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Kono H, Takaishi K, Onuma M, Fukushima M, Takeuchi R. Bystanders' willingness to assist using automated external defibrillators during cardiac arrest. Heliyon 2024; 10:e37316. [PMID: 39296246 PMCID: PMC11407973 DOI: 10.1016/j.heliyon.2024.e37316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 08/19/2024] [Accepted: 08/30/2024] [Indexed: 09/21/2024] Open
Abstract
The "bystander effect," in which the presence of others inhibits rescue actions, has not been specifically examined in the context of cardiac arrest; understanding this effect in relation to rescue with automated external defibrillators (AEDs) is important. This study aims to identify the presence of others as a factor inhibiting rescue actions using an AED, from a social psychology perspective. We collected data through a web-based questionnaire involving registered residents in all 47 prefectures of Japan. The participants were presented with hypothetical scenarios of witnessing cardiac arrest events at train stations, under sparse or crowded conditions, and with or without the presence of competent parties (e.g., station staff or security guards). Their willingness to intervene was assessed across three levels of rescue behavior: (1) running and calling for help, (2) retrieving an AED, and (3) using an AED. This study found evidence of the bystander effect, indicating that the presence of competent others reduced behavioral interventions by bystanders during out-of-hospital cardiac arrest (OHCA) events. Moreover, the perceived presence of competent parties at the scene of a cardiac arrest reduced bystanders' willingness to initiate rescue under certain circumstances. While many bystanders were willing to initiate rescue efforts in response to calls for help, they resisted rescues involving an AED. This study observes that a bystander effect occurs among bystanders witnessing OHCA, explores the inhibiting effects of identifying competent parties on the initiation of rescue efforts, and suggests that there are significant invisible barriers to using AEDs in rescuing patients with OHCA.
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Affiliation(s)
- Hideko Kono
- Graduate School of International Social Sciences, Yokohama National University, 79-4 Tokiwadai, Hodogaya-ku, Yokohama-shi, 240-8501, Japan
| | - Koichi Takaishi
- Faculty of Business Administration, Asia University, 5-8 Sakai, Musashino-shi, 180-8629, Japan
| | - Masaya Onuma
- Graduate School of International Social Sciences, Yokohama National University, 79-4 Tokiwadai, Hodogaya-ku, Yokohama-shi, 240-8501, Japan
| | - Michi Fukushima
- Graduate School of Economics, Tohoku University, 27-1 Kawauchi, Aoba-ku, Sendai-shi, 980-8576, Japan
| | - Ryosuke Takeuchi
- Graduate School of International Social Sciences, Yokohama National University, 79-4 Tokiwadai, Hodogaya-ku, Yokohama-shi, 240-8501, Japan
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Motairek I, Rvo Salerno P, Chen Z, Deo S, Makhlouf MHE, Al-Araji R, Rajagopalan S, Nasir K, Al-Kindi S. Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest. Resuscitation 2024; 201:110264. [PMID: 38851447 DOI: 10.1016/j.resuscitation.2024.110264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is associated with low survival rates. Bystander cardiopulmonary resuscitation (CPR) is essential for improving outcomes, but its utilization remains limited, particularly among racial and ethnic minorities. Historical redlining, a practice that classified neighborhoods for mortgage risk in 1930s, may have lasting implications for social and health outcomes. This study sought to investigate the influence of redlining on the provision of bystander CPR during witnessed OHCA. METHODS We conducted an analysis using data from the comprehensive Cardiac Arrest Registry to Enhance Survival (CARES), encompassing 736,066 non-traumatic OHCA cases across the United States. The Home Owners' Loan Corporation (HOLC) map shapefiles were utilized to categorize census tracts of arrests into four grades (A signifying "best", B "still desirable", C "declining", and D "hazardous"). Multivariable hierarchical logistic regression models were employed to predict the likelihood of CPR provision, adjusting for various factors including age, sex, race/ethnicity, arrest location, calendar year, and state of occurrence. Additionally, we accounted for the percentage of Black residents and residents below poverty levels at the census tract level. RESULTS Among the 43,186 witnessed cases of OHCA in graded HOLC census tracts, 37.2% received bystander CPR. The rates of bystander CPR exhibited a gradual decline across HOLC grades, ranging from 41.8% in HOLC grade A to 35.8% in HOLC grade D. In fully adjusted model, we observed significantly lower odds of receiving bystander CPR in HOLC grades C (OR 0.89, 95% CI 0.81-0.98, p = 0.016) and D (OR 0.86, 95% CI 0.78-0.95, p = 0.002) compared to HOLC grade A. CONCLUSION Redlining, a historical segregation practice, is associated with reduced contemporary rates of bystander CPR during OHCA. Targeted CPR training in redlined neighborhoods may be imperative to enhance survival outcomes.
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Affiliation(s)
- Issam Motairek
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Pedro Rvo Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Salil Deo
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Surgical Services, Louis Stokes VA Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Mohamed H E Makhlouf
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Rabab Al-Araji
- Department of Global Health, Emory University, Atlanta, GA, United States
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Khurram Nasir
- Houston Methodist Hospital, Houston, TX, United States
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Shadarevian J, Li J, Allan KS, Grunau B, Sapp J, Dhillon S, Saini SS, Chakrabarti A, Chakrabarti S. A Cross-Sectional Analysis of Bystander Cardiopulmonary Resuscitation (CPR): Behavioural Changes in the COVID-19 Era. Cureus 2024; 16:e62299. [PMID: 39006630 PMCID: PMC11245745 DOI: 10.7759/cureus.62299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Objectives The coronavirus disease 2019 (COVID-19) pandemic has impacted public health systems and individuals' behaviour, with decreasing survival rates among out-of-hospital cardiac arrest (OHCA) patients. Bystander cardiopulmonary resuscitation (CPR) improves OHCA outcomes, which may have been affected by COVID-19. We sought to understand the impacts of COVID-19 on bystanders' willingness to administer CPR in three Canadian provinces. Methods Participants ≥ 18 years of age were surveyed online about their current and recalled pre-pandemic attitudes toward CPR and perceived transmission risk. We compared mean willingness to perform various CPR actions before and during the pandemic using paired t-tests. Differences in willingness across three provinces were assessed using analysis of variance (ANOVA) and Tukey's Honestly Significant Difference (HSD) test. We also conducted Chi-square tests to assess changes in willingness to perform CPR on children and older adults. Results Five hundred thirty-five participants were surveyed from October 1 to November 15, 2021. The mean age was 42.7 years (SD 14.5), and 60.2% were female. Participants reported less willingness to perform chest compressions on strangers during the pandemic compared to their recollections before the pandemic (mean willingness 86.2% vs. 94.3% prior, p<0.001). With personal protective equipment (PPE) available, particularly masks, willingness recovered to 91.3% (p<0.001). Willingness was higher in Nova Scotia (NS) than in British Columbia (BC) or Ontario (ON). Reluctance to assist older adults increased from 6.6% to 12.0% (p=0.020). Conclusions This study highlights changes in CPR willingness during the COVID-19 pandemic, underscoring the importance of PPE and offering insights into public health strategies pertaining to CPR during a pandemic.
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Affiliation(s)
| | - Jim Li
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, CAN
| | | | - Brian Grunau
- Department of Medicine, University of British Columbia, Vancouver, CAN
| | - John Sapp
- Department of Medicine, Dalhousie University, Halifax, CAN
| | - Santokh Dhillon
- Division of Cardiology, Izaak Walton Killam (IWK) Children's Heart Centre, Halifax, CAN
| | - Sumeet S Saini
- Department of Medicine, University of British Columbia, Vancouver, CAN
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Sun M, Waters CM, Zhu A. Public willingness, attitudes and related factors toward cardiopulmonary resuscitation: A grounded theory study. Public Health Nurs 2024; 41:233-244. [PMID: 38111292 DOI: 10.1111/phn.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/21/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Despite receiving cardiopulmonary resuscitation (CPR) training, over 50% of bystanders were unable to actually perform CPR. Understanding public willingness and attitudes toward bystander CPR is crucial in explaining whether people initiate CPR. This study aimed to develop a theoretical understanding of factors that influence the public's willingness and attitudes to perform CPR. DESIGN This was a qualitative study using the grounded theory method. METHODS The data were collected from semi-structured interviews with 28 participants between August 2022 and November 2022. Purposive sampling and theoretical sampling were used to recruit participants. Interviews were recorded and transcribed. Data were analyzed using open, axial, and selective coding. RESULTS Nine categories and 24 subcategories were summarized from four aspects: willingness, attitudes, implementation, and training. Willingness included self-willingness, self-perception, and societal factors; attitudes covered personality traits, reactions to patients and environment; implementation comprised knowledge and skills, situational coping, and risk perception; training included CPR training accessibility and barriers to CPR training. A theoretical framework of public CPR willingness, attitudes, and their influencing factors was developed. CONCLUSION The public's CPR willingness, attitudes, training, and implementation were interrelated and influential. The findings may have significant implications for the development of legislation and policy related to CPR popularization and training.
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Affiliation(s)
- Mengxue Sun
- Xiangya Nursing School of Central South University, Changsha, Hunan, China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Catherine M Waters
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, USA
| | - Aiqun Zhu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Department of Emergency Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Horriar L, Rott N, Böttiger BW. Improving survival after cardiac arrest in Europe: The synergetic effect of rescue chain strategies. Resusc Plus 2024; 17:100533. [PMID: 38205146 PMCID: PMC10776426 DOI: 10.1016/j.resplu.2023.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Sudden cardiac arrest is a global problem and is considered the third leading cause of death in industrialized countries. Patient survival rates after out-of-hospital cardiac arrest (OHCA) vary significantly between countries and continents. In particular, the 2021 European Resuscitation Council (ERC) Resuscitation Guidelines place a special focus on the chain of survival of patients after OHCA. As a complex, interconnected approach, the focus is on: Raising awareness for cardiac arrest and lay resuscitation, school children's education in resuscitation "KIDS SAVE LIVES", first responder systems - technologies to engage the community, telephone-assisted resuscitation (telephone-CPR; T-CPR) by dispatchers, and cardiac arrest centers (CAC) for further treatment in specialized hospitals. The Systems Saving Lives approach is a comprehensive strategy that emphasizes the interconnectedness of all links in the chain of survival following an OHCA, with a particular focus on the relationship between the community and emergency medical services (EMS). This system-level approach emphasizes the importance of the connection between all those involved in the chain of survival. It has a high potential to improve overall survival after OHCA. Therefore, it is recommended that these strategies be promoted and expanded in all countries.
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Affiliation(s)
- Lina Horriar
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
| | - Nadine Rott
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine Kerpener Straße 62, 50937 Cologne, Germany
| | - Bernd W. Böttiger
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine Kerpener Straße 62, 50937 Cologne, Germany
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Gao H, Liu X, Jiang Z, Huang S, Pan X, Long J, Tong Q, Li L, Zhou M, Hu R. Knowledge, attitudes, practices, and self-efficacy of the Chinese public regarding cardiopulmonary resuscitation: an online cross-sectional survey. Front Public Health 2024; 12:1341851. [PMID: 38487182 PMCID: PMC10937378 DOI: 10.3389/fpubh.2024.1341851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Objective To evaluate the current status of Chinese public's knowledge, attitudes, practices (KAP) and self-efficacy regarding cardiopulmonary resuscitation (CPR), and to analyze the factors that influence KAP and self-efficacy. Methods An online cross-sectional survey was conducted from February to June 2022 in Mainland China via a self-designed self-filled questionnaire. Potential participants were recruited through WeChat by convenience sampling and snowball sampling methods. Descriptive and quantitative analyses were used for statistical analysis. Results The survey included 4,450 participants from 31 provinces, autonomous regions, or municipalities across Mainland China, aged 18 or above. The public's average understanding (clear and very clear) of the knowledge regarding CPR was 67.4% (3,000/4,450), with an average proportion of positive attitudes at 96.8% (4,308/4,450). In practice, the average proportion of good practices was 92.8% (4,130/4,450), while the percentage of good self-efficacy averaged at 58.9% (2,621/4,450), only 42.4% (1,885/4,450) of the participants had confidence in the correct use of automated external defibrillator (AED). Pearson correlation analysis showed a significantly positive correlation among knowledge, attitude, practice, and self-efficacy (p < 0.01). Multiple linear regression analysis revealed that several factors have a significant influence on the public's CPR KAP and self-efficacy, including ever having received CPR training (p < 0.001), hearing about AED (p < 0.001), performing CPR on others (p < 0.001), hearing about CPR (p < 0.001), occupation (p < 0.001), personal health status (p < 0.001), education level (p < 0.001), gender (p < 0.001), and encountering someone in need of CPR (p = 0.021). Conclusion The Chinese public demonstrates good knowledge of CPR, positive attitude, and high willingness to perform CPR. However, there is still room for improvement in the mastery of some professional knowledge points related to CPR and AED. It should be noted that knowledge, attitude, practice, and self-efficacy are interrelated and influence each other. Factors such as prior CPR training, hearing about AED, having performed CPR before, hearing about CPR, occupation, personal health status, education level, gender, and having encountered someone in need of CPR have a significant impact on the public's KAP and self-efficacy.
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Affiliation(s)
- Huiming Gao
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiaohui Liu
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhixia Jiang
- Guizhou Nursing Vocational College, Guiyang, Guizhou, China
| | - Shiming Huang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiaoying Pan
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jianmei Long
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Qingqing Tong
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Li Li
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Manhong Zhou
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Department of Emergency, Kweichow Moutai Hospital, Renhuai, Guizhou, China
| | - Rujun Hu
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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7
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Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
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Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Schnaubelt S, Krammel M. PULS - Austrian Cardiac Arrest Awareness Association: An overview of a multi-tiered and multi-facetted regional initiative to save lives. Resusc Plus 2023; 15:100453. [PMID: 37645620 PMCID: PMC10461014 DOI: 10.1016/j.resplu.2023.100453] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Background Out-of-hospital cardiac arrest with subsequent cardiopulmonary resuscitation (CPR) still leads to dismal outcomes worldwide. The crucial gap between cardiac arrest and advanced life support can only be filled by bystander-CPR. However, knowledge and willingness of the public towards basic life support (BLS) remain low. Global and national initiatives for awareness building and CPR training have produced promising improvements, but an additional focus on regional initiatives might be necessary to truly implement change. Methods and results In order to support other like-minded groups, we present a "coming of age" narrative review of PULS - Austrian Cardiac Arrest Awareness Association, along with a future outlook and "lessons learned". Interviews with past and present employees, members, and functionaries were conducted by the authors. Additionally, the organization's archives were assessed. Conclusion Following current guidelines and the Utstein formula of survival, building a system to save lives is essential to achieve progress concerning cardiac arrest survival and outcomes. As kinds of "regional offices" of global resuscitation efforts, a network of individual local initiatives and organizations such as PULS can carry the respective messages, engage with local key figures of implementation, and keep up perpetual work for cardiac arrest awareness and BLS education.
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Affiliation(s)
- Sebastian Schnaubelt
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Mario Krammel
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- Emergency Medical Service Vienna, Austria
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9
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Orlob S, Grundner S, Wittig J, Eichinger M, Pucher F, Eichlseder M, Lingitz R, Rief M, Palt N, Hartwig C, Zangl G, Haar M, Manninger M, Rohrer U, Scherr D, Zirlik A, Prause G, Zweiker D. Assessing the weak links - Necessity and impact of regional cardiac arrest awareness campaigns for laypersons. Resusc Plus 2023; 13:100352. [PMID: 36654724 PMCID: PMC9841163 DOI: 10.1016/j.resplu.2022.100352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction Public knowledge of out-of-hospital cardiac arrest (OHCA), and initiation of basic life support (BLS) is crucial to increase survival in OHCA. Methods The study analysed the knowledge and willingness to perform BLS of laypersons passing an AED at a public train station. Interviewees were recruited at two time points before and after a four year-long structured regional awareness campaign, which focused on call, compress, shock in a mid-size European city (270,000 inhabitants). Complete BLS was defined as multiple responses for call for help; initiation of chest compressions; and usage of an AED, without mentioning recovery position. Minimal BLS was defined as call for help and initiation of chest compressions. Results A total of 784 persons were interviewed, 257 at baseline and 527 post-campaign. Confronted with a fictional OHCA, at baseline 8.5% of the interviewees spontaneously mentioned actions for complete BLS and 17.9% post-campaign (p = 0.009). An even larger increase in knowledge was seen in minimal BLS (34.6% vs 60.6%, p < 0.001). Conclusion After a regional cardiac arrest awareness campaign, we found an increase in knowledge of BLS actions in the lay public. However, our investigation revealed severe gaps in BLS knowledge, possibly resulting in weak first links of the chain of survival.
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Affiliation(s)
- Simon Orlob
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Stephan Grundner
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria,Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, 4020 Linz, Austria
| | - Johannes Wittig
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, 8200 Aarhus N, Denmark,Medical University of Graz; Auenbruggerplatz 12, 8036 Graz, Austria
| | - Michael Eichinger
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Felix Pucher
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Michael Eichlseder
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Raphaela Lingitz
- Department of Paediatrics, Hospital Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria
| | - Martin Rief
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Niklas Palt
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria,Medical University of Graz; Auenbruggerplatz 12, 8036 Graz, Austria
| | - Charlotte Hartwig
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Gregor Zangl
- State Hospital Hochsteiermark, Location Bruck, Tragösser Strasse 1, 8600 Bruck an der Mur, Austria
| | - Markus Haar
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246 Hamburg, Germany
| | - Martin Manninger
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria,Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Ursula Rohrer
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Andreas Zirlik
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Gerhard Prause
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - David Zweiker
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria,Third Medical Department for Cardiology and Intensive Care, Clinic Ottakring, Montleartstraße 37, Pavillon 29, 1160 Vienna, Austria,Corresponding author at: Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
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Compression-Only Cardiopulmonary Resuscitation and Automated External Defibrillator Course for Primary School Students: A Malaysian Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010058. [PMID: 36670609 PMCID: PMC9856577 DOI: 10.3390/children10010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/01/2022] [Accepted: 11/24/2022] [Indexed: 12/29/2022]
Abstract
The Malaysian national school curriculum currently lacks resources and tools to enforce CPR education. The aim of this study was to investigate the efficacy of a compression-only cardiopulmonary resuscitation and automated external defibrillator course among primary school students to increase their knowledge and technical skills and improve their attitudes. A quasi-experimental study was conducted using a pre−post non-equivalent design involving 38 students aged 10−12. Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, technical skills, and attitude towards CPR were assessed in a post test with three-month follow-up. Results of the MANOVA analysis showed significant differences in the level of knowledge (F = 10.29, p < 0.001) and attitude (F = 13.87, p < 0.001) based on the students’ age group at the time of the post test. The proportion of students who passed the technical skills component differed significantly by age (χ2 = 12.12; p = 0.002) and BMI (χ2 = 6.34; p = 0.041). No significant decay was reported in the total mean scores for knowledge, technical skills, and attitude (F = 0.727, p = 0.54) at 3-month follow-up. The course helped students perform CPR and utilize AED effectively while promoting a positive attitude with up to 3 months of retention, demonstrating the feasibility of extending the course within the Malaysian primary school curriculum.
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Cho YS, Park HJ, Choi D, Park HA, Kim S, Park JO, Wang SJ, Lee CA. Evaluation of class participation in non-face-to-face CPR training for medical students. PLoS One 2022; 17:e0278273. [PMID: 36454883 PMCID: PMC9714871 DOI: 10.1371/journal.pone.0278273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/13/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) education requires that learners practice key skills to promote mastery. Our aim in this study was to evaluate differences in post-education performance and class participation during CPR training between face-to- face (FF) and non-face-to-face (NFF) learning formats. METHODS This was a randomized controlled study of third-year medical students from two university hospital, allocated to either the FF or NFF format for CPR education. The learning scenario addressed single-person CPR, consisting of chest compression only, and excluded breathing. The Kahoot! application was used for NFF. Between-group comparisons for class participation and CPR skills were based on video recordings. RESULTS Seventy students participated in our study, with 35 randomly allocated to the FF and NFF groups. There were no between-group differences in terms of age, sex, previous basic life support training, and willingness and confidence in performing CPR. Compared to the FF group, the NFF group demonstrated significant differences during CPR, including fewer calling for assistance and using of defibrillator (p = 0.006), as well as fewer checking for breathing (p = 0.007), and fewer counting during chest compression (p = 0.006). Additionally, < 30% of learners in the NFF group completed rhythm analysis after the last defibrillator shock delivery and resumed immediate chest compression (p < 0.001). All students in both groups passed the post-training assessment. CONCLUSION Class participation in NFF learning was lower than that in FF learning. Although the post-education evaluation in the NFF group was not inferior, efforts on promoting active participation in NFF learning are required.
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Affiliation(s)
- Young Shin Cho
- Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Republic of Korea
| | - Hye Ji Park
- Department of Emergency Medicine, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Daun Choi
- Hallym Dongtan Simulation Center, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Hang A. Park
- Department of Emergency Medicine, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Sola Kim
- Department of Emergency Medicine, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Ju Ok Park
- Department of Emergency Medicine, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Soon-Joo Wang
- Department of Emergency Medicine, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Choung Ah Lee
- Department of Emergency Medicine, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong-si, Gyeonggi-do, Republic of Korea
- Hallym Dongtan Simulation Center, Hwaseong-si, Gyeonggi-do, Republic of Korea
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Mori Y, Iio Y, Aoyama Y, Kozai H, Tanaka M, Aoike M, Kawamura H, Seguchi M, Tsurudome M, Ito M. Willingness and Predictors of Bystander CPR Intervention in the COVID-19 Pandemic: A Survey of Freshmen Enrolled in a Japanese University. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15770. [PMID: 36497845 PMCID: PMC9737097 DOI: 10.3390/ijerph192315770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has decreased bystander cardiopulmonary resuscitation (BCPR) intervention rates. The purpose of this study was to elucidate the willingness of university freshmen to provide BCPR during the COVID-19 pandemic and the predictors thereof. A cross-sectional survey of 2789 newly enrolled university students was conducted after the end of the sixth wave of the COVID-19 epidemic in Japan; predictors of willingness to provide BCPR were assessed by regression analysis. Of the 2534 participants 1525 (60.2%) were willing to intervene and provide BCPR during the COVID-19 pandemic. Hesitancy due to the anxiety that CPR intervention might result in poor prognosis was a negative predictor of willingness. In contrast, anxiety about the possibility of infection during CPR intervention did not show a negative impact. On the other hand, interest in CPR and willingness to participate in a course, confidence in CPR skills, awareness of automated external defibrillation, and knowledge of CPR during the COVID-19 pandemic, were also positive predictors. This study suggests that the barrier to willingness to intervene with BCPR during a COVID-19 pandemic is not fear of infection, but rather hesitation due to the possibility of poor prognosis from the intervention. The significance of conducting this study during the COVID-19 epidemic is great, and there is an urgent need for measures to overcome hesitation regarding BCPR.
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Affiliation(s)
- Yukihiro Mori
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Center for Nursing Practicum Support, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Yoko Iio
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Yuka Aoyama
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Department of Clinical Engineering, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Hana Kozai
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Mamoru Tanaka
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Makoto Aoike
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Hatsumi Kawamura
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Manato Seguchi
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Masato Tsurudome
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Morihiro Ito
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
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Marcus M, Abdullah AA, Nor J, Tuan Kamauzaman TH, Pang NTP. Comparing the effectiveness of a group-directed video instruction versus instructor-led traditional classroom instruction for learning cardiopulmonary resuscitation skills among first-year medical students: A prospective randomized controlled study. GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc45. [PMID: 36310890 PMCID: PMC9585410 DOI: 10.3205/zma001566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 03/16/2022] [Accepted: 07/05/2022] [Indexed: 06/16/2023]
Abstract
Introduction: Bystander cardiopulmonary resuscitation (CPR) training is inconsistent among students and the public. Existing CPR teaching courses are costly, time-consuming, and inconsistent. This study aimed to determine the association between overall CPR competency and two teaching modules, a group-directed video instruction module versus an instructor-led traditional classroom instruction module. Methods: This randomized prospective interventional study involved first year medical students of Universiti Sains Malaysia Health Campus from November 2018 until January 2019. Pass-fail scores representing the overall CPR, individual skill performance, and willingness to perform CPR for strangers and family members were collected. Factors associated with reluctance to perform CPR were assessed in a questionnaire. Results: A total of 99 participants were included, 50 in the group-directed video instruction as the intervention module and 49 in the traditional classroom instruction as the control module. There was no statistical significance between the pass and fail outcomes for both video module (p=0.436). Participants in both modules performed similarly in 8 out of 12 individual CPR skills. There was a significant difference in the distribution of skill scores between the pass and fail outcomes (p=<0.001). The intervention module is non-inferior compared to the control module, in relation to CPR willingness rates for strangers (p=0.999) and family members (p=0.117) after the training. Conclusions: The group-directed video self-instruction method is as effective as the instructor-led traditional classroom method to help participants to be competent and willing to perform CPR. It can be used as an independent or supplementary teaching tool for first-time learners and refreshers, especially in a group setting when teaching materials are limited.
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Affiliation(s)
- Mexmollen Marcus
- Universiti Sains Malaysia, School of Medical Sciences, Kelantan, Malaysia
- Universiti Malaysia Sabah, Faculty of Medicine and Health Sciences, Sabah, Malaysia
| | - Ariff Arithra Abdullah
- Universiti Sains Malaysia, School of Medical Sciences, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Junainah Nor
- Universiti Sains Malaysia, School of Medical Sciences, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kelantan, Malaysia
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Factors Influencing Self-Confidence and Willingness to Perform Cardiopulmonary Resuscitation among Working Adults-A Quasi-Experimental Study in a Training Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148334. [PMID: 35886184 PMCID: PMC9322983 DOI: 10.3390/ijerph19148334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
Background: There is a potential relationship between the self-confidence and the willingness of bystanders to undertake resuscitation (CPR) and its training. The current guidelines increasingly focus on both the importance of the human factor and the fact that training programs should increase the willingness of bystanders to undertake resuscitation, which may have a direct impact on improving survival in out-of-hospital cardiac arrest (OHCA). Aim: The objective of the study was to analyze factors influencing the assessment of own skills crucial in basic life support (BLS) and the willingness to provide CPR to individual victims. Methods: A pre-test and post-test quasi-experimental design was used in this study. The data was collected from 4 December 2019 to 3 October 2020 in workplaces, during instructor-led BLS courses. Each intervention (training) consisted of a theoretical and a practical part. The program was focused both on the skills and the human factor. Results: Comparison of pre-test and post-test data concerning self-confidence scores of the ability to recognize OHCA among 967 participants demonstrated a significant difference (respectively, Me = 2.2, IQR [2−3] vs. Me = 3.4, IQR [3−4]; p = 0.000). Additionally, self-assessment scores for the ability to perform proper chest compressions between pre-test and post-test also differed significantly (respectively Me = 2.3, IQR [2−3] vs. Me = 3.3, IQR [3−4]; p = 0.000). A highly significant difference was found in the likelihood of changing the decision in favor of the willingness to undertake CPR for all types of victims, with the greatest difference found in relation to the willingness to conduct resuscitation on strangers (OR = 7.67, 95% CI 5.01−11.73; p < 0.01). Conclusions: Completing hands-on training has a highly significant, beneficial effect on the readiness to undertake resuscitation for all types of victims, strangers in particular. Training programs should place particular emphasis on developing readiness to undertake resuscitation for both those who have never been trained and those who had their last training more than one year ago.
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Abstract
PURPOSE OF REVIEW Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency in which a rapid response following the chain of survival is crucial to save life. Disparities in care can occur at each link in this pathway and hence produce health inequities. This review summarises the health inequities that exist for OHCA patients and suggests how they may be addressed. RECENT FINDINGS There is international evidence that the incidence of OHCA is increased with increasing deprivation and in ethnic minorities. These groups have lower rates of bystander CPR and bystander-initiated defibrillation, which may be due to barriers in accessing cardiopulmonary resuscitation training, provision of public access defibrillators, and language barriers with emergency call handlers. There are also disparities in the ambulance response and in-hospital care following resuscitation. These disadvantaged communities have poorer survival following OHCA. SUMMARY OHCA disproportionately affects deprived communities and ethnic minorities. These groups experience disparities in care throughout the chain of survival and this appears to translate into poorer outcomes. Addressing these inequities will require coordinated action that engages with disadvantaged communities.
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Park SY, Lim D, Kim SC, Ryu JH, Kim YH, Choi B, Kim SH. Effect of Prehospital Epinephrine Use on Survival from Out-of-Hospital Cardiac Arrest and on Emergency Medical Services. J Clin Med 2021; 11:jcm11010190. [PMID: 35011931 PMCID: PMC8745563 DOI: 10.3390/jcm11010190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 12/23/2022] Open
Abstract
This study was to identify the effect of epinephrine on the survival of out-of-hospital cardiac arrest (OHCA) patients and changes in prehospital emergency medical services (EMSs) after the introduction of prehospital epinephrine use by EMS providers. This was a retrospective observational study comparing two groups (epinephrine group and norepinephrine group). We used propensity score matching of the two groups and identified the association between outcome variables regarding survival and epinephrine use, controlling for confounding factors. The epinephrine group was 339 patients of a total 1943 study population. The survival-to-discharge rate and OR (95% CI) of the epinephrine group were 5.0% (p = 0.215) and 0.72 (0.43–1.21) in the total patient population and 4.7% (p = 0.699) and 1.15 (0.55–2.43) in the 1:1 propensity-matched population. The epinephrine group received more mechanical chest compression and had longer EMS response times and scene times than the norepinephrine group. Mechanical chest compression was a negative prognostic factor for survival to discharge and favorable neurological outcomes in the epinephrine group. The introduction of prehospital epinephrine use in OHCA patients yielded no evidence of improvement in survival to discharge and favorable neurological outcomes and adversely affected the practice of EMS providers, exacerbating the factors negatively associated with survival from OHCA.
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Affiliation(s)
- Song Yi Park
- Department of Emergency Medicine, Dong-A University College of Medicine, Dong-A University Hospital, Busan 48114, Korea
| | - Daesung Lim
- Department of Emergency Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| | - Seong Chun Kim
- Department of Emergency Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Busan 50612, Korea
| | - Yong Hwan Kim
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea
| | - Byungho Choi
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan 44033, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan 44033, Korea
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Kim DK, Kim TH, Shin SD, Ro YS, Song KJ, Hong KJ, Jeong J. Impact of crowding in local ambulance demand on call-to-ambulance scene arrival in out-of-hospital cardiac arrest. Am J Emerg Med 2021; 52:105-109. [PMID: 34920390 DOI: 10.1016/j.ajem.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Rapid emergency medical service (EMS) response is an important prognostic factor in out-of-hospital cardiac arrest (OHCA). This study aims to evaluate the association between local hourly EMS demand and ambulance response in OHCA. METHODS OHCA occurring in 24 districts of Seoul from 2013 to 2018 was analyzed. Hourly ambulance demand per ambulance in each local district of patient location at the hour of cardiac arrest was calculated as the crowding index. The crowding index was categorized according to quartiles (1Q: ≤0.43, 2Q: 0.44-0.67, 3Q: 0.68-0.99, 4Q: ≥1.0 calls/h\r/ambulance). The primary outcome was ambulance dispatched within 1 km of the OHCA scene. Multivariable logistic regression analysis was performed to test the association between the local hourly ambulance demand and outcomes. RESULTS A total of 26,479 patients were analyzed. The rate of ambulance dispatched within 1 km decreased according to the crowding quartile (1Q: 31.3%, 2Q: 30.0%, 3Q: 28.8%, and 4Q: 26.6%). Compared to 1Q, adjusted odds ratios (95% CIs) of dispatch distance within 1 km in 2Q, 3Q, and 4Q were 0.92 (0.86-0.99), 0.86 (0.80-0.94), and 0.77 (0.71-0.84), respectively. CONCLUSION Crowding in local ambulance demand was associated with less ambulance dispatched within 1 km and delayed response to the scene in OHCA. Strategies to mitigate and adjust to ambulance demand crowding may be considered for better EMS response performance.
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Affiliation(s)
- Dae Kon Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
| | - Tae Han Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, South Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, South Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea; Department of Emergency Medicine, Seoul National University Hospital, South Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, South Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea; Department of Emergency Medicine, Seoul National University Hospital, South Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
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Scapigliati A, Zace D, Matsuyama T, Pisapia L, Saviani M, Semeraro F, Ristagno G, Laurenti P, Bray JE, Greif R. Community Initiatives to Promote Basic Life Support Implementation-A Scoping Review. J Clin Med 2021; 10:jcm10245719. [PMID: 34945015 PMCID: PMC8703423 DOI: 10.3390/jcm10245719] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Early intervention of bystanders (the first links of the chain of survival) have been shown to improve survival and good neurological outcomes of patients suffering out-of-hospital cardiac arrest (OHCA). Many initiatives have been implemented to increase the engagement of communities in early basic life support (BLS) and cardiopulmonary resuscitation (CPR), especially of lay people with no duty to respond. A better knowledge of the most effective initiatives might help improve survival and health system organization. Aim of the scoping review: To assess the impact of specific interventions involving lay communities on bystander BLS rates and other consistent clinical outcomes, and to identify relevant knowledge gaps. METHODS This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We performed a literature search using the PubMed, EMBASE, and Cochrane databases until 1 February 2021. The screening process was conducted based on predefined inclusion/exclusion criteria, and for each included study, we performed data extraction focusing on the type of intervention implemented, and the impact of these interventions on the specific OHCAs outcomes. RESULTS Our search strategy identified 19 eligible studies, originating mainly from the USA (47.4%) and Denmark (21%). The type of intervention included in 57.9% of cases was a community CPR training program, in 36.8% bundled interventions, and in 5.3% mass-media campaigns. The most commonly reported outcome for OHCAs was bystander CPR rate (94.7%), followed by survival to hospital discharge (36.8%), proportion of people trained (31.6%), survival to hospital discharge with good neurological outcome (21%), and Return of Spontaneous Circulation (10.5%). Community training programs and bundled interventions improved bystander CPR in most of the included studies. CONCLUSION Based on the results of our scoping review, we identified the potential benefit of community initiatives, such as community training in BLS, even as part of bundled intervention, in order to improve bystander CPR rates and patient outcomes.
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Affiliation(s)
- Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (L.P.); (M.S.)
- Italian Resuscitation Council, 40128 Bologna, Italy; (D.Z.); (F.S.); (G.R.)
- Correspondence: ; Tel.: +39-630154507
| | - Drieda Zace
- Italian Resuscitation Council, 40128 Bologna, Italy; (D.Z.); (F.S.); (G.R.)
- Section of Hygiene, University Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Luca Pisapia
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (L.P.); (M.S.)
| | - Michela Saviani
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (L.P.); (M.S.)
| | - Federico Semeraro
- Italian Resuscitation Council, 40128 Bologna, Italy; (D.Z.); (F.S.); (G.R.)
- Department of Anaesthesia and Intensive Care and EMS, Maggiore Hospital Bologna, 40133 Bologna, Italy
| | - Giuseppe Ristagno
- Italian Resuscitation Council, 40128 Bologna, Italy; (D.Z.); (F.S.); (G.R.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Patrizia Laurenti
- Section of Hygiene, University Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Janet E. Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3400, Australia;
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- School of Medicine, Sigmund Freud University Vienna, 1020 Vienna, Austria
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Jung E, Ro YS, Ryu HH, Kong SY, Lee SY. Effect of implementation of multi-tier response system and prolonged on-scene resuscitation for out-of-hospital cardiac arrest. Am J Emerg Med 2021; 51:79-84. [PMID: 34688965 DOI: 10.1016/j.ajem.2021.09.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The purpose of this study was to explain the process and results of implementing a bundle of two cardiopulmonary resuscitation (CPR) programs in Gwang-ju metropolitan city and to determine whether the use of these programs improved the clinical outcomes for out-of-hospital cardiac arrest (OHCA) patients. METHODS This was a before- and after-intervention study of the implementation of a bundle of two CPR programs in Gwang-ju. The main intervention was a multi-tier response (MTR) system, with an emphasis on prolonged on-scene resuscitation. The primary outcome was good neurological recovery, and secondary outcomes were survival to discharge and prehospital return of spontaneous circulation (ROSC). A multivariable logistic regression model was used to estimate the association between the study period and outcomes, after adjusting for potential confounders. Interaction analysis was conducted to determine whether the location of arrest and witness status modified the effect of the study period on the study outcomes. RESULTS The adjusted odds ratios (AORs) for the intervention were 1.35 (0.96-1.90) for pre-hospital ROSC, 1.19 (0.49-2.86) for survival to discharge, and 3.45 (1.01-11.80) for good CPC. The AORs for good neurological recovery of the after-intervention period were 2.93 (0.73-11.77) for a private place, 4.82 (1.04-22.39) for a public place, 5.88 (1.47-23.57) for a witnessed arrest, and 1.49 (0.28-7.86) for a non-witnessed arrest. CONCLUSIONS OHCA patients treated in the after-intervention period with the bundle of CPR programs including MTR and prolonged on-scene resuscitation showed better clinical outcomes, especially pre-hospital ROSC, and neurological recovery at hospital discharge than those treated in the before-intervention period.
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Affiliation(s)
- Eujene Jung
- Department of Emergency medicine, Chonnam National University Hospital, Republic of Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea
| | - Hyun Ho Ryu
- Department of Emergency medicine, Chonnam National University Hospital, Republic of Korea; Chonnam National University College of Medicine, Republic of Korea.
| | | | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Republic of Korea
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Lim D, Park SY, Choi B, Kim SH, Ryu JH, Kim YH, Sung AJ, Bae BK, Kim HB. The Comparison of Emergency Medical Service Responses to and Outcomes of Out-of-hospital Cardiac Arrest before and during the COVID-19 Pandemic in an Area of Korea. J Korean Med Sci 2021; 36:e255. [PMID: 34519188 PMCID: PMC8438185 DOI: 10.3346/jkms.2021.36.e255] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/29/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 has affected the responses of emergency medical service (EMS) systems to cases of out-of-hospital cardiac arrest (OHCA). The purpose of this study was to identify the impact of the COVID-19 pandemic on EMS responses to and outcomes of adult OHCA in an area of South Korea. METHODS This was a retrospective observational study of adult OHCA patients attended by EMS providers comparing the EMS responses to and outcomes of adult OHCA during the COVID-19 pandemic to those during the pre-COVID-19 period. Propensity score matching was used to compare the survival rates, and logistic regression analysis was used to assess the impact of the COVID-19 pandemic on the survival of OHCA patients. RESULTS A total of 891 patients in the pre-COVID-19 group and 1,063 patients in the COVID-19 group were included in the final analysis. During the COVID-19 period, the EMS call time was shifted to a later time period (16:00-24:00, P < 0.001), and the presence of an initial shockable rhythm was increased (pre-COVID-19 vs. COVID-19, 7.97% vs. 11.95%, P = 0.004). The number of tracheal intubations decreased (5.27% vs. 1.22%, P < 0.001), and the use of mechanical chest compression devices (30.53% vs. 44.59%, P < 0.001) and EMS response time (median [quartile 1-quartile 3], 7 [5-10] vs. 8 [6-11], P < 0.001) increased. After propensity score matching, the survival at admission rate (22.52% vs. 18.24%, P = 0.025), survival to discharge rate (7.77% vs. 5.52%, P = 0.056), and favorable neurological outcome (5.97% vs. 3.49%, P < 0.001) decreased. In the propensity score matching analysis of the impact of COVID-19, odds ratios of 0.768 (95% confidence interval [CI], 0.592-0.995) for survival at admission and 0.693 (95% CI, 0.446-1.077) for survival to discharge were found. CONCLUSION During the COVID-19 period, there were significant changes in the EMS responses to OHCA. These changes are considered to be partly due to social distancing measures. As a result, the proportion of patients with an initial shockable rhythm in the COVID-19 period was greater than that in the pre-COVID-19 period, but the final survival rate and favorable neurological outcome were lower.
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Affiliation(s)
- Daesung Lim
- Department of Emergency Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Song Yi Park
- Department of Emergency Medicine, Dong-A University College of Medicine, Dong-A University Hospital, Busan, Korea.
| | - Byungho Choi
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Busan, Korea
| | - Yong Hwan Kim
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ae Jin Sung
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Byung Kwan Bae
- Department of Emergency Medicine, Pusan National University College of Medicine, Pusan National University Hospital, Busan, Korea
| | - Han Byeol Kim
- Department of Emergency Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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Greif R, Lockey A, Breckwoldt J, Carmona F, Conaghan P, Kuzovlev A, Pflanzl-Knizacek L, Sari F, Shammet S, Scapigliati A, Turner N, Yeung J, Monsieurs KG. [Education for resuscitation]. Notf Rett Med 2021; 24:750-772. [PMID: 34093075 PMCID: PMC8170459 DOI: 10.1007/s10049-021-00890-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/22/2022]
Abstract
Diese Leitlinien des European Resuscitation Council basieren auf dem internationalen wissenschaftlichen Konsens 2020 zur kardiopulmonalen Reanimation mit Behandlungsempfehlungen (International Liaison Committee on Resuscitation 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations [ILCOR] 2020 CoSTR). Dieser Abschnitt bietet Bürgern und Angehörigen der Gesundheitsberufe Anleitungen zum Lehren und Lernen der Kenntnisse, der Fertigkeiten und der Einstellungen zur Reanimation mit dem Ziel, das Überleben von Patienten nach Kreislaufstillstand zu verbessern.
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Affiliation(s)
- Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Schweiz.,School of Medicine, Sigmund Freud University Vienna, Wien, Österreich
| | - Andrew Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, Großbritannien
| | - Jan Breckwoldt
- Institute of Anesthesiology, University Hospital Zurich, Zürich, Schweiz
| | | | - Patricia Conaghan
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, Großbritannien
| | - Artem Kuzovlev
- Negovsky Research Institute of General Reanimatology of the Federal research and clinical center of intensive care medicine and Rehabilitology, Moskau, Russland
| | - Lucas Pflanzl-Knizacek
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Ferenc Sari
- Emergency Department, Skellefteå Hospital, Skellefteå, Schweden
| | | | - Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rom, Italien
| | - Nigel Turner
- Department of Pediatric Anesthesia, Division of Vital Functions, Wilhelmina Children's Hospital at the University Medical Center, Utrecht, Niederlande
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
| | - Koenraad G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Edegem, Belgien
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22
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Mentzelopoulos SD, Couper K, Van de Voorde P, Druwé P, Blom M, Perkins GD, Lulic I, Djakow J, Raffay V, Lilja G, Bossaert L. [Ethics of resuscitation and end of life decisions]. Notf Rett Med 2021; 24:720-749. [PMID: 34093076 PMCID: PMC8170633 DOI: 10.1007/s10049-021-00888-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.
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Affiliation(s)
- Spyros D. Mentzelopoulos
- Evaggelismos Allgemeines Krankenhaus, Abteilung für Intensivmedizin, Medizinische Fakultät der Nationalen und Kapodistrischen Universität Athen, 45–47 Ipsilandou Street, 10675 Athen, Griechenland
| | - Keith Couper
- Universitätskliniken Birmingham NHS Foundation Trust, UK Critical Care Unit, Birmingham, Großbritannien
- Medizinische Fakultät Warwick, Universität Warwick, Coventry, Großbritannien
| | - Patrick Van de Voorde
- Universitätsklinikum und Universität Gent, Gent, Belgien
- staatliches Gesundheitsministerium, Brüssel, Belgien
| | - Patrick Druwé
- Abteilung für Intensivmedizin, Universitätsklinikum Gent, Gent, Belgien
| | - Marieke Blom
- Medizinisches Zentrum der Universität Amsterdam, Amsterdam, Niederlande
| | - Gavin D. Perkins
- Medizinische Fakultät Warwick, Universität Warwick, Coventry, Großbritannien
| | | | - Jana Djakow
- Intensivstation für Kinder, NH Hospital, Hořovice, Tschechien
- Abteilung für Kinderanästhesiologie und Intensivmedizin, Universitätsklinikum und Medizinische Fakultät der Masaryk-Universität, Brno, Tschechien
| | - Violetta Raffay
- School of Medicine, Europäische Universität Zypern, Nikosia, Zypern
- Serbischer Wiederbelebungsrat, Novi Sad, Serbien
| | - Gisela Lilja
- Universitätsklinikum Skane, Abteilung für klinische Wissenschaften Lund, Neurologie, Universität Lund, Lund, Schweden
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Short-Term Learning Effects of a Cardiopulmonary Resuscitation Program with Focus on the Relationship between Learning Effect and Trainees' Perceived Competence. Healthcare (Basel) 2021; 9:healthcare9050598. [PMID: 34069850 PMCID: PMC8157350 DOI: 10.3390/healthcare9050598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022] Open
Abstract
High-quality education and training are essential for effectively improving the quality of cardiopulmonary resuscitation (CPR); however, the relationship between the acquisition of motor skills and learners’ psychological characteristic has not been investigated fully. Therefore, we investigated the relationship between intrinsic motivation for training, self-efficacy for CPR, and CPR skill acquisition through training. Twenty health sciences undergraduate students participated in a 3-hour basic life support course. Their chest compression skills were assessed before and after the course. The main outcome of this study was the chest compression score, with changes in the score from pretest to posttest regarded as the short-term learning effects from training. The chest compression score was significantly higher after the course (median 53.5%, interquartile range [IQR] 39.8–83.0) than before the course (median 14.0%, IQR 0–43.3, p < 0.001). Furthermore, we found a significant correlation between perceived competence after the training and changes in the chest compression score from pretest to posttest (r = 0.483, p = 0.031), but other psychological indices did not correlate with changes in the chest compression score. A significant correlation was noted between trainees’ perceived competency and the short-term learning effects of CPR training. We suggest instructors focus on psychological components of training, including trainees’ perceived competence.
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25
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Kim KH, Ro YS, Park JH, Kim TH, Jeong J, Hong KJ, Song KJ, Shin SD. Association between case volume of ambulance stations and clinical outcomes of out-of-hospital cardiac arrest: A nationwide multilevel analysis. Resuscitation 2021; 163:71-77. [PMID: 33895233 DOI: 10.1016/j.resuscitation.2021.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/12/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The case volume effects of ambulance stations on the survival of out-of-hospital cardiac arrest (OHCA) patients are uncertain. This study was conducted to evaluate the association between the case volume of ambulance stations and clinical outcomes in OHCAs by the number of emergency medical services (EMS) providers at the scene. METHODS Adult cardiac EMS-treated OHCAs between 2015 and 2018 were enrolled. The main exposure was the annual OHCA case volumes of 204 ambulance stations in Korea, which were categorized into three groups; low-volume (<100), moderate-volume (100-159) and high-volume (≥160). The primary and secondary outcomes were good neurological recovery and survival to discharge. Multilevel multivariable logistic regression analysis was conducted to calculate adjusted odds ratios (AORs). Interaction analysis between the number of EMS providers at the scene and the exposure variable was performed. RESULTS A total of 92,534 patients were enrolled. OHCAs in the low-volume group tended to be arrest in a public place or a non-metropolitan area, less prehospital administration of an advanced airway and intravenous management. Significant differences were found the main analysis: AORs (95% CIs) compared to the low-volume group were 1.15 (1.03-1.29) and 1.14 (1.03-1.27) in the high-volume and moderate-volume groups for good neurological recovery and 1.19 (1.07-1.33) and 1.14 (1.04-1.25) in the high-volume and moderate-volume groups for survival to discharge. Significant interaction effects between the number of EMS providers at the scene and case volume on clinical outcomes were found. CONCLUSION OHCA case volumes of ambulance stations are associated with clinical outcomes after cardiac arrest.
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Affiliation(s)
- Ki Hong Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Tae Han Kim
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
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26
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Jung E, Hong KJ, Shin SD, Ro YS, Ryu HH, Song KJ, Park JH, Kim TH, Jeong J. Interaction Effect Between Prehospital Mechanical Chest Compression Device Use and Post-Cardiac Arrest Care on Clinical Outcomes After Out-Of-Hospital Cardiac Arrest. J Emerg Med 2021; 61:119-130. [PMID: 33789822 DOI: 10.1016/j.jemermed.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/31/2020] [Accepted: 02/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prehospital application of a mechanical chest compression device (MCD) and post-cardiac arrest (PCA) care including coronary reperfusion therapy (CRT) or targeted temperature management (TTM) could affect the clinical outcome in out-of-hospital cardiac arrest (OHCA). OBJECTIVES This study aimed to assess whether the effect of PCA care including CRT or TTM differs according to prehospital MCD use in patients with OHCA. METHODS Adult OHCA cases with a presumed cardiac etiology and with survival to admission from 2016 to 2017 were enrolled from the Korean nationwide OHCA registry. The main exposures were CRT and TTM during PCA care. The primary outcome was good neurologic recovery defined by a cerebral performance category score of 1 or 2 at hospital discharge. We conducted interaction analyses between MCD use and PCA care including CRT or TTM. RESULTS Four thousand three hundred sixty-six OHCA cases were enrolled and 7.9% underwent MCD application. TTM and CRT were performed in 11.2% and 17.9% of the study population. In the interaction analysis, the adjusted odds ratios of TTM and CRT for good neurologic recovery were 2.41 (1.90-3.06) and 3.40 (2.79-4.14) in patients without MCD use and 1.89 (0.97-3.68), and 1.54 (0.79-3.01) in patients with MCD use. CONCLUSIONS The effect of PCA care on neurologic outcomes was different according to MCD use in OHCA. The association of good neurologic outcome and PCA care was not observed in the prehospital MCD use group compared with that in the MCD nonuse group.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Han Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Joo Jeong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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Abstract
The European Resuscitation Council (ERC) has produced these Systems Saving Lives guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include chain of survival, measuring performance of resuscitation, social media and smartphones apps for engaging community, European Restart a Heart Day, World Restart a Heart, KIDS SAVE LIVES campaign, lower-resource setting, European Resuscitation Academy and Global Resuscitation Alliance, early warning scores, rapid response systems, and medical emergency team, cardiac arrest centres and role of dispatcher.
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Mentzelopoulos SD, Couper K, Voorde PVD, Druwé P, Blom M, Perkins GD, Lulic I, Djakow J, Raffay V, Lilja G, Bossaert L. European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions. Resuscitation 2021; 161:408-432. [PMID: 33773832 DOI: 10.1016/j.resuscitation.2021.02.017] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.
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Affiliation(s)
| | - Keith Couper
- UK Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick Van de Voorde
- University Hospital and University Ghent, Belgium; Federal Department Health, Belgium
| | - Patrick Druwé
- Ghent University Hospital, Department of Intensive Care Medicine, Ghent, Belgium
| | - Marieke Blom
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Gavin D Perkins
- UK Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Violetta Raffay
- European University Cyprus, School of Medicine, Nicosia, Cyprus; Serbian Resuscitation Council, Novi Sad, Serbia
| | - Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
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Greif R, Lockey A, Breckwoldt J, Carmona F, Conaghan P, Kuzovlev A, Pflanzl-Knizacek L, Sari F, Shammet S, Scapigliati A, Turner N, Yeung J, Monsieurs KG. European Resuscitation Council Guidelines 2021: Education for resuscitation. Resuscitation 2021; 161:388-407. [PMID: 33773831 DOI: 10.1016/j.resuscitation.2021.02.016] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
These European Resuscitation Council education guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidance to citizens and healthcare professionals with regard to teaching and learning the knowledge, skills and attitudes of resuscitation with the ultimate aim of improving patient survival after cardiac arrest.
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Affiliation(s)
- 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.
| | - Andrew Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, UK
| | - Jan Breckwoldt
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Patricia Conaghan
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Artem Kuzovlev
- Negovsky Research Institute of General Reanimatology of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Lucas Pflanzl-Knizacek
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ferenc Sari
- Emergency Department, Skellefteå Hospital, Sweden
| | | | - Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Nigel Turner
- Department of Pediatric Anesthesia, Division of Vital Functions, Wilhelmina Children's Hospital at the University Medical Center, Utrecht, The Netherlands
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Koenraad G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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Ebunlomo EO, Gerik L, Ramon R. Save a Life: Implementation and Evaluation of a Community-Focused CPR Education Program in Houston, Texas. J Prim Care Community Health 2021; 12:2150132721998249. [PMID: 33648361 PMCID: PMC7930652 DOI: 10.1177/2150132721998249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Over 350 000 people in the United States experience out-of-hospital cardiac arrest (OHCA) annually—and almost 90% die as a result. However, survival varies widely between counties, ranging from 3.4% to 22.0%—a disparity that the American Heart Association (AHA) largely attributes to variation in rates of bystander CPR. Studies show that regions with low rates of bystander CPR have low rates of CPR training, making CPR training initiatives a high-priority intervention to reduce OHCA mortality. In Houston, Texas, researchers have identified census tracts with higher OCHA incidence and lower rates of bystander CPR. We developed a free, annual Hands-Only CPR bilingual health education program central to these high-risk neighborhoods. In 5 years, this collaborative effort trained over 2700 individuals. In 2016, 2017, and 2018, we conducted a process evaluation to assess fidelity, dose delivered, and dose received. We also conducted an outcome evaluation using the Kirkpatrick Model for Training Evaluation to assess participants’ reactions and learning. Overall, the program yielded positive outcomes. Of the 261 respondents (from 314 attendees), 63% were first-time learners. The majority (87%) were satisfied with the event and 85% felt that information was presented clearly and concisely. Pre- and post-knowledge assessments showed a 51% increase in the proportion of respondents who could correctly identify the steps for Hands-Only CPR. This program exemplifies how collaborative education can impact a community’s health status. Leveraging each partner’s resources and linkages with the community can enhance the reach and sustainability of health education initiatives.
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Affiliation(s)
- Ebun O Ebunlomo
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Laura Gerik
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Rene Ramon
- American Heart Association, Houston, TX, USA
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Lee SGW, Park JH, Ro YS, Hong KJ, Song KJ, Shin SD. Time to first defibrillation and survival outcomes of out-of-hospital cardiac arrest with refractory ventricular fibrillation. Am J Emerg Med 2021; 40:96-102. [DOI: 10.1016/j.ajem.2020.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/15/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
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Oving I, de Graaf C, Masterson S, Koster RW, Zwinderman AH, Stieglis R, AliHodzic H, Baldi E, Betz S, Cimpoesu D, Folke F, Rupp D, Semeraro F, Truhlar A, Tan HL, Blom MT. European first responder systems and differences in return of spontaneous circulation and survival after out-of-hospital cardiac arrest: A study of registry cohorts. THE LANCET REGIONAL HEALTH. EUROPE 2021; 1:100004. [PMID: 35104306 PMCID: PMC8454711 DOI: 10.1016/j.lanepe.2020.100004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND In Europe, survival-rates after out-of-hospital cardiac arrest (OHCA) vary widely between regions. Whether a system dispatching First Responders (FRs; main FR-types: firefighters, police officers, citizen-responders) is present or not may be associated with survival-rates. This study aimed to assess the association between having a dispatched FR-system and rates of return of spontaneous circulation (ROSC) and survival across Europe. METHODS Results of an inventory of dispatched FR-systems for OHCA in Europe were combined with aggregate ROSC and survival data from the EuReCa-TWO study and additionally collected data. Regression analysis (weighted on number of patients included per region) was performed to study the association between having a dispatched FR-system and ROSC and survival-rates to hospital discharge in the total population and in patients with shockable initial rhythm, witnessed OHCA and bystander cardiopulmonary resuscitation (CPR; Utstein comparator group). For regions without a dispatched FR-system, the theoretical survival-rate if a dispatched FR-system would have existed was estimated. FINDINGS We included 27 European regions. There were 15,859 OHCAs in the total group and 2,326 OHCAs in the Utstein comparator group. Aggregate ROSC and survival-rates were significantly higher in regions with an FR-system compared to regions without (ROSC: 36% [95%CI 35%-37%] vs. 24% [95%CI 23%-25%]; P<0.001; survival in total population [N=15.859]: 13% [95%CI 12%-15%] vs. 5% [95%CI 4%-6%]; P<0.001; survival in Utstein comparator group [N=2326]: 33% [95%CI 30%-36%] vs. 18% [95%CI 16%-20%]; P<0.001), and in regions with more than one FR-type compared to regions with only one FR-type. All main FR-types were associated with higher survival-rates (all P<0.050). INTERPRETATION European regions with dispatched FRs showed higher ROSC and survival-rates than regions without. FUNDING This project/work has received funding from the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381 (IO, HLT and MTB) and the European Union's COST programme under acronym PARQ, registered under grant agreement No CA19137 (IO, DC, HLT, MTB). HLT and MTB were supported by a grant from the Netherlands CardioVascular Research Initiative, Dutch Heart Foundation, Dutch Federation of University Medical Centres, Netherlands Organization for Health Research and Development, Royal Netherlands Academy of Sciences - CVON2017-15 RESCUED (HLT), and CVON2018-30 Predict2 (HLT and MTB).
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Affiliation(s)
- Iris Oving
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Corina de Graaf
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Siobhan Masterson
- Department of General Practice, National University of Ireland Galway and National Ambulance Service, Dublin, Ireland
| | - Rudolph W. Koster
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiologic Biostatics, Academic Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Remy Stieglis
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Hajriz AliHodzic
- Emergency Medical Service, Public Institution Health Centre 'Dr. Mustafa Šehović' Tuzla and Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Susanne Betz
- Department of Emergency Medicine, University Hospital Giessen and Marburg, Marburg, Germany
| | - Diana Cimpoesu
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Dennis Rupp
- Emergency Medical Services Mittelhessen, German Red Cross, Marburg, Germany
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy
| | - Anatolij Truhlar
- Emergency Medical Services of the Hradec Kralove Region and Department of Anaesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Corresponding author.
| | - Marieke T. Blom
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Knowledge and attitudes to cardiopulmonary resuscitation (CPR)- a cross-sectional population survey in Sweden. Resusc Plus 2021; 5:100071. [PMID: 34223339 PMCID: PMC8244385 DOI: 10.1016/j.resplu.2020.100071] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022] Open
Abstract
Aim of the study Rates of bystander CPR are increasing, yet mortality after out-of-hospital cardiac arrest (OHCA) remains high. The aim of this survey was to explore public knowledge and attitudes to CPR. Our hypotheses were that recent CPR training (< 5 years) would be associated with a high-quality response in a case vignette of OHCA with agonal breathing, and associated with an interest to become a smartphone app responder in suspected OHCA. Methods Data were collected through a web survey. Respondents (≥18 years) in Skåne County, Sweden were members of a panel created by a market research company. Data were weighted with respect to gender, age, municipalities and level of education to increase generalisability to the general population. Results A total of 1060 eligible answers were analysed. Seventy-six percent of non-healthcare professionals (n = 912) had participated in a CPR course at some time in life, 58 percent during the previous five years. The recommended CPR algorithm was known by 57 percent, whereas knowledge of the location of the nearest automated external defibrillator (AED) in a home environment was poor. Recent CPR training (< 5 years) did not favour high-quality response in a case vignette of OHCA with agonal breathing, but was one predictor of wanting to become a smartphone app responder. Conclusion This study highlights possible areas of improvement in CPR training, which might improve OHCA identification and facilitate knowledge retention. The potential to recruit smartphone app responders seems promising in certain groups.
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Matsuyama T, Scapigliati A, Pellis T, Greif R, Iwami T. Willingness to perform bystander cardiopulmonary resuscitation: A scoping review. Resusc Plus 2020; 4:100043. [PMID: 34223318 PMCID: PMC8244432 DOI: 10.1016/j.resplu.2020.100043] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
Background Despite the proven effectiveness of rapid initiation of cardiopulmonary resuscitation (CPR) for patients with out-of-hospital cardiac arrest (OHCA) by bystanders, fewer than half of the victims actually receive bystander CPR. We aimed to review the evidence of the barriers and facilitators for bystanders to perform CPR. Methods This scoping review was conducted as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. This review included studies assessing barriers or facilitators for the lay rescuers to perform CPR in actual emergency settings and excluded studies that overlapped with other ILCOR systematic reviews/scoping reviews (e.g. dispatcher instructed CPR etc). The key findings were classified into three kinds of factors: personal factors; CPR knowledge; and procedural issues. Results We identified 18 eligible studies. Of these studies addressing the reduced willingness to respond to cardiac arrest, 14 related to "personal factors", 3 to "CPR knowledge", and 2 to "procedural issues". On the other hand, we identified 5 articles assessing factors increasing bystanders' willingness to perform CPR. However, we observed significant heterogeneity among study populations, methodologies, factors definitions, outcome measures utilized and outcomes reported. Conclusions We found that a number of factors were present in actual settings which either inhibit or facilitate lay rescuers' performance of CPR. Interventional strategies to improve CPR performance of lay rescuers in the actual settings should be established, taking these factors into consideration.
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Affiliation(s)
- Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Andrea Scapigliati
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Robert Greif
- Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland.,Medical Education, School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S222-S283. [PMID: 33084395 DOI: 10.1161/cir.0000000000000896] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham BL, Blewer AL, Dainty KN, Diederich E, Lin Y, Leary M, Mahgoub M, Mancini ME, Navarro K, Donoghue A. Part 6: Resuscitation Education Science: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S551-S579. [PMID: 33081527 DOI: 10.1161/cir.0000000000000903] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC, Baldi E, Beck S, Beckers SK, Blewer AL, Boulton A, Cheng-Heng L, Yang CW, Coppola A, Dainty KN, Damjanovic D, Djärv T, Donoghue A, Georgiou M, Gunson I, Krob JL, Kuzovlev A, Ko YC, Leary M, Lin Y, Mancini ME, Matsuyama T, Navarro K, Nehme Z, Orkin AM, Pellis T, Pflanzl-Knizacek L, Pisapia L, Saviani M, Sawyer T, Scapigliati A, Schnaubelt S, Scholefield B, Semeraro F, Shammet S, Smyth MA, Ward A, Zace D. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A188-A239. [PMID: 33098918 DOI: 10.1016/j.resuscitation.2020.09.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, Bigham BL, Hirsch KG, Hoover AV, Kurz MC, Levy A, Lin Y, Magid DJ, Mahgoub M, Peberdy MA, Rodriguez AJ, Sasson C, Lavonas EJ. Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S580-S604. [PMID: 33081524 DOI: 10.1161/cir.0000000000000899] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Survival after cardiac arrest requires an integrated system of people, training, equipment, and organizations working together to achieve a common goal. Part 7 of the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, with an emphasis on elements that are relevant to a broad range of resuscitation situations. Previous systems of care guidelines have identified a Chain of Survival, beginning with prevention and early identification of cardiac arrest and proceeding through resuscitation to post-cardiac arrest care. This concept is reinforced by the addition of recovery as an important stage in cardiac arrest survival. Debriefing and other quality improvement strategies were previously mentioned and are now emphasized. Specific to out-of-hospital cardiac arrest, this Part contains recommendations about community initiatives to promote cardiac arrest recognition, cardiopulmonary resuscitation, public access defibrillation, mobile phone technologies to summon first responders, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about the recognition and stabilization of hospital patients at risk for developing cardiac arrest. This Part also includes recommendations about clinical debriefing, transport to specialized cardiac arrest centers, organ donation, and performance measurement across the continuum of resuscitation situations.
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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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Kim DK, Shin SD, Ro YS, Song KJ, Hong KJ, Joyce Kong SY. Place-provider-matrix of bystander cardiopulmonary resuscitation and outcomes of out-of-hospital cardiac arrest: A nationwide observational cross-sectional analysis. PLoS One 2020; 15:e0232999. [PMID: 32413089 PMCID: PMC7228068 DOI: 10.1371/journal.pone.0232999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 04/26/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS This study aims to test the association between the place-provider-matrix (PPM) of bystander cardiopulmonary resuscitation (CPR) and outcomes of out-of-hospital cardiac arrest (OHCA). METHODS Adult patients with OHCA with a cardiac etiology from 2012 to 2017 in Korea were analyzed, excluding patients who had unknown information on place, type of bystander, or outcome. The PPM was categorized into six groups by two types of places (public versus home) and three types of providers (trained responder (TR), family bystander, and layperson bystander). Outcomes were survival to discharge and good cerebral performance category (CPC) of 1 or 2. Multivariable logistic regression analysis was performed to test the association between PPM group and outcomes with adjustment for potential confounders to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) (reference = Public-TR). RESULTS A total of 73,057 patients were analyzed and were categorized into Public-TR (0.6%), Home-TR (0.3%), Public-Family (1.8%), Home-Family (79.8%), Public-Layperson (9.9%), and Home-Layperson (7.6%) groups. Compared with the Public-TR group, the AORs (95% CIs) for survival to discharge were 0.61 (0.35-1.05) in the Home-TR group, 0.85 (0.62-1.17) in the Public-Family group, 0.38 (0.29-0.50) in the Home-Family group, 1.12 (0.85-1.49) in the Public-Layperson group, and 0.42 (0.31-0.57) in the Home-Layperson group. The AORs (95% CIs) for good CPC were 0.58 (0.27-1.25) in the Home-TR group, 0.88 (0.61-1.27) in the Public-Family group, 0.38 (0.28-0.52) in the Home-Family group, 1.20 (0.87-1.65) in the Public-Layperson group, and 0.42 (0.30-0.59) in the Home-Layperson group. CONCLUSION The OHCA outcomes of the Home-Family and Home-Layperson groups were worse than those of the Public-TR group. This finding suggests that OHCA occurring in private places with family or layperson bystanders requires a new strategy, such as dispatching trained responders to the scene to improve CPR outcomes.
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Affiliation(s)
- Dae Kon Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - So Yeon Joyce Kong
- Laboratory of Emergency Medical Services, Seoul National University College of Medicine, Seoul, Republic of Korea
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Blewer AL, Putt ME, McGovern SK, Murray AD, Leary M, Riegel B, Shea JA, Berg RA, Asch DA, Viera AJ, Merchant RM, Nadkarni VM, Abella BS. A pragmatic randomized trial of cardiopulmonary resuscitation training for families of cardiac patients before hospital discharge using a mobile application. Resuscitation 2020; 152:28-35. [PMID: 32376347 DOI: 10.1016/j.resuscitation.2020.04.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
AIM OF THE STUDY Since over 80% of sudden cardiac arrests occur in the home, cardiopulmonary resuscitation (CPR) training for family members of high-risk cardiac patients represents a promising intervention. The use of mobile application-based (mApp) CPR training may facilitate this approach, but evidence regarding its efficacy is lacking. METHODS We conducted a multicenter, pragmatic, cluster-randomized trial assessing CPR training for family members of cardiac patients. The interventions were mApp (video, no manikin) and VSI (video + manikin). CPR skills were evaluated 6-months post-training. We hypothesized that chest compression (CC) rate from training with an mApp would be no worse than 5 compressions per minute (CPM) lower compared to VSI. RESULTS From 01/2016 to 01/2018, we enrolled 1325 eligible participants (mean age 51.6 years, 68.2% female and 59.4% white). CPR skills were evaluated 6-months post-training in 541 participants (275 VSI, 266 mApp). Mean rate was 84.6 CPM (95% CI: 80.4, 88.6) in VSI, compared to 82.7 CPM (95% CI: 76.2, 89.1) in the mApp, and mean depth was 42.1 mm (95% CI: 40.3, 43.8) in VSI, compared to 38.9 mm (95% CI: 36.2, 41.6) in the mApp. After adjustment, the mean difference in CC rate was -2.3 CPM (95% CI -9.4, 4.8, p = 0.25, non-inferiority) and CC depth was -3.2 mm (95% CI -5.9, 0.1, p = 0.056). CONCLUSION In this large prospective trial of CPR skill retention for family members of cardiac patients, mApp training was associated with lower CC quality. Future work is required to understand additional approaches to improve CPR skill retention. CLINICAL TRIAL REGISTRATION URL: ClinicalTrials.gov, Identifier: NCT02548793.
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Affiliation(s)
- Audrey L Blewer
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA.
| | - Mary E Putt
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Shaun K McGovern
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew D Murray
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marion Leary
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Judy A Shea
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care; University of Pennsylvania, Philadelphia, PA, USA; The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David A Asch
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Raina M Merchant
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care; University of Pennsylvania, Philadelphia, PA, USA; The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin S Abella
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, PA, USA
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Kim HS, Park KN, Kim SH, Lee BK, Oh SH, Jeung KW, Choi SP, Youn CS. Prognostic value of OHCA, C-GRApH and CAHP scores with initial neurologic examinations to predict neurologic outcomes in cardiac arrest patients treated with targeted temperature management. PLoS One 2020; 15:e0232227. [PMID: 32330180 PMCID: PMC7182181 DOI: 10.1371/journal.pone.0232227] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/09/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM) was to evaluate the prognostic value of OHCA, C-GRApH, and CAHP scores with initial neurologic examinations for predicting neurologic outcomes. METHODS This retrospective study included OHCA patients treated with TTM from 2009 to 2017. We calculated three cardiac arrest (CA)-specific risk scores (OHCA, C-GRApH, and CAHP) at the time of admission. The initial neurologic examination included an evaluation of the Full Outline of UnResponsiveness brainstem reflexes (FOUR_B) and Glasgow Coma Scale motor (GCS_M) scores. The primary outcome was the neurologic outcome at hospital discharge. RESULTS Of 311 subjects, 99 (31.8%) had a good neurologic outcome at hospital discharge. The OHCA score had an area under the receiver operating characteristic curve (AUROC) of 0.844 (95% confidence interval (CI): 0.798-0.884), the C-GRApH score had an AUROC of 0.779 (95% CI: 0.728-0.824), and the CAHP score had an AUROC of 0.872 (95% CI: 0.830-0.907). The addition of the FOUR_B or GCS_M score to the OHCA score improved the prediction of poor neurologic outcome (with FOUR_B: AUROC = 0.899, p = 0.001; with GCS_M: AUROC = 0.880, p = 0.004). The results were similar with the C-GRApH and CAHP scores in predicting poor neurologic outcome. CONCLUSIONS This study confirms the good prognostic performance of CA-specific scores to predict neurologic outcomes in OHCA patients treated with TTM. By adding new variables associated with the initial neurologic examinations, the prognoses of neurologic outcomes improved compared to the existing scoring models.
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Affiliation(s)
- Hyun Soo Kim
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyu Nam Park
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soo Hyun Kim
- Department of Emergency Medicine, Eunpyeong St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Hoon Oh
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Pill Choi
- Department of Emergency Medicine, Eunpyeong St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chun Song Youn
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- * E-mail:
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Does second EMS unit response time affect outcomes of OHCA in multi-tiered system? A nationwide observational study. Am J Emerg Med 2020; 42:161-167. [PMID: 32111405 DOI: 10.1016/j.ajem.2020.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/13/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The time dependence of a multi-tier response for out-of-hospital cardiac arrest (OHCA) is unclear. The aim of this study was to evaluate the time-dependent effect of EMS response type in a multi-tiered system on the clinical outcomes of OHCA. METHODS Adult EMS-treated OHCA of presumed cardiac etiology who were not witnessed by EMS between January 2015 and December 2017 were included. The main exposure was EMS response type: single-tier response, early multi-tier response (0-18 min from call to second EMS arrival), and late multi-tier response (19 min from call to second EMS arrival). The primary outcome was good neurologic recovery at the time of discharge from the hospital. Multivariate logistic regression analysis was performed, adjusting for patient-community and prehospital variables. RESULTS Among 54,436 patients, 29,995 patients (55.1%), 21,552 patients (39.6%), and 2889 patients (5.3%) were treated by single-tiered EMS, early multi-tiered EMS, and late multi-tiered EMS, respectively. Good neurological recovery and survival to discharge were more frequent in the early multi-tiered response group (6.4% and 9.7%) than in the single-tiered response group (4.8% and 7.5%) or late multi-tiered response group (3.1% and 5.8%). Compared to the single-tiered response group, the early multi-tiered response group was more likely to have good neurological recovery (adjusted OR, 95% CI: 1.15 [1.06-1.26]), but the late multi-tiered response group was less likely to have good neurological recovery (adjusted OR, 95% CI: 0.76 [0.61-0.96]). CONCLUSION In our basic to intermediate-tiered EMS system, early multi-tier response was associated with improved survival and good neurological recovery.
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Metelmann C, Metelmann B, Kohnen D, Prasser C, Süss R, Kuntosch J, Scheer D, Laslo T, Fischer L, Hasebrook J, Flessa S, Hahnenkamp K, Brinkrolf P. Evaluation of a Rural Emergency Medical Service Project in Germany: Protocol for a Multimethod and Multiperspective Longitudinal Analysis. JMIR Res Protoc 2020; 9:e14358. [PMID: 32130193 PMCID: PMC7055856 DOI: 10.2196/14358] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND German emergency medical services are a 2-tiered system with paramedic-staffed ambulances as the primary response, supported by prehospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply, whereas the demand for timely emergency medical care is constantly growing. In rural areas, this has led to critical delays in the provision of emergency medical care. In particular, in cases of cardiac arrest, time is of the essence because, with each passing minute, the chance of survival with good neurological outcome decreases. OBJECTIVE The project has 4 main objectives: (1) reduce the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (ie, bystander cardiopulmonary resuscitation), (2) provide faster professional first aid in addition to rescue services through alerting trained first aiders by mobile phone, (3) make more emergency physicians available more quickly through introducing the tele-emergency physician system, and (4) enhance emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services. METHODS We will evaluate project implementation in a tripartite prospective and intervention study. First, in medical evaluation, we will assess the influences of various project measures on quality of care using multiple methods. Second, the economic evaluation will mainly focus on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. Third, as part of the work and organizational analysis, we will assess important work- and occupational-related parameters, as well as network and regional indexes. RESULTS We started the project in 2017 and will complete enrollment in 2020. We finished the preanalysis phase in September 2018. CONCLUSIONS Overall, implementation of the project will entail realigning emergency medicine in rural areas and enhancing the quality of medical emergency care in the long term. We expect the project to lead to a measurable increase in medical laypersons' individual motivation to provide resuscitation, to strengthen resuscitation skills, and to result in medical laypersons providing first aid much more frequently. Furthermore, we intend the project to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via mobile phones. Previous projects in urban regions have shown that the tele-emergency physician system can provide a higher availability and quality of emergency call-outs in regular health care. We expect a closer interrelation of emergency practices of statutory health insurance physicians with the rescue service to lead to better coordination of rescue and on-call services. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14358.
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Affiliation(s)
- Camilla Metelmann
- Clinic for Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Bibiana Metelmann
- Clinic for Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Dorothea Kohnen
- zeb.business school, Steinbeis University Berlin, Münster, Germany
| | - Clara Prasser
- Chair of General Business Administration and Health Management, University of Greifswald, Greifswald, Germany
| | - Rebekka Süss
- Chair of General Business Administration and Health Management, University of Greifswald, Greifswald, Germany
| | - Julia Kuntosch
- Chair of General Business Administration and Health Management, University of Greifswald, Greifswald, Germany
| | - Dirk Scheer
- District of Vorpommern-Greifswald, Greifswald, Germany
| | - Timm Laslo
- Communal Rescue Services, District of Vorpommern-Greifswald, Greifswald, Germany
| | - Lutz Fischer
- Communal Rescue Services, District of Vorpommern-Greifswald, Greifswald, Germany
| | | | - Steffen Flessa
- Chair of General Business Administration and Health Management, University of Greifswald, Greifswald, Germany
| | - Klaus Hahnenkamp
- Clinic for Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Peter Brinkrolf
- Clinic for Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
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Cartledge S, Saxton D, Finn J, Bray JE. Australia's awareness of cardiac arrest and rates of CPR training: results from the Heart Foundation's HeartWatch survey. BMJ Open 2020; 10:e033722. [PMID: 31911523 PMCID: PMC6955479 DOI: 10.1136/bmjopen-2019-033722] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We aimed to provide the first national estimates of cardiopulmonary resuscitation (CPR) training and awareness of cardiac arrest. DESIGN A retrospective analysis of a national cross-sectional survey was undertaken. Data were collected online from adults in July 2017 as part of the Heart Foundation of Australia's HeartWatch survey. We used logistic regression to examine demographic factors associated with CPR training. PARTICIPANTS A national cohort was invited to participate in the survey using purposive, non-probability sampling methods with quotas for age, gender and area of residence, in order to reflect the wider Australian population. The final sample consisted of 1076 respondents. MAIN OUTCOME MEASURE To determine an estimation of the prevalence of cardiac arrest awareness and CPR training at a national level and the relationship of training to demographic factors. RESULTS The majority (76%) of respondents were born in Australia with 51% female and 66% aged between 35 and 64 years. Only 16% of respondents could identify the difference between a cardiac arrest and a heart attack. While 56% reported previous CPR training, only 22% were currently trained (within 1 year). CPR training was associated with younger age (35 to 54 years) (OR 1.45, 95% CI 1.06 to 2.0), being born in Australia (OR 1.59, 95% CI 1.17 to 2.17) and higher levels of education (university, OR 1.86, 95% CI 1.35 to 2.57). CPR training increased confidence in respondents ability to perform effective CPR and use a defibrillator. Lack of CPR training was the most common reason why respondents would not provide CPR to a stranger. CONCLUSIONS There is a need to improve the community's understanding of cardiac arrest, and to increase awareness and training in CPR. CPR training rates have not changed over the past decades-new initiatives are needed.
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Affiliation(s)
- Susie Cartledge
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
| | - Danielle Saxton
- National Heart Foundation of Australia, Melbourne, Victoria, Australia
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Perth, Western Australia, Australia
| | - Janet E Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Perth, Western Australia, Australia
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Kim KH, Park JH, Ro YS, Shin SD, Song KJ, Hong KJ, Jeong J, Lee KW, Hong WP. Association Between Post-Resuscitation Coronary Angiography With and Without Intervention and Neurological Outcomes After Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2019; 24:485-493. [DOI: 10.1080/10903127.2019.1668989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lim HJ, Jeong J, Kim J, Ro YS, Shin SD. Effect of estimated glomerular filtration rate (eGFR) on incidence of out-of-hospital cardiac arrests: A case-control study. Resuscitation 2019; 142:38-45. [PMID: 31299221 DOI: 10.1016/j.resuscitation.2019.06.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/09/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Serum creatinine levels in the post-resuscitative state have been associated with poor prognosis for out-of-hospital cardiac arrest (OHCA). Several studies have focused on kidney dysfunction in the general population, and the results suggested that serum creatinine level elevation or reduction of the estimated glomerular filtration rate (eGFR) are associated with increased risk of death and cardiovascular events. However, it is uncertain whether the serum creatinine levels or eGFR of OHCA patients are related to the incidence of OHCA. The aim of this study was to determine the association between eGFR and the incidence of OHCA. METHODS This study was a case-control study performed using the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES) project dataset and the Korea National Health and Nutrition Examination Survey (KNHANES) dataset. Cases were defined as emergency medical service-treated adult OHCA patients with presumed cardiac etiology collected from the CAPTURES dataset. Four controls from the KNHANES dataset were matched to one case based on age, gender, and county. Multivariable conditional logistic regression analysis was conducted to evaluate the effect of eGFR on the incidence of OHCA. RESULTS A total of 1211 matched case-control pairs were included in the study analysis. We classified eGFR into 6 categories (≥90, 60-89, 45-59, 30-44, 15-29, and <15 mL/min/1.73 m2) according to the chronic kidney disease stage. Subjects with an eGFR ≥90 mL/min/1.73 m2 were used as the reference group. In both the unadjusted and adjusted models, lower eGFR was significantly associated with OHCA incidence. The odds ratio (OR) for OHCA incidence increased sharply as the eGFR declined; the adjusted OR (95% CI) for OHCA incidence was 4.09 (2.81-5.95) with an eGFR of 60-89 mL/min/1.73 m2, 36.59 (22.24-60.21) with an eGFR of 45-59 mL/min/1.73 m2, 55.26(29.66-102.94) with an eGFR of 30-44 mL/min/1.73 m2, 89.65 (37.25-215.79) with an eGFR of 15-29 mL/min/1.73 m2, and 241.87 (73.49-796.01) with an eGFR of less than 15 mL/min/1.73 m2. CONCLUSION In this study, we observed an association between reduced eGFR and the risk of OHCA incidence in a large, community-based population. Future prospective studies are needed to better understand how reduced renal function is associated with OHCA occurrence as well as the impact of intensive risk management and intervention of renal function on OHCA incidence.
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Affiliation(s)
- Hyouk Jae Lim
- Department of Emergency Medicine, Seoul National University Hospital, South Korea.
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea.
| | - Jungeun Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea.
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea.
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, South Korea.
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Baldi E, Contri E, Bailoni A, Rendic K, Turcan V, Donchev N, Nadareishvili I, Petrica AM, Yerolemidou I, Petrenko A, Franke J, Labbe G, Jashari R, Pérez Dalí A, Borg J, Hertenberger N, Böttiger BW. Final-year medical students' knowledge of cardiac arrest and CPR: We must do more! Int J Cardiol 2019; 296:76-80. [PMID: 31375334 DOI: 10.1016/j.ijcard.2019.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Students are an important part of the community response to an out-of-hospital cardiac arrest (OHCA). If even schoolchildren now know cardio-pulmonary resuscitation (CPR), even more the reason a young doctor should know how to treat an OHCA. The aim of our study was to assess medical students' knowledge of CPR and OHCA throughout Europe. METHODS An online survey was given to final-year students by the Medical Student Associations of different countries. RESULTS 1012 medical students from 99 different universities and 14 different countries completed the questionnaire. A total of 82.2% attended a BLS or BLS/AED course, provided by the University in only 69.7% of cases. In 84.3% it was a mandatory part of their degree. A total of 78.6% felt able to rescue a person in OHCA. Only 49.3% knew that 'unresponsiveness' and 'absence of normal breathing' are sufficient for lay people to identify an OHCA, and less than half of those interviewed knew the incidence of OHCA in Europe and the decrease in chance of survival if CPR is not performed. The correct compression:ventilation ratio was known by 90.2%, the correct compression depth by 69.7%, whilst only 57.8% knew the right compression rate. In total, 69.7% knew that an AED must be used immediately when available, and only 57.2% recognized the AED symbol. CONCLUSIONS Medical students' knowledge of cardiac arrest and CPR needs to be improved throughout Europe and we believe that BLS/AED training should be mandatory in all European Universities.
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Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Pavia nel Cuore, Pavia, Italy; Robbio nel Cuore, Robbio, Italy.
| | - Enrico Contri
- Pavia nel Cuore, Pavia, Italy; Robbio nel Cuore, Robbio, Italy; AREU Azienda Regionale Emergenza Urgenza-AAT Pavia c/o Fondazione IRCCS Policlinico San Matteo Hospital, Pavia, Italy
| | | | - Kristina Rendic
- Srpska Medical Students' International Committee-SaMSIC, Banja Luka, Bosnia and Herzegovina
| | - Valeria Turcan
- Asociaţia Studenţilor şi Rezidenţilor în Medicină-ASRM, Chișinău, Republic of Moldova
| | - Nikola Donchev
- Association of Medical Students in Bulgaria-AMSB, Sofia, Bulgaria
| | - Ilia Nadareishvili
- Georgian Medical Students Association-GMSA, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia
| | - Ana-Maria Petrica
- Federaţia Asociaţiilor Studenţilor în Medicină din România-FASMR, Bucharest, Romania
| | | | | | | | - Gabrielle Labbe
- Association Nationale des Etudiants en Médecine de France-ANEMF, Montrouge, France
| | - Redon Jashari
- Kosova's Organization of Medical Students-KOMS, Pristina, Kosovo
| | - Alba Pérez Dalí
- Federación Española de Estudiantes de Medicina para la cooperación internacional-IFMSA Spain, Valladolid, Spain
| | - Jordy Borg
- Malta Medical Students' Association-MMSA, Msida, Malta
| | | | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Köln, Germany; European Resuscitation Council, Niel, Belgium
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Yoon H, Kwon Y, An J, Hong S, Kim YT. Main outcomes of the sudden cardiac arrest survey 2006 to 2016. Clin Exp Emerg Med 2019; 6:183-188. [PMID: 31261487 PMCID: PMC6614049 DOI: 10.15441/ceem.18.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/26/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hajung Yoon
- Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Yunhyung Kwon
- Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Juyeon An
- Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Sungok Hong
- Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Young Taek Kim
- Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea
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Association between county-level cardiopulmonary resuscitation training and changes in Survival Outcomes after out-of-hospital cardiac arrest over 5 years: A multilevel analysis. Resuscitation 2019; 139:291-298. [DOI: 10.1016/j.resuscitation.2019.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/01/2018] [Accepted: 01/09/2019] [Indexed: 01/17/2023]
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