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Fan CY, Pei-Chuan Huang E, Kuo YC, Chen YC, Chiang WC, Huang CH, Sung CW, Chang WT. The short- and mid-term mortality trends in out-of-hospital cardiac arrest survivors: insights from a 5-year multicenter retrospective study in Taiwan. Resusc Plus 2024; 19:100747. [PMID: 39253685 PMCID: PMC11381848 DOI: 10.1016/j.resplu.2024.100747] [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: 05/17/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 09/11/2024] Open
Abstract
Background The survival trend and factors influencing short- and mid-term mortality in Asian out-of-hospital cardiac arrest (OHCA) survivors should be elucidated. We performed survival analyses on days 3 and 30, hypothesizing decreased survival rates within the initial 3 days post-resuscitation. Additionally, variables linked to mortality at these two timepoints were examined. Methods We performed a retrospective analysis on adult nontraumatic OHCA survivors admitted to the National Taiwan University Hospital and its branches between 2017 and 2021. We collected the following variables from the NTUH-Integrative Medical Database: basic characteristics, cardiopulmonary resuscitation events, inotrope administration, and post-resuscitation management. The outcomes included 3- and 30-day mortality. Subgroup analyses with the Kaplan-Meier method explored the survival probability of the OHCA survivors and assessed differences in cumulative survival among subgroups. Cox proportional hazards model was used to estimate adjusted hazard ratios with 95% confidence interval. Results Of the 967 survivors, 273 (28.2%) and 604 (62.5%) died within 3 and 30 days, respectively. The 30-day survival curve after OHCA showed an uneven decline, with the most significant decrease within the first 3 days of admission. Various risk factors influence mortality at 3- and 30-day intervals. Although increased age, noncardiac etiology, and prolonged low-flow time increased mortality risks, bystander CPR, targeted temperature management, and continuous renal replacement therapy were associated with reduced mortality at 3- and 30-day timeframes. Conclusion Survival declined in most OHCA survivors within 3 days post-resuscitation. The risk factors associated with mortality at 3- and 30-day intervals varied in this population.
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Affiliation(s)
- Cheng-Yi Fan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Chien Kuo
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yun-Chang Chen
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Kahlam J, Sacher A, Reilly JP, Lo DF. Public interest in America on cardiac arrest following cardiovascular events of Bronny and Damar: A Google trend study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 45:100433. [PMID: 39257556 PMCID: PMC11386054 DOI: 10.1016/j.ahjo.2024.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/21/2024] [Accepted: 07/22/2024] [Indexed: 09/12/2024]
Abstract
Background Heart disease is one of the leading causes of death in the United States. Increased education and utilization of BLS by first responders have had a significant impact, but certain populations remain high risk, such as African Americans. Raising awareness among at-risk populations may lead to more bystander CPR performed, improving mortality rates. The influence of celebrity deaths and illnesses is an important driver of public awareness. Therefore, the cardiac arrests of both Bronny James and Damar Hamlin may have influenced cardiac arrest awareness. Methods Google Trends data was pulled for the following search terms from 8/21/2022-8/14/2023: Cardiac arrest (disease), Cardiopulmonary Resuscitation (topic), Basic Life Support (topic), Myocardial Infarction (disease), Defibrillation (topic) and Automatic External Defibrillator (topic). The average relative search volume (RSV) for each search term was taken for a three-week period encompassing the week of and two weeks following the cardiac arrests of Damar Hamlin and Lebron James Jr., respectively. We used one-way ANOVA and independent sample t-tests to compare the average values of Damar Hamlin's and LeBron James Jr.'s incidents with their respective 12-month averages. Results RSV was significantly higher surrounding Hamlin's cardiac arrest compared to James Jr.'s for Cardiopulmonary Resuscitation and Automatic External Defibrillator. RSV for Basic Life Support was increased in LeBron James Jr.'s time compared to the 12-month average and Damar Hamlin's incident. Compared to the 12-month average, Cardiac arrest, Cardiopulmonary Resuscitation, Defibrillation, and Automatic External Defibrillator during Hamlin's incident. Myocardial infarction RSV was higher during James Jr.'s incident compared to baseline. Over the long term, the search terms showed a significant increase after Damar Hamlin's incident when compared to before.RSV was significantly higher surrounding Hamlin's cardiac arrest compared to James Jr.'s for "Cardiopulmonary Resuscitation" (23.56 vs. 22.0, p < 0.00) and "Automatic External Defibrillator" (19.59 vs. 19.4, p < 0.00). RSV for "Basic Life Support" was increased in LeBron James Jr.'s time compared to the 12-month average and Damar Hamlin's incident (80.9 vs. 66.88, p = 0.04). Compared to the 12-month average, "Cardiac arrest," "Cardiopulmonary Resuscitation," "Defibrillation," and "Automatic External Defibrillator" during Hamlin's incident showed significant increases. "Myocardial infarction" RSV was higher during James Jr.'s incident compared to baseline (55 vs. 46.6, p = 0.026). Over the long term, the search terms showed a significant increase after Damar Hamlin's incident when compared to before (p < 0.05). Conclusions Increases in the search terms for Hamlin's cardiac arrest compared to James Jr.'s cardiac arrest were associated with seeing the event live and increasing cardiac arrest awareness. Hamlins Cardiac Arrest also showed a significant increase in search terms over the long term. The increase in searches for "Basic Life Support" during James Jr.'s cardiac arrest indicates increased awareness. Also, the increase in myocardial infarction searches during both incidents could show confusion between cardiac arrest and myocardial infarction.
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Affiliation(s)
- Jasneel Kahlam
- Department of Internal Medicine, Stony Brook Southampton, Southampton, NY, USA
| | - Alexander Sacher
- Department of Internal Medicine, New York Presbyterian, Flushing, NY, USA
| | - John P Reilly
- Department of Cardiology, Stony Brook Southampton, Southampton, NY, USA
| | - David F Lo
- American Preventive Screening & Education Association (APSEA), Stratford, NJ, USA
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Levy MJ, Wend CM, Flemming WP, Lazieh A, Rosenblum AJ, Pineda CM, Wolfberg DM, Jenkins JL, Goolsby CA, Margolis AM. Bleeding Control Protections Within US Good Samaritan Laws. Prehosp Disaster Med 2024; 39:156-162. [PMID: 38572644 DOI: 10.1017/s1049023x24000268] [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] [Indexed: 04/05/2024]
Abstract
INTRODUCTION In the United States, all 50 states and the District of Columbia have Good Samaritan Laws (GSLs). Designed to encourage bystanders to aid at the scene of an emergency, GSLs generally limit the risk of civil tort liability if the care is rendered in good faith. Nation-wide, a leading cause of preventable death is uncontrolled external hemorrhage. Public bleeding control initiatives aim to train the public to recognize life-threatening external bleeding, perform life-sustaining interventions (including direct pressure, tourniquet application, and wound packing), and to promote access to bleeding control equipment to ensure a rapid response from bystanders. METHODS This study sought to identify the GSLs in each state and the District of Columbia to identify what type of responder is covered by the law (eg, all laypersons, only trained individuals, or only licensed health care providers) and if bleeding control is explicitly included or excluded in their Good Samaritan coverage. RESULTS Good Samaritan Laws providing civil liability qualified immunity were identified in all 50 states and the District of Columbia. One state, Oklahoma, specifically includes bleeding control in its GSLs. Six states - Connecticut, Illinois, Kansas, Kentucky, Michigan, and Missouri - have laws that define those covered under Good Samaritan immunity, generally limiting protection to individuals trained in a standard first aid or resuscitation course or health care clinicians. No state explicitly excludes bleeding control from their GSLs, and one state expressly includes it. CONCLUSION Nation-wide across the United States, most states have broad bystander coverage within GSLs for emergency medical conditions of all types, including bleeding emergencies, and no state explicitly excludes bleeding control interventions. Some states restrict coverage to those health care personnel or bystanders who have completed a specific training program. Opportunity exists for additional research into those states whose GSLs may not be inclusive of bleeding control interventions.
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Affiliation(s)
- Matthew J Levy
- Johns Hopkins School of Medicine, Baltimore, MarylandUSA
| | | | | | - Antoin Lazieh
- Rutgers New Jersey Medical School, Newark, New JerseyUSA
| | | | | | | | | | | | - Asa M Margolis
- Johns Hopkins School of Medicine, Baltimore, MarylandUSA
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Veigl C, Orlob S, Kloimstein T, Schnaubelt B, Krammel M, Draxl M, Feurhuber L, Wittig J, Schlieber J, Schnaubelt S. [Layperson basic life support education in Austria: An overview]. Wien Klin Wochenschr 2024:10.1007/s00508-024-02331-7. [PMID: 38300333 DOI: 10.1007/s00508-024-02331-7] [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: 12/08/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
Early interventions of laypersons can improve the survival and neurological outcome in patients with out-of-hospital cardiac arrest. There are several organizations in Austria which train lay people in basic life support and raise awareness for sudden cardiac death. To obtain an overview of the various initiatives, a questionnaire was sent to 26 organizations, and 15 of the organizations (58%) replied. The geographical distribution of the organizations between rural and urban areas was illustrated in a map. Most of them are situated in a university city, resulting in accessibility disparities for individuals in urban and rural settings. Layperson resuscitation education in Austria is largely dependent on the individual commitments of volunteers. The time spent practicing chest compressions in resuscitation courses ranges from 25% to 90% of the total course time. Furthermore, reasons for a lack of scientific endeavours could be identified, and solutions are suggested. Through better networking between organizations and initiatives, more laypersons could be trained in the future, which would lead to improved survival chances for persons suffering from out-of-hospital cardiac arrest in Austria. Appropriate support by political bodies and public authorities is and will remain a key element.
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Affiliation(s)
- Christoph Veigl
- Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
- PULS - Verein zur Bekämpfung des plötzlichen Herztodes, Wien, Österreich
- Österreichischer Rat für Wiederbelebung (ARC), Graz, Österreich
| | - Simon Orlob
- Österreichischer Rat für Wiederbelebung (ARC), Graz, Österreich
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Graz, Österreich
- Drück Mich! Arbeitsgemeinschaft für Notfallmedizin, Graz, Österreich
| | - Thomas Kloimstein
- Österreichischer Rat für Wiederbelebung (ARC), Graz, Österreich
- Ordensklinikum Linz Elisabethinen, Linz, Österreich
- SINUS - Interdisziplinäre Notfallinitiative Linz, Linz, Österreich
| | - Benedikt Schnaubelt
- PULS - Verein zur Bekämpfung des plötzlichen Herztodes, Wien, Österreich
- Zurück ins Leben, Horn, Österreich
| | - Mario Krammel
- PULS - Verein zur Bekämpfung des plötzlichen Herztodes, Wien, Österreich
- Berufsrettung Wien (MA 70), Wien, Österreich
| | - Markus Draxl
- Medizinische Universität Innsbruck, Innsbruck, Österreich
- IGNI - Interessengemeinschaft Notfallmedizin Innsbruck, Innsbruck, Österreich
| | - Lukas Feurhuber
- Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Krems an der Donau, Österreich
- emerKREMSy - studentischer Verband für Notfallmedizin Krems, Krems an der Donau, Österreich
| | - Johannes Wittig
- Österreichischer Rat für Wiederbelebung (ARC), Graz, Österreich
- Drück Mich! Arbeitsgemeinschaft für Notfallmedizin, Graz, Österreich
- Research Center for Emergency Medicine, Universityhospital Aarhus, Aarhus, Dänemark
- Randers Regional Hospital, Randers, Dänemark
| | - Joachim Schlieber
- Österreichischer Rat für Wiederbelebung (ARC), Graz, Österreich
- Abteilung für Anästhesiologie und Intensivmedizin, Unfallkrankenhaus Salzburg, Salzburg, Österreich
| | - Sebastian Schnaubelt
- Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
- PULS - Verein zur Bekämpfung des plötzlichen Herztodes, Wien, Österreich.
- Österreichischer Rat für Wiederbelebung (ARC), Graz, Österreich.
- Zurück ins Leben, Horn, Österreich.
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Kirkpatrick JN, Kersey CB, Truong KP. Staying Alive: Patients Who Lived Through Disco Era Benefit From Bystander CPR. JACC. ADVANCES 2023; 2:100608. [PMID: 38938343 PMCID: PMC11198449 DOI: 10.1016/j.jacadv.2023.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- James N. Kirkpatrick
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Cooper B. Kersey
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Katie P. Truong
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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Chan PS, Merritt R, McNally B, Chang A, Al-Araji R, Mawani M, Ahn KO, Girotra S. Bystander CPR and Long-Term Survival in Older Adults With Out-of-Hospital Cardiac Arrest. JACC. ADVANCES 2023; 2:100607. [PMID: 38084207 PMCID: PMC10713355 DOI: 10.1016/j.jacadv.2023.100607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/09/2023] [Accepted: 06/24/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Most studies on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) have focused on in-hospital or short-term survival. OBJECTIVES The purpose of this study was to examine the association between bystander CPR and long-term survival outcomes for OHCA. METHODS Within the Cardiac Arrest Registry to Enhance Survival, we identified 152,653 patients with OHCA ≥65 years of age or older. Using multivariable hierarchical logistic regression, we first examined the association between bystander CPR and in-hospital survival. Then, among those surviving to discharge and linked to Medicare files, we evaluated the association between bystander CPR and long-term mortality over 5 years using multivariable Cox regression. RESULTS Overall, 58,464 (38.3%) received bystander CPR. Patients receiving bystander CPR were more likely to have an OHCA that was witnessed, in a public location, and with an initial shockable rhythm. Bystander CPR was associated with a 24% higher likelihood of surviving to hospital discharge (10.2% vs 5.5%; adjusted relative risk: 1.24 [95% CI: 1.19-1.29]; P < 0.001), and this survival benefit was similar (interaction P = 0.24) for those who were 65 to 74, 75 to 84, and ≥85 years of age. Among patients surviving to hospital discharge (median follow-up of 31 months), bystander CPR was additionally associated with lower long-term mortality vs those without bystander CPR (adjusted hazard ratio: 0.78 [95% CI: 0.73-0.84]; P < 0.001), and this benefit was also consistent across age groups (interaction P = 0.13). CONCLUSIONS In older adults with OHCA, bystander CPR was associated with higher rates of in-hospital survival. This survival benefit was not attenuated by competing mortality risks but increased in magnitude after hospital discharge.
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Affiliation(s)
- Paul S. Chan
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Robert Merritt
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bryan McNally
- Department of Emergency Medicine, Emory University and Rollins School of Public Health, Atlanta, Georgia, USA
| | - Anping Chang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rabab Al-Araji
- Emory University and Rollins School of Public Health, Atlanta, Georgia, USA
| | - Minaz Mawani
- University of Georgia College of Public Health, Atlanta, GA, USA
| | - Ki Ok Ahn
- Department of Medicine, Hanyang University College of Medicine and Myongji Hospital, Seoul, South Korea
| | - Saket Girotra
- University of Texas-Southwestern, Dallas, Texas, USA
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Ko JS, Kim SR, Cho BJ. The Effect of Cardiopulmonary Resuscitation (CPR) Education on the CPR Knowledge, Attitudes, Self-Efficacy, and Confidence in Performing CPR among Elementary School Students in Korea. Healthcare (Basel) 2023; 11:2047. [PMID: 37510488 PMCID: PMC10379098 DOI: 10.3390/healthcare11142047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Cardiopulmonary resuscitation (CPR) education for schoolchildren is emphasized, as bystander CPR is a vital key to increasing the survival rate of out-of-hospital cardiac arrest (OHCA) victims. This study was conducted to verify the effect of CPR education on knowledge, attitudes, self-efficacy, and confidence of Korean elementary school students in performing CPR. Data were collected through structured questionnaires before and after CPR education and analyzed using descriptive statistics, T-tests, and hierarchical regression. Significant improvements in CPR knowledge, attitudes, self-efficacy, and confidence in performing CPR were found after CPR education, with the greatest increase observed in confidence (p = 0.000). The influencing factors on confidence in performing CPR were school grade, attitude, and self-efficacy. Although a significant increase in schoolchildren's CPR knowledge after education was shown, knowledge did not affect confidence in performing CPR. Therefore, early CPR education which focuses on improving confidence in performing CPR is recommended. CPR education might raise attitude and self-efficacy leading to increased confidence in performing bystander CPR. In conclusion, early and regular CPR education for elementary school students is crucial and should be conducted repeatedly.
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Affiliation(s)
- Jang-Sik Ko
- Department of Paramedicine, College of Health Science, Kangwon National University, 346 Hwangjo-gil, Dogye-up, Samcheok-si 25945, Republic of Korea
| | - Seon-Rye Kim
- Department of Healthcare Management, College of Health Science, Youngsan University, 288 Junam-ro, Yangsan-si 50510, Republic of Korea
| | - Byung-Jun Cho
- Department of Paramedicine, College of Health Science, Kangwon National University, 346 Hwangjo-gil, Dogye-up, Samcheok-si 25945, Republic of Korea
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Lafrance M, Recher M, Javaudin F, Chouihed T, Wiel E, Helft G, Hubert H, Canon V. Bystander basic life support and survival after out-of-hospital cardiac arrest: A propensity score matching analysis. Am J Emerg Med 2023; 67:135-143. [PMID: 36871482 DOI: 10.1016/j.ajem.2023.02.028] [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: 10/12/2022] [Revised: 01/25/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES In out-of-hospital cardiac arrest, early recognition, calling for emergency medical assistance, and early cardiopulmonary resuscitation are acknowledged to be the three most important components in the chain of survival. However, bystander basic life support (BLS) initiation rates remain low. The objective of the present study was to evaluate the association between bystander BLS and survival after an out-of-hospital cardiac arrest (OHCA). METHODS We conducted a retrospective cohort study of all patients with OHCA with a medical etiology treated by a mobile intensive care unit (MICU) in France from July 2011 to September 2021, as recorded in the French National OHCA Registry (RéAC). Cases in which the bystander was an on-duty fire fighter, paramedic, or emergency physician were excluded. We assessed the characteristics of patients who received bystander BLS vs. those who did not. The two classes of patient were then matched 1:1, using a propensity score. Conditional logistic regression was then used to probe the putative association between bystander BLS and survival. RESULTS During the study, 52,303 patients were included; BLS was provided by a bystander in 29,412 of these cases (56.2%). The 30-day survival rates were 7.6% in the BLS group and 2.5% in the no-BLS group (p < 0.001). After matching, bystander BLS was associated with a greater 30-day survival rate (odds ratio (OR) [95% confidence interval (CI)] = 1.77 [1.58-1.98]). Bystander BLS was also associated with greater short-term survival (alive on hospital admission; OR [95%CI] = 1.29 [1.23-1.36]). CONCLUSIONS The provision of bystander BLS was associated with a 77% greater likelihood of 30-day survival after OHCA. Given than only one in two OHCA bystanders provides BLS, a greater focus on life saving training for laypeople is essential.
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Affiliation(s)
- Martin Lafrance
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France.
| | - Morgan Recher
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - François Javaudin
- Department of Emergency Medicine, CHU Nantes, F-44000 Nantes, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, F-54000 Nancy, France; INSERM, UMRS 1116, University Hospital of Nancy, F-54000 Nancy, France
| | - Eric Wiel
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France; SAMU du Nord and Emergency Department for Adults, Lille University Hospital, F-59000 Lille, France
| | - Gérard Helft
- Cardiology Department, Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, F-75013 Paris, France
| | - Hervé Hubert
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France
| | - Valentine Canon
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France
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- French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France
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The monoacylglycerol lipase inhibitor, JZL184, has comparable effects to therapeutic hypothermia, attenuating global cerebral injury in a rat model of cardiac arrest. Biomed Pharmacother 2022; 156:113847. [DOI: 10.1016/j.biopha.2022.113847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/24/2022] [Accepted: 10/06/2022] [Indexed: 11/18/2022] Open
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10
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Amacher SA, Bohren C, Blatter R, Becker C, Beck K, Mueller J, Loretz N, Gross S, Tisljar K, Sutter R, Appenzeller-Herzog C, Marsch S, Hunziker S. Long-term Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis. JAMA Cardiol 2022; 7:633-643. [PMID: 35507352 PMCID: PMC9069345 DOI: 10.1001/jamacardio.2022.0795] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce. Objective To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA. Data Sources A systematic search of the EMBASE and MEDLINE databases was performed from database inception to March 25, 2021. Study Selection Clinical studies reporting long-term survival after OHCA were selected based on predefined inclusion and exclusion criteria according to a preregistered study protocol. Data Extraction and Synthesis Patient data were reconstructed from Kaplan-Meier curves using an iterative algorithm and then pooled to generate survival curves. As a separate analysis, an aggregate data meta-analysis was performed. Main Outcomes and Measures The primary outcome was long-term survival (>12 months) after OHCA for patients surviving to hospital discharge or 30 days after OHCA. Results The search identified 15 347 reports, of which 21 studies (11 800 patients) were included in the Kaplan-Meier-based meta-analysis and 33 studies (16 933 patients) in an aggregate data meta-analysis. In the Kaplan-Meier-based analysis, the median survival time for patients surviving to hospital discharge was 5.0 years (IQR, 2.3-7.9 years). The estimated survival rates were 82.8% (95% CI, 81.9%-83.7%) at 3 years, 77.0% (95% CI, 75.9%-78.0%) at 5 years, 63.9% (95% CI, 62.3%-65.4%) at 10 years, and 57.5% (95% CI, 54.8%-60.1%) at 15 years. Compared with patients with a nonshockable initial rhythm, patients with a shockable rhythm had a lower risk of long-term mortality (hazard ratio, 0.30; 95% CI, 0.23-0.39; P < .001). Different analyses, including an aggregate data meta-analysis, confirmed these results. Conclusions and Relevance In this comprehensive systematic review and meta-analysis, long-term survival after 10 years in patients surviving the initial hospital stay after OHCA was between 62% and 64%. Additional research is needed to understand and improve the long-term survival in this vulnerable patient population.
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Affiliation(s)
- Simon A Amacher
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland.,Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Chantal Bohren
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - René Blatter
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Katharina Beck
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Jonas Mueller
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Nina Loretz
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Sebastian Gross
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Kai Tisljar
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Christian Appenzeller-Herzog
- Medical Faculty, University of Basel, Basel, Switzerland.,University Medical Library, University of Basel, Basel, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
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11
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Schnaubelt S, Mayr FB, Losert H, Domanovits H, Sulzgruber P, Holzer M, Sterz F, Uray T. Very long-term survivors of in-hospital and out-of-hospital cardiac arrest show considerable impairment of daily life. Resuscitation 2022; 173:192-200. [DOI: 10.1016/j.resuscitation.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 01/27/2023]
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12
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Smida T, Salerno J, Weiss L, Martin-Gill C, Salcido DD. PulsePoint dispatch associated patient characteristics and prehospital outcomes in a mid-sized metropolitan area. Resuscitation 2021; 170:36-43. [PMID: 34774964 DOI: 10.1016/j.resuscitation.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mobile phone-based dispatch of volunteers to out-of-hospital cardiac arrests (OHCA) has been shown to increase the likelihood of early CPR and AED application. In the United States, limited characterization of patients encountered as a result of such systems exists. AIMS Examine prehospital case characteristics and outcomes from a multi-year deployment of PulsePoint Respond in Pittsburgh, Pennsylvania. METHODS PulsePoint event timing, location, and associated prehospital electronic health records (ePCRs) were obtained for EMS-encountered OHCA cases that did and did not generate PulsePoint alerts within the service area of Pittsburgh EMS from July 2016 to October 2020. ePCRs were reviewed and OHCA case characteristics were extracted according to the Utstein template. PulsePoint-associated OHCA and non-PulsePoint-associated OHCA were compared. RESULTS Of 840 total PulsePoint dispatches, 64 (7.6%) were for OHCA associated with a resuscitation attempt. Forty-one (64.1%) were witnessed, 38 (59.4%) received bystander CPR, and 13 (20.0%) of these patients had an AED applied prior to EMS arrival. Twenty-seven (39.7%) had an initial shockable rhythm, and 31 (48.4%) patients achieved ROSC in the field. In the city of Pittsburgh, there were 1229 total OHCA during the study period, with an estimated 29.6% occurring in public. When PulsePoint-associated and publicly occurring non-PulsePoint-associated OHCA were compared, baseline characteristics (age, sex, witnessed status) were similar, but PulsePoint-associated OHCA received more bystander CPR (p = 0.008). CONCLUSIONS A minority of PulsePoint dispatches in Pittsburgh were triggered by true OHCA. The majority of OHCA during the study period occurred within private residences where PulsePoint responders are not currently dispatched. PulsePoint dispatches were associated with prognostically favorable OHCA characteristics and increased bystander CPR performance.
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Affiliation(s)
- Tanner Smida
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; West Virginia University MD/PhD Program, United States.
| | - Jessica Salerno
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Leonard Weiss
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - David D Salcido
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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13
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Monahan BV, Reid MJ, Houser CS, Day CR, Nable JV. Medical emergencies on a medium-sized urban university campus with collegiate-based EMS. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:971-975. [PMID: 31995453 DOI: 10.1080/07448481.2019.1709475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/17/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
ObjectiveThis study aimed to identify the types and frequency of acute medical events at a university with a collegiate-based emergency medical services (CBEMS) agency. Participants: Patients who requested assistance from the studied CBEMS agency, which provides emergency medical services coverage at a medium-sized urban university. Methods: This retrospective chart review examined requests for emergency service from August 2010-July 2017. Data abstracted include the type of medical event, frequency, call times/dates, and locations of reported medical events. Results: The studied agency received an average 889.4 (SD +/-68.6 calls) per year with the most common falling under the categories of "Substance Abuse" (231.7 calls/year, SD +/-15.7) and "Minor Trauma" (207.1 calls/year, SD+/-37.8). Most requests for acute medical attention occurred between the hours of 1800-0600 on Fridays and Saturdays. Implications/Conclusions: These results suggest that universities can potentially predict patterns and prepare for the types of acute medical issues that occur on campus.
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Affiliation(s)
- Brian V Monahan
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Miranda J Reid
- Brown School, Washington University in St Louis, Missouri, USA
| | - Christina S Houser
- Department of Emergency Medicine, MedStar Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA
| | - Carol R Day
- School of Nursing and Health Studies/Human Science, Georgetown University, Washington, DC, USA
| | - Jose V Nable
- Georgetown Emergency Response Medical Service, MedStar Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC, USA
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14
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Zheng G, Xu J, He F, Hu J, Ge W, Ji X, Wang C, Bradley JL, Peberdy MA, Ornato JP, Toldo S, Wang T, Tang W. Effects of NLRP3 inflammasome blockade on postresuscitation cerebral function in a rat model of cardiopulmonary resuscitation. Biomed Pharmacother 2021; 143:112093. [PMID: 34474352 DOI: 10.1016/j.biopha.2021.112093] [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: 05/03/2021] [Revised: 08/05/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022] Open
Abstract
Cardiac arrest (CA) remains a major public health issue. Inflammatory responses with overproduction of interleukin-1β regulated by NLRP3 inflammasome activation play a crucial role in cerebral ischemia/reperfusion injury. We investigated the effects of the selective NLRP3-inflammasome inhibitor MCC950 on post-resuscitation cerebral function and neurologic outcome in a rat model of cardiac arrest. Thirty-six male rats were randomized into the MCC950 group, the control group, or the sham group (N = 12 of each group). Each group was divided into a 6 h non-survival subgroup (N = 6) and a 24 h survival subgroup (N = 6). Ventricular fibrillation (VF) was electrically induced and untreated for 6 min, followed by 8 min of precordial compressions and mechanical ventilation. Resuscitation was attempted with a 4J defibrillation. Either MCC950 (10 mg/kg) or vehicle was injected intraperitoneally immediately after the return of spontaneous circulation (ROSC). Rats in the sham group underwent the same surgical procedures without VF and CPR. Brain edema, cerebral microcirculation, plasma interleukin Iβ (IL-1β), and neuron-specific enolase (NSE) concentration were measured at 6 h post-ROSC of non-survival subgroups, while 24 h survival rate, neurological deficits were measured at 24 h post-ROSC of survival subgroups. Post-resuscitation brain edema was significantly reduced in animals treated with MCC950 (p < 0.05). Cerebral perfused vessel density (PVD) and microcirculatory flow index (MFI) values were significantly higher in the MCC950 group compared with the control group (p < 0.05). The plasma concentrations of IL-1β and NSE were significantly decreased in animals treated with MCC950 compared with the control group (p < 0.05). 24 h-survival rate and neurological deficits score (NDS) was also significantly improved in the MCC950 group compared with the control group (p < 0.05). NLRP3 inflammasome blockade with MCC950 at ROSC reduces the circulatory level of IL-1β, preserves cerebral microcirculation, mitigates cerebral edema, improves the 24 h-survival rate, and neurological deficits.
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Affiliation(s)
- Guanghui Zheng
- Department of Emergency, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-Sen University, Guangzhou, China
| | - Jing Xu
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Fenglian He
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Juntao Hu
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Weiwei Ge
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Xianfei Ji
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Changsheng Wang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer L Bradley
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Mary Ann Peberdy
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Departments of Internal Medicine and Emergency Medicine, Virginia Commonwealth University Health System, Richmond,VA, USA
| | - Joseph P Ornato
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond,VA, USA
| | - Stefano Toldo
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond,VA, USA
| | - Tong Wang
- Department of Emergency, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Wanchun Tang
- Department of Emergency, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond,VA, USA.
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15
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Ha FJ, Han HC, Sanders P, La Gerche A, Teh AW, Farouque O, Lim HS. Sudden cardiac death related to physical exercise in the young: a nationwide cohort study of Australia. Intern Med J 2021; 53:497-502. [PMID: 34719841 DOI: 10.1111/imj.15606] [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: 07/20/2021] [Revised: 09/24/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) during physical exercise is devastating. We aimed to evaluate causes and circumstances of exercise-related SCD in the young in Australia. METHODS We reviewed the National Coronial Information System database for deaths in Australia relating to cardiovascular disease in cases aged 10-35 years between 2000-2016. Included cases had undertaken physical exercise at time of event. We collected demographics, circumstances of death, type of physical exercise, bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use prior to ambulance arrival. RESULTS Over a 17-year period, 1,925 SCD cases were identified of which 110 cases (6%) (median age 27 years [interquartile range [IQR] 21-32 years], 92% male) were related to sports/physical exercise. Thirteen cases (12%) occurred in active athletes. Most common causes were coronary artery disease (CAD; 37%) and sudden arrhythmic death syndrome (SADS; 20%). Amongst Aboriginal and Torres Strait Islanders (n=10), all deaths were related to CAD. Australian Rules Football (24%), running/jogging (14%) and soccer (14%) were the most frequent physical exercise activities. Prior symptoms were present in 39% (chest pain 37%, presyncope/syncope 26%). Most were witnessed (87%) with bystander CPR in 70%. AED use prior to ambulance arrival was 8%. CONCLUSIONS This study demonstrates the high occurrence of CAD and SADS in SCD in the young related to physical exercise. Aboriginal and Torres Strait Islanders were disproportionately affected by CAD. Although events were commonly witnessed, AED was seldom used prior to ambulance arrival and highlights an important opportunity to improve outcomes in the post-arrest chain of survival. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Francis J Ha
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,St Vincent's Hospital Melbourne, Victoria, Australia
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, South Australia, Australia
| | - Andre La Gerche
- St Vincent's Hospital Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Northern Health, Melbourne, Victoria, Australia
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16
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dos Santos ECA, Fontes CJF, D’Artibale EF, Miravete JDC, Ferreira GE, Ribeiro MRR. Simulation for teaching cardiorespiratory resuscitation by teams: setting and performance assessment. Rev Lat Am Enfermagem 2021; 29:e3406. [PMID: 34231784 PMCID: PMC8253347 DOI: 10.1590/1518-8345.3932.3406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 07/31/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE to evaluate the acquisition of cognitive knowledge in cardiorespiratory resuscitation through training mediated by health simulation and to verify satisfaction with the teaching methodology design. METHOD a study of quasi-experimental intervention, of the before and after type, with only one group. Population composed of medical students in the internship phase, nurses and resident physicians, nursing technicians and nurses of the institution's effective staff. Convenience sampling consisting of 91 participants. Data collected through the Sociodemographic and Educational Questionnaire, Knowledge Test and Simulation Design Scale. Data was organized in tables and analyzed based on absolute frequencies, measures of central tendency and dispersion, Cronbach's alpha reliability test, Wilcoxon's test. RESULTS the increase in cognitive learning was 81.9%, being that for nursing technicians it was 117.8 %. Wilcoxon's test showed a significant increase (p<0.0001) in knowledge. The Simulation Design Scale, displayed 4.55 of global mean. Cronbach's alpha pointed good internal consistency (0.898). CONCLUSION the health simulation was effective as a learning-teaching method in cardiorespiratory resuscitation, being effective in increasing knowledge in cardiorespiratory arrest, with a great level of design satisfaction.
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17
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Lau VI, Xie F, Basmaji J, Cook DJ, Fowler R, Kiflen M, Sirotich E, Iansavichene A, Bagshaw SM, Wilcox ME, Lamontagne F, Ferguson N, Rochwerg B. Health-Related Quality-of-Life and Cost Utility Analyses in Critical Care: A Systematic Review. Crit Care Med 2021; 49:575-588. [PMID: 33591013 DOI: 10.1097/ccm.0000000000004851] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Cost utility analyses compare the costs and health outcome of interventions, with a denominator of quality-adjusted life year, a generic health utility measure combining both quality and quantity of life. Cost utility analyses are difficult to compare when methods are not standardized. It is unclear how cost utility analyses are measured/reported in critical care and what methodologic challenges cost utility analyses pose in this setting. This may lead to differences precluding cost utility analyses comparisons. Therefore, we performed a systematic review of cost utility analyses conducted in critical care. Our objectives were to understand: 1) methodologic characteristics, 2) how health-related quality-of-life was measured/reported, and 3) what costs were reported/measured. DESIGN Systematic review. DATA SOURCES We systematically searched for cost utility analyses in critical care in MEDLINE, Embase, American College of Physicians Journal Club, CENTRAL, Evidence-Based Medicine Reviews' selected subset of archived versions of UK National Health Service Economic Evaluation Database, Database of Abstracts of Reviews of Effects, and American Economic Association electronic databases from inception to April 30, 2020. SETTING Adult ICUs. PATIENTS Adult critically ill patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 8,926 citations, 80 cost utility analyse studies were eligible. The time horizon most commonly reported was lifetime (59%). For health utility reporting, health-related quality-of-life was infrequently measured (29% reported), with only 5% of studies reporting baseline health-related quality-of-life. Indirect utility measures (generic, preference-based health utility measurement tools) were reported in 85% of studies (majority Euro-quality-of-life-5 Domains, 52%). Methods of estimating health-related quality-of-life were seldom used when the patient was incapacitated: imputation (19%), assigning fixed utilities for incapacitation (19%), and surrogates reporting on behalf of incapacitated patients (5%). For cost utility reporting transparency, separate incremental costs and quality-adjusted life years were both reported in only 76% of studies. Disaggregated quality-adjusted life years (reporting separate health utility and life years) were described in only 34% of studies. CONCLUSIONS We identified deficiencies which warrant recommendations (standardized measurement/reporting of resource use/unit costs/health-related quality-of-life/methodological preferences) for improved design, conduct, and reporting of future cost utility analyses in critical care.
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Affiliation(s)
- Vincent I Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - John Basmaji
- Department of Medicine, Division of Critical Care Medicine, Western University, London, ON, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care Medicine, McMaster University, Hamilton, ON, Canada
| | - Robert Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Ontario, ON, Canada
| | - Michel Kiflen
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Emily Sirotich
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | | | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - M Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Ontario, ON, Canada
| | - François Lamontagne
- Centre de Recherche du CHU de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Niall Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Ontario, ON, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care Medicine, McMaster University, Hamilton, ON, Canada
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18
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Li J, Zhang Y, Long M, Liu M, Zhang W, Gu L, Su C, Xiong Y, Wang L, Idris A. Out-of-hospital cardiac arrest patients with implantable cardioverter-defibrillators: What are their outcomes? Resuscitation 2020; 157:141-148. [PMID: 33191208 DOI: 10.1016/j.resuscitation.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
THE AIM OF THE STUDY To identify the prognostic factors and effects of implantable cardioverter-defibrillators (ICDs) in out-of-hospital cardiac arrest (OHCA) patients with ICDs because the clinical characteristics and outcomes of OHCA patients with ICDs are unknown. METHODS The North American Resuscitation Outcomes Consortium (ROC) Cardiac Epistry Version 3 dataset was analyzed. Eligible patients were divided into OHCA patients with and without ICDs. Multivariable regressions were employed to analyze. RESULTS Of 51,634 eligible OHCA patients, 581 (1.13%) had implanted ICDs. Among them, 53 (9.1%) patients survived to hospital discharge, and 40 (6.9%) patients had favorable neurological outcome at hospital discharge. Multivariable regression showed ICDs were not associated with OHCA outcomes in the total OHCA patients. In the OHCA patients with ICDs, shockable initial emergency medical services (EMS)-recorded rhythms and the ICD-shock-only defibrillation pattern were independent favorable factors for survival to hospital discharge(OR = 3.3, 95%CI 1.7-6.2, P < 0.001; OR = 2.4, 95%CI 1.1-5.5, P = 0.035, respectively) and neurological outcome at hospital discharge (OR = 6.5, 95%CI 2.9-14.4, P < 0.001; OR = 3.6, 95%CI 1.4-9.1, P = 0.006, respectively). During field resuscitation in OHCA patients with ICDs, at least 34.9% of total patients and 64.6% of patients with initial EMS-recorded VT/VF rhythms needed additional external shocks. CONCLUSIONS Shockable initial EMS-recorded rhythms and ICD-shock-only defibrillation pattern were independent factors for the favorable outcomes of OHCA patients with ICDs. ICDs were not associated with the outcomes of OHCA, and additional external shocks were needed in a substantial number of OHCA patients with ICDs during field resuscitation.
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Affiliation(s)
- Jie Li
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China; Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Yongshu Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Ming Long
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China
| | - Wanwan Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Liwen Gu
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Chen Su
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China
| | - Yan Xiong
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
| | - Lichun Wang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China.
| | - Ahamed Idris
- University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA
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19
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Heffernan E, Oving I, Barry T, Phung VH, Siriwardena AN, Masterson S. Factors that motivate individuals to volunteer to be dispatched as first responders in the event of a medical emergency: A systematic review protocol. HRB Open Res 2020; 2:34. [PMID: 32490350 PMCID: PMC7236422 DOI: 10.12688/hrbopenres.12969.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Voluntary First Response is an important component of prehospital care for medical emergencies, particularly cardiac arrest, in many countries. This intervention entails the mobilisation of volunteers, known as Community First Responders (CFRs), by the Emergency Medical Services to respond to medical emergencies in their locality. They include lay responders and/or professional responders (e.g. police officers, fire fighters, and general practitioners). A wide variety of factors are thought to motivate CFRs to join and remain engaged in Voluntary First Response schemes, such as the availability of learning opportunities, recognition, counselling, and leadership. The aim of this review is to develop an in-depth understanding of CFR motivation, including the factors that influence the initial decision to volunteer as a CFR and the factors that sustain involvement in Voluntary First Response over time. Any factors relevant to CFR de-motivation and turnover will also be examined. Methods: This is a protocol for a qualitative systematic review of the factors that influence the motivation of individuals to participate in Voluntary First Response. A systematic search will be carried out on seven electronic databases. Qualitative studies, mixed-methods studies, and any other studies producing data relating to the review question will be eligible for inclusion. Title and abstract screening, as well as full text screening, will be completed independently by two authors. A narrative synthesis, which is an established qualitative synthesis methodology, will be performed. The quality of each of the included studies will be critically appraised. Discussion: The findings of this review will be used to optimise the intervention of Voluntary First Response. Specifically, the results will inform the design and organisation of Voluntary First Response schemes, including their recruitment, training, and psychological support processes. This could benefit a range of stakeholders, including CFRs, paramedics, emergency physicians, patients, and the public.
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Affiliation(s)
- Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, H91 TK33, Ireland
| | - Iris Oving
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Tomás Barry
- School of Medicine, University College Dublin, Dublin 4, D04 V1W8, Ireland
| | - Viet-Hai Phung
- Community and Health Research Unit, School of Health and Social Care, Sarah Swift Building, University of Lincoln, Lincoln, LN5 7AT, UK
| | - Aloysius Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, Sarah Swift Building, University of Lincoln, Lincoln, LN5 7AT, UK
| | - Siobhán Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, H91 TK33, Ireland
- National Ambulance Service, Health Service Executive, St. Eunan's Hall, St Conal's Hospital, Letterkenny, Donegal, F92 XK84, Ireland
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20
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Survival until hospital admission after out-of-hospital cardia arrest – A costly victory? Resuscitation 2020; 153:262-263. [DOI: 10.1016/j.resuscitation.2020.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/17/2022]
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21
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Oberholtzer JA, Hofmeister EH. Perception of small animal cardiopulmonary resuscitation of owners presenting to a small animal teaching clinic including a large first opinion service. J Vet Emerg Crit Care (San Antonio) 2020; 30:411-417. [PMID: 32588977 DOI: 10.1111/vec.12975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To gather information from veterinary clients to better understand and gauge the knowledge level and perception of small animal cardiopulmonary resuscitation (CPR) in an academic veterinary hospital. DESIGN Prospective cross-sectional survey. SETTING A veterinary teaching hospital including a large first opinion service. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS An anonymous survey was developed to gauge the knowledge of veterinary clients on a variety of CPR related topics at a university veterinary hospital. Surveys were randomly distributed to a convenience sample of clients in the waiting room through the client services staff between October 2017 and March 2018. Of the 451 surveys distributed, 296 were used for the statistical analysis. The majority of respondents (92%) knew the appropriate definition of CPR but only 11% knew how to perform CPR on a dog or cat. Most respondents (82%) wanted to discuss their pet's CPR status at a veterinary visit. The mean ± SD estimate of rate of discharge from hospital after cardiac arrest was 39.4 ± 25.6% and the majority of respondents (202 [68%]) got their estimate from an educated guess. The respondents who elected CPR that day provided an estimated cost of 257 ± 365 USD while the respondents who elected not to have CPR provided an estimated cost of 491 ± 875 USD; P = 0.019. The respondents that watched television medical dramas estimated a higher rate of survival to discharge at 42 ± 25%, while people who did not watch television medical dramas provided an estimated survival rate of 35 ± 26%; P = 0.034. CONCLUSIONS Inaccurate perceptions regarding CPR and survival rates exist among the general public; however, respondents are interested in becoming better informed.
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Affiliation(s)
- Jennifer A Oberholtzer
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Erik H Hofmeister
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
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Cordoza M, Thompson H, Bridges E, Burr R, Carlbom D. Association Between Target Temperature Variability and Neurologic Outcomes for Patients Receiving Targeted Temperature Management at 36°C After Cardiac Arrest: A Retrospective Cohort Study. Ther Hypothermia Temp Manag 2020; 11:103-109. [PMID: 32552615 DOI: 10.1089/ther.2020.0005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Maintaining strict temperature control during the maintenance phase of targeted temperature management (TTM) after cardiac arrest may be an important component of clinical care. Temperature variability outside of the goal temperature range may lessen the benefit of TTM and worsen neurologic outcomes. The purpose of this retrospective study of 186 adult patients (70.4% males, mean age 53.8 ± 15.7 years) was to investigate the relationship between body temperature variability (at least one body temperature measurement outside of 36°C ± 0.5°C) during the maintenance phase of TTM at 36°C after cardiac arrest and neurologic outcome at hospital discharge. Patients with temperature variability (n = 124 [66.7%]) did not have significantly higher odds of poor neurologic outcome compared with those with no temperature variability (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.36-2.82). Use of neuromuscular blocking agents (NMBAs) and having an initial shockable rhythm were associated with both higher odds of good neurologic outcome (shockable rhythm: OR = 10.77, 95% CI = 4.30-26.98; NMBA use: OR = 4.54, 95% CI = 1.34-15.40) and survival to hospital discharge (shockable rhythm: OR = 5.90, 95% CI = 2.65-13.13; NMBA use: OR = 3.03, 95% CI = 1.16-7.90). In this cohort of postcardiac arrest comatose survivors undergoing TTM at 36°C, having temperature variability during maintenance phase did not significantly impact neurologic outcome or survival.
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Affiliation(s)
- Makayla Cordoza
- Division of Sleep and Chronobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hilaire Thompson
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
| | - Elizabeth Bridges
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Robert Burr
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - David Carlbom
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
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Pivač S, Gradišek P, Skela-Savič B. The impact of cardiopulmonary resuscitation (CPR) training on schoolchildren and their CPR knowledge, attitudes toward CPR, and willingness to help others and to perform CPR: mixed methods research design. BMC Public Health 2020; 20:915. [PMID: 32532235 PMCID: PMC7291419 DOI: 10.1186/s12889-020-09072-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 06/08/2020] [Indexed: 11/12/2022] Open
Abstract
Background The benefits of cardiopulmonary resuscitation training for schoolchildren are well known, but the appropriate age for introducing training is still being discussed. This is a very important issue, since out-of-hospital cardiac arrest is a major public health concern. The objective of this study was to investigate the effects of implemented cardiopulmonary resuscitation training on the knowledge of schoolchildren in the last three grades of Slovenian elementary schools and theirs willingness, attitudes, and intentions toward helping others and performing cardiopulmonary resuscitation. The experience of training instructors was also explored. Methods A mixed methods research design was employed, using a Separate Pre-Post Samples Design and focus groups. Research was conducted in 15 Slovenian public elementary schools offering cardiopulmonary resuscitation training. Focus groups included training instructors and developers. Data was collected with a structured questionnaire from April to June 2018 and analyzed using univariate and bivariate analyses. The three focus groups were convened in September and October 2018. Content analysis of the discussion transcriptions was conducted. The sample included 764 schoolchildren aged 12.5–14.5 years before cardiopulmonary resuscitation training and 566 schoolchildren after training. Three non-homogeneous focus groups included eight cardiopulmonary resuscitation instructors. Results Significant progress in cardiopulmonary resuscitation knowledge was noted after training implementation, with the greatest progress seen in the youngest age group (mean age 12.5). The greatest increase after training was seen for the variables Attitude toward helping others (p = 0.001) and Self-confidence (p = 0.001). Analysis of the focus groups yielded two themes: (a) the effects of cardiopulmonary resuscitation training on schoolchildren, and (b) the systemic responsibility of the school system and professional bodies. Conclusions Significant progress in schoolchildren’s cardiopulmonary resuscitation knowledge after training was established. Early introduction of training is recommended. Cardiopulmonary resuscitation knowledge raises awareness of the responsibility to help others and increases self-confidence to provide bystander cardiopulmonary resuscitation. It can be concluded that early cardiopulmonary resuscitation training for children is crucial. It should be a mandatory part of school curricula in those countries where cardiopulmonary resuscitation is not yet mandatory.
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Affiliation(s)
- Sanela Pivač
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, SI-4270, Jesenice, Slovenia.
| | - Primož Gradišek
- University Medical Center Ljubljana, Clinical Department of Anesthesiology and Intensive Therapy, and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Brigita Skela-Savič
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, SI-4270, Jesenice, Slovenia
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Doan TN, Schultz BV, Rashford S, Bosley E. Surviving out-of-hospital cardiac arrest: The important role of bystander interventions. Australas Emerg Care 2020; 23:47-54. [DOI: 10.1016/j.auec.2019.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 01/01/2023]
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Kurz MC, Bobrow BJ, Buckingham J, Cabanas JG, Eisenberg M, Fromm P, Panczyk MJ, Rea T, Seaman K, Vaillancourt C. Telecommunicator Cardiopulmonary Resuscitation: A Policy Statement From the American Heart Association. Circulation 2020; 141:e686-e700. [PMID: 32088981 DOI: 10.1161/cir.0000000000000744] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Every year in the United States, >350 000 people have sudden cardiac arrest outside of a hospital environment. Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness and is commonly the result of an electric disturbance in the heart. Unfortunately, only ≈1 in 10 victims survives this dramatic event. Early access to 9-1-1 and early cardiopulmonary resuscitation (CPR) are the first 2 links in the chain of survival for out-of-hospital cardiac arrest. Although 9-1-1 is frequently accessed, in the majority of cases, individuals with out-of-hospital cardiac arrest do not receive lay rescuer CPR and wait for the arrival of professional emergency rescuers. Telecommunicators are the true first responders and a critical link in the cardiac arrest chain of survival. In partnership with the 9-1-1 caller, telecommunicators have the first opportunity to identify a patient in cardiac arrest and provide initial care by delivering CPR instructions while quickly dispatching emergency medical services. The telecommunicator and the caller form a unique team in which the expertise of the telecommunicator is provided just in time to a willing caller, transforming the caller into a lay rescuer delivering CPR. The telecommunicator CPR (T-CPR) process, also previously described as dispatch CPR, dispatch-assisted CPR, or telephone CPR, represents an important opportunity to improve survival from sudden cardiac arrest. Conversely, failure to provide T-CPR in this manner results in preventable harm. This statement describes the public health impact of out-of-hospital cardiac arrest, provides guidance and resources to construct and maintain a T-CPR program, outlines the minimal acceptable standards for timely and high-quality delivery of T-CPR instructions, and identifies strategies to overcome common implementation barriers to T-CPR.
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Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint. Resuscitation 2020; 149:82-86. [PMID: 32088255 DOI: 10.1016/j.resuscitation.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The objective of this study was to test if caller descriptions of chief complaint delays emergency medical dispatchers' (EMDs) recognition of the need for telephone-assisted CPR (T-CPR). METHODS We conducted an analysis of N = 433 cardiac arrest calls from six large call centers in the United States. Calls were abstracted for initial chief complaint description: caller reports (1) correct medical condition (CMC); (2) incorrect medical condition (IMC), or (3) signs/symptoms only (SS), as well the time interval between call pickup and recognition of the need for T-CPR. In addition, we abstracted if EMDs asked questions related to the caller's chief complaint (rather than, or before), asking about patients' consciousness and breathing status. RESULTS The majority of cardiac arrest calls (60%) were reported as SS. Median time to recognition of the need for T-CPR was 64 s for SS chief complaints, 47 s for CMC chief complaints, and 100 s for IMC chief complaints. EMDs pursued chief complaint descriptions for 9% of the calls with SS chief complaints, 41% of the calls with IMC chief complaints, and 19% of the calls with CMC chief complaints. Median time to recognition of the need for CPR for calls in which the chief complaint description was pursued was 166 s compared to 62 s for calls in which the chief complaint description was not pursued. CONCLUSION Caller chief complaint description affects the time to recognition of the need for T-CPR. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov Trial # NCT01972087.
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Heffernan E, Oving I, Barry T, Phung VH, Siriwardena AN, Masterson S. Factors that motivate individuals to volunteer to be dispatched as first responders in the event of a medical emergency: A systematic review protocol. HRB Open Res 2019; 2:34. [PMID: 32490350 PMCID: PMC7236422 DOI: 10.12688/hrbopenres.12969.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 01/21/2024] Open
Abstract
Background: Voluntary First Response is an important component of prehospital care for medical emergencies, particularly cardiac arrest, in many countries. This intervention entails the mobilisation of volunteers, known as Community First Responders (CFRs), by the Emergency Medical Services to respond to medical emergencies in their locality. They include lay responders and/or professional responders (e.g. police officers, fire fighters, and general practitioners). A wide variety of factors are thought to motivate CFRs to join and remain engaged in Voluntary First Response schemes, such as the availability of learning opportunities, recognition, counselling, and leadership. The aim of this review is to develop an in-depth understanding of CFR motivation, including the factors that influence the initial decision to volunteer as a CFR and the factors that sustain involvement in Voluntary First Response over time. Any factors relevant to CFR de-motivation and turnover will also be examined. Methods: This is a protocol for a qualitative systematic review of the factors that influence the motivation of individuals to participate in Voluntary First Response. A systematic search will be carried out on seven electronic databases. Qualitative studies, mixed-methods studies, and any other studies producing data relating to the review question will be eligible for inclusion. Title and abstract screening, as well as full text screening, will be completed independently by two authors. A narrative synthesis, which is an established qualitative synthesis methodology, will be performed. The quality of each of the included studies will be critically appraised. Discussion: The findings of this review will be used to optimise the intervention of Voluntary First Response. Specifically, the results will inform the design and organisation of Voluntary First Response schemes, including their recruitment, training, and psychological support processes. This could benefit a range of stakeholders, including CFRs, paramedics, emergency physicians, patients, and the public.
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Affiliation(s)
- Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, H91 TK33, Ireland
| | - Iris Oving
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Tomás Barry
- School of Medicine, University College Dublin, Dublin 4, D04 V1W8, Ireland
| | - Viet-Hai Phung
- Community and Health Research Unit, School of Health and Social Care, Sarah Swift Building, University of Lincoln, Lincoln, LN5 7AT, UK
| | - Aloysius Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, Sarah Swift Building, University of Lincoln, Lincoln, LN5 7AT, UK
| | - Siobhán Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, H91 TK33, Ireland
- National Ambulance Service, Health Service Executive, St. Eunan's Hall, St Conal's Hospital, Letterkenny, Donegal, F92 XK84, Ireland
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Long-term trends in the epidemiology of out-of-hospital cardiac arrest precipitated by suspected drug overdose. Resuscitation 2019; 144:17-24. [DOI: 10.1016/j.resuscitation.2019.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/12/2019] [Accepted: 08/25/2019] [Indexed: 11/21/2022]
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Ströhle M, Vögele A, Neuhauser P, Rauch S, Brugger H, Paal P. Sudden Cardiac Arrest and Cardiopulmonary Resuscitation with Automated External Defibrillator in the Austrian Mountains: A Retrospective Study. High Alt Med Biol 2019; 20:392-398. [PMID: 31618064 DOI: 10.1089/ham.2018.0134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Few data exist on the likelihood of surviving sudden cardiac arrest in the mountains. The aim of this study was to analyze the epidemiology and outcomes of patients suffering sudden cardiac arrest and undergoing cardiopulmonary resuscitation (CPR) with automated external defibrillator (AED) in the Austrian mountains. Materials and Methods: We analyzed all cardiac arrest cases in the Austrian mountains reported in the nationwide Austrian Alpine Police database from October 26, 2005, to December 31, 2015. To obtain information on outcomes, these patient data were manually merged with patient data from the main Austrian referral center for mountain emergencies, Innsbruck Medical University Hospital. Results: Overall, 781 cases of sudden cardiac arrest in the Austrian mountains were recorded. In 136 cases (17%), CPR with AED was attempted. The most frequent activities at the time of sudden cardiac arrest were hiking (n = 63, 46%) and skiing or snowboarding (n = 44, 32%). In the nationwide Austrian Alpine Police database, only 4 (3%) patients survived, whereas in the Innsbruck Medical University Hospital database, there were seven survivors who received CPR and AED. All survivors had received immediate CPR with an AED. Five patients had good neurological outcome (cerebral performance category 1-2). Conclusions: In the Austrian mountains, CPR was attempted in less than 20% of sudden cardiac arrest cases. The few that survived had received immediate CPR with an AED. To better understand the circumstances and outcome of sudden cardiac arrest in the mountains, out-of hospital and in-hospital data should be linked.
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Affiliation(s)
- Mathias Ströhle
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Vögele
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Paul Neuhauser
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Paracelsus Medical University Salzburg, Hospitallers Brothers Hospital, Salzburg, Austria
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Kim CH, Kim TH, Shin SD, Song KJ, Ro YS, Ahn KO, Hong KJ, Lee YJ, Lee EJ, Ha SY. The effect of automatic external defibrillator with a real-time feedback on quality of bystander cardiopulmonary resuscitation: A before-and-after simulation study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e744-e751. [PMID: 31225932 DOI: 10.1111/hsc.12800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/16/2019] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
High-quality bystander cardiopulmonary resuscitation (CPR) and early defibrillation in the community are important for survival in out-of hospital-cardiac-arrest, but maintaining the quality of CPR in bystanders is difficult. We aimed to determine the effect of an automated external defibrillator (AED) with real-time feedback on the quality of bystander CPR in a community setting. A before-and-after simulation study was designed. Trainees of basic life support education were recruited for the simulation experiment. Each team consisted of two bystanders with different roles (initial witness and CPR supporter). 82 teams performed simulation scenarios with the real-time feedback function of AED disabled initially, and then repeated it with feedback function enabled. Quality measures of chest compression depth and no-flow fraction were compared between each of the two simulation scenarios. CPR quality data from 82 teams were analysed. The mean percentage of chest compressions with adequate depth was significantly higher in simulations with real-time feedback (78.1% vs. 89.3%, p < 0.01). Similarly, no-flow fractions were lower in simulation scenarios with real-time feedback (32.0% vs. 30.3% p = 0.05). In a subgroup with the lowest percentage of adequate depth performance in the initial simulation without real-time feedback, a mean increase of 47.7% (95% CI 31.3-64.0) in the fraction of chest compressions with adequate depth was seen with real-time feedback. Use of an AED with real-time feedback improves the quality of bystander CPR in a simulated community setting. The positive effect of real-time feedback is greatest among people with a low level of CPR skill.
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Affiliation(s)
- Chu Hyun Kim
- Department of Emergency Medicine, Inje University College of Medicine and Seoul Paik Hospital, Seoul, Korea
| | - Tae Han Kim
- Department of Emergency Medicine, Seoul National University Hospital/Seoul National University College of Medicine, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital/Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ki Ok Ahn
- Department of Emergency Medicine, Myongji Hospital, Gyeonggi, Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital/Seoul National University College of Medicine, Seoul, Korea
| | - Yu Jin Lee
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Eui Jung Lee
- Department of Emergency Medicine, Korea University College of Medicine and Anam Hospital, Seoul, Korea
| | - So Young Ha
- Department of Emergency Medicine, Sejong General Hospital, Bucheon, Gyeonggi, Korea
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Abstract
In patients with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR), the prognosis is influenced by various factors. In the prehospital setting, the duration of ischemia from the time of onset of cardiac arrest to the beginning of effective resuscitation measures is by far the most critical and determining factor for outcome. This interval can be shortened by an increase in the rate of lay CPR measures. With respect to intrahospital follow-up care, a number of structural factors have a relevant influence on prognosis. According to the literature, case volume, size of the hospital and the number of post-OHCA patients treated per year also have a large influence on the further prognosis. The crucial factor here is the availability and permanent readiness of a catheterization laboratory with the possibility of an immediate coronary intervention. In OHCA patients with ST-segment elevation myocardial infarction (STEMI), the time passed until the reopening of the occluded infarcted vessel is of paramount importance for survival. The 24/7 around the clock availability of a catheterization laboratory is therefore one of the indispensable prerequisites for a cardiac arrest center (CAC). In addition, a number of technical, structural, and organizational arrangements must be implemented in the CAC clinics in order to fulfil the requirements for such a center. The certification of CACs is currently being implemented by the German Resuscitation Council (GRC) and the German Society of Cardiology (DGK). As an important aim the GRC and the medical societies involved are hoping to avoid misallocation of post-OHCA patients to the nearest hospital, which may not be a suitable center for the treatment of these patients. Future studies will show whether CACs can indeed comprehensively improve the prognosis of OHCA patients following successful prehospital resuscitation.
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Self-confidence and level of knowledge after cardiopulmonary resuscitation training in 14 to 18-year-old schoolchildren: A randomised-interventional controlled study in secondary schools in Germany. Eur J Anaesthesiol 2019; 35:519-526. [PMID: 29300273 DOI: 10.1097/eja.0000000000000766] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Education of schoolchildren in cardiopulmonary resuscitation (CPR) is a strategic goal for improvement of bystander CPR in society. OBJECTIVE(S) The primary objective was to analyse the impact of CPR training on the resuscitation knowledge and self-confidence of secondary schoolchildren. In addition, independent predictors of improved CPR knowledge and self-confidence were investigated. DESIGN Randomised-interventional controlled study. SETTING Four secondary schools in Germany. PARTICIPANTS Four hundred and twenty-four schoolchildren aged from 14 to 18 years were included into the study. Fifty-one percent were female, and 33% had an immigrant background. INTERVENTION The intervention group received a 90-min CPR training session, whereas controls had no intervention. Levels of knowledge and self-confidence in initiating CPR were analysed by a study questionnaire before (t0), 90 min after (t1) and 6 months after training (t2). MAIN OUTCOME MEASURES Based on the evaluation of study questionnaires, the primary endpoint was to determine the development of resuscitation knowledge and self-confidence in initiating cardiopulmonary resuscitation at survey time-points t0, t1 and t2. RESULTS Schoolchildren in the intervention group (n=207) showed a significantly higher level of knowledge (P < 0.001) and self-confidence (P < 0.001) at t1 and t2 compared with controls (n=217). Age was a predictor for long-term self-confidence [odds ratio (OR), 1.20; 95% confidence interval (95% CI), 1.02 to 1.41; P = 0.032]. The long-term benefit in the level of knowledge and self-confidence were significantly higher in native compared with immigrant schoolchildren: (OR, 1.79; 95% CI, 1.14 to 2.82; P = 0.011) and (OR, 1.67; 95% CI, 1.07 to 2.60; P = 0.024), respectively. CONCLUSION Guideline compliant (90 min) theoretical and practical CPR training improves the level of knowledge and self-confidence in 14 to 18-year-old schoolchildren. Older schoolchildren are more likely to have increased self-confidence with respect to initiating CPR. Schoolchildren with an immigrant background showed a significantly lower increase in their level of knowledge and self-confidence compared with native children. Adaptation and simplification of teaching materials and further research on educational methods for CPR are urgently needed to enable a sustainable approach to teaching CPR, which also produces a long-lasting effect in the entire population.
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Andersen LW, Holmberg MJ, Granfeldt A, James LP, Caulley L. Cost-effectiveness of public automated external defibrillators. Resuscitation 2019; 138:250-258. [PMID: 30926453 DOI: 10.1016/j.resuscitation.2019.03.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/11/2019] [Accepted: 03/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite a consistent association with improved outcomes, public automated external defibrillators (AEDs) are rarely used in out-of-hospital cardiac arrest. One of the barriers towards increased use might be cost-effectiveness. METHODS We compared the cost-effectiveness of public AEDs to no AEDs for out-of-hospital cardiac arrest in the United States over a life-time horizon. The analysis assumed a societal perspective and results are presented as costs per quality-adjusted life year (QALY). Model inputs were based on reviews of the literature. For the base case, we modelled an annual cardiac arrest incidence per AED of 20%. A probabilistic sensitivity analysis was conducted to account for joint parameter uncertainty. RESULTS The no AED strategy resulted in 1.63 QALYs at a cost of $28,964. The AED strategy yielded an additional 0.26 QALYs for an incremental increase in cost of $13,793 per individual. The AED strategy yielded an incremental cost-effectiveness ratio of $53,797 per QALY gained. The yearly incidence of cardiac arrests occurring in the presence of an AED had minimal effect on the incremental cost-effectiveness ratio except at very low incidences. In several sensitivity analyses across a plausible range of health care and societal estimates, the AED strategy remained cost-effective. In the probabilistic sensitivity analysis, the AED strategy was cost-effective in 43%, 85%, and 91% of the scenarios at a willingness-to-pay threshold of $50,000, $100,000, and $150,000 per QALY gained, respectively. CONCLUSION Public AEDs are a cost-effective public health intervention in the United States. These findings support widespread dissemination of public AEDs.
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Affiliation(s)
- Lars W Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Mathias J Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Asger Granfeldt
- Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lyndon P James
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
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Maurer H, Masterson S, Tjelmeland I, Gräsner J, Lefering R, Böttiger B, Bossaert L, Herlitz J, Koster R, Rosell-Ortiz F, Perkins G, Wnent J. When is a bystander not a bystander any more? A European survey. Resuscitation 2019; 136:78-84. [DOI: 10.1016/j.resuscitation.2018.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/09/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
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A 5-year change of knowledge and willingness by sampled respondents to perform bystander cardiopulmonary resuscitation in a metropolitan city. PLoS One 2019; 14:e0211804. [PMID: 30730932 PMCID: PMC6366762 DOI: 10.1371/journal.pone.0211804] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 01/20/2019] [Indexed: 11/30/2022] Open
Abstract
Background Nationwide and regional interventions can help improve bystander cardiopulmonary resuscitation (CPR) awareness, knowledge, and the willingness. Periodic community investigation will help monitor the effect. This study aimed to compare the experience of CPR education, CPR knowledge, and CPR willingness, during a 5-year interval. Methods This is a pre and post study. Two surveys were done in February 2012 and December 2016. National and regional intervention including legislation promoting public involvement, standardizing CPR education programs, training CPR instructors, and installing supporting organizations were done at the period. In both surveys, respondents were selected via quota sampling in Daegu Metropolitan City and answered the survey through face-to-face interview. Respondents’ general demographic characteristics, CPR educational experience, CPR knowledge and CPR willingness were questioned. Results Total of 2141 respondents (1000 in 2012, 1141 in 2016) were selected. The percentage of respondents who received CPR education itself and recent education were higher after intervention compared to before intervention (36.2% vs. 55.1%, 16.9% vs. 30.1%, respectively). Correct knowledge of performing CPR seems to be improved overall (1.6% vs. 11.7%, odd ratio 14.28, 95% confidence interval 5.68–35.94). However, less respondents were willing to perform CPR on strangers (54.5% vs 35.0%). Conclusion Nationwide and regional interventions to promote bystander CPR and CPR education were associated with increased CPR education experience and improved correct CPR knowledge in performing bystander CPR. Willingness to perform bystander CPR on family did not increase significantly and CPR willingness to strangers was decreased. Additional legal and technological measures should be implemented to promote bystander CPR.
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Al Harbi N, Afifi A, Alateeq M, Tourkmani A, Alharbi T, Albattal S. Awareness of basic life support and cardiopulmonary resuscitation among female secondary school students in government schools in Riyadh city, KSA. J Family Med Prim Care 2019; 7:1493-1500. [PMID: 30613548 PMCID: PMC6293950 DOI: 10.4103/jfmpc.jfmpc_21_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background and Objective Basic life support (BLS) and cardiopulmonary resuscitation (CPR) are urgently required and must be performed when cardiac arrest occurs. These lifesaving procedures must be learned by healthcare professionals. In developed countries, members of the public, academics, and students learn how to carry out these emergency procedures. Knowledge of these simple procedures determines successful outcome. This study was conducted to determine the level of awareness of BLS and CPR among female secondary students at governmental schools in Riyadh city, Saudi Arabia (SA). Methods This cross-sectional study was conducted in five governmental secondary schools in Riyadh city, SA, between June 2015 and June 2016. Total of 1224 female students were selected randomly, and data were collected using a self-reported structured questionnaire. Results A total of 1170 participants completed the questionnaire. Most of the participants (81.5%) were Saudis. More than 50% of the students (54.8%) did not have information about BLS, and 82.6% felt their knowledge about BLS was insufficient. Only 10.8% of the participants had taken a BLS course, and only 38.5% believe BLS courses should be mandatory. Conclusion The level of awareness regarding BLS among female secondary school students in governmental schools in Riyadh was found to be insufficient. The introduction of BLS and CPR courses in the curriculum of governmental secondary schools in Riyadh city is highly recommended.
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Affiliation(s)
- Nouf Al Harbi
- Department of Family and Community Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ayman Afifi
- Department of Family and Community Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alateeq
- Department of Family Medicine and PHC, National Guard Health Affairs, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Ayla Tourkmani
- Department of Family and Community Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Turki Alharbi
- Department of Family and Community Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Saad Albattal
- Department of Family and Community Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Lee TH, Juan IC, Hsu HY, Chen WL, Huang CC, Yang MC, Lei WY, Lin CM, Chou CC, Chang CF, Lin YR. Demographics of Pediatric OHCA Survivors With Postdischarge Diseases: A National Population-Based Follow-Up Study. Front Pediatr 2019; 7:537. [PMID: 32039107 PMCID: PMC6992593 DOI: 10.3389/fped.2019.00537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 12/10/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Postdischarge diseases (PDDs) have been reported for adult survivors of out-of-hospital cardiac arrest (OHCA). However, the detailed demographics of pediatric OHCA survivors with PDDs are not well-documented, and information regarding functional survivors is particularly limited. We aimed to report detailed information on the PDDs of survivors of traumatic and non-traumatic pediatric OHCA using a national healthcare database. Methods: We retrospectively obtained data from the Taiwan government healthcare database (2011-2015). Information on the demographics of traumatic and non-traumatic pediatric OHCA survivors (<20 years) was obtained and reported. The patients who survived to discharge (survivors) and those classified as functional survivors were followed up for 1 year for the analysis of newly diagnosed PDDs. The time from discharge to PDD diagnosis was also reported. Results: A total of 2,178 non-traumatic and 288 traumatic OHCA pediatric cases were included. Among the non-traumatic OHCA survivors (n = 374, survival rate = 17.2%), respiratory tract (n = 270, 72.2%), gastrointestinal (n = 187, 50.0%), and neurological diseases (n = 167, 49.1%) were the three most common PDD categories, and in these three categories, the majority of PDDs were atypical/influenza pneumonia, non-infective acute gastroenteritis, and generalized/status epilepsy, respectively. Among the traumatic OHCA survivors (n = 21, survival rate = 7.3%), respiratory tract diseases (n = 17, 81.0%) were the most common, followed by skin or soft tissue (n = 14, 66.7%) diseases. Most functional survivors still suffered from neurological and respiratory tract diseases. Most PDDs, except for skin or soft tissue diseases, were newly diagnosed within the first 3 months after discharge. Conclusions: Respiratory tract (pneumonia), neurological (epilepsy), and skin or soft tissue (dermatitis) diseases were very common among both non-traumatic and traumatic OHCA survivors. More importantly, most PDDs, except for skin or soft tissue diseases, were newly diagnosed within the first 3 months after discharge.
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Affiliation(s)
- Tsung-Han Lee
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - I-Cheng Juan
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Hsiu-Ying Hsu
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan.,Department of Nursing, Dayeh University, Changhua City, Taiwan.,Department of Nursing, Changhua Christian Hospital, Changhua City, Taiwan
| | - Wen-Liang Chen
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Cheng-Chieh Huang
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Mei-Chueh Yang
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Wei-Yuan Lei
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Chih-Ming Lin
- Department of Neurology, Changhua Christian Hospital, Changhua City, Taiwan.,Department of Social Work and Child Welfare, Providence University, Taichung City, Taiwan.,Department of Medicinal Botanicals and Health Applications, Dayeh University, Changhua City, Taiwan
| | - Chu-Chung Chou
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
| | - Chin-Fu Chang
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yan-Ren Lin
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung City, Taiwan
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Community Outreach in Terms of Early Heart Attack Care as a New Way of Thinking in Chest Pain Center/Unit Care Giving-Commentary on the German Chest Pain Unit Network. Crit Pathw Cardiol 2018; 16:167-168. [PMID: 29135626 DOI: 10.1097/hpc.0000000000000127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Fernando SM, Vaillancourt C, Morrow S, Stiell IG. Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators. Resuscitation 2018; 128:138-143. [PMID: 29753856 DOI: 10.1016/j.resuscitation.2018.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/14/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Little is known regarding the quality of cardiopulmonary resuscitation (CPR) performed by bystanders in out-of-hospital cardiac arrest (OHCA). We sought to determine quality of bystander CPR provided during OHCA using CPR quality data stored by Automated External Defibrillators (AEDs). METHODS We used the Resuscitation Outcomes Consortium database to identify OHCA cases of presumed cardiac etiology where an AED was utilized. We then matched AED data to each case identified. AED data was analyzed using manufacturer software in order to determine overall measures of bystander CPR quality, changes in bystander CPR quality over time, and adherence to existing 2010 Resuscitation Quality Guidelines. RESULTS 100 cases of OHCA of presumed cardiac etiology involving bystander CPR and with corresponding AED data. Mean age was 62.3 years, and 75% were male. Bystanders demonstrated high-quality CPR over all minutes of resuscitation, with a chest compression fraction of 76%, a compression depth of 5.3 cm, and a compression rate of 111.2 compressions/min. Mean perishock pause was 26.8 s. Adherence rates to 2010 Resuscitation Guidelines for compression rate and depth were found to be 66% and 55%, respectively. CPR quality was lowest in the first minute, resulting from increased delay to rhythm analysis (mean 40.7 s). In cases involving shock delivery, latency from initiation of AED to shock delivery was 59.2 s. CONCLUSIONS We found that bystanders perform high-quality CPR, with strong adherence rates to existing Resuscitation Guidelines. High-quality CPR is maintained over the first five minutes of resuscitation, but was lowest in the first minute.
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Affiliation(s)
- Shannon M Fernando
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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40
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Goto Y, Funada A, Goto Y. Relationship Between Emergency Medical Services Response Time and Bystander Intervention in Patients With Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2018; 7:JAHA.117.007568. [PMID: 29703811 PMCID: PMC6015296 DOI: 10.1161/jaha.117.007568] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The response time of emergency medical services (EMS) is an important determinant of survival after out‐of‐hospital cardiac arrest. We sought to identify upper limits of EMS response times and bystander interventions associated with neurologically intact survival. Methods and Results We analyzed the records of 553 426 patients with out‐of‐hospital cardiac arrest in a Japanese registry between 2010 and 2014. The primary study end point was 1‐month neurologically intact survival (Cerebral Performance Category scale 1 or 2). Increased EMS response time was associated with significantly decreased adjusted odds of 1‐month neurologically intact survival (adjusted odds ratio [aOR] for each 1‐minute increase, 0.89; 95% confidence interval [CI], 0.89–0.90), although this relationship was modified by bystander interventions. The bystander interventions and the ranges of EMS response times that were associated with increased adjusted 1‐month neurologically intact survival were as follows: bystander defibrillation, from ≤2 minutes (aOR, 3.10 [95% CI, 1.25–7.31]) to 13 minutes (aOR, 5.55 [95% CI, 2.66–11.2]); bystander conventional cardiopulmonary resuscitation, from 3 minutes (aOR 1.48 [95% CI, 1.02–2.12]) to 11 minutes (aOR 2.41 [95% CI, 1.61–3.56]); and bystander chest‐compression‐only cardiopulmonary resuscitation, from ≤2 minutes (aOR 1.57 [95% CI, 1.01–2.25]) to 11 minutes (aOR 1.92 [95% CI, 1.45–2.56]). However, the increase in neurologically intact survival of those receiving bystander interventions became statistically insignificant compared with no bystander interventions when the EMS response time was outside these ranges. Conclusions The upper limits of the EMS response times associated with improved 1‐month neurologically intact survival were 13 minutes when bystanders provided defibrillation (typically with cardiopulmonary resuscitation) and 11 minutes when bystanders provided cardiopulmonary resuscitation without defibrillation.
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Affiliation(s)
- Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Akira Funada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Yumiko Goto
- Department of Cardiology, Yawata Medical Center, Komatsu, Japan
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Dispatcher-assisted bystander cardiopulmonary resuscitation in rural and urban areas and survival outcomes after out-of-hospital cardiac arrest. Resuscitation 2018; 125:1-7. [DOI: 10.1016/j.resuscitation.2018.01.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/23/2017] [Accepted: 01/17/2018] [Indexed: 11/19/2022]
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42
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Nolan J, Ornato J, Parr M, Perkins G, Soar J. Resuscitation highlights in 2017. Resuscitation 2018; 124:A1-A8. [DOI: 10.1016/j.resuscitation.2018.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 12/11/2022]
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43
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Bray JJH, Bucciarelli-Ducci C, Stuart G. Implantable cardioverter defibrillators in the context of hypertrophic cardiomyopathy: a lesson in patient autonomy. BMJ Case Rep 2018; 2018:bcr-2017-223352. [DOI: 10.1136/bcr-2017-223352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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44
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Pan CL, Lin CH, Lin YR, Wen HY, Wen JC. The Significance of Witness Sensors for Mass Casualty Incidents and Epidemic Outbreaks. J Med Internet Res 2018; 20:e39. [PMID: 29396388 PMCID: PMC5816259 DOI: 10.2196/jmir.8249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/30/2017] [Accepted: 11/22/2017] [Indexed: 11/26/2022] Open
Abstract
Due to the increasing number of natural and man-made disasters, mass casualty incidents occur more often than ever before. As a result, health care providers need to adapt in order to cope with the overwhelming patient surge. To ensure quality and safety in health care, accurate information in pandemic disease control, death reduction, and health quality promotion should be highlighted. However, obtaining precise information in real time is an enormous challenge to all researchers of the field. In this paper, innovative strategies are presented to develop a sound information network using the concept of “witness sensors.” To overcome the reliability and quality limitations of information obtained through social media, researchers must focus on developing solutions that secure the authenticity of social media messages, especially for matters related to health. To address this challenge, we introduce a novel concept based on the two elements of “witness” and “sensor.” Witness sensors can be key players designated to minimize limitations to quality of information and to distinguish fact from fiction during critical events. In order to enhance health communication practices and deliver valid information to end users, the education and management of witness sensors should be further investigated, especially for implementation during mass casualty incidents and epidemic outbreaks.
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Affiliation(s)
- Chih-Long Pan
- Research Center for Soil & Water Resources and Natural Disaster Prevention, National Yunlin University of Science & Technology, Douliou, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yan-Ren Lin
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsin-Yu Wen
- Department of Clinical Medicine, West China School of Medicine, Sichuan University, Sichuan, China
| | - Jet-Chau Wen
- Research Center for Soil & Water Resources and Natural Disaster Prevention, National Yunlin University of Science & Technology, Douliou, Taiwan.,Department and Graduate School of Safety and Environment Engineering, National Yunlin University of Science & Technology, Douliou, Taiwan
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45
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Perkins GD, Olasveengen TM, Maconochie I, Soar J, Wyllie J, Greif R, Lockey A, Semeraro F, Van de Voorde P, Lott C, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation: 2017 update. Resuscitation 2017; 123:43-50. [PMID: 29233740 DOI: 10.1016/j.resuscitation.2017.12.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Gavin D Perkins
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium.
| | | | - Ian Maconochie
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jasmeet Soar
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jonathan Wyllie
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Robert Greif
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Andrew Lockey
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Federico Semeraro
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | | | - Carsten Lott
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Koenraad G Monsieurs
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jerry P Nolan
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
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Meischke H, Painter IS, Stangenes SR, Weaver MR, Fahrenbruch CE, Rea T, Turner AM. Simulation training to improve 9-1-1 dispatcher identification of cardiac arrest: A randomized controlled trial. Resuscitation 2017; 119:21-26. [PMID: 28760696 DOI: 10.1016/j.resuscitation.2017.07.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to test the effectiveness of simulation training, using actors to make mock calls, on improving Emergency Medical Dispatchers' (EMDs) ability to recognize the need for, and reduce the time to, telephone-assisted CPR (T-CPR) in simulated and real cardiac arrest 9-1-1 calls. METHODS We conducted a parallel prospective randomized controlled trial with n=157 EMDs from thirteen 9-1-1 call centers. Study participants were randomized within each center to intervention (i.e., completing 4 simulation training sessions over 12-months) or control (status quo). After the intervention period, performance on 9 call processing skills and 2 time-intervals were measured in 2 simulation assessment calls for both arms. Six of the 13 call centers provided recordings of real cardiac arrest calls taken by study participants during the study period. RESULTS Of the N=128 EMDs who completed the simulation assessment, intervention participants (n=66) performed significantly better on 6 of 9 call processing skills and started T-CPR 23s faster (73 vs 91s respectively, p<0.001) compared to participants in the control arm (n=62). In real cardiac arrest calls, EMDs who completed 3 or 4 training sessions were more likely to recognize the need for T-CPR for more challenging cardiac arrest calls than EMDs who completed fewer than 3, including controls who completed no training (68% vs 53%, p=0.018). CONCLUSIONS Simulation training improves call processing skills and reduces time to T-CPR in simulated call scenarios, and may improve the recognition of the need for T-CPR in more challenging real-life cardiac arrest calls. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov Trial # NCT01972087.
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Affiliation(s)
- Hendrika Meischke
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Ian S Painter
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Scott R Stangenes
- Department of Health Services, University of Washington, Seattle, WA, United States.
| | - Marcia R Weaver
- Department of Health Services and Department of Global Health, University of Washington, Seattle WA, United States
| | - Carol E Fahrenbruch
- Public Health Seattle-King County, Emergency Medical Services Division, Seattle, WA, United States
| | - Tom Rea
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Anne M Turner
- Department of Health Services and Department of Biomedical Informatics University of Washington, Seattle, WA, United States
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Unilateral Dilated Pupil and Spontaneous Cardiac Arrest with Successful Bystander Resuscitation. Case Rep Emerg Med 2017; 2017:4071531. [PMID: 28596923 PMCID: PMC5449724 DOI: 10.1155/2017/4071531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022] Open
Abstract
A 75-year-old man collapsed on a golf course and received cardiopulmonary resuscitation from a bystander, including the use of a public automated external defibrillator (AED). The AED was discharged once, with return of spontaneous circulation. An air ambulance crew found the patient haemodynamically stable, with no acute abnormalities on a 12-lead ECG. He had reduced consciousness and a dilated left pupil. On contacting the patient's wife by telephone, she said that he had fallen and hit his head earlier that day. The crew decided to convey the patient to a Major Trauma Centre that had both neurosurgical and cardiology specialist services (rather than the nearest hospital) so that both traumatic brain injury and cardiac pathologies could be addressed if required. A head CT was normal, but coronary angiography demonstrated occlusion of two coronary arteries. These were successfully treated with stenting, and the patient went home two weeks later. He informed medical staff that his left pupil has been permanently dilated since he was a boy following a traumatic ocular injury. This case illustrates the utility of early deployment of an AED as well as the importance of an accurate history and emergency decision-making by prehospital personnel.
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