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Naboureh A, Farrokhi M, Saatchi M, Ahmadi S, Layeghi F, Khankeh H. Exploring national and international experiences with community first responder models: protocol for a scoping review. BMJ Open 2024; 14:e085071. [PMID: 39214657 DOI: 10.1136/bmjopen-2024-085071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Timely arrival of emergency medical services (EMS) is pivotal for effective prehospital care, and efforts by EMS leaders and policymakers to reduce response times, especially in cardiac arrests responsible for 70%-80% of coronary heart disease-related deaths, underscore the global urgency. With approximately 55 out-of-hospital cardiac arrests per 100 000 people annually, survival rates hinge on timely cardiopulmonary resuscitation, emphasising its initiation within a 4-6 min window. Trauma, causing 6 million deaths and nearly 40 million injuries a year, further underscores the need for prompt prehospital care. Acknowledging these challenges, health systems have incorporated community first responder (CFR) models, where trained community members provide initial aid, aiming to bridge the crucial gap until professional help arrives. This scoping review intends to explore the experiences of various countries with CFR models, including their conceptual and theoretical frameworks, recognising CFR as a critical solution for reducing response times in prehospital emergency care. METHODS AND ANALYSIS Arksey and O'Malley's approach will be followed in this scoping review. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols extension for Scoping Reviews. The study objective is to comprehensively understand and map current knowledge about CFR model characteristics and identify effective components and indicators. The review will encompass available articles indexed in PubMed, Scopus and Web of Science without restrictions on date of publication. Additional searches will explore grey literature on Google Scholar and reliable websites in the field of EMS. Articles published in languages other than English and those inaccessible in full text will not be considered for inclusion. ETHICS AND DISSEMINATION Since the study data are accessible from publicly accessible secondary sources, no ethical approval is necessary. Peer-reviewed publications will be used to report the study findings.
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Affiliation(s)
- Abbas Naboureh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Science, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Mehrdad Farrokhi
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Science, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Mohammad Saatchi
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Shokoufeh Ahmadi
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Science, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Fereydon Layeghi
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Science, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Science, Tehran, Tehran, Iran (the Islamic Republic of)
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Stockholm, Sweden
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Bray JE, Grasner JT, Nolan JP, Iwami T, Ong MEH, Finn J, McNally B, Nehme Z, Sasson C, Tijssen J, Lim SL, Tjelmeland I, Wnent J, Dicker B, Nishiyama C, Doherty Z, Welsford M, Perkins GD. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: 2024 Update of the Utstein Out-of-Hospital Cardiac Arrest Registry Template. Circulation 2024; 150:e203-e223. [PMID: 39045706 DOI: 10.1161/cir.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The Utstein Out-of-Hospital Cardiac Arrest Resuscitation Registry Template, introduced in 1991 and updated in 2004 and 2015, standardizes data collection to enable research, evaluation, and comparisons of systems of care. The impetus for the current update stemmed from significant advances in the field and insights from registry development and regional comparisons. This 2024 update involved representatives of the International Liaison Committee on Resuscitation and used a modified Delphi process. Every 2015 Utstein data element was reviewed for relevance, priority (core or supplemental), and improvement. New variables were proposed and refined. All changes were voted on for inclusion. The 2015 domains-system, dispatch, patient, process, and outcomes-were retained. Further clarity is provided for the definitions of out-of-hospital cardiac arrest attended resuscitation and attempted resuscitation. Changes reflect advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes. Time intervals such as emergency medical service response time now emphasize precise reporting of the times used. New flowcharts aid the reporting of system effectiveness for patients with an attempted resuscitation and system efficacy for the Utstein comparator group. Recognizing the varying capacities of emergency systems globally, the writing group provided a minimal dataset for settings with developing emergency medical systems. Supplementary variables are considered useful for research purposes. These revisions aim to elevate data collection and reporting transparency by registries and researchers and to advance international comparisons and collaborations. The overarching objective remains the improvement of outcomes for patients with out-of-hospital cardiac arrest.
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Grasner JT, Bray JE, Nolan JP, Iwami T, Ong MEH, Finn J, McNally B, Nehme Z, Sasson C, Tijssen J, Lim SL, Tjelmeland I, Wnent J, Dicker B, Nishiyama C, Doherty Z, Welsford M, Perkins GD. Cardiac arrest and cardiopulmonary resuscitation outcome reports: 2024 update of the Utstein Out-of-Hospital Cardiac Arrest Registry template. Resuscitation 2024; 201:110288. [PMID: 39045606 DOI: 10.1016/j.resuscitation.2024.110288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The Utstein Out-of-Hospital Cardiac Arrest Resuscitation Registry Template, introduced in 1991 and updated in 2004 and 2015, standardizes data collection to enable research, evaluation, and comparisons of systems of care. The impetus for the current update stemmed from significant advances in the field and insights from registry development and regional comparisons. This 2024 update involved representatives of the International Liaison Committee on Resuscitation and used a modified Delphi process. Every 2015 Utstein data element was reviewed for relevance, priority (core or supplemental), and improvement. New variables were proposed and refined. All changes were voted on for inclusion. The 2015 domains-system, dispatch, patient, process, and outcomes-were retained. Further clarity is provided for the definitions of out-of-hospital cardiac arrest attended resuscitation and attempted resuscitation. Changes reflect advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes. Time intervals such as emergency medical service response time now emphasize precise reporting of the times used. New flowcharts aid the reporting of system effectiveness for patients with an attempted resuscitation and system efficacy for the Utstein comparator group. Recognizing the varying capacities of emergency systems globally, the writing group provided a minimal dataset for settings with developing emergency medical systems. Supplementary variables are considered useful for research purposes. These revisions aim to elevate data collection and reporting transparency by registries and researchers and to advance international comparisons and collaborations. The overarching objective remains the improvement of outcomes for patients with out-of-hospital cardiac arrest.
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Sereno M, Couvreur R, Guenezan J, Marjanovic N, Mimoz O. Automatic mobile phone alerting of citizen rescuers using a nationally deployed software can improve neurological outcome and survival of out-of-hospital cardiac arrest. Resuscitation 2024; 202:110326. [PMID: 39029578 DOI: 10.1016/j.resuscitation.2024.110326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Affiliation(s)
- Maxime Sereno
- CHU de Poitiers, Service des Urgences adultes - SAMU - SMUR, Poitiers, France
| | - Raphael Couvreur
- CHU de Poitiers, Service des Urgences adultes - SAMU - SMUR, Poitiers, France
| | - Jérémy Guenezan
- CHU de Poitiers, Service des Urgences adultes - SAMU - SMUR, Poitiers, France; Université de Poitiers, Faculté de Médecine, Poitiers, France
| | - Nicolas Marjanovic
- CHU de Poitiers, Service des Urgences adultes - SAMU - SMUR, Poitiers, France; Université de Poitiers, Faculté de Médecine, Poitiers, France.
| | - Olivier Mimoz
- CHU de Poitiers, Service des Urgences adultes - SAMU - SMUR, Poitiers, France; Université de Poitiers, Faculté de Médecine, Poitiers, France
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Allert C, Nilsson B, Svensson A, Andersson EK. Voluntary first responders' experiences of being dispatched to suspected out-of-hospital cardiac arrest in rural areas: an interview study. BMC Cardiovasc Disord 2024; 24:157. [PMID: 38486144 PMCID: PMC10938808 DOI: 10.1186/s12872-024-03826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a leading cause of death, and survival outcomes vary across countries and regions. To improve survival, the European Resuscitation Council Guidelines encourage the implementation of technologies like smartphone applications to alert voluntary first responders (VFRs) who are near a suspected OHCA. VFRs are of great importance in the ´chain of survival´, but there is still a lack of knowledge about their experiences; especially of those operating in rural areas. Understanding those experiences is crucial in developing appropriate interventions to train, encourage, and safeguard VFRs in their mission. Therefore, the aim of this study was to describe VFRs´ experiences of being dispatched to suspected OHCA in rural areas. METHODS The study used an inductive design. The data were collected using individual interviews with 16 VFRs and analysed using qualitative content analysis. RESULTS The results are presented in terms of six generic categories ''Being motivated and prepared'', ''Having strategies to undertake the mission'', ''Collaborating with others'', ''Being ethically aware'', ''Supporting the family members'', and ''Coping with the mission'', which formed the basis of the main category 'Desire to save lives and help others'. The findings showed that VFRs had a genuine desire to contribute to save lives in this rural area. Regardless of the circumstances, they were prepared to leave everything and act to the best for the victim and their family members. In theirs' missions they collaborated with others at the scene and were guided by ethics while they acted in complex circumstances. CONCLUSIONS VFRs dispatched in rural areas express a desire to save lives. In their missions, they acted in complex situations and experienced both emotional and ethical challenges. The design, implementation, and evaluation of support interventions directed at VFRs should be prioritised, especially in rural areas, as it can contribute to more people becoming and remaining VFRs, which in turn could contribute to sustainable development.
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Affiliation(s)
- Camilla Allert
- Department of Health and Caring Sciences, University Lecturer Faculty of Health and Life Sciences Linnaeus University, 392 31, Växjö/Kalmar, Sweden.
- Centre of Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden.
| | - Bengt Nilsson
- Department of Forestry and Wood Technology, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Agunnaryd Voluntary Fire Brigade, Ljungby, Sweden
| | - Anders Svensson
- Department of Health and Caring Sciences, University Lecturer Faculty of Health and Life Sciences Linnaeus University, 392 31, Växjö/Kalmar, Sweden
- Centre of Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Department of Ambulance Service, Region Kronoberg, Växjö, Sweden
| | - Ewa K Andersson
- Department of Health and Caring Sciences, University Lecturer Faculty of Health and Life Sciences Linnaeus University, 392 31, Växjö/Kalmar, Sweden
- Centre of Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
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Dainty KN, Yng Ng Y, Pin Pek P, Koster RW, Eng Hock Ong M. Wolf creek XVII part 4: Amplifying lay-rescuer response. Resusc Plus 2024; 17:100547. [PMID: 38292468 PMCID: PMC10827540 DOI: 10.1016/j.resplu.2023.100547] [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: 02/01/2024] Open
Abstract
Introduction Amplifying lay-rescuer response is a key priority to increase survival from out-of-hospital cardiac arrest (OHCA). We describe the current state of lay-rescuer response, how we envision the future, and the gaps, barriers, and research priorities that will amplify response to OHCA. Methods 'Amplifying Lay-Rescuer Response' was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17, 2023, in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of cardiac arrest resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results The top five knowledge gaps as ranked by the panel, reflected a recognition of the need to better understand the psycho-social aspects of lay response. The top five barriers to translation reflected issues at the individual, community, societal, structural, and governmental levels. The top five research priorities were focused on understanding the social/psychological and emotional barriers to action, finding the most effective/cost-effective strategies to educate lay persons and implement community life-saving interventions, evaluation of new technological solutions and how to enhance the role of dispatch working with lay-rescuers. Conclusion Future research in lay rescuer response should incorporate technology innovations, understand the "humanity" of the situation, leverage implementation science and systems thinking to save lives. This will require the field of resuscitation to engage with scholars outside our traditional ranks and to be open to new ways of thinking about old problems.
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Affiliation(s)
- Katie N. Dainty
- Patient-Centered Outcomes, North York General Hospital Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Yih Yng Ng
- Digital and Smart Health Office, Ng Teng Fong Centre for Healthcare Innovation Department of Preventive and Population Medicine, Tan Tock Seng Hospital Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Pin Pin Pek
- Prehospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School Department of Emergency Medicine, Singapore General Hospital Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rudolph W. Koster
- Department of Cardiology, Amsterdam University Medical Centers, The Netherlands
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Svensson A, Nilsson B, Lantz E, Bremer A, Årestedt K, Israelsson J. Response times in rural areas for emergency medical services, fire and rescue services and voluntary first responders during out-of-hospital cardiac arrests. Resusc Plus 2024; 17:100548. [PMID: 38292470 PMCID: PMC10825318 DOI: 10.1016/j.resplu.2023.100548] [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: 02/01/2024] Open
Abstract
Aim To increase survival in out-of-hospital cardiac arrests (OHCA), great efforts are made to improve the number of voluntary first responders (VFR). However, evidence of the potential utility of such efforts is sparse, especially in rural areas. Therefore, the aim was to describe and compare response times for emergency medical services (EMS), fire and rescue services (FRS), and VFR during OHCA in relation to population density. Methods This observational and comparative study was based on data including positions and time stamps for VFR and response times for EMS and FRS in a region in southern Sweden. Results In total, 285 OHCAs between 1 July 2020 and 31 December 2021 were analysed. VFR had the shortest median response time in comparison to EMS and FRS in all studied population densities. The overall median (Q1-Q3) time gain for VFR was 03:07 (01:39-05:41) minutes. A small proportion (19.2%) of alerted VFR accepted the assignments. This is most problematic in rural and sub-rural areas, where there were low numbers of alerted VFR. Also, FRS had shorter response time than EMS in all studied population densities except in urban areas. Conclusion The differences found in median response times between rural and urban areas are worrisome from an equality perspective. More focus should be placed on recruiting VFR, especially in rural areas since VFR can potentially contribute to saving more lives. Also, since FRS has a shorter response time than EMS in rural, sub-rural, and sub-urban areas, FRS should be dispatched more frequently.
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Affiliation(s)
- Anders Svensson
- Department of Health and Caring Sciences, Linnaeus University, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE) Linnaeus University, Sweden
- Department of Ambulance Service, Region Kronoberg, Sweden
| | - Bengt Nilsson
- Centre of Interprofessional Collaboration within Emergency Care (CICE) Linnaeus University, Sweden
- Department of Forestry and Wood Technology, Linnaeus University, Sweden
- Agunnaryd Voluntary Fire Brigade, Ljungby, Sweden
| | - Emelie Lantz
- Centre of Interprofessional Collaboration within Emergency Care (CICE) Linnaeus University, Sweden
- Division of Fire Safety Engineering, Lund University, Lund, Sweden
- Research School for Doctoral Students within the Swedish Rescue Services, The Swedish Fire Research Foundation, Stockholm, Sweden
- West Blekinge Fire and Rescue Service, Karlshamn, Sweden
| | - Anders Bremer
- Department of Health and Caring Sciences, Linnaeus University, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE) Linnaeus University, Sweden
| | - Kristofer Årestedt
- Department of Health and Caring Sciences, Linnaeus University, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE) Linnaeus University, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Johan Israelsson
- Department of Health and Caring Sciences, Linnaeus University, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE) Linnaeus University, Sweden
- Department of Internal Medicine, Kalmar County Hospital, Region Kalmar County, Kalmar, Sweden
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Müller MP, Ganter J, Busch HJ, Trummer G, Sahlmann J, Brettner F, Reden M, Elschenbroich D, Preusch M, Rusnak J, Katzenschlager S, Nauheimer D, Wunderlich R, Pooth JS. Out-of- Hospital cardiac arrest & Smartphon E Resp Ond Er S trial ( HEROES Trial): Methodology and study protocol of a pre-post-design trial of the effect of implementing a smartphone alerting system on survival in out-of-hospital cardiac arrest. Resusc Plus 2024; 17:100564. [PMID: 38328746 PMCID: PMC10847368 DOI: 10.1016/j.resplu.2024.100564] [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: 02/09/2024] Open
Abstract
Background Since 2021, international guidelines for cardiopulmonary resuscitation recommend the implementation of so-called "life-saving systems". These systems include smartphone alerting systems (SAS), which enable dispatch centres to alert first responders via smartphone applications, who are in proximity of a suspected out-of-hospital cardiac arrest (OHCA). However, the effect of SAS on survival remains unknown. Aim The aim is to assess the rate of survival to hospital discharge in adult patients with OHCA not witnessed by emergency medical services (EMS): before and after SAS implementation. Design Multicentre, prospective, observational, intention-to-treat, pre-post design clinical trial. Population Adults (aged ≥ 18 years), OHCA not witnessed by EMS, no traumatic cause for cardiac arrest, cardiopulmonary resuscitation initiated or continued by EMS. Setting Dispatch-centre-based. Outcomes Primary: survival to hospital discharge. Secondary: time to first compression, rate of basic life support measures before EMS arrival, rate of patients with shockable rhythm at EMS arrival, Cerebral Performance Category at hospital discharge, and duration of hospital stay. Sample size Assuming an absolute difference in survival rates to hospital discharge of 4% in the two groups (11% before implementation of the SAS versus 15% after) and 80% power, and a type 1 error rate of 0.05, the required sample size is N = 1,109 patients per group (at least N = 2,218 evaluated patients in total). Conclusions The HEROES trial will investigate the effects of a SAS on the survival rate after OHCA. Trial registration German Clinical Trials Register (DRKS, ID: DRKS00032920).
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Affiliation(s)
- Michael P. Müller
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefs Hospital, Freiburg, Germany
| | - Julian Ganter
- Department of Anaesthesiology and Critical Care, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Trummer
- Department of Cardiovascular Surgery, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jörg Sahlmann
- Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine − University Medical Center Freiburg, Freiburg, Germany
| | - Florian Brettner
- Department of Anaesthesiology and Intensive Care Medicine, Barmherzige Brüder Hospital St. Barbara, Schwandorf, Germany
| | - Maria Reden
- Department of Anaesthesiology and Intensive Care, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Daniel Elschenbroich
- Charite Universitätsmedizin Berlin, Corporate Member of Freie Unversität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Preusch
- Department of Internal Medicine III, Intensive Care, University of Heidelberg Heidelberg, Germany
| | - Jonas Rusnak
- Department of Internal Medicine III, Intensive Care, University of Heidelberg Heidelberg, Germany
| | - Stephan Katzenschlager
- Department of Anesthesiology, Heidelberg University, Medical Faculty Heidelberg, Heidelberg, Germany
| | - Dirk Nauheimer
- Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Robert Wunderlich
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Jan-Steffen Pooth
- Department of Emergency Medicine, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - HEROES Investigators2
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefs Hospital, Freiburg, Germany
- Department of Anaesthesiology and Critical Care, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Department of Emergency Medicine, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiovascular Surgery, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine − University Medical Center Freiburg, Freiburg, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Barmherzige Brüder Hospital St. Barbara, Schwandorf, Germany
- Department of Anaesthesiology and Intensive Care, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
- Charite Universitätsmedizin Berlin, Corporate Member of Freie Unversität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal Medicine III, Intensive Care, University of Heidelberg Heidelberg, Germany
- Department of Anesthesiology, Heidelberg University, Medical Faculty Heidelberg, Heidelberg, Germany
- Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
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Horriar L, Rott N, Böttiger BW. Improving survival after cardiac arrest in Europe: The synergetic effect of rescue chain strategies. Resusc Plus 2024; 17:100533. [PMID: 38205146 PMCID: PMC10776426 DOI: 10.1016/j.resplu.2023.100533] [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: 01/12/2024] Open
Abstract
Sudden cardiac arrest is a global problem and is considered the third leading cause of death in industrialized countries. Patient survival rates after out-of-hospital cardiac arrest (OHCA) vary significantly between countries and continents. In particular, the 2021 European Resuscitation Council (ERC) Resuscitation Guidelines place a special focus on the chain of survival of patients after OHCA. As a complex, interconnected approach, the focus is on: Raising awareness for cardiac arrest and lay resuscitation, school children's education in resuscitation "KIDS SAVE LIVES", first responder systems - technologies to engage the community, telephone-assisted resuscitation (telephone-CPR; T-CPR) by dispatchers, and cardiac arrest centers (CAC) for further treatment in specialized hospitals. The Systems Saving Lives approach is a comprehensive strategy that emphasizes the interconnectedness of all links in the chain of survival following an OHCA, with a particular focus on the relationship between the community and emergency medical services (EMS). This system-level approach emphasizes the importance of the connection between all those involved in the chain of survival. It has a high potential to improve overall survival after OHCA. Therefore, it is recommended that these strategies be promoted and expanded in all countries.
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Affiliation(s)
- Lina Horriar
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
| | - Nadine Rott
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine Kerpener Straße 62, 50937 Cologne, Germany
| | - Bernd W. Böttiger
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine Kerpener Straße 62, 50937 Cologne, Germany
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Maass AH. Inequities in access and use of automated external defibrillators. Heart 2024; 110:154-155. [PMID: 37666649 DOI: 10.1136/heartjnl-2023-323200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Affiliation(s)
- Alexander H Maass
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Müller MP, Jonsson M, Böttiger BW, Rott N. Telephone cardiopulmonary resuscitation, first responder systems, cardiac arrest centers, and global campaigns to save lives. Curr Opin Crit Care 2023; 29:621-627. [PMID: 37861192 DOI: 10.1097/mcc.0000000000001112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW The latest resuscitation guidelines contain a new chapter, which focuses on systems improving care for patients with out-of-hospital cardiac arrest (OHCA). In this article, we describe recent developments regarding telephone cardiopulmonary resuscitation (CPR), first responder systems, cardiac arrest centers, and global campaigns. RECENT FINDINGS Telephone CPR has been implemented in many countries, and recent developments include artificial intelligence and video calls to improve dispatch assisted CPR. However, the degree of implementation is not yet satisfying. Smartphone alerting systems are effective in reducing the resuscitation-free interval, but many regions do not yet use this technology. Further improvements are needed to reduce response times. Cardiac arrest centers increase the survival chance after OHCA. Specific criteria need to be defined and professional societies should establish a certification process. Global campaigns are effective in reaching people around the world. However, we need to evaluate the effects of the campaigns. SUMMARY Telephone CPR, first responder systems, cardiac arrest centers, and global campaigns are highlighted in the recent resuscitation guidelines. However, the degree of implementation is not yet sufficient. We do not only need to implement these measures, but we should also aim to monitor the systems regarding their performance and further improve them.
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Affiliation(s)
- Michael P Müller
- Department of Anesthesiology, Intensive Care, and Emergency Medicine, Artemed St. Josef's Hospital, Freiburg, Germany
| | - Martin Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet. Stockholm, Sweden
| | - Bernd W Böttiger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Nadine Rott
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany
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Todd V, Dicker B, Okyere D, Smith K, Smith T, Howie G, Stub D, Ray M, Stewart R, Scott T, Swain A, Heriot N, Brett A, Mahony E, Nehme Z. A study protocol for a cluster-randomised controlled trial of smartphone-activated first responders with ultraportable defibrillators in out-of-hospital cardiac arrest: The First Responder Shock Trial (FIRST). Resusc Plus 2023; 16:100466. [PMID: 37711685 PMCID: PMC10497988 DOI: 10.1016/j.resplu.2023.100466] [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: 09/16/2023] Open
Abstract
Objective To describe the First Responder Shock Trial (FIRST), which aims to determine whether equipping frequently responding, smartphone-activated (GoodSAM) first responders with an ultraportable AED can increase 30-day survival rates in OHCA. Methods The FIRST trial is an investigator-initiated, bi-national (Victoria, Australia and New Zealand), registry-nested cluster-randomised controlled trial where the unit of randomisation is the smartphone-activated (GoodSAM) first responder. High-frequency GoodSAM responders are randomised 1:1 to receive an ultraportable, single-use AED or standard alert procedures using the GoodSAM app.The primary outcome is survival to 30 days. The secondary outcome measures (shockable rhythm, return of spontaneous circulation, event survival, and time to first shock delivery) are routinely collected by OHCA registries in both regions. The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (Registration: ACTRN12622000448741) on 22 March 2022. Results The trial started in November 2022 and the last patient is expected to be enrolled in November 2024. We aim to detect a 7% increase in the proportion of 30-day survivors, from 9% in patients attended by control responders to 16% in patients attended by responders randomised to the ultraportable AED intervention arm. With 80% power, an alpha of 0.05, a cluster size of 1.5 and a coefficient of variation for cluster sizes of 1, the sample size required to detect this difference is 714 (357 per arm). Conclusion The FIRST study will increase our understanding of the potential role of portable AED use by smartphone-activated community responders and their impact on survival outcomes.
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Affiliation(s)
- Verity Todd
- Clinical Audit and Research Team, Hato Hone St John, National Headquarters, Ellerslie, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Manukau, Auckland, New Zealand
| | - Bridget Dicker
- Clinical Audit and Research Team, Hato Hone St John, National Headquarters, Ellerslie, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Manukau, Auckland, New Zealand
| | - Daniel Okyere
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
- Department of Research and Innovation, Silverchain, Victoria, Australia
| | - Tony Smith
- Clinical Audit and Research Team, Hato Hone St John, National Headquarters, Ellerslie, Auckland, New Zealand
| | - Graham Howie
- Clinical Audit and Research Team, Hato Hone St John, National Headquarters, Ellerslie, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Manukau, Auckland, New Zealand
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Ray
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Ralph Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, Te Toka Tumai, Te Whatu Ora – Health New Zealand, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Tony Scott
- Cardiology Department, North Shore Hospital, Waitematā, Te Whatu Ora – Health New Zealand, Takapuna, Auckland, New Zealand
| | - Andy Swain
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Manukau, Auckland, New Zealand
- Wellington Free Ambulance, Wellington, New Zealand
| | - Natalie Heriot
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Aroha Brett
- Clinical Audit and Research Team, Hato Hone St John, National Headquarters, Ellerslie, Auckland, New Zealand
| | - Emily Mahony
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
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Huebinger R, Spring M, McNally B, Humphries A, Persse D, Diggs D, Boerwinkle E, Bobrow B. Agency factors associated with first response systems that improve out-of-hospital cardiac arrest outcomes. Resuscitation 2023; 193:109954. [PMID: 37661014 DOI: 10.1016/j.resuscitation.2023.109954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/08/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Data are conflicting regarding the association between first responder (FR) intervention and improved outcomes after out-of-hospital cardiac arrest (OHCA). We evaluated characteristics of agencies that have positive associations between FR interventions and outcomes. METHODS We analyzed the 2016-2021 national Cardiac Arrest Registry to Enhance Survival (CARES). We defined the exposures as FR CPR and AED. The outcome was survival with favorable neurologic status. We used logistic regression models to evaluate the association between FR interventions with OHCA outcome for each agency, stratifying agencies into positive association (95% confidence interval above 1) and no/inverse association (95% confidence below or including 1). We compared characteristics between cohorts. RESULTS For the association between FR CPR and outcomes, 21 agencies caring for 42,856 OHCAs had a positive association; 371 agencies caring for 449,824 OHCAs had no association. For FR AED, 47 agencies caring for 103,120 OHCAs had a positive association; 262 agencies caring for 327,761 OHCAs had no association. Comparing agency characteristics for FR CPR, agencies with a positive association had more annual OHCAs (+300), lower FR CPR rate (-11.3%), and lower FR AED rate (-10.8%). Comparing FR AED, agencies with a positive association had more OHCAs per year (+150.5), lower FR CPR rate (-6.8%), lower FR AED rate (-13.3%), lower response time (-0.6 minutes), and more OHCAs from high-income neighborhoods (+3.7%). CONCLUSION FR AED more commonly had a positive association with outcomes than FR CPR. Agencies with better outcomes from FR interventions treated more OHCAs and had lower rates of FR intervention.
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Affiliation(s)
- Ryan Huebinger
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, United States; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States.
| | - Mary Spring
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, United States; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States.
| | - Brian McNally
- Department of Emergency Medicine, Emory University, Atlanta, GA, United States
| | - Amanda Humphries
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, United States; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States.
| | - David Persse
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, United States; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States; Houston Fire Department, United States.
| | - Dominique Diggs
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, United States; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States.
| | - Eric Boerwinkle
- School of Public Health, UTHealth Houston, Houston, TX, United States.
| | - Bentley Bobrow
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, United States; Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States.
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Siddiqui FJ, Fook-Chong S, Shahidah N, Tan CK, Poh JY, Ng WM, Quah D, Ng YY, Leong BSH, Ong MEH. Technology activated community first responders in Singapore: Real-world care delivery & outcome trends. Resusc Plus 2023; 16:100486. [PMID: 37859630 PMCID: PMC10582741 DOI: 10.1016/j.resplu.2023.100486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Community first responders (CFRs) strengthen the Chain of Survival for out-of-hospital cardiac arrest (OHCA) care. Considerable efforts have been invested in Singapore's CFR program, during the years 2016-2020, by developing an app-based activation system called myResponder. This paper reports on national CFR response indicators to evaluate the real-world impact of these efforts. METHODS We matched data from the Singapore Civil Defence Force's CFR registry with the Pan Asian Resuscitation Outcomes Study (PAROS) registry data to calculate performance indicators. These included the number of CFRs receiving and accepting an issued alert per OHCA event. Also calculated were the fraction of OHCA events where CFRs received an issued alert, or accepted the alert, and arrived at the scene either before or after EMS. We also present trends of these indicators and compare the prevalence of these fractions between the CFR-attended and CFR-unattended OHCA events. RESULTS Of 6577 alerted OHCA events, 42.7% accepted an alert, 50% of these arrived at the scene and 71% of them arrived before EMS. Almost all CFR response indicators improved over time even for the pandemic year (2020). The fraction of OHCA events where >2 CFRs received an alert increased from 62% to 96%; the same figure for accepting an alert did not change much but >2 CFRs arriving at the scene increased from 0% to 7.5%. The fraction of OHCA events with an automated external defibrillator applied and defibrillation performed by CFR increased from 4.2% to 10.3% and 1.6% to 3%, respectively. Statistically significant differences were observed in these indicators when CFR-attended and CFR-unattended OHCA events were compared. CONCLUSION This real-world study shows that activating CFRs using mobile technology can improve community response to OHCA and are bearing fruit in Singapore at a national level. Some targets for improvement and future research are highlighted in this report.
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Affiliation(s)
| | | | - Nur Shahidah
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Colin K Tan
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Jinn Yang Poh
- Volunteer & Community Partnership Department, Singapore Civil Defence Force, Singapore
| | - Wei Ming Ng
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore
| | - Dennis Quah
- Operations Department, Singapore Civil Defence Force, Singapore
| | - Yih Yng Ng
- Digital and Smart Health Office, Ng Teng Fong Centre for Healthcare Innovation, Tan Tock Seng Hospital, Singapore
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore
| | - Benjamin SH Leong
- Emergency Medicine Department, National University Hospital, Singapore
| | - Marcus EH Ong
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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15
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Ahmed A, Mewes JC, Lepage-Nefkens I, Tan HL, Vrijhoef HJM. Early modelling of the effects and healthcare costs of the Dutch citizen-rescuer system for out-of-hospital cardiac arrests. PLoS One 2023; 18:e0293965. [PMID: 37948427 PMCID: PMC10637662 DOI: 10.1371/journal.pone.0293965] [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: 08/18/2022] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES 1) to analyse the total average healthcare costs of a patient with an out-of-hospital cardiac arrest (OHCA), as well as estimating the operational costs of the citizen-rescuer system (CRS); 2) to conduct an early modelling of the effects and healthcare costs of the Dutch CRS in comparison to no CRS. METHODS A health economic modelling study was conducted. Adult patients with OHCA from cardiac causes in the province of Limburg (the Netherlands) were included. The time horizon was from OHCA occurrence up to one year after hospital discharge. First, the total average healthcare costs of OHCA patients were analysed as well as the yearly operating costs of the CRS. Second, an early modelling was conducted to compare from the healthcare perspective the healthcare costs of OHCA patients with the CRS being activated but no responders attended (CRS-NV) versus the CRS being activated with attendance of ≥1 responder(s) (CRS-V). RESULTS The total average healthcare costs per patient are €42,533. The yearly operating costs for the CRS are approximately €1.5 million per year in the Netherlands. The early modelling of costs and effects showed that the incremental healthcare costs per patient thus were €4,131 in the CRS-V versus the CRS-NV group (€25,184 in the CRS-V group and €21,053 in the CRS-NV group). Incremental quality-adjusted life years (QALYs) was 5 per 100 patients (16 per 100 patients in the CRS-V group versus 11 per 100 patients in the CRS-NV group). The incremental cost-effectiveness ratio (ICER) was €79,662 per QALY for the CRS-V group. CONCLUSION This study shows that patients in the CSR-V group had additional health care costs of €4,131 per patient compared to patients in the CRS-NV group. This increase is caused by patients surviving more often, who then continue to utilise health services, which results in a (logic) increase in healthcare costs. For future research, accurate and up-to-date data on effectiveness and costs of the CRS needs to be collected.
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Affiliation(s)
- Anam Ahmed
- Panaxea B.V., Den Bosch, The Netherlands
| | | | | | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
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Juul Grabmayr A, Malta Hansen C, Bo N, Sheikh AP, Hassager C, Ersbøll A, Kjaergaard J, Lippert F, Tjørnhøj-Thomsen T, Gislason G, Torp-Pedersen C, Folke F. Community intervention to improve defibrillation before ambulance arrival in residential neighbourhoods with a high risk of out-of-hospital cardiac arrest: study protocol of a cluster-randomised trial (the CARAMBA trial). BMJ Open 2023; 13:e073541. [PMID: 37816557 PMCID: PMC10565309 DOI: 10.1136/bmjopen-2023-073541] [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: 03/08/2023] [Accepted: 08/21/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION In Denmark, multiple national initiatives have been associated with improved bystander defibrillation and survival following out-of-hospital cardiac arrest (OHCA) in public places. However, OHCAs in residential neighbourhoods continue to have poor outcomes. The Cardiac Arrest in Residential Areas with MoBile volunteer responder Activation trial aims to improve bystander defibrillation and survival following OHCA in residential neighbourhoods with a high risk of OHCA. The intervention consists of: (1) strategically deployed automated external defibrillators accessible at all hours, (2) cardiopulmonary resuscitation (CPR) training of residents and (3) recruitment of residents for a volunteer responder programme. METHODS AND ANALYSIS This is a prospective, pair-matched, cluster-randomised, superiority trial with clusters of 26 residential neighbourhoods, testing the effectiveness of the intervention in a real-world setting. The areas are randomised for intervention or control. Intervention and control areas will receive the standard OHCA emergency response, including volunteer responder activation. However, targeted automated external defibrillator deployment, CPR training and volunteer responder recruitment will only be provided in the intervention areas. The primary outcome is bystander defibrillation, and the secondary outcome is 30-day survival. Data on patients who had an OHCA will be collected through the Danish Cardiac Arrest Registry. ETHICS AND DISSEMINATION Approval to store OHCA data has been granted from the Legal Office, Capital Region of Denmark (j.nr: 2012-58-0004, VD-2018-28, I-Suite no: 6222, and P-2021-670). In Denmark, formal approval from the ethics committee is only obtainable when the study regards testing medicine or medical equipment on humans or using genome or diagnostic imagine as data source. The Ethics Committee of the Capital Region of Denmark has evaluated the trial and waived formal approval unnecessary (H-19037170). Results will be published in peer-reviewed papers and shared with funders, stakeholders, and housing organisations through summaries and presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04446585).
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Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Nanna Bo
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Annam Pervez Sheikh
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annette Ersbøll
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Population Health and Morbidity, National Institute of Public Health, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
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17
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Blackwood J, Daya MR, Sorenson B, Schaeffer B, Dawson M, Charter M, Nania JM, Charbonneau J, Robertson J, Mancera M, Carbon C, Jorgenson DB, Gao M, Price R, Rosse C, Rea T. Characterization of non-cardiac arrest PulsePoint activations in public and private settings. BMC Emerg Med 2023; 23:79. [PMID: 37501072 PMCID: PMC10375779 DOI: 10.1186/s12873-023-00849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Geospatial smartphone application alert systems are used in some communities to crowdsource community response for out-of-hospital cardiac arrest (OHCA). Although the clinical focus of this strategy is OHCA, dispatch identification of OHCA is imperfect so that activation may occur for the non-arrest patient. The frequency and clinical profile of such non-arrest patients has not been well-investigated. METHODS We undertook a prospective 3-year cohort investigation of patients for whom a smartphone geospatial application was activated for suspected OHCA in four United States communities (total population ~1 million). The current investigation evaluates those patients with an activation for suspected OHCA who did not experience cardiac arrest. The volunteer response cohort included off-duty, volunteer public safety personnel (verified responders) notified regardless of location (public or private) and laypersons notified to public locations. The study linked the smartphone application information with the EMS records to report the frequency, condition type, and EMS treatment for these non-arrest patients. RESULTS Of 1779 calls where volunteers were activated, 756 had suffered OHCA, resulting in 1023 non-arrest patients for study evaluation. The most common EMS assessments were syncope (15.9%, n=163), altered mental status (15.5%, n=159), seizure (14.3%, n=146), overdose (13.0%, n=133), and choking (10.5%, n=107). The assessment distribution was similar for private and public locations. Overall, the most common EMS interventions included placement of an intravenous line (43.1%, n=441), 12-Lead ECG(27.9%, n=285), naloxone treatment (9.8%, n=100), airway or ventilation assistance (8.7%, n=89), and oxygen administration (6.6%, n=68). CONCLUSIONS More than half of patients activated for suspected OHCA had conditions other than cardiac arrest. A subset of these conditions may benefit from earlier care that could be provided by both layperson and public safety volunteers if they were appropriately trained and equipped.
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Affiliation(s)
- Jennifer Blackwood
- Seattle & King County Public Health, 401 5th Ave, Suite 1200, Seattle, WA, 98104, USA.
| | - Mohamud R Daya
- Oregon Health & Sciences University, Portland, OR, USA
- Tualatin Valley Fire & Rescue, Tigard, OR, USA
| | | | | | | | | | - James Mark Nania
- City of Spokane Fire Dept, Spokane, WA, USA
- Spokane Valley Fire, Spokane Valley, WA, USA
- Spokane County EMS Office, Spokane, WA, USA
| | | | | | | | - Chris Carbon
- City of Madison Fire Department, Madison, WI, USA
| | | | | | | | | | - Thomas Rea
- Seattle & King County Public Health, 401 5th Ave, Suite 1200, Seattle, WA, 98104, USA
- University of Washington, Seattle, WA, USA
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18
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Jonsson M, Berglund E, Baldi E, Caputo ML, Auricchio A, Blom MT, Tan HL, Stieglis R, Andelius L, Folke F, Hollenberg J, Svensson L, Ringh M. Dispatch of Volunteer Responders to Out-of-Hospital Cardiac Arrests. J Am Coll Cardiol 2023; 82:200-210. [PMID: 37438006 DOI: 10.1016/j.jacc.2023.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Systems for dispatch of volunteer responders to collect automated external defibrillators and/or to provide cardiopulmonary resuscitation (CPR) in cases of nearby out-of-hospital cardiac arrest (OHCA) are widely implemented. OBJECTIVES This study aimed to investigate whether the activation of a volunteer responder system to OHCAs was associated with higher rates of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. METHODS This was a retrospective observational analysis within the ESCAPE-NET (European Sudden Cardiac Arrest network: Towards Prevention, Education, New Effective Treatment) collaborative research network. Included were cases of OHCA between 2015 and 2019 from 5 European sites with volunteer responder systems. At all sites, systems were activated by dispatchers at the emergency medical communication center in response to suspected OHCA. Exposed cases (system activation) were compared with nonexposed cases (no system activation). Risk ratios (RRs) were calculated for the outcomes of bystander CPR, bystander defibrillation, and 30-day survival after inverse probability treatment weighting. Missing data were handled using multiple imputation. RESULTS In total, 9,553 cases were included. In 4,696 cases, the volunteer responder system was activated, and in 4,857 it was not. The pooled RRs were 1.30 (95% CI: 1.15-1.47) for bystander CPR, 1.89 (95% CI: 1.36-2.63) for bystander defibrillation, and 1.22 (95% CI: 1.07-1.39) for 30-day survival. CONCLUSIONS Activation of a volunteer response system in cases of OHCA was associated with a higher chance of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. A randomized controlled trial is necessary to determine fully the causal effect of volunteer responder systems.
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Affiliation(s)
- Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
| | - Ellinor Berglund
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Enrico Baldi
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, San Matteo Foundation Institute for Research, Hospitalization and Health Care, Pavia, Italy
| | - Maria Luce Caputo
- Division of Cardiology, Ticino Cardiocentro Institute, Cantonal Hospital Group, Lugano, Switzerland
| | - Angelo Auricchio
- Division of Cardiology, Ticino Cardiocentro Institute, Cantonal Hospital Group, Lugano, Switzerland
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Free University of Amsterdam, Amsterdam, the Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Remy Stieglis
- Department of Cardiology, Heart Center, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
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Grubic N, Hill B, Allan KS, Dainty KN, Johri AM, Brooks SC. Community Interventions for Out-of-Hospital Cardiac Arrest in Resource-Limited Settings: A Scoping Review Across Low, Middle, and High-Income Countries. PREHOSP EMERG CARE 2023; 27:1088-1100. [PMID: 37406163 DOI: 10.1080/10903127.2023.2231559] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a major global health challenge, characterized by poor survival outcomes worldwide. Resource-limited settings are burdened with suboptimal emergency response and worse outcomes than high-resource areas. Engaging the community in the response to OHCA has the potential to improve outcomes, although an overview of community interventions in resource-limited settings has not been provided. OBJECTIVE This review evaluated the scope of community-based OHCA interventions in resource-limited settings. METHODS Literature searches in electronic databases (MEDLINE, EMBASE, Global Health, CINAHL, Cochrane Central Register of Controlled Clinical Trials) and grey literature sources were performed. Abstract screening, full-text review, and data extraction of eligible studies were conducted independently by two reviewers. The PCC (Population, Concept, and Context) framework was used to assess study eligibility. Studies that evaluated community-based interventions for laypeople (Population), targeting emergency response activation, cardiopulmonary resuscitation (CPR), or automated external defibrillator (AED) use (Concept) in resource-limited settings (Context) were included. Resource-limited settings were identified by financial pressures (low-income or lower-middle-income country, according to World Bank data on year of publication) or geographical factors (setting described using keywords indicative of geographical remoteness in upper-middle-income or high-income country). RESULTS Among 14,810 records identified from literature searches, 60 studies from 28 unique countries were included in this review. Studies were conducted in high-income (n = 35), upper-middle-income (n = 2), lower-middle-income (n = 22), and low-income countries (n = 1). Community interventions included bystander CPR and/or AED training (n = 34), community responder programs (n = 8), drone-delivered AED networks (n = 6), dispatcher-assisted CPR programs (n = 4), regional resuscitation campaigns (n = 3), public access defibrillation programs (n = 3), and crowdsourcing technologies (n = 2). CPR and/or AED training were the only interventions evaluated in low-income, lower-middle-income, and upper-middle-income countries. CONCLUSIONS Interventions aimed at improving the community response to OHCA in resource-limited settings differ globally. There is a lack of reported studies from low-income countries and certain continental regions, including South America, Africa, and Oceania. Evaluation of interventions other than CPR and/or AED training in low- and middle-income countries is needed to guide community emergency planning and health policies.
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Affiliation(s)
- Nicholas Grubic
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Katherine S Allan
- Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Katie N Dainty
- Patient-Centred Outcomes, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, University of Toronto, Toronto, Ontario, Canada
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
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Huebinger R, Panczyk M, Villa N, Al-Araji R, Schulz K, Humphries A, Gill J, Persse D, J Bobrow B. First Responder CPR and Survival Differences in Texas Minority and Lower Socioeconomic Status Neighborhoods. PREHOSP EMERG CARE 2023; 27:1076-1082. [PMID: 36880880 DOI: 10.1080/10903127.2023.2188331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION First responder (FR) cardiopulmonary resuscitation (CPR) is an important component of out-of-hospital cardiac arrest (OHCA) care. However, little is known about FR CPR disparities. METHODS We linked the 2014-2021 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) database to census tract data. We included non-traumatic OHCAs that were not witnessed by 9-1-1 responders and did not receive bystander CPR. We defined census tracts as having >50% of a race/ethnicity: White, Black, or Hispanic/Latino. We also stratified patients into quartiles based on socioeconomic status (SES): household income, high school graduation, and unemployment. We also combined race/ethnicity and income to create a total of five mixed strata, comparing lower income and minority census tracts to high income White census tracts. We created mixed model logistic regression models, adjusting for confounders and modeling census tract as a random intercept. Using the models, we compared FR CPR rates for census race/ethnicity (Black and Hispanic/Latino compared to White), and SES quartiles (2nd, 3rd, and 4th quartiles compared to 1st quartiles). Secondarily, we evaluated the association between FR CPR and survival for all strata. RESULTS We included 21,966 OHCAs, and 57.4% had FR CPR. Evaluating the association between census tract characteristic and FR CPR, majority Black (aOR 0.30, 95% CI 0.22-0.41) had a lower bystander CPR rate when compared to majority White. The lowest income quartile had a lower rate of bystander CPR (aOR 0.80, 95% CI 0.65-0.98). The worst unemployment quartile was also associated with a lower rate of FR CPR (aOR 0.75, 95% CI 0.61-0.92). Combining race/ethnicity and income, middle income majority Black (30.0%; aOR 0.27, 95% CI 0.17-0.46) and low income >80% Black (31.8%; aOR 0.27, 95% CI 0.10-0.68) had lower rates of FR CPR in comparison to high income majority White. There were no associations between Hispanic or lower high school graduation and lower rates of FR CPR. We found no association between FR CPR and survival for all three strata. CONCLUSION While we identified disparities in FR CPR in low SES and majority Black census tracts, we identified no association between FR CPR and survival in Texas.
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Affiliation(s)
- Ryan Huebinger
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Micah Panczyk
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Normandy Villa
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Rabab Al-Araji
- Public Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Kevin Schulz
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
- Houston Fire Department, Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Amanda Humphries
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Joseph Gill
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - David Persse
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
- Houston Fire Department, Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Bentley J Bobrow
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
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21
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Kragh AR, Grabmayr AJ, Tjørnhøj-Thomsen T, Zinckernagel L, Gregers MCT, Andelius LC, Christensen AK, Kjærgaard J, Folke F, Malta Hansen C. Volunteer responder provision of support to relatives of out-of-hospital cardiac arrest patients: a qualitative study. BMJ Open 2023; 13:e071220. [PMID: 36944472 PMCID: PMC10032384 DOI: 10.1136/bmjopen-2022-071220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES Smartphone dispatch of volunteer responders for out-of-hospital cardiac arrest (OHCA) is implemented worldwide. While basic life support courses prepare participants to provide CPR, the courses rarely address the possibility of meeting a family member or relative in crisis. This study aimed to examine volunteer responders' provision of support to relatives of cardiac arrest patients and how relatives experienced the interaction with volunteer responders. DESIGN In this qualitative study, we conducted 16 semistructured interviews with volunteer responders and relatives of cardiac arrest patients. SETTING Interviews were conducted face to face and by video and recorded and transcribed verbatim. PARTICIPANTS Volunteer responders dispatched to cardiac arrests and relatives of cardiac arrest patients were included in the study. Participants were included from all five regions of Denmark. RESULTS A thematic analysis was performed with inspiration from Braun and Clarke. We identified three themes: (1) relatives' experiences of immediate relief at arrival of assistance, (2) volunteer responders' assessment of relatives' needs and (3) the advantage of being healthcare educated. CONCLUSIONS Relatives to out-of-hospital cardiac arrest patients benefited from volunteer responders' presence and support and experienced the mere presence of volunteer responders as supportive. Healthcare-educated volunteer responders felt confident and skilled to provide care for relatives, while some non-healthcare-educated volunteer responders felt they lacked the proper training and knowledge to provide emotional support for relatives. Future basic life support courses should include a lesson on how to provide emotional support to relatives of cardiac arrest patients.
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Affiliation(s)
- Astrid Rolin Kragh
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Juul Grabmayr
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | | | - Mads Christian Tofte Gregers
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
| | | | | | - Jesper Kjærgaard
- Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Carolina Malta Hansen
- Department of Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
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Gamberini L, Del Giudice D, Saltalamacchia S, Taylor B, Sala I, Allegri D, Pastori A, Coniglio C, Gordini G, Semeraro F. Factors associated with the arrival of smartphone-activated first responders before the emergency medical services in Out-of-Hospital cardiac arrest dispatch. Resuscitation 2023; 185:109746. [PMID: 36822460 DOI: 10.1016/j.resuscitation.2023.109746] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND First responder programs were developed to speed up access to cardiopulmonary resuscitation and defibrillation for out-of-hospital cardiac arrest (OHCA) victims. Little is known about the factors influencing the efficiency of the first responders arriving before the EMS and, therefore, effectively contributing to the chain of survival. OBJECTIVES The primary objective of this retrospective observational study was to identify the factors associated with first responders' arrival before EMS in the context of a regional first responder program arranged to deliver automated external defibrillators on suspected OHCA scenes. METHODS Eight hundred ninety-six dispatches where FRs intervened were collected from 2018 to 2022. A robust Poisson regression was performed to estimate the role of the time of day, the immediate availability of a defibrillator, the type of first responder, distances between the responder, the event and the dispatched vehicle, and the nearest available defibrillator on the probability of responder arriving before EMS. Moreover, a geospatial logistic regression model was built. RESULTS Responders arrived before EMS in 13.4% of dispatches and delivered a shock in 0.9%. The immediate availability of a defibrillator for the responder (OR = 3.24) and special categories such as taxi drivers and police (OR = 1.74) were factors significantly associated with the responder arriving before EMS. Moreover, a geospatial effect suggested that first responder programs may have a greater impact in rural areas. CONCLUSIONS When dispatched to OHCA scenes, responders already carrying defibrillators could more probably reach the scene before EMS. Special first responder categories are more competitive and should be further investigated.
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | | | - Stefano Saltalamacchia
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Benjamin Taylor
- University College Cork, Department School of Mathematical Sciences, Ireland
| | - Isabella Sala
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Antonio Pastori
- Settore Assistenza Ospedaliera, Direzione Generale Cura della Persona, Salute e Welfare, Assessorato Politiche per la Salute, Regione Emilia, Bologna, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
| | - Giovanni Gordini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Federico Semeraro
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
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Oosterveer DM, de Visser M, Heringhaus C. Improved ROSC rates in out-of-hospital cardiac arrest patients after introduction of a text message alert system for trained volunteers. Neth Heart J 2023; 31:36-41. [PMID: 34993887 PMCID: PMC9807694 DOI: 10.1007/s12471-021-01656-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To evaluate whether a text message (TM) alert system for trained volunteers contributed to early cardiopulmonary resuscitation, the use of automated external defibrillators (AEDs), return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest (OHCA) patients in a region with above-average survival rates. DESIGN Data on all OHCA patients in 2012 (non-TM group) were compared with those of all OHCA patients in 2018 (TM group). The association of the presence of a TM alert system with ROSC and survival was assessed with multivariate regression analyses. RESULTS TM responders reached 42 OHCA patients (15.9%) earlier than the first responders or ambulance. They connected 31 of these 42 OHCA patients (73.8%) to an AED before the ambulance arrived, leading to a higher percentage of AEDs being attached in 2018 compared to the 2012 non-TM group (55% vs 46%, p = 0.03). ROSC was achieved more often in the TM group (61.0% vs 29.4%, p < 0.01). Three-month and 1‑year survival did not differ significantly between the two groups (29.3% vs 24.3%, p = 0.19, and 25.9% vs 23.5%, p = 0.51). Multivariate regression analyses confirmed the positive association of ROSC with the TM alert system (odds ratio 1.49, 95% confidence interval 1.02‑2.19, p = 0.04). CONCLUSION A TM alert system seems to improve the chain of survival; because TM responders reached patients early, AEDs were attached more often and more OHCA patients achieved ROSC. However, the introduction of a TM alert system was not associated with improved 3‑month or 1‑year survival in a region with above-average survival rates.
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Affiliation(s)
| | - M. de Visser
- Department of Research and Development, Hollands Midden Regional Ambulance Service, Leiden, The Netherlands ,Emergency Department, Leiden University Medical Centre, Leiden, The Netherlands
| | - C. Heringhaus
- Emergency Department, Leiden University Medical Centre, Leiden, The Netherlands
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24
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Andelius L, Malta Hansen C, Jonsson M, Gerds TA, Rajan S, Torp-Pedersen C, Claesson A, Lippert F, Tofte Gregers MC, Berglund E, Gislason GH, Køber L, Hollenberg J, Ringh M, Folke F. Smartphone-activated volunteer responders and bystander defibrillation for out-of-hospital cardiac arrest in private homes and public locations. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 12:87-95. [PMID: 36574433 PMCID: PMC9910568 DOI: 10.1093/ehjacc/zuac165] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
AIMS To investigate the association between the arrival of smartphone-activated volunteer responders before the Emergency Medical Services (EMS) and bystander defibrillation in out-of-hospital cardiac arrest (OHCA) at home and public locations. METHODS AND RESULTS This is a retrospective study (1 September 2017-14 May 2019) from the Stockholm Region of Sweden and the Capital Region of Denmark. We included 1271 OHCAs, of which 1029 (81.0%) occurred in private homes and 242 (19.0%) in public locations. The main outcome was bystander defibrillation. At least one volunteer responder arrived before EMS in 381 (37.0%) of OHCAs at home and 84 (34.7%) in public. More patients received bystander defibrillation when a volunteer responder arrived before EMS at home (15.5 vs. 2.2%, P < 0.001) and in public locations (32.1 vs. 19.6%, P = 0.030). Similar results were found among the 361 patients with an initial shockable heart rhythm (52.7 vs. 11.5%, P < 0.001 at home and 60.0 vs. 37.8%, P = 0.025 in public). The standardized probability of receiving bystander defibrillation increased with longer EMS response times in private homes. The 30-day survival was not significantly higher when volunteer responders arrived before EMS (9.2 vs. 7.7% in private homes, P = 0.41; and 40.5 vs. 35.4% in public locations, P = 0.44). CONCLUSION Bystander defibrillation was significantly more common in private homes and public locations when a volunteer responder arrived before the EMS. The standardized probability of bystander defibrillation increased with longer EMS response times in private homes. Our findings support the activation of volunteer responders and suggest that volunteer responders could increase bystander defibrillation, particularly in private homes.
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Affiliation(s)
| | - Carolina Malta Hansen
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Thomas A Gerds
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5,1014 Copenhagen, Denmark
| | - Shahzleen Rajan
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Copenhagen University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark,Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Freddy Lippert
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark
| | - Mads Chr Tofte Gregers
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ellinor Berglund
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Gunnar H Gislason
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Fredrik Folke
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
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Scquizzato T, Gamberini L, D'Arrigo S, Galazzi A, Babini G, Losiggio R, Imbriaco G, Fumagalli F, Cucino A, Landoni G, Scapigliati A, Ristagno G, Semeraro F, Bertoncello F, Canalini A, Colelli S, Conti G, Giacometti M, Giuliani G, Graziano A, Mina A, Orazio S, Paoli A, Peratoner A, Pegani C, Roncarati A, Sabetta C, Savastano S, Stella F, Varutti R, Verginella F, Zuliani M. Incidence, characteristics, and outcome of out-of-hospital cardiac arrest in Italy: A systematic review and meta-analysis. Resusc Plus 2022; 12:100329. [DOI: 10.1016/j.resplu.2022.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
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Fazel MF, Mohamad MHN, Sahar MA, Juliana N, Abu IF, Das S. Readiness of Bystander Cardiopulmonary Resuscitation (BCPR) during the COVID-19 Pandemic: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10968. [PMID: 36078684 PMCID: PMC9518324 DOI: 10.3390/ijerph191710968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Early cardiopulmonary resuscitation (CPR) is a strong link in the of survival for sudden cardiac arrest. Hence, bystander CPR (BPCR) plays an important role in curbing mortality and morbidity from out-of-hospital sudden cardiac arrest. However, the recent global Coronavirus disease 2019 (COVID-19) pandemic has impacted both public training and confidence in performing out-of-hospital CPR. This paper reviews detailed information from databases including Google Scholar, Scopus, PubMed and Web of Science on the readiness of BCPR during the pandemic. We also discussed the challenges bystanders encountered during the COVID-19 pandemic and the precautions to follow. Finally, we also highlighted the limitations which would benefit future endeavours in establishing well-planned and sustainable CPR training programs for the public. Therefore, regardless of the existing COVID-19 pandemic, BCPR must be emphasised to curb out-of-hospital cardiac arrest (OHCA) mortality.
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Affiliation(s)
- Muhammad Fattah Fazel
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
- Institute of Medical Science Technology, Universiti Kuala Lumpur, Kuala Lumpur 50250, Malaysia
| | | | - Mohd Azmani Sahar
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Norsham Juliana
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Izuddin Fahmy Abu
- Institute of Medical Science Technology, Universiti Kuala Lumpur, Kuala Lumpur 50250, Malaysia
| | - Srijit Das
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Alkoudh, Muscat 123, Oman
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27
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Basic Life Support Knowledge among Junior Medical and Dental Students, Communication Channels, and the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081073. [PMID: 36013540 PMCID: PMC9416785 DOI: 10.3390/medicina58081073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
Background and objective: The prognosis of cardiac arrest victims strongly depends on the prompt provision of Basic Life Support (BLS) maneuvers. Medical students should therefore be proficient in this area, but many lack essential BLS knowledge. The goal of this prospective, closed web-based study was to determine whether a short intervention designed to motivate first-year medical students to follow a blended BLS course could lead to a significant improvement in BLS knowledge in the following year. Materials and Methods: A fully automated web-based questionnaire was administered to second-year medical students one year after they had been given the opportunity of following a blended BLS course (e-learning and practice session). The primary outcome was the difference, on a 6-question score assessing essential BLS knowledge, between these students and those from the 2020 promotion since the latter had not been offered the optional BLS course. Results: The score was similar between the two study periods (3.3 ± 0.8 in 2022 vs. 3.0 ± 1.0 in 2020, p = 0.114), but no firm conclusion could be drawn since participation was much lower than expected (17.9% in 2022 vs. 43.7% in 2020, p < 0.001). Therefore, a second questionnaire was created and administered to understand the reasons underlying this low participation. Conclusions: There was a lack of improvement in BLS knowledge in second-year medical students after the introduction of an optional introductory BLS course in the first-year curriculum, but the limited participation rate precludes drawing definitive conclusions. Ineffective communication appears to be the cause of this low participation rate, but a lack of motivation in the aftermath of the COVID-19 pandemic cannot be ruled out. Corrective actions should be considered to enhance communication, restore motivation, and ultimately improve BLS knowledge among medical and dental students.
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Zheng K, Bai Y, Zhai QR, Du LF, Ge HX, Wang GX, Ma QB. Correlation between the warning symptoms and prognosis of cardiac arrest. World J Clin Cases 2022; 10:7738-7748. [PMID: 36158514 PMCID: PMC9372869 DOI: 10.12998/wjcc.v10.i22.7738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/21/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A low survival rate in patients with cardiac arrest is associated with failure to recognize the condition in its initial stage. Therefore, recognizing the warning symptoms of cardiac arrest in the early stage may play an important role in survival.
AIM To investigate the warning symptoms of cardiac arrest and to determine the correlation between the symptoms and outcomes.
METHODS We included all adult patients with all-cause cardiac arrest who visited Peking University Third Hospital or Beijing Friendship Hospital between January 2012 and December 2014. Data on population, symptoms, resuscitation parameters, and outcomes were analysed.
RESULTS Of the 1021 patients in the study, 65.9% had symptoms that presented before cardiac arrest, 25.2% achieved restoration of spontaneous circulation (ROSC), and 7.2% survived to discharge. The patients with symptoms had higher rates of an initial shockable rhythm (12.2% vs 7.5%, P = 0.020), ROSC (29.1% vs 17.5%, P = 0.001) and survival (9.2% vs 2.6%, P = 0.001) than patients without symptoms. Compared with the out-of-hospital cardiac arrest (OHCA) without symptoms subgroup, the OHCA with symptoms subgroup had a higher rate of calls before arrest (81.6% vs 0.0%, P < 0.001), health care provider-witnessed arrest (13.0% vs 1.4%, P = 0.001) and bystander cardiopulmonary resuscitation (15.5% vs 4.9%, P = 0.002); a shorter no flow time (11.7% vs 2.8%, P = 0.002); and a higher ROSC rate (23.8% vs 13.2%, P = 0.011). Compared to the in-hospital cardiac arrest (IHCA) without symptoms subgroup, the IHCA with symptoms subgroup had a higher mean age (66.2 ± 15.2 vs 62.5 ± 16.3 years, P = 0.005), ROSC (32.0% vs 20.6%, P = 0.003), and survival rates (10.6% vs 2.5%, P < 0.001). The top five warning symptoms were dyspnea (48.7%), chest pain (18.3%), unconsciousness (15.2%), paralysis (4.3%), and vomiting (4.0%). Chest pain (20.9% vs 12.7%, P = 0.011), cardiac etiology (44.3% vs 1.5%, P < 0.001) and survival (33.9% vs 16.7%, P = 0.001) were more common in males, whereas dyspnea (54.9% vs 45.9%, P = 0.029) and a non-cardiac etiology (53.3% vs 41.7%, P = 0.003) were more common in females.
CONCLUSION Most patients had warning symptoms before cardiac arrest. Dyspnea, chest pain, and unconsciousness were the most common symptoms. Immediately recognizing these symptoms and activating the emergency medical system prevents resuscitation delay and improves the survival rate of OHCA patients in China.
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Affiliation(s)
- Kang Zheng
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Yi Bai
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Qiang-Rong Zhai
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Lan-Fang Du
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Hong-Xia Ge
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Guo-Xing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Beijing 100050, China
| | - Qing-Bian Ma
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
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Murphy TW, Cohen SA, Hwang CW, Avery KL, Balakrishnan MP, Balu R, Chowdhury MAB, Crabb DB, Elmelige Y, Maciel CB, Gul SS, Han F, Becker TK. Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020. J Am Coll Emerg Physicians Open 2022; 3:e12773. [PMID: 35845142 PMCID: PMC9282171 DOI: 10.1002/emp2.12773] [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: 11/11/2021] [Revised: 05/15/2022] [Accepted: 06/02/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its third year, the goals of the review are to highlight annual updates in the interdisciplinary world of clinical cardiac arrest research with a focus on clinically relevant and impactful clinical and population-level studies from 2020. Methods A search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and abstracts were screened for relevance and sorted into 7 categories: Epidemiology & Public Health Initiatives; Prehospital Resuscitation, Technology & Care; In-Hospital Resuscitation & Post-Arrest Care; Prognostication & Outcomes; Pediatrics; Interdisciplinary Guidelines & Reviews; and a new section dedicated to the coronavirus disease 2019 (COVID-19) pandemic. Screened manuscripts underwent standardized scoring of methodological quality and impact on the respective fields by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99 percentiles by category were selected for full critique. Systematic differences between editors' and reviewers' scores were assessed using Wilcoxon signed-rank test. Results A total of 3594 articles were identified on initial search; of these, 1026 were scored after screening for relevance and deduplication, and 51 underwent full critique. The leading category was Prehospital Resuscitation, Technology & Care representing 35% (18/51) of fully reviewed articles. Four COVID-19 related articles were included for formal review that was attributed to a relative lack of high-quality data concerning cardiac arrest and COVID-19 specifically by the end of the 2020 calendar year. No significant differences between editor and reviewer scoring were found among review articles (P = 0.697). Among original research articles, section editors scored a median 1 point (interquartile range, 0-3; P < 0.01) less than reviewers. Conclusions Several clinically relevant studies have added to the evidence base for the management of cardiac arrest patients including methods for prognostication of neurologic outcome following arrest, airway management strategy, timing of coronary intervention, and methods to improve expeditious performance of key components of resuscitation such as chest compressions in adults and children.
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Affiliation(s)
- Travis W. Murphy
- Division of Critical Care MedicineDepartment of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
- Cardiothoracic Critical CareMiami Transplant InstituteUniversity of MiamiMiamiFloridaUSA
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Scott A. Cohen
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Charles W. Hwang
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - K. Leslie Avery
- Division of Pediatric Critical CareDepartment of PediatricsUniversity of FloridaGainesvilleFloridaUSA
| | | | - Ramani Balu
- Division of Neurocritical CareDepartment of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - David B. Crabb
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Yasmeen Elmelige
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Carolina B. Maciel
- Division of Neurocritical CareDepartment of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of NeurologyYale UniversityNew HavenConnecticutUSA
- Division of Neurocritical CareDepartment of NeurologyUniversity of FloridaGainesvilleFloridaUSA
| | - Sarah S. Gul
- Department of SurgeryYale UniversityNew HavenConnecticutUSA
| | - Francis Han
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
- Lake Erie College of Osteopathic MedicineBradentonFloridaUSA
| | - Torben K. Becker
- Division of Critical Care MedicineDepartment of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
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Shekhar AC. Significant ethical considerations with cardiac arrest resuscitation by dispatched volunteer rescuers. Eur Heart J 2022; 43:2812-2813. [PMID: 35678571 DOI: 10.1093/eurheartj/ehac279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aditya C Shekhar
- Center for Bioethics, Harvard Medical School, Boston, MA, USA
- Center for Resuscitation Science, Harvard University, Boston, MA, USA
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Munot S, Redfern J, Bray JE, Angell B, Bauman A, Coggins A, Denniss AR, Ferry C, Jennings G, Kovoor P, Kumar S, Lai K, Khanlari S, Marschner S, Middleton PM, Nelson M, Opperman I, Semsarian C, Taylor L, Vukasovic M, Ware S, Chow C. Improving community-based first response to out of hospital cardiac arrest (FirstCPR): protocol for a cluster randomised controlled trial. BMJ Open 2022; 12:e057175. [PMID: 35680270 PMCID: PMC9185498 DOI: 10.1136/bmjopen-2021-057175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is associated with poor survival outcomes, but prompt bystander action can more than double survival rates. Being trained, confident and willing-to-perform cardiopulmonary resuscitation (CPR) are known predictors of bystander action. This study aims to assess the effectiveness of a community organisation targeted multicomponent education and training initiative on being willing to respond to OHCAs. The study employs a novel approach to reaching community members via social and cultural groups, and the intervention aims to address commonly cited barriers to training including lack of availability, time and costs. METHODS AND ANALYSIS FirstCPR is a cluster randomised trial that will be conducted across 200 community groups in urban and regional Australia. It will target community groups where CPR training is not usual. Community groups (clusters) will be stratified by region, size and organisation type, and then randomly assigned to either immediately receive the intervention programme, comprising digital and in-person education and training opportunities about CPR and OHCA over 12 months, or a delayed programme implementation. The primary outcome is self-reported 'training and willingness-to-perform CPR' at 12 months. It will be assessed through surveys of group members that consent in intervention versus control groups and administered prior to control groups receiving the intervention. The primary analysis will follow intention-to-treat principles, use log binomial regression accounting for baseline covariates and be conducted at the individual level, while accounting for clustering within communities. Focus groups and interviews will be conducted to examine barriers and enablers to implementation and costs will also be examined. ETHICS AND DISSEMINATION Ethical approval was obtained from The University of Sydney. Findings from this study will be disseminated via presentations at scientific conferences, publications in peer-reviewed journals, scientific and lay reports. TRIAL REGISTRATION NUMBER ACTRN12621000367842.
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Affiliation(s)
- Sonali Munot
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Janet E Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Blake Angell
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Adrian Bauman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Coggins
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Alan Robert Denniss
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Cate Ferry
- NSW Division, Heart Foundation, Sydney, New South Wales, Australia
| | - Garry Jennings
- Sydney Health Partners, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kevin Lai
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sarah Khanlari
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, New South Wales, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul M Middleton
- Emergency Department, Ingham Institute, Liverpool, New South Wales, Australia
- The MARCS Institute for Brain, Behaviour and Development, Milperra, New South Wales, Australia
| | - Michael Nelson
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, New South Wales, Australia
| | - Ian Opperman
- NSW Data Analytics Centre, NSW Government, Sydney, New South Wales, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Lee Taylor
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, New South Wales, Australia
| | - Matthew Vukasovic
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sandra Ware
- Ambulance Service of NSW, Rozelle, New South Wales, Australia
| | - Clara Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW Technology is being increasingly implemented in the fields of cardiac arrest and cardiopulmonary resuscitation. In this review, we describe how recent technological advances have been implemented in the chain of survival and their impact on outcomes after cardiac arrest. Breakthrough technologies that are likely to make an impact in the future are also presented. RECENT FINDINGS Technology is present in every link of the chain of survival, from prediction, prevention, and rapid recognition of cardiac arrest to early cardiopulmonary resuscitation and defibrillation. Mobile phone systems to notify citizen first responders of nearby out-of-hospital cardiac arrest have been implemented in numerous countries with improvement in bystanders' interventions and outcomes. Drones delivering automated external defibrillators and artificial intelligence to support the dispatcher in recognising cardiac arrest are already being used in real-life out-of-hospital cardiac arrest. Wearables, smart speakers, surveillance cameras, and artificial intelligence technologies are being developed and studied to prevent and recognize out-of-hospital and in-hospital cardiac arrest. SUMMARY This review highlights the importance of technology applied to every single step of the chain of survival to improve outcomes in cardiac arrest. Further research is needed to understand the best role of different technologies in the chain of survival and how these may ultimately improve outcomes.
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Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Lorenzo Gamberini
- Department of Anaesthesia and Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
| | - Federico Semeraro
- Department of Anaesthesia and Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
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Scquizzato T, Belloni O, Semeraro F, Greif R, Metelmann C, Landoni G, Zangrillo A. Dispatching citizens as first responders to out-of-hospital cardiac arrests: a systematic review and meta-analysis. Eur J Emerg Med 2022; 29:163-172. [PMID: 35283448 DOI: 10.1097/mej.0000000000000915] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mobile phone technologies to alert citizen first responders to out-of-hospital cardiac arrests (OHCAs) were implemented in numerous countries. This systematic review and meta-analysis aim to investigate whether activating citizen first responders increases bystanders' interventions and improves outcomes. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to 24 November 2021, for studies comparing citizen first responders' activation versus standard emergency response in the case of OHCA. The primary outcome was survival at hospital discharge or 30 days. Secondary outcomes were discharge with favourable neurological outcome, bystander-initiated cardiopulmonary resuscitation (CPR), and the use of automated external defibrillators (AEDs) before ambulance arrival. Evidence certainty was evaluated with GRADE. Our search strategy yielded 1215 articles. After screening, we included 10 studies for a total of 23 351 patients. OHCAs for which citizen first responders were activated had higher rates of survival at hospital discharge or 30 days compared with standard emergency response [nine studies; 903/9978 (9.1%) vs. 1104/13 247 (8.3%); odds ratio (OR), 1.45; 95% confidence interval (CI), 1.21-1.74; P < 0.001], return of spontaneous circulation [nine studies; 2575/9169 (28%) vs. 3445/12 607 (27%); OR, 1.40; 95% CI, 1.07-1.81; P = 0.01], bystander-initiated CPR [eight studies; 5876/9074 (65%) vs. 6384/11 970 (53%); OR, 1.75; 95% CI, 1.43-2.15; P < 0.001], and AED use [eight studies; 654/9132 (7.2%) vs. 624/14 848 (4.2%); OR, 1.82; 95% CI, 1.31-2.53; P < 0.001], but similar rates of neurological intact discharge [three studies; 316/2685 (12%) vs. 276/2972 (9.3%); OR, 1.37; 95% CI, 0.81-2.33; P = 0.24]. Alerting citizen first responders to OHCA patients is associated with higher rates of bystander-initiated CPR, use of AED before ambulance arrival, and survival at hospital discharge or 30 days.
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Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Olivia Belloni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Camilla Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Taramarcaz V, Herren T, Golay E, Regard S, Martin-Achard S, Mach F, Schnetzler N, Ricci G, Zamberg I, Larribau R, Niquille M, Suppan M, Schiffer E, Suppan L. A Short Intervention and an Interactive E-Learning Module to Motivate Medical and Dental Students to Enlist as First Responders: Implementation Study (Preprint). J Med Internet Res 2022; 24:e38508. [PMID: 35583927 PMCID: PMC9161047 DOI: 10.2196/38508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
Background Prompt and proficient basic life support (BLS) maneuvers are essential to increasing the odds of survival after out-of-hospital cardiac arrest. However, significant time can elapse before the arrival of professional rescuers. To decrease these delays, many countries have developed first responder networks. These networks are composed of BLS-certified lay or professional rescuers who can be dispatched by emergency medical communication centers to take care of those who experience out-of-hospital cardiac arrest. Many systems are, however, limited by a relatively low number of active first responders, and first-year medical and dental students may represent an almost untapped pool of potential rescuers. On top of providing an enhanced BLS coverage to the population, this could also help medical students be better prepared to their future role as certified health care providers and address societal expectations regarding health care students. Objective Our objective was to describe the impact of a short motivational intervention followed by a blended BLS course (e-learning and practice session) designed to motivate first-year medical and dental students to enlist as first responders. Methods A short, web-based, motivational intervention presenting this project took place, and first-year University of Geneva, Faculty of Medicine students were provided with a link to the study platform. Those who agreed to participate were redirected to a demographic questionnaire before registering on the platform. The participants were then asked to answer a second questionnaire designed to determine their baseline knowledge prior to following an interactive e-learning module. Upon completion, a web-based booking form enabling them to register for a 1-hour practice session was displayed. These sessions were held by senior medical students who had been trained and certified as BLS instructors. The participants who attended these practice sessions were asked to answer a postcourse questionnaire before receiving the certificate enabling them to register as first responders. Results Out of the 529 first-year students registered at University of Geneva, Faculty of Medicine on January 14, 2021, 190 (35.9%) initially agreed to participate. Moreover, 102 (19.3%) attended the practice sessions, and 48 (9.1%) had completed all training and enlisted as first responders on the dedicated platform, Save a Life, at 6 months (July 14, 2021). Postcourse confidence in resuscitation skills was associated with a higher likelihood of registering as first responder (P=.03). No association was found between prior BLS knowledge and the probability of registering to a practice session (P=.59), of obtaining a course completion certificate (P=.29), or of enlisting as first responder (P=.56). Conclusions This study shows that a motivational intervention associated with a short BLS course can convince medical students to enlist as first responders. Further studies are needed to understand the rather low proportion of medical students finally registering as first responders. International Registered Report Identifier (IRRID) RR2-10.2196/24664
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Affiliation(s)
- Victor Taramarcaz
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Tara Herren
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Eric Golay
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Simon Regard
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Francois Mach
- Cardiology Department, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Nicolas Schnetzler
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gaëtan Ricci
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ido Zamberg
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Eduardo Schiffer
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Högstedt A, Thuccani M, Carlström E, Claesson A, Bremer A, Ravn-Fischer A, Berglund E, Ringh M, Hollenberg J, Herlitz J, Rawshani A, Lundgren P. Characteristics and motivational factors for joining a lay responder system dispatch to out-of-hospital cardiac arrests. Scand J Trauma Resusc Emerg Med 2022; 30:22. [PMID: 35331311 PMCID: PMC8943963 DOI: 10.1186/s13049-022-01009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been in increase in the use of systems for organizing lay responders for suspected out-of-hospital cardiac arrests (OHCAs) dispatch using smartphone-based technology. The purpose is to increase survival rates; however, such systems are dependent on people's commitment to becoming a lay responder. Knowledge about the characteristics of such volunteers and their motivational factors is lacking. Therefore, we explored characteristics and quantified the underlying motivational factors for joining a smartphone-based cardiopulmonary resuscitation (CPR) lay responder system. METHODS In this descriptive cross-sectional study, 800 consecutively recruited lay responders in a smartphone-based mobile positioning first-responder system (SMS-lifesavers) were surveyed. Data on characteristics and motivational factors were collected, the latter through a modified version of the validated survey "Volunteer Motivation Inventory" (VMI). The statements in the VMI, ranked on a Likert scale (1-5), corresponded to(a) intrinsic (an inner belief of doing good for others) or (b) extrinsic (earning some kind of reward from the act) motivational factors. RESULTS A total of 461 participants were included in the final analysis. Among respondents, 59% were women, 48% between 25 and 39 years of age, 37% worked within health care, and 66% had undergone post-secondary school. The most common way (44%) to learn about the lay responder system was from a CPR instructor. A majority (77%) had undergone CPR training at their workplace. In terms of motivation, where higher scores reflect greater importance to the participant, intrinsic factors scored highest, represented by the category values (mean 3.97) followed by extrinsic categories reciprocity (mean 3.88) and self-esteem (mean 3.22). CONCLUSION This study indicates that motivation to join a first responder system mainly depends on intrinsic factors, i.e. an inner belief of doing good, but there are also extrinsic factors, such as earning some kind of reward from the act, to consider. Focusing information campaigns on intrinsic factors may be the most important factor for successful recruitment. When implementing a smartphone-based lay responder system, CPR instructors, as a main information source to potential lay responders, as well as the workplace, are crucial for successful recruitment.
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Affiliation(s)
- A Högstedt
- Prehospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
| | - M Thuccani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Carlström
- Institute of Healthcare Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, Kongsberg, Norway
| | - A Claesson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - A Bremer
- Prehospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - A Ravn-Fischer
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Berglund
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - M Ringh
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - J Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - J Herlitz
- Prehospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - A Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Lundgren
- Prehospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Out-of-hospital cardiac arrest: Does rurality decrease chances of survival? Resusc Plus 2022; 9:100208. [PMID: 35146464 PMCID: PMC8819014 DOI: 10.1016/j.resplu.2022.100208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Geographical setting is seldomly taken into account when investigating out-of-hospital cardiac arrest (OHCA). It is a common notion that living in rural areas means a lower chance of fast and effective helpwhen suffering a time-critical event. This retrospective cohort study investigates this hypothesis and compares across healthcare-divided administrative regions. Methods We included only witnessed OHCAs to minimize the risk that outcome was predetermined by time to caller arrival and/or recognition. Arrests were divided into public and residential. Residential arrests were categorized according to population density of the area in which they occurred. We investigated incidence, EMS response time and 30-day survival according to area type and subsidiarily by healthcare-divided administrative region. Results The majority (71%) of 8,579 OHCAs were residential, and 53.2% of all arrests occurred in the most densely populated cell group amongst residential arrests. This group had a median EMS response time of six minutes, whereas the most sparsely populated group had a median of 10 minutes. Public arrests also had a median response time of six minutes. 30-day survival was highest in public arrests (38.5%, [95% CI 36.9;40.1]), and varied only slightly with no statistical significance between OHCAs in densely and sparsely populated areas from 14.8% (95% CI 14.4;15.2) and 13.4% (95% CI 12.2;14.7). Conclusion Our study demonstrates that while EMS response times in Denmark are longer in the rural areas, there is no statistically significant decrease in survival compared to the most densely populated areas.
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Scquizzato T, Bonaccorso A, Consonni M, Scandroglio AM, Swol J, Landoni G, Zangrillo A. Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized and propensity score-matched studies. Artif Organs 2022; 46:755-762. [PMID: 35199375 PMCID: PMC9307006 DOI: 10.1111/aor.14205] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In selected patients with refractory out-of-hospital cardiac arrest, extracorporeal cardiopulmonary resuscitation represents a promising approach when conventional cardiopulmonary resuscitation fails to achieve return of spontaneous circulation. This systematic review and meta-analysis aimed to compare extracorporeal cardiopulmonary resuscitation to conventional cardiopulmonary resuscitation. METHODS We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials up to November 28, 2021, for randomized trials and observational studies reporting propensity score-matched data and comparing adults with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation with those treated with conventional cardiopulmonary resuscitation. The primary outcome was survival with favorable neurological outcome at the longest follow-up available. Secondary outcomes were survival at the longest follow-up available and survival at hospital discharge/30 days. RESULTS We included six studies, two randomized and four propensity score-matched studies. Patients treated with extracorporeal cardiopulmonary resuscitation had higher rates of survival with favorable neurological outcome (81/584 [14%] vs. 46/593 [7.8%]; OR = 2.11; 95% CI, 1.41-3.15; p < 0.001, number needed to treat 16) and of survival (131/584 [22%] vs. 102/593 [17%]; OR = 1.40; 95% CI, 1.05-1.87; p = 0.02) at the longest follow-up available compared with conventional cardiopulmonary resuscitation. Survival at hospital discharge/30 days was similar between the two groups (142/584 [24%] vs. 122/593 [21%]; OR = 1.26; 95% CI, 0.95-1.66; p = 0.10). CONCLUSIONS Evidence from randomized trials and propensity score-matched studies suggests increased survival and favorable neurological outcome in patients with refractory out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation. Large, multicentre randomized studies are still ongoing to confirm these findings.
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Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Bonaccorso
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michela Consonni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Justyna Swol
- Department of Pneumology, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Affiliation(s)
- Remy Stieglis
- Department of Cardiology Amsterdam University Medical Center, Location AMC Amsterdam the Netherlands
| | - Rudolph W. Koster
- Department of Cardiology Amsterdam University Medical Center, Location AMC Amsterdam the Netherlands
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Smith CM, Lall R, Fothergill RT, Spaight R, Perkins GD. The effect of the GoodSAM volunteer first-responder app on survival to hospital discharge following out-of-hospital cardiac arrest. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:20-31. [PMID: 35024801 PMCID: PMC8757292 DOI: 10.1093/ehjacc/zuab103] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/08/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022]
Abstract
AIMS Bystander cardiopulmonary resuscitation and defibrillation can double survival to hospital discharge in out-of-hospital cardiac arrest. Mobile phone applications, such as GoodSAM, alerting nearby volunteer first-responders about out-of-hospital cardiac arrest could potentially improve bystander cardiopulmonary resuscitation and defibrillation, leading to better patient outcomes. The aim of this study was to determine GoodSAM's effect on survival to hospital discharge following out-of-hospital cardiac arrest. METHODS AND RESULTS We collected data from the Out-of-Hospital Cardiac Arrest Outcomes Registry (University of Warwick, UK) submitted by the London Ambulance Service (1 April 2016 to 31 March 2017) and East Midlands Ambulance Service (1 January 2018 to 17 June 2018) and matched out-of-hospital cardiac arrests to GoodSAM alerts. We constructed logistic regression models to determine if there was an association between a GoodSAM first-responder accepting an alert and survival to hospital discharge, adjusting for location type, presenting rhythm, age, gender, ambulance service response time, cardiac arrest witnessed status, and bystander actions. Survival to hospital discharge was 9.6% (393/4196) in London and 7.2% (72/1001) in East Midlands. A GoodSAM first-responder accepted an alert for out-of-hospital cardiac arrest in 1.3% (53/4196) cases in London and 5.4% (51/1001) cases in East Midlands. When a responder accepted an alert, the adjusted odds ratio for survival to hospital discharge was 3.15 (95% CI: 1.19-8.36, P = 0.021) in London and 3.19 (95% CI: 1.17-8.73, P = 0.024) in East Midlands. CONCLUSION Alert acceptance was associated with improved survival in both ambulance services. Alert acceptance rates were low, and challenges remain to maximize the potential benefit of GoodSAM.
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Affiliation(s)
- Christopher M Smith
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Rachael T Fothergill
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK.,Clinical Audit and Research Unit, London Ambulance Service NHS Trust, 8-20 Pocock Street, London SE1 8SD, UK
| | - Robert Spaight
- East Midlands Ambulance Service NHS Trust, 1 Horizon Place, Mellors Way, Nottingham NG8 6PY, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
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41
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Folke F, Hansen CM. Volunteer first-responder activation in out-of-hospital cardiac arrest-a lot of potential and a lot of unknowns. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:32-34. [PMID: 34893802 DOI: 10.1093/ehjacc/zuab115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Fredrik Folke
- Copenhagen University Hospital - Copenhagen Emergency Medical Services, Ballerup, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Copenhagen University Hospital - Copenhagen Emergency Medical Services, Ballerup, Denmark
- Department of Cardiology, The Heart Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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43
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Debaty G, Duhem H, Lamhaut L. Citizen first responders dispatched using smartphone app to suspected cardiac arrest, a meaningful experience that can save a live. Resuscitation 2021; 170:361-362. [PMID: 34920015 DOI: 10.1016/j.resuscitation.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Guillaume Debaty
- University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble, France.
| | - Hélène Duhem
- University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble, France
| | - Lionel Lamhaut
- SAMU de Paris, Université de Paris/INSERM U970, Assistance Publique-Hôpitaux de Paris, Paris, France
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44
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Basic life support and systems saving lives. Curr Opin Crit Care 2021; 27:617-622. [PMID: 34629420 DOI: 10.1097/mcc.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe recent science in basic life support (BLS) after cardiac arrest and how evolving knowledge in resuscitation is changing current guidelines and practices. RECENT FINDINGS The core elements of BLS have remained mostly unchanged since 2005 when Cardiopulmonary Resuscitation recommendations were changed from 2 ventilations to 15 compressions and up to three stacked shocks for shockable rhythms, to 30 compressions to 2 ventilations and single shocks. Since 2010, basic life support has largely focused on the importance of providing high-quality CPR for professional and lay rescuers alike. The most recent resuscitation updates has seen an increased focus on the systems perspective. The 'Systems Saving Lives' concept emphasizes the interconnection between community and Emergency Medical Services (EMS). The main changes in current resuscitation practice are within three important basic life support domains: recognition of cardiac arrest, interaction between rescuers and EMS and improving resuscitation quality. SUMMARY This review highlights the importance of strengthening both community and emergency medical services efforts to improve outcomes in cardiac arrest. Strategies that enhance the communication and collaboration between lay rescuers and professional resuscitation systems are important new avenues to pursue in developing systems that save more lives.
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Scquizzato T, Landoni G, Scandroglio AM, Franco A, Calabrò MG, Paoli A, D’Amico F, Yavorovskiy A, Zangrillo A. Outcomes of out-of-hospital cardiac arrest in patients with SARS-CoV-2 infection: a systematic review and meta-analysis. Eur J Emerg Med 2021; 28:423-431. [PMID: 34690258 PMCID: PMC8549129 DOI: 10.1097/mej.0000000000000878] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Out-of-hospital cardiac arrests increased during the COVID-19 pandemic and a direct mechanism of cardiac arrest in infected patients was hypothesized. Therefore, we conducted a systematic review and meta-analysis to assess outcomes of SARS-CoV-2 patients with out-of-hospital cardiac arrest. METHODS PubMed and EMBASE were searched up to April 05, 2021. We included studies comparing out-of-hospital cardiac arrests patients with suspected or confirmed SARS-CoV-2 infection versus noninfected patients. The primary outcome was survival at hospital discharge or at 30 days. Secondary outcomes included return of spontaneous circulation, cardiac arrest witnessed and occurring at home, bystander-initiated cardiopulmonary resuscitation, proportion of nonshockable rhythm and resuscitation attempted, and ambulance arrival time. RESULTS In the ten included studies, 18% (1341/7545) of out-of-hospital cardiac arrests occurred in patients with SARS-CoV-2 infection. Patients with out-of-hospital cardiac arrest and SARS-CoV-2 infection had reduced rates of survival (16/856 [1.9%] vs. 153/2344 [6.5%]; odds ratio (OR) = 0.33; 95% confidence interval (CI), 0.17-0.65; P = 0.001; I2 = 28%) and return of spontaneous circulation (188/861 [22%] vs. 640/2403 [27%]; OR = 0.75; 95% CI, 0.65-0.86; P < 0.001; I2 = 0%) when compared to noninfected patients. Ambulance arrived later (15 ± 10 vs. 13 ± 7.5 min; mean difference = 1.64; 95% CI, 0.41-2.88; P = 0.009; I2 = 61%) and nonshockable rhythms (744/803 [93%] vs. 1828/2217 [82%]; OR = 2.79; 95% CI, 2.08-3.73; P < 0.001; I2 = 0%) occurred more frequently. SARS-CoV-2 positive patients suffered a cardiac arrest at home more frequently (1186/1263 [94%] vs. 3598/4055 [89%]; OR = 1.86; 95% CI, 1.45-2.40; P<0.001; I2 = 0%) but witnessed rate (486/890 [55%] vs. 1385/2475 [56%]; OR = 0.97; 95% CI, 0.82-1.14; P = 0.63; I2 = 0%) and bystander-initiated cardiopulmonary resuscitation rate (439/828 [53%] vs. 1164/2304 [51%]; OR = 0.95; 95% CI, 0.73-1.24; P = 0.70; I2 = 53%) were similar. CONCLUSIONS One-fifth of out-of-hospital cardiac arrest patients had SARS-CoV-2 infection. These patients had low rates of return of spontaneous circulation and survival and were characterized by higher nonshockable rhythms but similar bystander-initiated cardiopulmonary resuscitation rate. REVIEW REGISTRATION PROSPERO - CRD42021243540.
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Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - Annalisa Franco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - Andrea Paoli
- Emergency Medical Services (SUEM 118), Azienda Ospedale-Università Padova, Padova, Italy
| | - Filippo D’Amico
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - Andrey Yavorovskiy
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan
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Scquizzato T, Semeraro F. No more unwitnessed out-of-hospital cardiac arrests in the future thanks to technology. Resuscitation 2021; 170:79-81. [PMID: 34822935 DOI: 10.1016/j.resuscitation.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy.
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Ganter J, Pooth JS, Damjanovic D, Trummer G, Busch HJ, Baldas K, Schmitz D, Müller MP. Association of GPS-Based Logging and Manual Confirmation of the First Responders' Arrival Time in a Smartphone Alerting System: An Observational Study. PREHOSP EMERG CARE 2021; 26:829-837. [PMID: 34550048 DOI: 10.1080/10903127.2021.1983094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The latest guidelines for cardiopulmonary resuscitation recommend that in case of suspected cardiac arrest first responders, who are close to the emergency location, should be notified by a smartphone app or text message. Smartphone Alerting Systems (SAS) aim to reduce the resuscitation-free interval. Thus, there is a need for uniform reporting of process times. Objective: To compare the response times in a SAS either by using global positioning system (GPS) data or by manual confirmation of first responders arriving at the scene. Methods: In the region of Freiburg (Southern Germany, 1,531 km2, 493,000 inhabitants), a SAS is activated when the emergency dispatch center receives a call regarding suspected cardiac arrest. First responders who accept a mission are tracked using GPS. GPS-based times are logged for each responder when their position is within a radius of 100, 50, or 10 meters around the geographical position of the reported emergency. When arriving at the patient location, the first responders manually confirm "arrived" via their app. GPS-based and manually confirmed response arrival times were compared for all cases between 1 October and 31 March. Results: 192 missions with correct manual logging of the arrival time were included. GPS-based times were available in 175 (91%), 100 (52%), and 30 (16%) cases within radii of 100, 50, and 10 meters, respectively. GPS arrival times were approximately 1.5 minutes shorter when using a 100-meter radius and significantly longer when using a 10-meter radius. No difference was found for a 50-meter radius, but this would result in a lack of data in nearly half of the cases. Conclusion: GPS-based logging of arrival times leads to missing data. A 100-meter circle is associated with a low number of missing values, but 1.5 minutes must be added for the last 100 meters the first responder has to move. A wide range of the difference in response times (GPS vs. manual confirmation) must be regarded as a disadvantage. Manual confirmation reveals precise response times, but first responders may forget to confirm when they arrive. Trial registration: DRKS00016625 (14 April 2019).
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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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Evaluation psychischer Belastungssituationen der Smartphone-basierten Ersthelferalarmierung „Mobile Retter“. Notf Rett Med 2021. [DOI: 10.1007/s10049-020-00773-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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Andelius L, Malta Hansen C, Tofte Gregers MC, Kragh AMR, Køber L, Gislason GH, Kjær Ersbøll A, Torp-Pedersen C, Folke F. Risk of Physical Injury for Dispatched Citizen Responders to Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2021; 10:e021626. [PMID: 34259016 PMCID: PMC8483463 DOI: 10.1161/jaha.121.021626] [Citation(s) in RCA: 3] [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] [Indexed: 11/25/2022]
Abstract
Background Citizen responder programs are implemented worldwide to dispatch volunteer citizens to participate in out‐of‐hospital cardiac arrest resuscitation. However, the risk of injuries in relation to activation is largely unknown. We aimed to assess the risk of physical injury for dispatched citizen responders. Methods and Results Since September 2017, citizen responders have been activated through a smartphone application when located close to a suspected cardiac arrest in the Capital Region of Denmark. A survey was sent to all activated citizen responders, including a specific question about risk of acquiring an injury during activation. We included all surveys from September 1, 2017, to May 15, 2020. From May 15, 2019, to May 15, 2020, we followed up on all survey nonresponders by phone call, e‐mail, or text messages to examine if nonresponders were at higher risk of severe or fatal injuries. In 1665 suspected out‐of‐hospital cardiac arrests, 9574 citizen responders were dispatched and 76.6% (7334) answered the question regarding physical injury. No injury was reported by 99.3% (7281) of the responders. Being at risk of physical injury was reported by 0.3% (24), whereas 0.4% (26) reported an injury (25 minor injuries and 1 severe injury [ankle fracture]). When following up on nonresponders (2472), we reached 99.1% (2449). No one reported acquired injuries, and only 1 reported being at risk of injury. Conclusions We found low risk of physical injury reported by volunteer citizen responders dispatched to out‐of‐hospital cardiac arrest. Risk of injury should be considered and monitored as a safety measure in citizen responder programs.
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Affiliation(s)
- Linn Andelius
- Copenhagen Emergency Medical Services Copenhagen University Hospital Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services Copenhagen University Hospital Copenhagen Denmark.,Department of Cardiology Copenhagen University Hospital - Herlev and Gentofte Copenhagen Denmark
| | - Mads C Tofte Gregers
- Copenhagen Emergency Medical Services Copenhagen University Hospital Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Astrid M Rolin Kragh
- Copenhagen Emergency Medical Services Copenhagen University Hospital Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Lars Køber
- Department of Cardiology Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
| | - Gunnar H Gislason
- Department of Cardiology Copenhagen University Hospital - Herlev and Gentofte Copenhagen Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public HealthUniversity of Southern Denmark Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research Nordsjaellands Hospital Hilleroed Denmark.,Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services Copenhagen University Hospital Copenhagen Denmark.,Department of Cardiology Copenhagen University Hospital - Herlev and Gentofte Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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