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Su YC, Ng CJ, Chien LT, Tsai LH, Chien CY, Hsu SC. Comparative Analysis of Out-of-Hospital Cardiac Arrest Outcomes in Health Clinics, Nursing Homes, and Public Places: Implications for Optimizing Automated External Defibrillator Strategies. Int J Gen Med 2024; 17:2241-2249. [PMID: 38779653 PMCID: PMC11110817 DOI: 10.2147/ijgm.s464936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose Various factors, such as event location and response time, influence the outcomes of out-of-hospital cardiac arrest (OHCA). Very few studies have explored the delivery of basic life support (BLS) to patients having OHCA at health clinics or nursing homes-settings with professional BLS providers. Thus, in this study, we compared prognostic and survival outcomes between health clinics, nursing homes, and other public places (eg, workplaces and sports facilities/recreational areas) to offer insights for optimizing OHCA outcomes. Patients This study included adults who had nontraumatic OHCA in Taoyuan City between January 2017 and December 2022. Methods We collected data on patient characteristics, emergency medical service parameters, onsite patient management, automated external defibrillator (AED) locations, OHCA prognosis, and survival outcomes. Multivariate analyses were performed to predict survival to discharge (primary outcome) and neurological outcomes at discharge (secondary outcome). Results During the study period, the numbers of OHCA events at health clinics, nursing homes, and other public places were 158, 208, and 1986, respectively. The mean age of OHCA in health medical clinics, nursing home and other public places were 63.4, 81.5 and 64.7, respectively (P value<0.001). The proportion of witnessed events, rate of bystander resuscitation, and frequency of AED utilization were the highest for health clinics (53.2% (84/158), 83.4% (132/158), and 13.3% (21/158), respectively, P value<0.001). The average AED-scene distances and response times were the lowest for health clinics (388.8 m and 5.4 min, respectively). In initial shockable rhythm group, the probabilities of survival to discharge at discharge were the highest for health clinics (aOR=1.41, 95% CI=1.04-1.81, P value=0.041)) and lowest for nursing homes (aOR=0.84, 95% CI=0.76-0.93, P value=0.024). Conclusion Our research shows that OHCA patients at medical health clinics have higher rates of witnessing and bystander CPR and AED usage than other public places. However, while survival rates for patients with shockable rhythms are slightly better at health clinics, the neurological outcomes are not significantly different. The AED-scene distances are too far to be used effectively.
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Affiliation(s)
- Yi-Chia Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Liang-Tien Chien
- Graduate Institute of Management, College of Management, Chang Gung University, Taoyuan, Taiwan
- Taoyuan Fire Department, Taoyuan, Taiwan
| | - Li-Heng Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan
- Department of Senior Service Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan
| | - Shou-Chien Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan
- Department of Occupational Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
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Horning J, Griffith D, Slovis C, Brady W. Pre-Arrival Care of the Out-of-Hospital Cardiac Arrest Victim. Emerg Med Clin North Am 2023; 41:413-432. [PMID: 37391242 DOI: 10.1016/j.emc.2023.03.001] [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: 07/02/2023]
Abstract
Lay rescuers play a pivotal role in the recognition and initial management of out-of-hospital cardiac arrest. The provision of timely pre-arrival care by lay responders, including cardiopulmonary resuscitation and the use of automated external defibrillator before emergency medical service arrival, is important link in the chain of survival and has been shown to improve outcomes from cardiac arrest. Although physicians are not directly involved in bystander response to cardiac arrest, they play a key role in emphasizing the importance of bystander interventions.
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Affiliation(s)
- Jillian Horning
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Daniel Griffith
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Corey Slovis
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA; Department of Emergency Medicine, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - William Brady
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA.
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Missel AL, Donnelly JP, Tsutsui J, Wilson N, Friedman C, Rooney DM, Neumar RW, Cooke JM. Effectiveness of Lay Bystander Hands-Only Cardiopulmonary Resuscitation on a Mattress versus the Floor: A Randomized Cross-Over Trial. Ann Emerg Med 2023; 81:691-698. [PMID: 36841661 PMCID: PMC10599351 DOI: 10.1016/j.annemergmed.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/27/2023]
Abstract
STUDY OBJECTIVE Bystander cardiopulmonary resuscitation increases the likelihood of out-of-hospital cardiac arrest survival by more than two-fold. A common barrier to the prompt initiation of compressions is moving victims to the floor, but compression quality on a "floor" versus a "mattress" has not been tested among lay bystanders. METHODS We conducted a prospective, randomized, cross-over trial comparing lay bystander compression quality using a manikin on a bed versus the floor. Participants included adults without professional health care training. We randomized participants to the order of manikin placement, either on a mattress or on the floor. For both, participants were instructed to perform 2 minutes of chest compressions on a cardiopulmonary resuscitation Simon manikin Gaumard (Gaumard Scientific, Miami, FL). The primary outcome was mean compression depth (cm) over 2 minutes. We fit a linear regression model adjusted for scenario order, age, sex, and body mass index with robust standard errors to account for repeated measures and reported mean differences with 95% confidence intervals (CIs). RESULTS Our sample of 80 adults was 66% female with a mean age of 50.5 years (SD 18.2). The mean compression depth on the mattress was 2.9 cm (SD 2.3) and 3.5 cm (SD 2.2) on the floor, a mean difference of 0.58 cm (95% CI 0.18, 0.98). Compression depth fell below the 5 to 6 cm depth recommended by the American Heart Association on both surfaces. In the adjusted model, the mean depth was greater when the manikin was on the floor than the mattress (adjusted mean difference 0.62 cm; 95% CI 0.23 to 1.01), and mean depth was less for females than males (adjusted mean difference -1.42 cm, 95% CI -2.59, -0.25). In addition, the difference in compression depth was larger for female participants (mean difference 0.94 cm; 95% CI 0.54, 1.34) than for male participants (mean difference -0.01 cm; 95% CI -0.80, 0.78), and the interaction was statistically significant (P = .04). CONCLUSION The mean compression depth was significantly smaller on the mattress and with female bystanders. Further research is needed to understand the benefit of moving out-of-hospital cardiac arrest victims to the floor relative to the detrimental effect of delaying chest compressions.
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Affiliation(s)
- Amanda L Missel
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI.
| | - John P Donnelly
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI; VA QUERI Center for Evaluation and Implementation Resources and HSR&D Center for Clinical Management Research, Ann Arbor, MI
| | | | | | - Charles Friedman
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Deborah M Rooney
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Medical School and Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
| | - James M Cooke
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI; Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
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Clinical outcomes following out-of-hospital cardiac arrest: The minute-by-minute impact of bystander cardiopulmonary resuscitation. Resuscitation 2023; 185:109693. [PMID: 36646371 DOI: 10.1016/j.resuscitation.2023.109693] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
AIMS The time-dependent prognostic role of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients has not been described with great precision, especially for neurologic outcomes. Our objective was to assess the association between bystander CPR, emergency medical service (EMS) response time, and OHCA patients' outcomes. METHODS This cohort study used the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registries. Bystander-witnessed adult OHCA treated by EMS were included. The primary outcome was survival to hospital discharge and secondary outcome was survival with a good neurologic outcome (modified Rankin scale 0-2). Multivariable logistic regression models were used to assess the associations and interactions between bystander CPR, EMS response time and clinical outcomes. RESULTS Out of 229,637 patients, 41,012 were included (18,867 [46.0%] without bystander CPR and 22,145 [54.0%] with bystander CPR). Bystander CPR was independently associated with higher survival (adjusted odds ratio [AOR] = 1.70 [95%CI 1.61-1.80]) and survival with a good neurologic outcome (AOR = 1.87 [95%CI 1.70-2.06]), while longer EMS response times were independently associated with lower survival to hospital discharge (each additional minute of EMS response time: AOR = 0.92 [95%CI 0.91-0.93], p < 0.001) and lower survival with a good neurologic outcome (AOR = 0.88 [95%CI 0.86-0.89], p < 0.001). There was no interaction between bystander CPR and EMS response time's association with survival (p = 0.12) and neurologic outcomes (p = 0.65). CONCLUSIONS Although bystander CPR is associated with an immediate increase in odds of survival and of good neurologic outcome for OHCA patients, it does not influence the negative association between longer EMS response time and survival and good neurologic outcome.
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Tanaka H, Kinoshi T, Tanaka S, Sagisaka R, Takahashi H, Sone E, Hara T, Takeda Y, Takyu H. Prehospital interventions and neurological outcomes in marathon-related sudden cardiac arrest using a rapid mobile automated external defibrillator system in Japan: a prospective observational study. Br J Sports Med 2022; 56:bjsports-2021-104964. [PMID: 35589377 DOI: 10.1136/bjsports-2021-104964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe neurological outcomes after sudden cardiac arrests (SCAs) in road and long-distance races using a rapid mobile automated external defibrillator system (RMAEDS) intervention. METHODS A total of 42 SCAs from 3 214 701 runners in 334 road and long-distance races from 1 February 2007 to 29 February 2020 were examined. Demographics, SCA interventions, EMS-related data and SCA-related outcomes were measured. Primary endpoints were favourable neurological outcomes (Cerebral Performance Categories 1-2) at 1-month and 1-year post-SCA. Secondary endpoints were factors related to the field return of spontaneous circulation (ROSC) and resuscitation characteristics, including the initial ECG waveform classification and resuscitation sequence times according to the initial ECG rhythm. RESULTS The SCA incidence rate was 1.31 per 100 000 runners (age: median (IQR), 51 (36.5, 58.3) years). Field ROSC and full neurological recovery at 1-month post-SCA was achieved 90.4% and 92.9% of cases, respectively. In 22 cases in which bystander cardiopulmonary resuscitation was initiated within 1 min and defibrillation performed within 3 min, full neurological recovery was achieved at 1-month and 1-year post-SCA in 95.5.% and 95.5% of cases, respectively. CONCLUSIONS The RMAEDS successfully treated patients with SCA during road and long-distance races yielding a high survival rate and favourable neurological outcomes. These findings support rapid intervention and the proper placement of healthcare teams along the race course to initiate chest compressions within 1 min and perform defibrillation within 3 min.
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Affiliation(s)
- Hideharu Tanaka
- Department of Sports Medicine, Kokushikan University, Tama, Tokyo, Japan
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Tokyo, Japan
| | - Tomoya Kinoshi
- Department of Sports Medicine, Kokushikan University, Tama, Tokyo, Japan
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Tokyo, Japan
| | - Shota Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama, Tokyo, Japan
- School of Medicine, Tokai University, Isehara, Kanagawa, Japan
| | - Ryo Sagisaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama, Tokyo, Japan
- Department of Integrated Science and Engineering for Sustainable Societies, Chuo University, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Sports Medicine, Kokushikan University, Tama, Tokyo, Japan
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Tokyo, Japan
| | - Etsuko Sone
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama, Tokyo, Japan
| | - Takahiro Hara
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Tokyo, Japan
| | - Yui Takeda
- Department of Sports and Health Management, Jobu University, Isesaki, Gunma, Japan
| | - Hiroshi Takyu
- Department of Sports Medicine, Kokushikan University, Tama, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Tokyo, Japan
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Parlow S, Fay Lepage-Ratte M, Jung RG, Fernando SM, Visintini S, Sterling LH, Di Santo P, Simard T, Russo JJ, Labinaz M, Hibbert B, Nolan JP, Rochwerg B, Mathew R. Inhaled anaesthesia compared with conventional sedation in post cardiac arrest patients undergoing temperature control: a systematic review and meta-analysis. Resuscitation 2022; 176:74-79. [DOI: 10.1016/j.resuscitation.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
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7
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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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Jellestad ASL, Folke F, Molin R, Lyngby RM, Hansen CM, Andelius L. Collaboration between emergency physicians and citizen responders in out-of-hospital cardiac arrest resuscitation. Scand J Trauma Resusc Emerg Med 2021; 29:110. [PMID: 34344415 PMCID: PMC8330065 DOI: 10.1186/s13049-021-00927-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Citizen responder programmes dispatch volunteer citizens to initiate resuscitation in nearby out-of-hospital cardiac arrests (OHCA) before the Emergency Medical Services (EMS) arrival. Little is known about the interaction between citizen responders and EMS personnel during the resuscitation attempt. In the Capital Region of Denmark, emergency physicians are dispatched to all suspected OHCAs. The aim of this study was to evaluate how emergency physicians perceived the collaboration with citizen responders during resuscitation attempts. METHOD This cross-sectional study was conducted through an online questionnaire. It included all 65 emergency physicians at Copenhagen EMS between June 9 and December 13, 2019 (catchment area 1.8 million). The questionnaire examined how emergency physicians perceived the interaction with citizen responders at the scene of OHCA (use of citizen responders before and after EMS arrival, citizen responders' skills in cardiopulmonary resuscitation (CPR), and challenges in this setting). RESULTS The response rate was 87.7% (57/65). Nearly all emergency physicians (93.0%) had interacted with a citizen responder at least once. Of those 92.5%(n = 49) considered it relevant to activate citizen responders to OHCA resuscitation, and 67.9%(n = 36) reported the collaboration as helpful. When citizen responders arrived before EMS, 75.5%(n = 40) of the physicians continued to use citizen responders to assist with CPR or to carry equipment. Most (84.9%, n = 45) stated that citizen responders had the necessary skills to perform CPR. Challenges in the collaboration were described by 20.7%(n = 11) of the emergency physicians and included citizen responders being mistaken for relatives, time-consuming communication, or crowding problems during resuscitation. CONCLUSION Emergency physicians perceived the collaboration with citizen responders as valuable, not only for delivery of CPR, but were also considered an extra helpful resource providing non-CPR related tasks such as directing the EMS to the arrest location, carrying equipment and taking care of relatives.
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Affiliation(s)
- Anne-Sofie Linde Jellestad
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Rune Molin
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark
| | - Rasmus Meyer Lyngby
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark.,Kingston University and St. Georges, University of London, London, UK
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Kosmopoulos M, Bartos JA, Raveendran G, Goslar T, Kalra R, Hoke L, Tsangaris A, Sebastian P, Walser E, Yannopoulos D. Coronary artery disease burden relation with the presentation of acute cardiac events and ventricular fibrillation. Catheter Cardiovasc Interv 2021; 99:804-811. [PMID: 34236756 DOI: 10.1002/ccd.29858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/18/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Evaluate the differences in coronary artery disease (CAD) burden between patients with ischemic resuscitated, ischemic refractory VT/VF OHCA events and N/STEMI. BACKGROUND Refractory out-of-hospital cardiac arrest patients presenting with initial shockable rhythms (VT/VF OHCA) have the highest mortality among patients with acute cardiac events. No predictors of VT/VF OHCA refractoriness have been identified. METHODS A retrospective cohort design was used to assess baseline characteristics, clinical outcomes, and the angiographic severity of disease among patients with VT/VF OHCA undergoing emergent coronary angiography at the University of Minnesota Medical Center. The Gensini score was calculated for all patients to assess the angiographic burden of CAD. For patients with ischemia-related cardiac arrest, outcomes were further compared to an independent non-OHCA population presenting with N/STEMI. RESULTS During the study period, 538 patients were admitted after VT/VF OHCA. Among them, 305 presented with resuscitated, and 233 with refractory VT/VF. 66% of resuscitated and 70% of refractory VT/VF had an underlying, angiographically documented, ischemic etiology. Ischemic resuscitated and refractory VT/VF had significant differences in Gensini score, (80.7 ± 3.6 and 127.6 ± 7.1, respectively, p < 0.001) and survival (77.3% and 30.0%, respectively, p < 0.001). Both groups had a higher CAD burden and worse survival than the non-OHCA N/STEMI population (360 patients). Ischemic refractory VT/VF was significantly more likely to present with chronic total occlusion in comparison to both N/STEMI and ischemic resuscitated VT/VF. CONCLUSION Ischemia-related, refractory VT/VF OHCA has a higher burden of CAD and the presence of CTOs compared to resuscitated VT/VF OHCA and N/STEMI.
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Affiliation(s)
- Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason A Bartos
- Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ganesh Raveendran
- Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tomaz Goslar
- Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA.,Center for Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Rajat Kalra
- Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lindsay Hoke
- Best Practices Integrated Informatics Core, University of Minnesota Clinical and Translational Science Institute, Minneapolis, Minnesota, USA
| | - Adamantios Tsangaris
- Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pierre Sebastian
- Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Emily Walser
- Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Demetris Yannopoulos
- Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
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11
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Chocron R, Jobe J, Guan S, Kim M, Shigemura M, Fahrenbruch C, Rea T. Bystander Cardiopulmonary Resuscitation Quality: Potential for Improvements in Cardiac Arrest Resuscitation. J Am Heart Assoc 2021; 10:e017930. [PMID: 33660519 PMCID: PMC8174211 DOI: 10.1161/jaha.120.017930] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out‐of‐hospital cardiac arrest. We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator CPR (TCPR). Methods and Results We investigated non‐traumatic out‐of‐hospital cardiac arrest occurring in a large metropolitan emergency medical system during a 6‐month period. Information about bystander care was ascertained through review of the 9‐1‐1 recordings in addition to emergency medical system and hospital records to determine bystander CPR status (none versus TCPR versus unassisted), the number of bystanders on‐scene, and CPR performance metrics of compression fraction and compression rate. Of the 428 eligible out‐of‐hospital cardiac arrest, 76.4% received bystander CPR including 43.7% unassisted CPR and 56.3% TCPR; 35.2% had one bystander, 33.3% had 2 bystanders, and 31.5% had ≥3 bystanders. Overall compression fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (fraction=52%, rate=87 per minute for TCPR versus fraction=69%, rate=102 for unassisted CPR, P<0.05 for each comparison) and the number of bystanders (fraction=55%, rate=87 per minute for 1 bystander, fraction=59%, rate=89 for 2 bystanders, fraction=65%, rate=97 for ≥3 bystanders, test for trend P<0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an automated external defibrillator (8.0%). Conclusions Bystander CPR quality as gauged by compression fraction and rate approached guideline goals though performance depended upon the type of CPR and number of bystanders.
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Affiliation(s)
- Richard Chocron
- Paris Research Cardiovascular Center (PARCC) INSERMParis University Paris France.,Emergency Department AP-HPGeorges Pompidou European Hospital Paris France
| | | | - Sally Guan
- Emergency Medical Services Division Public Health Seattle and King County Seattle WA
| | | | | | - Carol Fahrenbruch
- Emergency Medical Services Division Public Health Seattle and King County Seattle WA
| | - Thomas Rea
- University of Washington Seattle WA.,Emergency Medical Services Division Public Health Seattle and King County Seattle WA
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12
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Derkenne C, Jost D, Haruel PA, Kedzierewicz R, Frattini B, Frédéric L, Diegelmann P, Gouze J, Roquet F, Travers S, Bihannic R, Prunet B. Insufficient quality of public automated external defibrillator recordings in the greater Paris area, a descriptive study. Emerg Med J 2020; 37:623-628. [PMID: 32878960 DOI: 10.1136/emermed-2019-209371] [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: 12/16/2019] [Revised: 07/15/2020] [Accepted: 07/25/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Western countries report a significant increase in the proportion of patients who experience out-of-hospital cardiac arrests (OHCAs) and benefit from a public automated external defibrillator (pAED) before the arrival of rescue teams. However, recordings of devices recovered after resuscitation are of variable quality. Analysis of these data may inform decisions of whether to implement an internal defibrillator for survivors, and provide useful information about the performance of pAED algorithms and the actions of bystanders. OBJECTIVE To investigate the quality of the information recorded by pAEDs during OHCAs in the Paris area. METHODS pAED files used for some of the 8629 OHCAs that occurred in the greater Paris area between 1 January 2017 and 31 April 2019 on the day of the arrest were collected. The presence and accuracy of 23 factors required to interpret the recording was noted, including readability of the ECG, the presence of an impedance curve and the accuracy of the date and time. The recordings were analysed to assess the diagnostic and therapeutic performance of the pAEDs used. RESULTS A total of 258 patients with an OHCA received assistance from a pAED, and 182 recordings were recovered. The pAEDs were made by 12 different manufacturers. Data extraction required eight different transmission modes and 16 software programmes; recordings were of highly heterogeneous quality. Two per cent of the recordings were of such poor quality that they were not interpretable. Among the 98% remaining, only 43% included a thoracic impedance curve, 34% the intensity of the shocks delivered and 8% the patient name. The date and time were accurate in 68% and 48% of recordings, respectively. The pAEDs had 87.6% (95% CI 83.7% to 91.0%) sensitivity and 99.5% (99.5% to 99.5%) specificity for defibrillating shockable rhythms (positive predictive value 98.2% (96.4% to 99.0%), negative predictive value 96.4% (95.3% to 96.8%)). The absence of important variables prevented the analysis of approximately half of the inappropriate decisions made by pAEDs. CONCLUSION Collection of pAED recordings is a major challenge. Their analysis is compromised by heterogeneity and poor quality (incomplete maintenance records, patient details and logs). AED recordings are currently the most relevant resource to track pAED performance and bystander practices. The quality of these recordings needs to improve.
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Affiliation(s)
- Clément Derkenne
- Emergency Medical Department, Paris Fire Brigade, Clamart, France
| | - Daniel Jost
- Emergency Medical Department, Paris Fire Brigade, Clamart, France
| | | | | | - Benoit Frattini
- Emergency Medical Department, Paris Fire Brigade, Clamart, France
| | - Lemoine Frédéric
- Emergency Medical Department, Paris Fire Brigade, Clamart, France
| | | | - Jeremy Gouze
- Emergency Medical Department, Paris Fire Brigade, Clamart, France
| | - Florian Roquet
- Emergency Medical Department, Paris Fire Brigade, Clamart, France
| | - Stéphane Travers
- Emergency Medical Department, Paris Fire Brigade, Clamart, France
| | | | - Rene Bihannic
- Emergency Medical Department, Paris Fire Brigade, Clamart, France
| | - Bertrand Prunet
- Emergency Medical Department, Paris Fire Brigade, Clamart, France.,French Military Health Service, Val de Grâce Military Academy, Paris, France
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13
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Chien CY, Fang SY, Tsai LH, Tsai SL, Chen CB, Seak CJ, Weng YM, Lin CC, Chien WC, Huang CH, Lin CY, Chaou CH, Liu PH, Tseng HJ, Chen JC, Peng SY, Cheng TH, Hsu KH, Ng CJ. Traditional versus blended CPR training program: A randomized controlled non-inferiority study. Sci Rep 2020; 10:10032. [PMID: 32572100 PMCID: PMC7308401 DOI: 10.1038/s41598-020-67193-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/03/2020] [Indexed: 11/09/2022] Open
Abstract
Cardiopulmonary resuscitation (CPR) training and its quality are critical in improving the survival rate of cardiac arrest. This randomized controlled study investigated the efficacy of a newly developed CPR training program for the public in a Taiwanese setting. A total of 832 adults were randomized to either a traditional or blended (18-minute e-learning plus 30-minute hands-on) compression-only CPR training program. The primary outcome was compression depth. Secondary outcomes included CPR knowledge test, practical test, quality of CPR performance, and skill retention. The mean compression depth was 5.21 cm and 5.24 cm in the blended and traditional groups, respectively. The mean difference in compression depth between groups was -0.04 (95% confidence interval -0.13 to infinity), demonstrating that the blended CPR training program was non-inferior to the traditional CPR training program in compression depth after initial training. Secondary outcome results were comparable between groups. Although the mean compression depth and rate were guideline-compliant, only half of the compressions were delivered with adequate depth and rate in both groups. CPR knowledge and skill retained similarly in both groups at 6 and 12 months after training. The blended CPR training program was non-inferior to the traditional CPR training program. However, there is still room for improvement in optimizing initial skill performance as well as skill retention. Clinical Trial Registration: NCT03586752; www.clinicaltrial.gov.
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Affiliation(s)
- Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, 302, Taiwan
| | - Shao-Yu Fang
- Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, 105, Taiwan
| | - Li-Heng Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Shang-Li Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, 105, Taiwan
| | - Chen-Bin Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, 330, Taiwan
| | - Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, 302, Taiwan
| | - Wei-Che Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, 105, Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, 330, Taiwan
| | - Cheng-Yu Lin
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, 302, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Peng-Huei Liu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, 105, Taiwan
| | - Hsiao-Jung Tseng
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan
| | - Jih-Chang Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, 330, Taiwan
| | - Shu-Yuan Peng
- Department of nursing, Ton-Yen General Hospital, Zhubei, 302, Taiwan
| | - Tsung-Hsuan Cheng
- Department of nursing, Ton-Yen General Hospital, Zhubei, 302, Taiwan
| | - Kuang-Hung Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Laboratory for Epidemiology, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Urology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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Study on the Improvement of Electrical Facility System of Automated External Defibrillators by Real-Time Measurement of Thoracic Impedance. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10093323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sudden Cardiac Arrest (SCA) is a serious emergency disease that has increased steadily every year. To this end, an Automated External Defibrillator (AED) is placed in a public place so that even non-professional medical personnel can respond to SCA. However, the thoracic impedance of patients changes due to CardioPulmonary Resuscitation (CPR) and artificial respiration during first aid treatment. In addition, changes in chest statues due to gender, age, and accidents cause changes in thoracic impedance in real time. The change in thoracic impedance caused by this has a negative effect on the intended electrical energy of the automatic heart shocker to the emergency patient. To prove this, we divided it into adult and pediatric modes and experimented with the energy error of the AED according to the same impedance change. When the first peak current was up to 56.4 (A) and at least 8.4 (A) in the adult mode, the first peak current was up to 32.2 (A) and at least 4.8 (A), respectively, when the impedance changed, the error of the current figure occurred. In this paper, the inverse relationship between thoracic impedance and electric shock energy according to the state of the cardiac arrest patient is demonstrated through the results of the experiment, and the need for an electric facility system that can revise for changes in thoracic impedance of the cardiac arrest patient by reflecting them on electric shock energy in real time is presented.
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15
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Haskins B, Smith K, Cameron P, Bernard S, Nehme Z, Murphy-Smith J, Metcalf M, Moussa R, Harvey D, Turnbull L, Dyson K. The impact of bystander relation and medical training on out-of-hospital cardiac arrest outcomes. Resuscitation 2020; 150:72-79. [PMID: 32194165 DOI: 10.1016/j.resuscitation.2020.02.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/11/2020] [Accepted: 02/27/2020] [Indexed: 01/29/2023]
Abstract
AIM In this study, we investigate the impact of bystander relation and medical training on survival to hospital discharge in out-of-hospital cardiac arrest (OHCA) patients receiving bystander cardiopulmonary resuscitation (CPR). METHODS A retrospective analysis was performed on non-traumatic OHCA patients receiving bystander CPR and Emergency Medical Service (EMS) attempted resuscitation from 2015 through 2017. Adjusted logistic regression was used to assess the association between related versus unrelated and layperson versus medically trained bystander CPR providers and survival to hospital discharge. RESULTS A total of 4464 OHCA were eligible for inclusion, of which 2385 (53.4%) received CPR from a relative, 468 (10.5%) from a work colleague or friend and 1611 (36.1%) from a stranger. Layperson's provided CPR in 3703 (83.0%) OHCA and medically trained professionals in 761 (17.0%). After adjustment for arrest characteristics, there was no difference in survival to hospital discharge between related versus unrelated CPR (adjusted odds ratio [AOR] 0.92, 95% confidence interval [CI]: 0.68-1.23, p = 0.555). However, bystander CPR by a medically trained provider rather than a layperson, was associated with an increase in the odds of survival by 47% (AOR 1.47, 95% CI: 1.09-2.00, p = 0.012) in the overall population and 73% (AOR 1.73, 95% CI: 1.21-2.49; p = 0.003) in patients with an initial shockable arrest. Adjusting for public access defibrillation significantly attenuated the effect of medically trained bystander CPR in initial shockable arrests (AOR 1.42, 95% CI: 0.97-2.07; p = 0.073). CONCLUSION This study supports ongoing efforts to crowdsource a larger number of first responders with medical training to OHCA patients to assist with the provision of CPR and early defibrillation.
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Affiliation(s)
- Brian Haskins
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia.
| | - Karen Smith
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Peter Cameron
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Australia
| | - Steve Bernard
- NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; The Alfred Hospital, Melbourne, Australia
| | - Ziad Nehme
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Jake Murphy-Smith
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Matthew Metcalf
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Rana Moussa
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Douglas Harvey
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Lauren Turnbull
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Kylie Dyson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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16
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Factors Associated with High-Quality Cardiopulmonary Resuscitation Performed by Bystander. Emerg Med Int 2020; 2020:8356201. [PMID: 32211207 PMCID: PMC7063209 DOI: 10.1155/2020/8356201] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
Bystander cardiopulmonary dresuscitation (CPR) improves the survival and neurological outcomes of sudden cardiac arrest patients. The rate of bystander CPR is increasing; however, its performance quality has not been evaluated in detail. In this study, emergency medical technicians (EMTs) in the field evaluated bystander CPR quality, and we aimed to investigate the association between bystander information and CPR quality. This retrospective cohort study was based on data included in the Smart Advanced Life Support (SALS) registry between January 2016 and December 2017. We included patients older than 18 years who experienced an out-of-hospital cardiac arrest (OHCA) due to medical causes. Bystander CPR quality was judged to be "high" when the hand positions were appropriate and when compression rates of at least 100/min and compression depths of at least 5 cm were achieved. Among 6,769 eligible patients, 3,799 (58.7%) received bystander CPR, and 6% of bystanders performed high-quality CPR. After adjustment, the occurrence of cardiac arrest at home (adjusted odds ratio (aOR), 95% confidence interval (CI); 0.42, 0.27-0.64), witnessed cardiac arrest (1.45, 1.03-2.06), and younger bystander age all showed associations with one another. High-quality CPR led to a 4.29-fold increase in the chance of neurological recovery. In particular, high-quality CPR in patients aged 60 years showed a significant association compared with other age groups (7.61, 1.41-41.04). The main factor affecting CPR quality in this study was the age of the bystander, and older bystanders found it more difficult to maintain CPR quality. To improve the quality of bystander CPR, training among older bystanders should be the focus.
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17
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Noel L, Jaeger D, Baert V, Debaty G, Genin M, Sadoune S, Bassand A, Tazarourte K, Gueugniaud PY, El Khoury C, Hubert H, Chouihed T. Effect of bystander CPR initiated by a dispatch centre following out-of-hospital cardiac arrest on 30-day survival: Adjusted results from the French National Cardiac Arrest Registry. Resuscitation 2019; 144:91-98. [PMID: 31499101 DOI: 10.1016/j.resuscitation.2019.08.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/11/2019] [Accepted: 08/19/2019] [Indexed: 11/27/2022]
Abstract
AIM Cardiac arrest (CA) was considered irreversible until 1960, when basic cardiopulmonary resuscitation (CPR) was defined. CPR guidelines include early recognition of CA, rapid and effective CPR, effective defibrillation strategies and organized post-resuscitation to ensure a strengthening of the survival chain. Bystanders are the key to extremely early management, which is associated with the early medical care provided by EMS. This study aims to assess the prognosis of a bystander's cardiac CPR when it is initiated by the Dispatch Centre (DC). METHODS We included patients in 3 groups according to who initiated the CPR. The groups were matched according to multiple propensity partition methods. We presented our results in terms of 30-day survival and neurological prognosis. RESULTS 85,634 patients were included. Statistical study focused on 18,185 patients once the exclusion criteria were applied. 12,743 (70.1%) are men and the average age is 70.1 years. Survival at D30 was 5.11% in the absence of CPR, 8.86% with bystander initiation and 7.35% with DC initiation (p < 0.001). Survival at D30 with favourable neurologic prognosis (CPC 1-2) was 76.30%, 83.69% and 82.82%, respectively. Our results show a 3.75% increase in the chance of survival at D30 if CPR was initiated by bystanders compared to patients for whom CPR was not initiated, a 2.25% increase in survival in the group that received from CPR initiated by the DC compared to the group that did not receive CPR. CONCLUSIONS Bystander CPR initiated by the DC represents a suitable option following out-of-hospital cardiac arrest.
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Affiliation(s)
- Lucile Noel
- Emergency Department, University Hospital of Nancy, France
| | - Deborah Jaeger
- Emergency Department, University Hospital of Nancy, France; INSERM, Clinical Investigation Center - Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France
| | - Valentine Baert
- Univ. Lille, CHU Lille, EA2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France
| | - Guillaume Debaty
- University Grenoble Alps/CNRS/CHU de Grenoble Alpes/TIMC-IMAG UMR 5525, Grenoble, France
| | - Michael Genin
- Univ. Lille, CHU Lille, EA2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France
| | - Sonia Sadoune
- Emergency Department, University Hospital of Nancy, France
| | - Adrien Bassand
- Emergency Department, University Hospital of Nancy, France
| | - Karim Tazarourte
- Emergency "URMARS" Pole, Edouard Herriot Hospital Group, HCL, Lyon, France; Health Services and Performance Research, HESPER, EA7425, Claude Bernard University, Lyon 1, France
| | - Pierre-Yves Gueugniaud
- French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France; Emergency "URMARS" Pole, Edouard Herriot Hospital Group, HCL, Lyon, France
| | - Carlos El Khoury
- Health Services and Performance Research, HESPER, EA7425, Claude Bernard University, Lyon 1, France; Emergency Department and RESCUe Network, Lucien Hussel Hospital, France
| | - Hervé Hubert
- Univ. Lille, CHU Lille, EA2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, France; INSERM, Clinical Investigation Center - Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
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18
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Circumstances, outcome and quality of cardiopulmonary resuscitation by lifeboat crews. Resuscitation 2019; 142:104-110. [PMID: 31351088 DOI: 10.1016/j.resuscitation.2019.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/20/2019] [Accepted: 07/06/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Little is known regarding circumstances, outcomes and quality of cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) performed by operational lifeboat crews. Our aim is to evaluate circumstances, outcomes and quality of CPR performed by the Royal Dutch Lifeboat Institution (KNRM) in out-of-hospital cardiac arrest (OHCA). METHODS The internal KNRM database has been used to identify and analyse all OHCA cases between July 2011 and December 2017. A limited set of AED data was available to study the quality of CPR. RESULTS In 37 patients the lifeboat crew members have performed CPR, of which 29 (78.4%) occurred under hostile conditions. The median response time to arrive at the location was 15min. In 11 (29.7%) patients return of spontaneous circulation was achieved at any moment during CPR and 3 (8.1%) patients were still alive after one month. The lifeboat AED was used in 12 patients. Their recordings show a high median compression frequency (120, IQR 111-131) and prolonged median interruption periods (pre-analysis pause 11s (IQR 10-13), post-analysis pause 4s (IQR 3-8), pre-shock pause 24s (IQR 19-26), post-shock pause 6s (IQR 6-11), ventilation pause 6s (IQR 4-8) and other pauses 9s (IQR 4-17)). CONCLUSIONS Compared to most out-of-hospital resuscitations, resuscitations by lifeboat crews have a low incidence, occur under difficult circumstances and in a younger population. AED's on lifeboats have not contributed to any of the survivals. Analysis of AED information can be used to study the quality of CPR and provide input for improving future training of lifeboat crews.
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19
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Trethewey SP, Vyas H, Evans S, Hall M, Melody T, Perkins GD, Couper K. The impact of resuscitation guideline terminology on quality of dispatcher-assisted cardiopulmonary resuscitation: A randomised controlled manikin study. Resuscitation 2019; 142:91-96. [PMID: 31330198 DOI: 10.1016/j.resuscitation.2019.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/08/2019] [Accepted: 07/10/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) guidelines vary in the terminology used to describe target chest compression depth, which may impact CPR quality. We investigated the impact of using different chest compression depth instruction terminologies on CPR quality. METHODS We conducted a parallel group, three-arm, randomised controlled manikin trial in which individuals without recent CPR training were instructed to deliver compression-only CPR for 2-min based on a standardised dispatcher-assisted CPR script. Participants were randomised in a 1:1:1 ratio to receive CPR delivery instructions that instructed them to deliver chest compressions based on the following terminologies: 'press at least 5 cm', 'press approximately 5 cm' or 'press hard and fast.' The primary outcome was compression depth, measured in millimetres. RESULTS Between October 2017 and June 2018, 330 participants were randomised to 'at least 5 cm' (n = 109), 'approximately 5 cm' (n = 110) and 'hard and fast' (n = 111), in which mean chest compression depth was 40.9 mm (SD 13.8), 35.4 mm (SD 14.1), and 46.8 mm (SD 15.0) respectively. Mean difference in chest compression depth between 'at least 5 cm' and 'approximately 5 cm' was 5.45 (95% confidence interval (95% CI) 0.78-10.12), between 'hard and fast' and 'approximately 5 cm' was 11.32 (95% CI 6.65-15.99), and between 'hard and fast' and 'at least 5 cm' was 5.87 (95% CI 1.21-10.53). Chest compression rate and count were both highest in the 'hard and fast' group. CONCLUSIONS The use of 'hard and fast' terminology was superior to both 'at least 5 cm' and 'approximately 5 cm' terminologies. TRIAL REGISTRATION ISRCTN15128211.
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Affiliation(s)
- Samuel P Trethewey
- Critical Care Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hrushikesh Vyas
- Critical Care Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah Evans
- Critical Care Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michelle Hall
- Critical Care Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Teresa Melody
- Critical Care Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gavin D Perkins
- Critical Care Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Keith Couper
- Critical Care Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
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Smereka J, Iskrzycki Ł, Makomaska-Szaroszyk E, Bielski K, Frass M, Robak O, Ruetzler K, Czekajło M, Rodríguez-Núnez A, López-Herce J, Szarpak Ł. The effect of chest compression frequency on the quality of resuscitation by lifeguards. A prospective randomized crossover multicenter simulation trial. Cardiol J 2018; 26:769-776. [PMID: 30338845 DOI: 10.5603/cj.a2018.0121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/16/2018] [Accepted: 10/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The ability to perform high-quality cardiopulmonary resuscitation is one of the basic skills for lifeguards. The aim of the study was to assess the influence of chest compression frequency on the quality of the parameters of chest compressions performed by lifeguards. METHODS This prospective observational, randomized, crossover simulation study was performed with 40 lifeguards working in Warsaw, Wroclaw, and Poznan, Poland. The subjects then participated in a target study, in which they were asked to perform 2-min cycles of metronome-guided chest compressions at different rates: 80, 90, 100, 110, 120, 130, 140, and 150 compressions per minute (CPM). RESULTS The study involved 40 lifeguards. Optimal chest compression score calculated by manikin software was achieved for 110-120 CPM. Chest compression depth achieved 53 (interquartile range [IQR] 52-54) mm, 56 (IQR 54-57) mm, 52.5 (IQR 50-54) mm, 53 (IQR 52-53) mm, 50 (IQR 49-51) mm, 47 (IQR 44-51) mm, 41 (IQR 40-42) mm, 38 (IQR 38-43) mm for 80, 90, 100, 110, 120, 130, 140 and 150 CPM, respectively. The percentage of chest compressions with the correct depth was lower for rates exceeding 120 CPM. CONCLUSIONS The rate of 100-120 CPM, as recommended by international guidelines, is the optimal chest compression rate for cardiopulmonary resuscitation performed by lifeguards. A rate above 120 CPM was associated with a dramatic decrease in chest compression depth and overall chest compression quality. The role of full chest recoil should be emphasized in basic life support training.
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Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland., Wroclaw, Poland
| | - Łukasz Iskrzycki
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland., Wroclaw, Poland
| | | | | | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesia, Cleveland Clinic, Cleveland, OH, USA., Cleveland, United States
| | - Michael Czekajło
- Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, VA, USA, Richmond, United States
| | - Antonio Rodríguez-Núnez
- Paediatric Emergency and Critical Care Division, Paediatric Area Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain., Santiago de Compostela, Spain
| | - Jesús López-Herce
- Paediatric Intensive Care Department, Hospital General Universitario Gregorio Marannón, Medical School, Complutense University of Madrid, Madrid, Spain., Madrid, Spain
| | - Łukasz Szarpak
- Lazarski University, Warsaw, Poland. .,Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, VA, USA, Richmond, United States.
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