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Miyako J, Nakagawa K, Sagisaka R, Tanaka S, Takeuchi H, Takyu H, Tanaka H. Association between bystander intervention and emergency medical services and the return of spontaneous circulation in out-of-hospital cardiac arrests occurring at a train station in the Tokyo metropolitan area: A retrospective cohort study. Resusc Plus 2023; 15:100438. [PMID: 37601412 PMCID: PMC10432941 DOI: 10.1016/j.resplu.2023.100438] [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: 05/06/2023] [Revised: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Aim The purpose of this study was to stratify patients who achieved return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) with bystander procedures pre-emergency medical service (EMS) arrival and those who achieved ROSC with procedures post-EMS arrival, compare outcomes at 1-month, and identify factors associated with pre-EMS-arrival-ROSC. Methods A retrospective cohort analysis of OHCAs occurring at stations in the Tokyo metropolitan area between 2014 and 2018 was conducted. Subjects were stratified by ROSC phase (categorized as pre- and post-EMS arrival and non-ROSC). Survival at 1-month post-OHCA and the percentage of favourable neurological function in each ROSC phase were analysed. In addition, factors associated with Pre-EMS-arrival-ROSC were identified using multivariable logistic regression analysis. The time of occurrence of OHCA was classified into four-time categories as follows. Rush hour on morning [7:00-9:00], Rush hour on evening [17:00-21:00], Daytime [9:00-17:00], and Night or Early morning [21:00-7:00]. Results Among the 63,089 OHCA in the dataset, 702 were analysed. At 1-month after OHCA occurrence, Pre-EMS-arrival ROSC had higher survival rates than post-EMS-arrival ROSC (86.8% vs. 54.1%) and CPC1-2 rates (73.6% vs. 38.5%). Pre-EMS-arrival ROSC was associated (adjusted odds ratio [95% confidence interval]) with non-older-adult patients (1.59 [1.05-2.43]), witnessed OHCA (1.82 [1.03-3.31]), evening rush-hour (17:00-21:00; 2.08 [1.05-4.11]), conventional CPR (33.42 [7.82-868.44]), hands-only CPR (17.06 [4.30-436.48]), bystander defibrillation performed once (3.31 [1.59-6.99]). Conclusions In an OHCA at a station in Tokyo, ROSC achieved with bystander treatment alone had a better outcome at 1-month compared to ROSC with EMS intervention.
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Affiliation(s)
- Joji Miyako
- Research Institute of Disaster Management and EMS, Kokushikan University, Tokyo, Japan
| | - Koshi Nakagawa
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, Japan
| | - Ryo Sagisaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tokyo, Japan
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, Japan
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan
- Research and Development Initiative, Chuo University, Tokyo, Japan
| | - Shota Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tokyo, Japan
| | - Hidekazu Takeuchi
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, Japan
| | - Hiroshi Takyu
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, Japan
| | - Hideharu Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tokyo, Japan
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, Japan
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Douma MJ, Picard CT, Brindley PG, Gibson J. The experience of online cardiac arrest video use for education and research: A qualitative interview study completed in partnership with survivors and co-survivors. Resusc Plus 2023; 14:100394. [PMID: 37215186 PMCID: PMC10197098 DOI: 10.1016/j.resplu.2023.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Background Swift recognition of cardiac arrest is required for survival, however failure to recognize (and delayed response) is common. Studying online cardiac arrest videos may aid recognition, however the ethical implications of this are unknown. We examined their use from the perspective of persons with lived experience of cardiac arrest, seeking to understand the experience of having one's cardiac arrest recorded and available online. Methods We gathered qualitative data using focused interviews of persons affected by cardiac arrest. Inductive thematic analysis was performed, as well as a deductive ethical analysis. Co-researcher survivors and co-survivors were involved in all stages of this project. Findings We identified themes of 'shock, hurt and helplessness' and 'surreality and reality' to describe the experience of having one's (or a family member's) cardiac arrest captured and distributed online. Participants provided guidance on the use of online videos for education and research, emphasising beneficence, autonomy, non-maleficence, and justice. Conclusions Finding one's own, or a family member's cardiac arrest video online is shocking and potentially harmful for families. If ethical principles are followed however, there may be acceptable procedures for the use of online videos of cardiac arrest for education or research purposes. The careful use of online videos of cardiac arrest for education and research may help improve recognition and response, though additional research is required to confirm or refute this claim.
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Affiliation(s)
- Matthew J Douma
- Nursing, Midwifery and Health Systems, University College Dublin, Ireland
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Peter G. Brindley
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Gibson
- Providence Health Care, Canada
- University of British Columbia Vancouver, British Columbia, Canada
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Folke F, Shahriari P, Hansen CM, Gregers MCT. Public access defibrillation: challenges and new solutions. Curr Opin Crit Care 2023; 29:168-174. [PMID: 37093002 PMCID: PMC10155700 DOI: 10.1097/mcc.0000000000001051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review the current status of public access defibrillation and the various utility modalities of early defibrillation. RECENT FINDINGS Defibrillation with on-site automated external defibrillators (AEDs) has been the conventional approach for public access defibrillation. This strategy is highly effective in cardiac arrests occurring in close proximity to on-site AEDs; however, only a few cardiac arrests will be covered by this strategy. During the last decades, additional strategies for public access defibrillation have developed, including volunteer responder programmes and drone assisted AED-delivery. These programs have increased chances of early defibrillation within a greater radius, which remains an important factor for survival after out-of-hospital cardiac arrest. SUMMARY Recent advances in the use of public access defibrillation show great potential for optimizing early defibrillation. With new technological solutions, AEDs can be transported to the cardiac arrest location reaching OHCAs in both public and private locations. Furthermore, new technological innovations could potentially identify and automatically alert the emergency medical services in nonwitnessed OHCA previously left untreated.
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Affiliation(s)
- Fredrik Folke
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Clinical Medicine, University of Copenhagen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte
| | - Persia Shahriari
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Clinical Medicine, University of Copenhagen
| | - Carolina Malta Hansen
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mads Christian Tofte Gregers
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Clinical Medicine, University of Copenhagen
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Abstract
PURPOSE OF REVIEW Technology is being increasingly implemented in the fields of cardiac arrest and cardiopulmonary resuscitation. In this review, we describe how recent technological advances have been implemented in the chain of survival and their impact on outcomes after cardiac arrest. Breakthrough technologies that are likely to make an impact in the future are also presented. RECENT FINDINGS Technology is present in every link of the chain of survival, from prediction, prevention, and rapid recognition of cardiac arrest to early cardiopulmonary resuscitation and defibrillation. Mobile phone systems to notify citizen first responders of nearby out-of-hospital cardiac arrest have been implemented in numerous countries with improvement in bystanders' interventions and outcomes. Drones delivering automated external defibrillators and artificial intelligence to support the dispatcher in recognising cardiac arrest are already being used in real-life out-of-hospital cardiac arrest. Wearables, smart speakers, surveillance cameras, and artificial intelligence technologies are being developed and studied to prevent and recognize out-of-hospital and in-hospital cardiac arrest. SUMMARY This review highlights the importance of technology applied to every single step of the chain of survival to improve outcomes in cardiac arrest. Further research is needed to understand the best role of different technologies in the chain of survival and how these may ultimately improve outcomes.
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Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Lorenzo Gamberini
- Department of Anaesthesia and Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
| | - Federico Semeraro
- Department of Anaesthesia and Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
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Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation. Circulation 2022; 145:e776-e801. [PMID: 35164535 DOI: 10.1161/cir.0000000000001013] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
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Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation. Resuscitation 2022; 172:204-228. [PMID: 35181376 DOI: 10.1016/j.resuscitation.2021.11.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
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Miyako J, Nakagawa K, Sagisaka R, Tanaka S, Takeuchi H, Takyu H, Tanaka H. Neurological outcomes of out-of-hospital cardiac arrest occurring in Tokyo train and subway stations. Resusc Plus 2021; 8:100175. [PMID: 34816139 PMCID: PMC8591414 DOI: 10.1016/j.resplu.2021.100175] [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: 06/03/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives The purpose of this study was to identify a relationship between the background environment, bystander and emergency medical services intervention, and favourable neurological outcomes (CPC1-2) one-month after out-of-hospital cardiac arrest (OHCA) occurred at Tokyo train and subway stations. Methods This retrospective observational study used OHCA data between 2014 and 2018 that occurred at train stations in Tokyo. The eligible 954 patients were analysed for correlation between background, time frame, and location. Multivariable logistic regression models were used to estimate factors associated with CPC1-2 in patients with cardiogenic OHCA. Results A total of 886 OHCA cases, cardiogenic (n=562) and non-cardiogenic (n=324), met the inclusion criteria. Of the cardiogenic cases, 71.9% occurred at the platform and on-a-train. One-month CPC1-2 was achieved in 32.0% of cardiogenic OHCAs, which included 47.3% during morning rush hour, 24.7% during daytime hours, 40.2% during evening rush hour, and 20.5% during night-time/early morning hours. CPC1-2 had significant correlation with morning rush hour (adjusted odds ratio [AOR],4.52; 95% confidence interval [CI], 1.09–18.78), evening rush hour (AOR, 6.85; 95% CI, 1.51–31.15), public access defibrillation (AOR, 5.19; 95% CI, 1.38–19.51), and ventricular fibrillation or pulseless ventricular tachycardia (AOR, 7.56; 95% CI, 1.35–42.43). Conclusion A total of 71.9% of cardiogenic OHCAs occurred at platforms and on trains. To improve neurological outcomes of OHCAs at stations, AED installations on train platforms are necessary. Additionally, using artificial intelligence-based platform monitoring for early detection of OHCAs and offering CPR training are required.
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Affiliation(s)
- J Miyako
- Research Institute of Disaster Management and EMS, Kokushikan University, Tokyo, Japan
| | - K Nakagawa
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, Japan
| | - R Sagisaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tokyo, Japan.,Department of Integrated Science and Engineering for Sustainable Societies, Chuo University, Tokyo, Japan.,Research and Development Initiative, Chuo University, Tokyo, Japan
| | - S Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tokyo, Japan.,Tokai University School of Medicine, Kanagawa, Japan
| | - H Takeuchi
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, Japan
| | - H Takyu
- Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, Japan
| | - H Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tokyo, Japan.,Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, Japan
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Scquizzato T, Semeraro F. No more unwitnessed out-of-hospital cardiac arrests in the future thanks to technology. Resuscitation 2021; 170:79-81. [PMID: 34822935 DOI: 10.1016/j.resuscitation.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy.
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