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Emotional Work Stress Reactions of Emergency Medical Technicians Involved in Transporting Out-of-Hospital Cardiac Arrest Patients with “Do Not Attempt Resuscitation” Orders. Resuscitation 2022; 173:61-68. [DOI: 10.1016/j.resuscitation.2022.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/19/2022]
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2
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Maruhashi T, Oi M, Asakuma S, Kotoh R, Shibuya H, Kurihara Y, Asari Y. Advanced do-not-attempt-resuscitation directives and emergency medical services for out-of-hospital cardiopulmonary arrest patients in Japan: a pilot study. Acute Med Surg 2021; 8:e692. [PMID: 34567576 PMCID: PMC8449586 DOI: 10.1002/ams2.692] [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: 05/14/2021] [Revised: 08/01/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
Aims We investigated how do‐not‐attempt‐resuscitation (DNAR) orders are currently used, and we examined the emergency medical team responses for out‐of‐hospital cardiac arrest (OHCA) cases in Japan. Methods The sample for this prospective study comprised all OHCA cases attended to by the Sagamihara Municipal Fire Department emergency medical services between May 30, 2019 and February 15, 2020. Data were recorded by the responding emergency medical team. Results There were 396 OHCA cases. The mean age was 75 ± 18 years, and individuals aged 65 years or older accounted for 80.6%. Approximately 70% of the patients had an underlying disease. A DNAR order was available in only 45 (11.4%) of the cases, of which 12 (26.7%) were written, 27 (60%) were verbally confirmed, and six (13.3%) were confirmed in some other way or both. The home physician was present and able to confirm the patient’s death in only one of the DNAR cases. In 43 (95.6%) of the cases, the emergency medical team carried out cardiopulmonary resuscitation despite a DNAR order; of them, a total of 17 (37.8%) patients were transported to a tertiary emergency hospital. Conclusions Our analyses indicate the under‐utilization of DNAR advance directives and advance care planning (which are important for better end‐of‐life care) in Japan. Currently, an emergency medical team could be required to attempt resuscitation against an individuals’ clear DNAR order. In the future, legal arrangements regarding the handling of DNAR directives on site may be required to respect patients’ wishes.
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Affiliation(s)
- Takaaki Maruhashi
- Department of Emergency and Critical Care Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Marina Oi
- Department of Emergency and Critical Care Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Sadataka Asakuma
- Department of Emergency and Critical Care Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Rika Kotoh
- Department of Emergency and Critical Care Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Hirotaka Shibuya
- Department of Emergency and Critical Care Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Yutaro Kurihara
- Department of Emergency and Critical Care Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine Kitasato University School of Medicine Sagamihara Japan
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3
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Payot C, Fehlmann CA, Suppan L, Niquille M, Lardi C, Sarasin FP, Larribau R. Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168323. [PMID: 34444071 PMCID: PMC8391446 DOI: 10.3390/ijerph18168323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.
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Affiliation(s)
- Charles Payot
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Christophe A. Fehlmann
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Emergency Medicine, Research Group, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Christelle Lardi
- University Center of Legal Medicine (CURML), Geneva University Hospitals, 1211 Geneva, Switzerland;
| | - François P. Sarasin
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
- Correspondence: ; Tel.: +41-79-553-9400
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4
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Watkins CL, Jones SP, Hurley MA, Benedetto V, Price CI, Sutton CJ, Quinn T, Bangee M, Chesworth B, Miller C, Doran D, Siriwardena AN, Gibson JME. Predictors of recognition of out of hospital cardiac arrest by emergency medical services call handlers in England: a mixed methods diagnostic accuracy study. Scand J Trauma Resusc Emerg Med 2021; 29:7. [PMID: 33407699 PMCID: PMC7789721 DOI: 10.1186/s13049-020-00823-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/13/2020] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to identify key indicator symptoms and patient factors associated with correct out of hospital cardiac arrest (OHCA) dispatch allocation. In previous studies, from 3% to 62% of OHCAs are not recognised by Emergency Medical Service call handlers, resulting in delayed arrival at scene. Methods Retrospective, mixed methods study including all suspected or confirmed OHCA patients transferred to one acute hospital from its associated regional Emergency Medical Service in England from 1/7/2013 to 30/6/2014. Emergency Medical Service and hospital data, including voice recordings of EMS calls, were analysed to identify predictors of recognition of OHCA by call handlers. Logistic regression was used to explore the role of the most frequently occurring (key) indicator symptoms and characteristics in predicting a correct dispatch for patients with OHCA. Results A total of 39,136 dispatches were made which resulted in transfer to the hospital within the study period, including 184 patients with OHCA. The use of the term ‘Unconscious’ plus one or more of symptoms ‘Not breathing/Ineffective breathing/Noisy breathing’ occurred in 79.8% of all OHCAs, but only 72.8% of OHCAs were correctly dispatched as such. ‘Not breathing’ was associated with recognition of OHCA by call handlers (Odds Ratio (OR) 3.76). The presence of key indicator symptoms ‘Breathing’ (OR 0.29), ‘Reduced or fluctuating level of consciousness’ (OR 0.24), abnormal pulse/heart rate (OR 0.26) and the characteristic ‘Female patient’ (OR 0.40) were associated with lack of recognition of OHCA by call handlers (p-values < 0.05). Conclusions There is a small proportion of calls in which cardiac arrest indicators are described but the call is not dispatched as such. Stricter adherence to dispatch protocols may improve call handlers’ OHCA recognition. The existing dispatch protocol would not be improved by the addition of further terms as this would be at the expense of dispatch specificity. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-020-00823-9.
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Affiliation(s)
- Caroline L Watkins
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Stephanie P Jones
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Margaret A Hurley
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Valerio Benedetto
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | | | | | - Tom Quinn
- Kingston University London and St George's, University of London, London, UK
| | - Munirah Bangee
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Brigit Chesworth
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Colette Miller
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | - Dawn Doran
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK
| | | | - Josephine M E Gibson
- School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK.
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Kangasniemi H, Setälä P, Olkinuora A, Huhtala H, Tirkkonen J, Kämäräinen A, Virkkunen I, Yli‐Hankala A, Jämsen E, Hoppu S. Limiting treatment in pre-hospital care: A prospective, observational multicentre study. Acta Anaesthesiol Scand 2020; 64:1194-1201. [PMID: 32521040 DOI: 10.1111/aas.13649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/17/2020] [Accepted: 05/26/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Data are scarce on the withdrawal of life-sustaining therapies and limitation of care orders (LCOs) during physician-staffed Helicopter Emergency Medical Service (HEMS) missions. We investigated LCOs and the quality of information available when physicians made treatment decisions in pre-hospital care. METHODS A prospective, nationwide, multicentre study including all Finnish physician-staffed HEMS bases during a 6-month study period. All HEMS missions where a patient had pre-existing LCOs and/or a new LCO were included. RESULTS There were 335 missions with LCOs, which represented 5.7% of all HEMS missions (n = 5895). There were 181 missions with pre-existing LCOs, and a total of 170 new LCOs were issued. Usually, the pre-existing LCO was a do not attempt cardiopulmonary resuscitation order only (n = 133, 74%). The most frequent new LCO was 'termination of cardiopulmonary resuscitation' only (n = 61, 36%), while 'no intensive care' combined with some other LCO was almost as common (n = 54, 32%). When issuing a new LCO for patients who did not have any preceding LCOs (n = 153), in every other (49%) case the physicians thought that the patient should have already had an LCO. When the physician made treatment decisions, patients' background information from on-scene paramedics was available in 260 (78%) of the LCO missions, while patients' medical records were available in 67 (20%) of the missions. CONCLUSION Making LCOs or treating patients with pre-existing LCOs is an integral part of HEMS physicians' work, with every twentieth mission involving LCO patients. The new LCOs mostly concerned withholding or withdrawal of cardiopulmonary resuscitation and intensive care.
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Affiliation(s)
- Heidi Kangasniemi
- Research and Development Unit FinnHEMS LtdWTC Helsinki Airport Vantaa Finland
- Emergency Medical Services Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Piritta Setälä
- Emergency Medical Services Tampere University Hospital Tampere Finland
| | - Anna Olkinuora
- Research and Development Unit FinnHEMS LtdWTC Helsinki Airport Vantaa Finland
| | - Heini Huhtala
- Faculty of Social Sciences Tampere University Tampere Finland
| | - Joonas Tirkkonen
- Department of Intensive Care Medicine and Department of Emergency, Anaesthesia and Pain Medicine Tampere University Hospital Tampere Finland
- Intensive Care Unit Liverpool Hospital Sydney Australia
| | - Antti Kämäräinen
- Emergency Medical Services Tampere University Hospital Tampere Finland
- Department of Emergency Medicine Department of Anaesthesia Hyvinkää District Hospital Hyvinkää Finland
| | - Ilkka Virkkunen
- Research and Development Unit FinnHEMS LtdWTC Helsinki Airport Vantaa Finland
- Emergency Medical Services Tampere University Hospital Tampere Finland
| | - Arvi Yli‐Hankala
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Department of Anaesthesia Tampere University Hospital Tampere Finland
| | - Esa Jämsen
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Centre of Geriatrics Tampere University Hospital Tampere Finland
| | - Sanna Hoppu
- Emergency Medical Services Tampere University Hospital Tampere Finland
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6
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Kangasniemi H, Setälä P, Huhtala H, Kämäräinen A, Virkkunen I, Tirkkonen J, Yli-Hankala A, Hoppu S. Limitation of treatment in prehospital care - the experiences of helicopter emergency medical service physicians in a nationwide multicentre survey. Scand J Trauma Resusc Emerg Med 2019; 27:89. [PMID: 31578145 PMCID: PMC6775669 DOI: 10.1186/s13049-019-0663-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/26/2019] [Indexed: 11/24/2022] Open
Abstract
Background Making ethically sound treatment limitations in prehospital care is a complex topic. Helicopter Emergency Medical Service (HEMS) physicians were surveyed on their experiences with limitations of care orders in the prehospital setting, including situations where they are dispatched to healthcare facilities or nursing homes. Methods A nationwide multicentre study was conducted among all HEMS physicians in Finland in 2017 using a questionnaire with closed five-point Likert-scale questions and open questions. The Ethics Committee of the Tampere University Hospital approved the study protocol (R15048). Results Fifty-nine (88%) physicians responded. Their median age was 43 (IQR 38–47) and median medical working experience was 15 (IQR 10–20) years. All respondents made limitation of care orders and 39% made them often. Three fourths (75%) of the physicians were often dispatched to healthcare facilities and nursing homes and the majority (93%) regularly met patients who should have already had a valid limitation of care order. Every other physician (49%) had sometimes decided not to implement a medically justifiable limitation of care order because they wanted to avoid conflicts with the patient and/or the next of kin and/or other healthcare staff. Limitation of care order practices varied between the respondents, but neither age nor working experience explained these differences in answers. Most physicians (85%) stated that limitations of care orders are part of their work and 81% did not find them especially burdensome. The most challenging patient groups for treatment limitations were the under-aged patients, the severely disabled patients and the patients in healthcare facilities or residing in nursing homes. Conclusion Making limitation of care orders is an important but often invisible part of a HEMS physician’s work. HEMS physicians expressed that patients in long-term care were often without limitations of care orders in situations where an order would have been ethically in accordance with the patient’s best interests. Electronic supplementary material The online version of this article (10.1186/s13049-019-0663-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heidi Kangasniemi
- Research and Development Unit, FinnHEMS Ltd, WTC Helsinki Airport, Lentäjäntie 3, 01530, Vantaa, Finland. .,Division of Anaesthesiology, Department of Perioperative, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Töölö Hospital, Topeliuksenkatu 5, FIN-00029 HUS, Helsinki, Finland. .,Faculty of Medicine and Life Sciences, Tampere University, FI-33014, Tampere, Finland.
| | - Piritta Setälä
- Emergency Medical Services, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, P.O. Box 100, FI-33014, Tampere, Finland
| | - Antti Kämäräinen
- Emergency Medical Services, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Ilkka Virkkunen
- Research and Development Unit, FinnHEMS Ltd, WTC Helsinki Airport, Lentäjäntie 3, 01530, Vantaa, Finland.,Emergency Medical Services, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Joonas Tirkkonen
- Department of Anaesthesia, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Arvi Yli-Hankala
- Faculty of Medicine and Life Sciences, Tampere University, FI-33014, Tampere, Finland.,Department of Anaesthesia, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Sanna Hoppu
- Emergency Medical Services, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
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7
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Cokljat M, Lloyd A, Clarke S, Crawford A, Clegg G. Identifying patients at risk of futile resuscitation: palliative care indicators in out-of-hospital cardiac arrest. BMJ Support Palliat Care 2019; 12:282-286. [PMID: 31530553 DOI: 10.1136/bmjspcare-2019-001828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/22/2019] [Accepted: 09/04/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Patients with indicators for palliative care, such as those with advanced life-limiting conditions, are at risk of futile cardiopulmonary resuscitation (CPR) if they suffer out-of-hospital cardiac arrest (OHCA). Patients at risk of futile CPR could benefit from anticipatory care planning (ACP); however, the proportion of OHCA patients with indicators for palliative care is unknown. This study quantifies the extent of palliative care indicators and risk of CPR futility in OHCA patients. METHODS A retrospective medical record review was performed on all OHCA patients presenting to an emergency department (ED) in Edinburgh, Scotland in 2015. The risk of CPR futility was stratified using the Supportive and Palliative Care Indicators Tool. Patients with 0-2 indicators had a 'low risk' of futile CPR; 3-4 indicators had an 'intermediate risk'; 5+ indicators had a 'high risk'. RESULTS Of the 283 OHCA patients, 12.4% (35) had a high risk of futile CPR, while 16.3% (46) had an intermediate risk and 71.4% (202) had a low risk. 84.0% (68) of intermediate-to-high risk patients were pronounced dead in the ED or ED step-down ward; only 2.5% (2) of these patients survived to discharge. CONCLUSIONS Up to 30% of OHCA patients are being subjected to advanced resuscitation despite having at least three indicators for palliative care. More than 80% of patients with an intermediate-to-high risk of CPR futility are dying soon after conveyance to hospital, suggesting that ACP can benefit some OHCA patients. This study recommends optimising emergency treatment planning to help reduce inappropriate CPR attempts.
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Affiliation(s)
- Mia Cokljat
- Infection and Immunity Research Institute, University of London Saint George's, London, UK .,Renal Medicine, Saint George's University Hospitals NHS Foundation Trust, London, UK.,Resuscitation Research Group, University of Edinburgh, Edinburgh, UK
| | - Adam Lloyd
- Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK.,Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Scott Clarke
- Resuscitation Research Group, University of Edinburgh, Edinburgh, UK.,Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anna Crawford
- Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gareth Clegg
- Resuscitation Research Group, University of Edinburgh, Edinburgh, UK.,Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.,Medical Directorate, Scottish Ambulance Service, Edinburgh, United Kingdom
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Hsu SC, Kuo CW, Weng YM, Lin CC, Chen JC. The effectiveness of teaching chest compression first in a standardized public cardiopulmonary resuscitation training program. Medicine (Baltimore) 2019; 98:e14418. [PMID: 30921176 PMCID: PMC6456000 DOI: 10.1097/md.0000000000014418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Effectiveness of bystander cardiopulmonary resuscitation (CPR) is known to provide emergency medical services which reduce the number of deaths in patients with out-of-hospital cardiac arrest. The survival at these patients is affected by the training level of the bystander, but the best format of CPR training is unclear. In this pilot study, we aimed to examine whether the sequence of CPR instruction improves learning retention on the course materials.A total of 95 participants were recruited and divided into 2 groups; Group 1: 49 participants were taught firstly how to recognize a cardiac arrest and activate the emergency response system, and Group 2: 46 participants were taught chest compression first. The performance of participants was observed and evaluated, the results from 1 pre-test and 2 post-tests between 2 groups were then compared.There was a significantly better improvement of participants in Group 2 regarding the recognition of a cardiac arrest and the activation of the emergency response system than of those in Group 1. At the post-test, participants in Group 2 had an improvement in chest compression compared to those in Group 1, but the difference was not statistically significant.Our study had revealed that teaching CPR first in a standardized public education program had improved the ability of participants to recognize cardiac arrest and to activate the emergency response system.
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Affiliation(s)
- Shou-Chien Hsu
- Department of Emergency Medicine, Camillians Saint Mary's Hospital Luodong
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linko
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linko
- Department of Emergency Medicine, Tao-Yuan General Hospital
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine
- Department of Emergency Medicine, Prehospital Care Division, Tao-Yuan General Hospital
- Faculty of Medicine, National Yang-Ming University
| | - Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linko
- Department of Emergency Medicine, Ton-Yen General Hospital, Taiwan
| | - Jih-Chang Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linko
- Department of Emergency Medicine, Tao-Yuan General Hospital
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9
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Ji C, Quinn T, Gavalova L, Lall R, Scomparin C, Horton J, Deakin CD, Pocock H, Smyth MA, Rees N, Brace-McDonnell SJ, Gates S, Perkins GD. Feasibility of data linkage in the PARAMEDIC trial: a cluster randomised trial of mechanical chest compression in out-of-hospital cardiac arrest. BMJ Open 2018; 8:e021519. [PMID: 30056384 PMCID: PMC6067361 DOI: 10.1136/bmjopen-2018-021519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES There is considerable interest in reducing the cost of clinical trials. Linkage of trial data to administrative datasets and disease-specific registries may improve trial efficiency, but it has not been reported in resuscitation trials conducted in the UK. To assess the feasibility of using national administrative and clinical datasets to follow up patients transported to hospital following attempted resuscitation in a cluster randomised trial of a mechanical chest compression device in out-of-hospital cardiac arrest. METHODS Hospital data on trial participants were requested from Hospital Episode Statistics (HES), the Intensive Care National Audit and Research Centre, and Myocardial Ischaemia National Audit Project and National Audit of Percutaneous Coronary Interventions, using unique patient identifiers. Linked data were received between June 2014 and June 2015. RESULTS Of 4471 patients randomised in the pre-hospital randomised assessment of a mechanical compression device in cardiac arrest (PARAMEDIC) trial, 2398 (53.6%) were not known to be deceased at emergency department arrival and were eligible for linkage. We achieved an overall match rate of 86.7% in the combined HES accident and emergency, inpatient and critical care dataset, with variable match rates (4.2%-80.4%) in individual datasets. Patient demographics, cardiac arrest-related characteristics and major outcomes were predominantly similar between HES matched and unmatched groups, in the linkage apart from location, response time and return of spontaneous circulation (ROSC) at handover. CONCLUSIONS This study shows that it is feasible to track patients from the prehospital setting through to hospital admission using routinely available administrative datasets with a moderate to high degree of success. This approach has the potential to complement the trial data with the demographic and clinical management information about the studied cohort, as well as to improve the efficiency and reduce the costs of follow-up in cardiac arrest trials. CLINICAL TRIAL REGISTRATION ISRCTN08233942; Post-results.
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Affiliation(s)
- Chen Ji
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
| | - Tom Quinn
- Faculty of Health, Social Care & Education, Kingston University and St George's, University of London, London, UK
| | - Lucia Gavalova
- Faculty of Health, Social Care & Education, Kingston University and St George's, University of London, London, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
| | - Charlotte Scomparin
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
| | - Jessica Horton
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
| | - Charles D Deakin
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - Helen Pocock
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - Michael A Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
| | - Nigel Rees
- Welsh Ambulance Service NHS Trust, Cardiff, UK
| | - Samantha J Brace-McDonnell
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Simon Gates
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
- Heart of England NHS Foundation Trust, Birmingham, UK
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10
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Kwan J, Ng YY. Respecting death at the coal face. Resuscitation 2017; 116:A7-A8. [DOI: 10.1016/j.resuscitation.2017.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 11/30/2022]
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11
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Prevalence of advance directives and impact on advanced life support in out-of-hospital cardiac arrest victims. Resuscitation 2017; 116:105-108. [DOI: 10.1016/j.resuscitation.2017.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 02/03/2017] [Accepted: 03/10/2017] [Indexed: 11/19/2022]
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