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Maurer H, Masterson S, Tjelmeland IBM, Strömsöe A, Ortiz FR, Gräsner JT, Wnent J. EuReCa - The European Registry of Cardiac Arrest and the related studies. Resusc Plus 2024; 19:100666. [PMID: 38827274 PMCID: PMC11143888 DOI: 10.1016/j.resplu.2024.100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major health issue throughout Europe. Due to limited knowledge about the epidemiology of OHCA in Europe, in 2011, the European Registry of Cardiac Arrest (EuReCa) project was established. Initially based on existing resuscitation registries in a few countries, the network expanded and in October 2014 the EuReCa ONE study was launched, bringing together 27 countries and showing that appropriate data acquisition (10,682 cases submitted) is feasible within Europe. EuReCa TWO was conducted from October to December 2017 and included 37,054 cases. EuReCa THREE data collection was carried out from September to November 2022 and data analysis is currently being conducted. EuReCa TWO and THREE studies generated more robust data, with both studies covering 3-month periods in 28 countries, respectively. While EuReCa TWO focused on the bystander, EuReCa THREE investigated the impact of time-related aspects (time from call to scene, time at scene, transport times and other) on resuscitation outcomes. EuReCa is a network supporting countries in their ambition to establishing continuously running registries as quality management tools and for scientific work.
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Affiliation(s)
- Holger Maurer
- University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Siobhán Masterson
- National Ambulance Service and National University of Ireland Galway (on behalf of the Out-of-Hospital Cardiac Arrest Register (OHCAR)), Ireland
| | - Ingvild Beathe Myrhaugen Tjelmeland
- Division of Prehospital Services, Oslo University Hospital, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Anneli Strömsöe
- School of Education, Health and Social Studies, Dalarna University, S-79188 Falun, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, S-79182 Falun, Sweden
- Department of Prehospital Care, Region of Dalarna, S-79129 Falun, Sweden
| | - Fernando Rosell Ortiz
- Servicio de Emergencias 061, Centro de Investigación Biomédica de La Rioja (CIBIR), C/ Piqueras 96, Hospital San Pedro, 26005 Logroño, Spain
| | - Jan-Thorsten Gräsner
- University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Holzkoppelweg 8-12, 24118 Kiel, Germany
- University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Arnold-Heller-Str. 3, Haus R3, 24105 Kiel, Germany
| | - Jan Wnent
- University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Holzkoppelweg 8-12, 24118 Kiel, Germany
- University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Arnold-Heller-Str. 3, Haus R3, 24105 Kiel, Germany
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Katzenschlager S, Elshaer A, Metelmann B, Metelmann C, Thilakasiri K, Karageorgos V, Barry T, Alm-Kruse K, Karim H, Maurer H, Kramer-Johansen J, Orlob S. Top 5 barriers in cardiac arrest research as perceived by international early career researchers - A consensus study. Resusc Plus 2024; 18:100608. [PMID: 38524147 PMCID: PMC10957401 DOI: 10.1016/j.resplu.2024.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Aim of the study Cardiac arrest research has not received as much scientific attention as research on other topics. Here, we aimed to identify cardiac arrest research barriers from the perspective of an international group of early career researchers. Methods Attendees of the 2022 international masterclass on cardiac arrest registry research accompanied the Global Out-of-Hospital Cardiac Arrest Registry collaborative meeting in Utstein, Norway, and used an adapted hybrid nominal group technique to obtain a diverse and comprehensive perspective. Barriers were identified using a web-based questionnaire and discussed and ranked during an in-person follow-up meeting. After each response was discussed and clarified, barriers were categorized and ranked over two rounds. Each participant scored these from 1 (least significant) to 5 (most significant). Results Nine participants generated 36 responses, forming seven overall categories of cardiac arrest research barriers. "Allocated research time" was ranked first in both rounds. "Scientific environment", including appropriate mentorship and support systems, ranked second in the final ranking. "Resources", including funding and infrastructure, ranked third. "Access to and availability of cardiac arrest research data" was the fourth-ranked barrier. This included data from the cardiac arrest registries, medical devices, and clinical studies. Finally, "uniqueness" was the fifth-ranked barrier. This included ethical issues, patient recruitment challenges, and unique characteristics of cardiac arrest. Conclusion By identifying cardiac arrest research barriers and suggesting solutions, this study may act as a tool for stakeholders to focus on helping early career researchers overcome these barriers, thus paving the road for future research.
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Affiliation(s)
- Stephan Katzenschlager
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Ahmed Elshaer
- The Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bibiana Metelmann
- Department of Anaesthesiology, Greifswald University Medicine, Greifswald, Germany
| | - Camilla Metelmann
- Department of Anaesthesiology, Greifswald University Medicine, Greifswald, Germany
| | - Kaushila Thilakasiri
- Oxford University Hospitals NHS Trust Oxford UK, Postgraduate Institute of Medicine, UK
- University of Colombo, Ministry of Health, Sri Lanka
| | - Vlasios Karageorgos
- Cardiopulmonary Resuscitation Lab, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Kristin Alm-Kruse
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hritul Karim
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Holger Maurer
- Department of Anesthesiology and Intensive Care Medicine, University of Luebeck, Luebeck, Germany
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) , Norway
- Norwegian Cardiac Arrest Registry, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Simon Orlob
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
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An S, Liu Y, Xi Q, Zhang Y, Gao Y, Zhang W. Standard cardiopulmonary resuscitation versus chest compressions only after out-of-hospital cardiac arrest: a protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e079167. [PMID: 38724047 PMCID: PMC11086416 DOI: 10.1136/bmjopen-2023-079167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The 2020 American Heart Association guidelines encourage lay rescuers to provide chest compression-only cardiopulmonary resuscitation to simplify the process and encourage cardiopulmonary resuscitation initiation. However, recent clinical trials had contradictory results about chest compression-only cardiopulmonary resuscitation. This study will aim to compare standard and chest compressions-only cardiopulmonary resuscitation after out-of-hospital cardiac arrest. METHODS AND ANALYSIS This study will retrieve only randomised and quasi-randomised controlled trials from the Cochrane Library, PubMed, Web of Science and Embase databases. Data on study design, participant characteristics, intervention details and outcomes will be extracted by a unified standard form. Primary outcomes to be assessed are hospital admission, discharge, and 30-day survival, and return of spontaneous circulation. The Grading of Recommendations, Assessment, Development and Evaluation framework will evaluate the quality of evidence. Cochrane's tool for assessing the risk of bias will evaluate risk deviation. If the I2 statistic is lower than 40%, the fixed-effects model will be used for meta-analysis. Otherwise, the random-effects model will be used. The search will be performed following the publication of this protocol (estimated to occur on 30 December 2024). DISCUSSION This study will evaluate the effect of chest compression-only cardiopulmonary resuscitation after out-of-hospital cardiac arrest and provide evidence for cardiopulmonary resuscitation guidelines. ETHICS AND DISSEMINATION No patient or public entity will be involved in this study. Therefore, the study does not need to be ethically reviewed. The results of the study will be disseminated through peer-reviewed journal publications and committee conferences. PROSPERO REGISTRATION NUMBER CRD42021295507.
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Affiliation(s)
- Shulin An
- Department of Emergency Medicine and West China School of Nursing, Disaster Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Yi Liu
- Department of Emergency Medicine and West China School of Nursing, Disaster Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Qian Xi
- Department of Emergency Medicine and West China School of Nursing, Disaster Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Yongqing Zhang
- Department of Emergency Medicine and West China School of Nursing, Disaster Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Yongli Gao
- Department of Emergency Medicine and West China School of Nursing, Disaster Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Wei Zhang
- Department of Emergency Medicine and West China School of Nursing, Disaster Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
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Masterson S. The European Resuscitation Council Cardiac Arrest Dashboard Service - Visualising out-of-hospital cardiac arrest data across Europe. Resusc Plus 2024; 17:100520. [PMID: 38162990 PMCID: PMC10755460 DOI: 10.1016/j.resplu.2023.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Siobhán Masterson
- National Ambulance Service, Health Service Executive, Dooradoyle House, Dooradoyle, Limerick, Ireland
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Katzenschlager S, Kelpanides IK, Ristau P, Huck M, Seewald S, Brenner S, Hoffmann F, Wnent J, Kramer-Johansen J, Tjelmeland IBM, Weigand MA, Gräsner JT, Popp E. Out-of-hospital cardiac arrest in children: an epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation. Crit Care 2023; 27:349. [PMID: 37679812 PMCID: PMC10485980 DOI: 10.1186/s13054-023-04630-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
AIM This work provides an epidemiological overview of out-of-hospital cardiac arrest (OHCA) in children in Germany between 2007 and 2021. We wanted to identify modifiable factors associated with survival. METHODS Data from the German Resuscitation Registry (GRR) were used, and we included patients registered between 1st January 2007 and 31st December 2021. We included children aged between > 7 days and 17 years, where cardiopulmonary resuscitation (CPR) was started, and treatment was continued by emergency medical services (EMS). Incidences and descriptive analyses are presented for the overall cohort and each age group. Multivariate binary logistic regression was performed on the whole cohort to determine the influence of (1) CPR with/without ventilation started by bystander, (2) OHCA witnessed status and (3) night-time on the outcome hospital admission with return of spontaneous circulation (ROSC). RESULTS OHCA in children aged < 1 year had the highest incidence of the same age group, with 23.42 per 100 000. Overall, hypoxia was the leading presumed cause of OHCA, whereas trauma and drowning accounted for a high proportion in children aged > 1 year. Bystander-witnessed OHCA and bystander CPR rate were highest in children aged 1-4 years, with 43.9% and 62.3%, respectively. In reference to EMS-started CPR, bystander CPR with ventilation were associated with an increased odds ratio for ROSC at hospital admission after adjusting for age, sex, year of OHCA and location of OHCA. CONCLUSION This study provides an epidemiological overview of OHCA in children in Germany and identifies bystander CPR with ventilation as one primary factor for survival. Trial registrations German Clinical Trial Register: DRKS00030989, December 28th 2022.
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Affiliation(s)
- Stephan Katzenschlager
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Inga K Kelpanides
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Patrick Ristau
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Huck
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sebastian Brenner
- Department of Pediatric and Adolescent Medicine, University Clinic Carl Gustav Carus, Dresden, Germany
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. Von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- School of Medicine, University of Namibia, Windhoek, Namibia
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Ingvild B M Tjelmeland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Markus A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Erik Popp
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
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European Registry of Cardiac Arrest - Study-THREE (EuReCa THREE) - An international, prospective, multi-centre, three-month survey of epidemiology, treatment and outcome of patients with out-of-hospital cardiac arrest in Europe - The study protocol. Resusc Plus 2022; 12:100314. [PMID: 36238583 PMCID: PMC9551137 DOI: 10.1016/j.resplu.2022.100314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background The aim of the European Registry of Cardiac Arrest (EuReCa) network is to provide high quality evidence on epidemiology of out-of-hospital cardiac arrest (OHCA) in Europe by supporting and developing cardiac arrest registries and performing European-wide studies. To date, the EuReCa ONE and EuReCa TWO studies have involved around 28 countries, with population covered increasing from the first to the second study. The aim of the EuReCa THREE study is to build on previous work and to support the promotion of quality data collection on OHCA throughout Europe. Methods/design EuReCa THREE will be the third prospective cohort study on epidemiology of OHCA and will involve around 30 European countries. The study will be conducted between 1st September and 30th November 2022. Data will be collected on cardiac arrest cases attended, resuscitation attempted, patient and cardiac arrest event characteristics and outcomes (including return of spontaneous circulation, status on hospital arrival and discharge). A particular focus for EuReCa THREE will be to describe key time intervals in OHCA management; time from call to EMS arrival on scene, time from cardiac arrest to start CPR, time from EMS arrival to delivery of patient to hospital.EuReCa THREE was registered with the German Registry of Clinical Trials Registration Number: DRKS00028591 searchable via WHO meta-registry (https://apps.who.int/trialsearch/). Discussion The EuReCa THREE study will increase our knowledge on longitudinal OHCA epidemiology and provide new knowledge on crucial time intervals in OHCA management in Europe. However, the primary aim of building a network to support quality data on OHCA, remains the central tenant of the EuReCa project.
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Heffernan E, Keegan D, Mc Sharry J, Barry T, Tugwell P, Murphy AW, Deasy C, Menzies D, O'Donnell C, Masterson S. Community first response and out-of-hospital cardiac arrest: Identifying priorities for data collection, analysis, and use via the nominal group technique. Resusc Plus 2022; 9:100197. [PMID: 35059679 PMCID: PMC8760509 DOI: 10.1016/j.resplu.2021.100197] [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: 09/20/2021] [Revised: 12/06/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022] Open
Abstract
AIM Community First Response (CFR) is an important component of Out-of-hospital Cardiac Arrest management in many countries, including Ireland. Reliable, strategic data collection and analysis are required to support the development of CFR. However, data on CFR are currently limited in Ireland and internationally. This research aimed to identify the most important CFR data to record, the most important uses of CFR data, and barriers and facilitators to CFR data collection and use. METHODS The Nominal Group Technique structured consensus process was used. An expert panel comprising key stakeholders, including volunteers, clinicians, researchers, policy-makers, and a patient, completed a survey to generate lists of the most important CFR data to record and the most important uses of CFR data. Subsequently, they participated in a consensus meeting to agree the top ten priorities from each list. They also identified barriers and facilitators to CFR data collection and use. RESULTS The top ten CFR data items to record included volunteer response time, interventions/activities completed by volunteers, and the mental/physical impact on volunteers. The top ten most important uses of CFR data included providing feedback to volunteers, improving volunteer training, and measuring CFR effectiveness. Barriers included time constraints and limited training. Facilitators included having appropriate software/equipment and collecting minimal data. CONCLUSION The results can guide CFR research and inform the development of CFR data collection and analysis policy and practice in Ireland and internationally. Ultimately, improving CFR data collection and use will help to optimise this important intervention and enhance its evidence base.
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Affiliation(s)
- Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Dylan Keegan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Tomás Barry
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The World Health Organization Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrew W. Murphy
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Conor Deasy
- Cork University Hospital, Cork, Ireland
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - David Menzies
- St Vincent’s University Hospital, Dublin, Ireland
- CFR Ireland, Ireland
| | | | - Siobhan Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Cork University Hospital, Cork, Ireland
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Tjelmeland IBM, Alm-Kruse K, Grasner JT, Isern CB, Jakisch B, Kramer-Johansen J, Renzing N, Wnent J, Seewald S. Importance of reporting survival as incidence: a cross-sectional comparative study on out-of-hospital cardiac arrest registry data from Germany and Norway. BMJ Open 2022; 12:e058381. [PMID: 35177465 PMCID: PMC8860078 DOI: 10.1136/bmjopen-2021-058381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Health registries are a unique source of information about current practice and can describe disease burden in a population. We aimed to understand similarities and differences in the German Resuscitation Registry (GRR) and the Norwegian Cardiac Arrest Registry (NorCAR) and compare incidence and survival for patients resuscitated after out-of-hospital cardiac arrest. DESIGN A cross-sectional comparative analysis reporting incidence and outcome on a population level. SETTING We included data from the cardiac arrest registries in Germany and Norway. PARTICIPANTS Patients resuscitated between 1 January 2015 and 31 December 2019 were included, resulting in 29 222 cases from GRR and 16 406 cases from NorCAR. From GRR, only emergency medical services (EMS) reporting survival information for patients admitted to the hospital were included. PRIMARY AND SECONDARY OUTCOME MEASURES This study focused on the EMS systems, the registries and the patients included in both registries. The results compare the total incidence, incidence of patients resuscitated by EMS, and the incidence of survival. RESULTS We found an incidence of 68 per 100 000 inhabitants in GRR and 63 in NorCAR. The incidence of patients treated by EMS was 67 in GRR and 53 in NorCAR. The incidence of patients arriving at a hospital was higher in GRR (24.3) than in NorCAR (15.1), but survival was similar (8 in GRR and 7.8 in NorCAR). CONCLUSION GRR is a voluntary registry, and in-hospital information is not reported for all cases. NorCAR has mandatory reporting from all EMS and hospitals. EMS in Germany starts treatment on more patients and bring a higher number to hospital, but we found no difference in the incidence of survival. This study has improved our knowledge of both registries and highlighted the importance of reporting survival as incidence when comparing registries.
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Affiliation(s)
- Ingvild Beathe Myrhaugen Tjelmeland
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin Alm-Kruse
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Jan-Thorsten Grasner
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Cecilie Benedicte Isern
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Barbara Jakisch
- Organization & Corporate Development, imland gGmbH, Rendsburg, Schleswig-Holstein, Germany
| | - Jo Kramer-Johansen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Niels Renzing
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- University of Namibia School of Medicine, Windhoek, Namibia
| | - Stephan Seewald
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Grubic N, Hill B, Phelan D, Baggish A, Dorian P, Johri AM. Bystander interventions and survival after exercise-related sudden cardiac arrest: a systematic review. Br J Sports Med 2021; 56:410-416. [PMID: 34853034 DOI: 10.1136/bjsports-2021-104623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the provision of bystander interventions and rates of survival after exercise-related sudden cardiac arrest (SCA). DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, Cochrane Library and grey literature sources were searched from inception to November/December 2020. STUDY ELIGIBILITY CRITERIA Observational studies assessing a population of exercise-related SCA (out-of-hospital cardiac arrests that occurred during exercise or within 1 hour of cessation of activity), where bystander cardiopulmonary resuscitation (CPR) and/or automated external defibrillator (AED) use were reported, and survival outcomes were ascertained. METHODS Among all included studies, the median (IQR) proportions of bystander CPR and bystander AED use, as well as median (IQR) rate of survival to hospital discharge, were calculated. RESULTS A total of 29 studies were included in this review, with a median study duration of 78.7 months and a median sample size of 91. Most exercise-related SCA patients were male (median: 92%, IQR: 86%-96%), middle-aged (median: 51, IQR: 39-56 years), and presented with a shockable arrest rhythm (median: 78%, IQR: 62%-86%). Bystander CPR was initiated in a median of 71% (IQR: 59%-87%) of arrests, whereas bystander AED use occurred in a median of 31% (IQR: 19%-42%) of arrests. Among the 19 studies that reported survival to hospital discharge, the median rate of survival was 32% (IQR: 24%-49%). Studies which evaluated the relationship between bystander interventions and survival outcomes reported that both bystander CPR and AED use were associated with survival after exercise-related SCA. CONCLUSION Exercise-related SCA occurs predominantly in males and presents with a shockable ventricular arrhythmia in most cases, emphasising the importance of rapid access to defibrillation. Further efforts are needed to promote early recognition and a rapid bystander response to exercise-related SCA.
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Affiliation(s)
- Nicholas Grubic
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada .,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Dermot Phelan
- Sports Cardiology Center, Atrium Health Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Case completeness in the Norwegian Cardiac Arrest Registry. Resusc Plus 2021; 8:100182. [PMID: 34825238 PMCID: PMC8605216 DOI: 10.1016/j.resplu.2021.100182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction This study aimed to assess the case completeness of out-of-hospital cardiac arrests (OHCA) in the Norwegian Cardiac Arrest Registry (NorCAR) and describe the differences between the registered and missing patients identified from the case-control assessment. Methods We identified the relevant patients in the Norwegian Patient Registry and the Norwegian Cause of Death Registry and compared them with the patients in NorCAR. Data processors used patient records to confirm if the potential cardiac arrest cases met the inclusion criteria in NorCAR. Results Between 2015 and 2017, 8612 OHCA patients were registered in NorCAR. Through the Patient Registry and the Cause of Death Registry we identified 11,114 potential OHCA patients, 3469 of these were already registered in NorCAR. After evaluating the patient records for the remaining 7645 patients, we found 344 patients (4%), were eligible for inclusion in NorCAR, giving a case completeness of 96%. The registered and missing patients were similar in age and gender distribution. Initial shockable rhythm and presumed cause were also comparable. However, the missing patients more frequently achieved return of spontaneous circulation, were more often transported to hospital, and had higher survival rates. The already registered patients had more key variables registered than the missing patients. Conclusion Our results indicate high case completeness in NorCAR. The missing patients were too few to introduce significant changes in the distribution of patient characteristics, indicating that NorCAR is representative of the Norwegian OHCA population.
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Riva G, Hollenberg J. Different forms of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest. J Intern Med 2021; 290:57-72. [PMID: 33527546 DOI: 10.1111/joim.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/24/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world with an estimated number of 275 000 treated with resuscitation attempts by the Emergency Medical Services (EMS) in Europe each year. Overall survival rates remain low, and most studies indicate that around 1 out 10 will survive to 30 days. Amongst the strongest factors associated with survival in OHCA is first recorded rhythm amendable to defibrillation, early defibrillation and prompt initiation of cardiopulmonary resuscitation (CPR). Overall, CPR started prior to EMS arrival has repeatedly been shown to be associated with survival rates 2-3 times higher compared with no such initiation. The primary goal of CPR is to generate sufficient blood flow to vital organs, mainly the brain and heart, until restoration of spontaneous circulation can be achieved. Barriers to the initiation of CPR by bystanders in OHCA include fear of being incapable, causing harm, and transmission of infectious diseases. Partly due to these barriers, and low rates of CPR, the concept of CPR with compression only was proposed as a simpler form of resuscitation with the aim to be more widely accepted by the public in the 1990s. But how reliable is the evidence supporting this simpler form of CPR, and are the outcomes after CO-CPR comparable to standard CPR?
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Affiliation(s)
- G Riva
- From the, Department of Cardiology, Karolinska Institutet, Solna, Sweden
| | - J Hollenberg
- From the, Department of Cardiology, Karolinska Institutet, Solna, Sweden
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To ventilate or not to ventilate during bystander CPR - A EuReCa TWO analysis. Resuscitation 2021; 166:101-109. [PMID: 34146622 DOI: 10.1016/j.resuscitation.2021.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/25/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). METHOD In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. RESULTS A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17-1.83). CONCLUSION In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both.
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Perkins GD, Gräsner JT, Bray J, Iwami T, Nolan JP. Reply letter to: Utstein-style and the importance of the system, is it time for a new Utstein revision? Resuscitation 2021; 165:198. [PMID: 34118350 DOI: 10.1016/j.resuscitation.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Janet Bray
- Emile Vanderveldelaan 35, 2845 Niel, Belgium
| | - Taku Iwami
- Emile Vanderveldelaan 35, 2845 Niel, Belgium
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- Emile Vanderveldelaan 35, 2845 Niel, Belgium
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Abstract
In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in and out of hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to inform health system planning and responses to cardiac arrest.
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Lee J, Lee W, Lee YJ, Sim H, Lee WK. Effectiveness of bystander cardiopulmonary resuscitation in improving the survival and neurological recovery of patients with out-of-hospital cardiac arrest: A nationwide patient cohort study. PLoS One 2020; 15:e0243757. [PMID: 33326454 PMCID: PMC7744051 DOI: 10.1371/journal.pone.0243757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Few studies have focused on enhancing causality and yielding unbiased estimates on the effectiveness of bystander cardiopulmonary resuscitation (BCPR) on the outcomes of out-of-hospital cardiac arrest (OHCA) in a real-world setting. Therefore, this study evaluated the effect of BCPR on the outcomes of OHCA and its differences according to the characteristics of OHCA. METHODS This study enrolled all patients with OHCA of cardiac etiology treated by emergency medical services (EMS) in Korea from 2012 to 2015. The endpoints were survival and neurological recovery at discharge, and the main exposure was BCPR conducted by a layperson. The effect of BCPR was analyzed after adjusting for confounders, determined using a directed acyclic graph, by inverse probability of treatment weighting (IPTW) and model-based standardization (STR). Moreover, differences in subgroups and time trends were evaluated. RESULTS Among 10,505 eligible patients after excluding those with missing data on BCPR, 7,721 patients received BCPR, accounting for 74.3% of EMS-treated OHCA patients. BCPR increased the odds of survival and good neurological recovery at discharge by 1.67- (95% confidence interval (CI): 1.44-1.93) and 1.93- (95% CI: 1.56-2.39) fold, respectively, in the IPTW analysis. These findings were comparable to those obtained with STR. The odds ratios were 2.39 (95% CI: 1.91-2.94) and 2.70 (95% CI: 1.94-3.41), respectively, in the sensitivity analysis of the missing BCPR information considering confounders and the outcome variable. However, the effect of qualified BCPR was not evenly distributed, and it did not increase with time. BCPR was likely to be more effective in male patients aged <65 years, those who experienced an OHCA in a private place or non-capital region, and those with shockable rhythm at the scene. CONCLUSION Based on data from a nationwide registry, the estimated effect of BCPR on survival and neurological recovery was moderate and did not improve from 2012 to 2015.
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Affiliation(s)
- Joongyub Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Woojoo Lee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Yu Jin Lee
- Department of Emergency Medicine, Inha University Hospital, School of Medicine, Inha University, Incheon, South Korea
| | - Hyunman Sim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Won Kyung Lee
- Department of Prevention and Management, Inha University Hospital, School of Medicine, Inha University, Incheon, South Korea
- * E-mail:
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Vercammen S, Moens E. Cost-effectiveness of a novel smartphone application to mobilize first responders after witnessed OHCA in Belgium. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:52. [PMID: 33292296 PMCID: PMC7673090 DOI: 10.1186/s12962-020-00248-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background EVapp (Emergency Volunteer Application) is a Belgian smartphone application that mobilizes volunteers to perform cardiopulmonary resuscitation (CPR) and defibrillation with publicly available automatic external defibrillators (AED) after an emergency call for suspected out of hospital cardiac arrest (OHCA). The aim is to bridge the time before the arrival of the emergency services. Methods An accessible model was developed, using literature data, to simulate survival and cost-effectiveness of nation-wide EVapp implementation. Initial validation was performed using field data from a first pilot study of EVapp implementation in a city in Flanders, covering 2.5 years of implementation. Results Simulation of nation-wide EVapp implementation resulted in an additional yearly 910 QALY gained over the current baseline case scenario (worst case 632; best case 3204). The cost per QALY associated with EVapp implementation was comparable to the baseline scenario, i.e., 17 vs 18 k€ QALY−1. Conclusions EVapp implementation was associated with a positive balance on amount of QALY gained and cost of QALY. This was a consequence of both the lower healthcare costs for patients with good neurological outcome and the more efficient use of yet available resources, which did not outweigh the costs of operation.
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Affiliation(s)
- Steven Vercammen
- EVapp vzw, AA Tower - 8th floor, Technologiepark 122 (zone C2a), 9052, Zwijnaarde, België.
| | - Esther Moens
- UGent, Sint-Pietersnieuwstraat 25, 9000, Gent, Belgium
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Jadhav S, Gaddam S. Gender and location disparities in prehospital bystander AED usage. Resuscitation 2020; 158:139-142. [PMID: 33189804 DOI: 10.1016/j.resuscitation.2020.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/22/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND With bystander AED usage being critical for prehospital cardiac arrest patient outcomes, it is important to analyze if the gender and location disparities found in bystander CPR rates also exist for bystander AED usage. METHODS Using the National Emergency Medical Services Information System (NEMSIS) database, 1,144,969 bystander AED cases were analyzed on the basis of gender and location. Chi-squared testing checked for statistical significance and effect size was measured using relative risk (RR). RESULTS Using female patients as a baseline, the RR for bystander AED usage for male patients was 1.34 (95% CI [1.3310, 1.3557], p < 0.001) indicating male patients are 34% more likely to receive bystander AED usage compared to female patients. Analyzing bystander AED usage per urbanity region using urban patients as a baseline, resulted in a RR of 0.87 for suburban patients (95% CI [0.8572, 0.8833], p < 0.001), 0.39 for rural patients (95% CI [0.3849, 0.3971], p < 0.001), and 0.36 for frontier patients (95% CI [0.3515, 0.3726], p < 0.001) showing a sharp decline in the chance of bystander AED usage in rural and frontier areas. CONCLUSIONS Female patients are less likely to receive bystander AED usage compared to male patients. To resolve these disparities increased public awareness is necessary that supports AED usage on females as socially acceptable and necessary for patient outcomes. Furthermore, given bystander AED usage among males and females declined as cardiac arrest locations became more remote, improvements in rural and frontier AED availability and training are necessary to increase bystander AED usage rates in those regions.
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Affiliation(s)
- Soham Jadhav
- The University of Texas at Austin, Austin, TX, United States.
| | - Sriman Gaddam
- The University of Texas at Austin, Austin, TX, United States.
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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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Tjelmeland IBM, Alm-Kruse K, Andersson LJ, Bratland S, Hafstad AK, Haug B, Langørgen J, Larsen AI, Lindner TW, Nilsen JE, Olasveengen TM, Soreide E, Skogvoll E, Kramer-Johansen J. Cardiac arrest as a reportable condition: a cohort study of the first 6 years of the Norwegian out-of-hospital cardiac arrest registry. BMJ Open 2020; 10:e038133. [PMID: 32641339 PMCID: PMC7348469 DOI: 10.1136/bmjopen-2020-038133] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The Norwegian Cardiac Arrest Registry (NorCAR) was established in 2013 when cardiac arrest became a mandatory reportable condition. The aim of this cohort study is to describe how the world's first mandatory, population-based cardiac arrest registry evolved during its first 6 years. SETTING Norway has a total population of 5.3 million inhabitants with a population density that varies considerably. All residents are assigned a unique identifier number, giving nationally approved registries access to information about all births and deaths in the country. Data in the registry are entered by data processors; public employees with close links to the emergency medical services. All data processors undergo a standardised training and meet for yearly retraining and updates. PARTICIPANTS All events of cardiac arrest where bystanders or healthcare professionals have started cardiopulmonary resuscitation or performed defibrillation are included into the NorCAR. PRIMARY AND SECONDARY OUTCOME MEASURES Since the establishment of the registry, the number of reporting health trusts, the number of reported events and the corresponding population at risk were followed year by year. Outcome is measured as changes in inclusion rate, incidence per 100 000 inhabitants and survival to 30 days after cardiac arrest. RESULTS In total, 14 849 cases were registered over 6 years, between 2013 and 2018. The number of health trusts reporting rose steadily from 2013. Within 3 years, all trusts reported to the registry with an increasing number of events reported; going from 1101 to 3400 per year. The prevalence of bystander cardiopulmonary resuscitation increased slightly, but the population incidence of survival did not change. CONCLUSION Declaring cardiac arrest as a reportable condition and close follow-up of all reporting areas is essential when building a national registry.
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Affiliation(s)
- Ingvild Beathe Myrhaugen Tjelmeland
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig Holstein, Kiel, Germany
| | - Kristin Alm-Kruse
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars-Jøran Andersson
- Clinic of Emergency Medicine, University Hospital of North Norway, Tromso, Norway
| | - Ståle Bratland
- Clinic of Emergency Medicine, University Hospital of North Norway, Tromso, Norway
| | | | - Bjørn Haug
- Department of Cardiology, Akershus University Hospital, Lorenskog, Norway
| | - Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Werner Lindner
- Regional Competency Center for Emergency Medicine (RAKOS), Stavanger University Hospital, Stavanger, Norway
| | - Jan Erik Nilsen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Theresa M Olasveengen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Development and Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - Eldar Soreide
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Hordaland, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St. Olav University Hospital, Trondheim, Norway
| | - Jo Kramer-Johansen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study. Resuscitation 2020; 148:218-226. [DOI: 10.1016/j.resuscitation.2019.12.042] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 12/07/2019] [Accepted: 12/22/2019] [Indexed: 11/22/2022]
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Hirlekar G, Jonsson M, Karlsson T, Bäck M, Rawshani A, Hollenberg J, Albertsson P, Herlitz J. Comorbidity and bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Heart 2020; 106:1087-1093. [PMID: 31974211 PMCID: PMC7361004 DOI: 10.1136/heartjnl-2019-315954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/07/2019] [Accepted: 12/13/2019] [Indexed: 11/03/2022] Open
Abstract
Objective Cardiopulmonary resuscitation (CPR) performed before the arrival of emergency medical services (EMS) is associated with increased survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to determine whether patients who receive bystander CPR have a different comorbidity compared with patients who do not, and to determine the association between bystander CPR and 30-day survival when adjusting for such a possible difference. Methods Patients with witnessed OHCA in the Swedish Registry for Cardiopulmonary Resuscitation between 2011 and 2015 were included, and merged with the National Patient Registry. The Charlson Comorbidity Index (CCI) was used to measure comorbidity. Multiple logistic regression was used to examine the effect of CCI on the association between bystander CPR and outcome. Results In total, 11 955 patients with OHCA were included, 71% of whom received bystander CPR. Patients who received bystander CPR had somewhat lower comorbidity (CCI) than those who did not (mean±SD: 2.2±2.3 vs 2.5±2.4; p<0.0001). However, this difference in comorbidity had no influence on the association between bystander CPR and 30-day survival in a multivariable model including other possible confounders (OR 2.34 (95% CI 2.01 to 2.74) without adjustment for CCI and OR 2.32 (95% CI 1.98 to 2.71) with adjustment for CCI). Conclusion Patients who undergo CPR before the arrival of EMS have a somewhat lower degree of comorbidity than those who do not. Taking this difference into account, bystander CPR is still associated with a marked increase in 30-day survival after OHCA.
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Affiliation(s)
- Geir Hirlekar
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg, Sweden .,Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Martin Jonsson
- Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Karlsson
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Maria Bäck
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg, Sweden
| | - Jacob Hollenberg
- Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Per Albertsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Johan Herlitz
- Center for Pre-Hospital Research, University of Borås, Borås, Sweden
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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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Schriefl C, Mayr F, Poppe M, Zajicek A, Nürnberger A, Clodi C, Herkner H, Sulzgruber P, Lobmeyr E, Schober A, Holzer M, Sterz F, Uray T. Time of out-of-hospital cardiac arrest is not associated with outcome in a metropolitan area: A multicenter cohort study. Resuscitation 2019; 142:61-68. [DOI: 10.1016/j.resuscitation.2019.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/21/2019] [Accepted: 07/06/2019] [Indexed: 12/01/2022]
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