all physicians listed as registered Society of Family Medicine members and in other online forums dedicated to residents and board-certified specialists in family medicine in Israel. The primary outcome measure was the proportion of respondents whose responses indicate that they fulfill all conditions for performing resuscitation.

RESULTS

Of approximately 2400 potential respondents, 185 replied to the survey; the study's findings should be viewed as preliminary. Respondents' characteristics were generally similar to those of the study population, but respondents had a higher rate of family medicine specialists. Respondents were mostly female (n = 108, 58%) Israeli graduates who have practiced medicine for > 10 years (72%, n = 134). 55% (n = 101) had undergone basic life support (BLS) training within < 2 years. Although just 5% (n = 10) estimated call-to-Emergency Medical Service (EMS) arrival time to their clinic to be <5 min, only 64% (n = 119) knew the telephone number for summoning EMS. Most confirmed the existence of a resuscitation cart in their clinic (85%, n = 157); 68% confirmed the presence of a defibrillator (n = 126). Most respondents were aware of the location of the defibrillator in their clinic (67%, n = 123), stated its accessibility during working hours (63%, n = 116), and 56% (n = 103) knew how to use it. Only 28% of the questionnaires indicated that all requirements for mounting an effective BLS response had been fulfilled.

CONCLUSIONS

The study suggests that many primary care clinics are under-equipped and their physicians are under-prepared to initiate life-saving services. Steps must be taken to rectify this situation. In addition, to develop more reliable estimates of the phenomena reported in this preliminary study, these issues should be re-examined in the context of a high response rate physician survey.