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Bemtgen X, Wengenmayer T. [Out-of-hospital resuscitation: where are we today?]. Dtsch Med Wochenschr 2023; 148:921-933. [PMID: 37493954 DOI: 10.1055/a-1936-5819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
In circulatory arrest, the first minutes and hours are crucial - rapid and adequate care can significantly increase the chances of survival. A large number of disciplines are involved in the recommendations and guidelines for out-of-hospital resuscitation. In particular, the European Resuscitation Council (ERC) as well as the European Society of Cardiology (ESC) and the American Heart Association (AHA) are leading the way. Both the ambulance service and the accepting hospital are faced with major challenges in this regard. This article will illustrate the most important steps during and after resuscitation and discuss innovations.
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Douma MJ, Picard CT, Brindley PG, Gibson J. The experience of online cardiac arrest video use for education and research: A qualitative interview study completed in partnership with survivors and co-survivors. Resusc Plus 2023; 14:100394. [PMID: 37215186 PMCID: PMC10197098 DOI: 10.1016/j.resplu.2023.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Background Swift recognition of cardiac arrest is required for survival, however failure to recognize (and delayed response) is common. Studying online cardiac arrest videos may aid recognition, however the ethical implications of this are unknown. We examined their use from the perspective of persons with lived experience of cardiac arrest, seeking to understand the experience of having one's cardiac arrest recorded and available online. Methods We gathered qualitative data using focused interviews of persons affected by cardiac arrest. Inductive thematic analysis was performed, as well as a deductive ethical analysis. Co-researcher survivors and co-survivors were involved in all stages of this project. Findings We identified themes of 'shock, hurt and helplessness' and 'surreality and reality' to describe the experience of having one's (or a family member's) cardiac arrest captured and distributed online. Participants provided guidance on the use of online videos for education and research, emphasising beneficence, autonomy, non-maleficence, and justice. Conclusions Finding one's own, or a family member's cardiac arrest video online is shocking and potentially harmful for families. If ethical principles are followed however, there may be acceptable procedures for the use of online videos of cardiac arrest for education or research purposes. The careful use of online videos of cardiac arrest for education and research may help improve recognition and response, though additional research is required to confirm or refute this claim.
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Affiliation(s)
- Matthew J Douma
- Nursing, Midwifery and Health Systems, University College Dublin, Ireland
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Peter G. Brindley
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Gibson
- Providence Health Care, Canada
- University of British Columbia Vancouver, British Columbia, Canada
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3
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Bjørshol CA, Nordseth T, Kramer-Johansen J. Why the Norwegian 2021 guideline for basic life support are different. Resusc Plus 2023; 14:100392. [PMID: 37207262 PMCID: PMC10189455 DOI: 10.1016/j.resplu.2023.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
- Conrad Arnfinn Bjørshol
- The Regional Centre for Emergency Medical Research and Development (RAKOS), Stavanger University Hospital, Stavanger, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Corresponding author at: RAKOS, Stavanger University Hospital, P. O. Box 8100, NO-4068 Stavanger, Norway.
| | - Trond Nordseth
- Department of Anaesthesia and Intensive Care Medicine. St. Olav’s University Hospital. NO-7030 Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Heath Sciences, Norwegian University of Science and Technology. NO-7491 Trondheim, Norway
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Nikolaj Blomberg S, Jensen TW, Porsborg Andersen M, Folke F, Kjær Ersbøll A, Torp-Petersen C, Lippert F, Collatz Christensen H. When the machine is wrong. Characteristics of true and false predictions of Out-of-Hospital Cardiac arrests in emergency calls using a machine-learning model. Resuscitation 2023; 183:109689. [PMID: 36634755 DOI: 10.1016/j.resuscitation.2023.109689] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND A machine-learning model trained to recognize emergency calls regarding Out-of-Hospital Cardiac Arrest (OHCA) was tested in clinical practice at Copenhagen Emergency Medical Services (EMS) from September 2018 to December 2019. We aimed to investigate emergency call characteristics where the machine-learning model failed to recognize OHCA or misinterpreted a call as being OHCA. METHODS All emergency calls were linked to the dispatch database and verified OHCAs were identified by linkage to the Danish Cardiac Arrest Registry. Calls with either false negative or false positive predictions of OHCA were evaluated by trained auditors. Descriptive analyses were performed with absolute numbers and percentages reported. RESULTS The machine-learning model processed 169,236 calls to Copenhagen EMS and suspected 5,811 (3.4%) of the calls as OHCA, resulting in 84.5% sensitivity and 97.1% specificity. Among OHCAs not recognised by machine-learning model, a condition completely different from OHCA was presented by caller in 31% of the cases. In 28% of unrecognised calls, patient was reported breathing normally, and language barriers were identified in 23% of the cases. Among falsely suspected OHCA, the patient was reported unconscious in 28% of the cases, and in 13% of the false positive cases the machine-learning model interpreted calls regarding dead patients with irreversible signs of death as OHCA. CONCLUSION Continuous optimization of the language model is needed to improve the prediction of OHCA and thereby improve sensitivity and specificity of the machine-learning model on recognising OHCA in emergency telephone calls.
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Affiliation(s)
- Stig Nikolaj Blomberg
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Theo W Jensen
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Fredrik Folke
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical Services, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Petersen
- Department of Cardiology, Nordsjællands Hospital, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Falck, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark
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5
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Dowker SR, Smith G, O'Leary M, Missel AL, Trumpower B, Hunt N, Herbert L, Sams W, Kamdar N, Coulter-Thompson EI, Shields T, Swor R, Domeier R, Abir M, Friedman CP, Neumar RW, Nallamothu BK. Assessment of telecommunicator cardiopulmonary resuscitation performance during out-of-hospital cardiac arrest using a standardized tool for audio review. Resuscitation 2022; 178:102-108. [PMID: 35483496 PMCID: PMC11249783 DOI: 10.1016/j.resuscitation.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Telecommunicator cardiopulmonary resuscitation (T-CPR) is a critical component of optimized out-of-hospital cardiac arrest (OHCA) care. We assessed a pilot tool to capture American Heart Association (AHA) T-CPR measures and T-CPR coaching by telecommunicators using audio review. METHODS Using a pilot tool, we conducted a retrospective review of 911 call audio from 65 emergency medical services-treated out-of-hospital cardiac arrest (OHCA) patients. Data collection included events (e.g., OHCA recognition), time intervals, and coaching quality measures. We calculated summary statistics for all performance and quality measures. RESULTS Among 65 cases, the patients' mean age was 64.7 years (SD: 14.6) and 17 (26.2%) were women. Telecommunicator recognition occurred in 72% of cases (47/65). Among 18 non-recognized cases, reviewers determined 12 (66%) were not recognizable based on characteristics of the call. Median time-to-recognition was 76 seconds (n = 40; IQR:39-138), while median time-to-first-instructed-compression was 198 seconds (n = 26; IQR:149-233). In 36 cases where coaching was needed, coaching on compression-depth occurred in 27 (75%); -rate in 28 (78%); and chest recoil in 10 (28%) instances. In 30 cases where repositioning was needed, instruction to position the patient's body flat occurred in 18 (60%) instances, on-back in 22 (73%) instances, and on-ground in 22 (73%) instances. CONCLUSIONS Successful collection of data to calculate AHA T-CPR measures using a pilot tool for audio review revealed performance near AHA benchmarks, although coaching instructions did not occur in many instances. Application of this standardized tool may aid in T-CPR quality review.
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Affiliation(s)
- Stephen R Dowker
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, 2139 Cardiovascular Center, Ann Arbor, MI 48109, United States; Department of Learning Health Sciences, University of Michigan Medical School, 209 Victor Vaughan Building, 2054, 1111 East Catherine Street, Ann Arbor, MI 48109, United States; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex (NCRC), Building 16, Ann Arbor, MI 48109, United States
| | - Graham Smith
- Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Building 10-A103, North Campus Research Complex (NCRC), 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Michael O'Leary
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex (NCRC), Building 16, Ann Arbor, MI 48109, United States
| | - Amanda L Missel
- Department of Learning Health Sciences, University of Michigan Medical School, 209 Victor Vaughan Building, 2054, 1111 East Catherine Street, Ann Arbor, MI 48109, United States
| | - Brad Trumpower
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, 2139 Cardiovascular Center, Ann Arbor, MI 48109, United States
| | - Nathaniel Hunt
- Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Building 10-A103, North Campus Research Complex (NCRC), 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Logan Herbert
- Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Woodrow Sams
- Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex (NCRC), Building 16, Ann Arbor, MI 48109, United States; Department of Obstetrics and Gynecology, University of Michigan Medical School, L4001 Women's Hospital, 1500, East Medical Center Drive, Ann Arbor, MI 48109, United States; Department of Surgery, University of Michigan Medical School, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Emilee I Coulter-Thompson
- Department of Learning Health Sciences, University of Michigan Medical School, 209 Victor Vaughan Building, 2054, 1111 East Catherine Street, Ann Arbor, MI 48109, United States; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex (NCRC), Building 16, Ann Arbor, MI 48109, United States
| | - Theresa Shields
- Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, United States
| | - Robert Domeier
- Saint Joseph Mercy Emergency Center - Ann Arbor, 5301 McAuley Drive, Ypsilanti, MI 48197, United States
| | - Mahshid Abir
- Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex (NCRC), Building 16, Ann Arbor, MI 48109, United States; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Building 10-A103, North Campus Research Complex (NCRC), 2800 Plymouth Road, Ann Arbor, MI 48109, United States; RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Charles P Friedman
- Department of Learning Health Sciences, University of Michigan Medical School, 209 Victor Vaughan Building, 2054, 1111 East Catherine Street, Ann Arbor, MI 48109, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Building 10-A103, North Campus Research Complex (NCRC), 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, 2139 Cardiovascular Center, Ann Arbor, MI 48109, United States; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex (NCRC), Building 16, Ann Arbor, MI 48109, United States; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Building 10-A103, North Campus Research Complex (NCRC), 2800 Plymouth Road, Ann Arbor, MI 48109, United States.
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Aldridge ES, Perera N, Ball S, Finn J, Bray J. A scoping review to determine the barriers and facilitators to initiation and performance of bystander cardiopulmonary resuscitation during emergency calls. Resusc Plus 2022; 11:100290. [PMID: 36034637 PMCID: PMC9403560 DOI: 10.1016/j.resplu.2022.100290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Emogene S. Aldridge
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- Corresponding author.
| | - Nirukshi Perera
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- St John Western Australia, Western Australia, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- St John Western Australia, Western Australia, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
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Byrsell F, Claesson A, Jonsson M, Ringh M, Svensson L, Nordberg P, Forsberg S, Hollenberg J, Nord A. Swedish dispatchers’ compliance with the American Heart Association performance goals for dispatch-assisted cardiopulmonary resuscitation and its association with survival in out-of-hospital cardiac arrest: A retrospective study. Resusc Plus 2022; 9:100190. [PMID: 35535343 PMCID: PMC9076962 DOI: 10.1016/j.resplu.2021.100190] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Aim We aimed 1) to investigate how Swedish dispatchers perform during emergency calls in accordance with the American Heart Association (AHA) goals for dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), 2) calculate the potential impact on 30-day survival. Methods This observational study includes a random sample of 1000 out-of-hospital cardiac arrest (OHCA) emergency ambulance calls during 2018 in Sweden. Voice logs were audited to evaluate dispatchers’ handling of emergency calls according to the AHA performance goals. Number of possible additional survivors was estimated assuming the timeframes of the AHA performance goals was achieved. Results A total of 936 cases were included. An OHCA was recognized by a dispatcher in 79% (AHA goal 75%). In recognizable OHCA, dispatchers recognized 85% (AHA goal 95%). Dispatch-directed compressions were given in 61% (AHA goal 75%). Median time to OHCA recognition was 113 s [interquartile range (IQR), 62, 204 s] (AHA goal < 60 s). The first dispatch-directed compression was performed at a median time of 240 s [IQR, 176, 332 s] (AHA goal < 90 s). If eligible patients receive dispatch-directed compressions within the AHA 90 s goal, 73 additional lives may be saved; if all cases are recognized within the AHA 60 s goal, 25 additional lives may be saved. Conclusions The AHA policy statement serves as a benchmark for all emergency medical dispatch centres (EMDC). Additional effort is needed at Swedish EMDC to achieve AHA goals for DA-CPR. Our study suggests that if EMDC further optimize handling of OHCA calls in accordance with AHA goals, many more lives may be saved.
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Affiliation(s)
- Fredrik Byrsell
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- SOS Alarm AB, Stockholm, Sweden
- Corresponding author at: SOS Alarm AB, Annetorpsvägen 4, 216 23 Malmö, Sweden.
| | - Andreas Claesson
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Sune Forsberg
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anette Nord
- Department of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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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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Kirby K, Voss S, Bird E, Benger J. Features of Emergency Medical System calls that facilitate or inhibit Emergency Medical Dispatcher recognition that a patient is in, or at imminent risk of, cardiac arrest: A systematic mixed studies review. Resusc Plus 2021; 8:100173. [PMID: 34841368 PMCID: PMC8605417 DOI: 10.1016/j.resplu.2021.100173] [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] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022] Open
Abstract
Aim To identify and appraise evidence relating to the features of an Emergency Medicine System call interaction that enable, or inhibit, an Emergency Medical Dispatcher’s recognition that a patient is in out-of-hospital cardiac arrest, or at imminent risk of out-of-hospital cardiac arrest. Methods All study designs were eligible for inclusion. Data sources included Medline, BNI, CINAHL, EMBASE, PubMed, Cochrane Database of Systematic Reviews, AMED and OpenGrey. Stakeholder resources were screened and experts in resuscitation were asked to review the studies identified. Studies were appraised using the Mixed Methods Appraisal Tool. Synthesis was completed using a segregated mixed research synthesis approach. Results Thirty-two studies were included in the review. Three main themes were identified: Key features of the Emergency Medical Service call interaction; Managing the Emergency Medical Service call; Emotional distress. Conclusion A dominant finding is the difficulty in recognising abnormal/agonal breathing during the Emergency Medical Service call. The interaction between the caller and the Emergency Medical Dispatcher is critical in the recognition of patients who suffer an out-of-hospital cardiac arrest. Emergency Medical Dispatchers adapt their approach to the Emergency Medical Service call, and regular training for Emergency Medical Dispatchers is recommended to optimise out-of-hospital cardiac arrest recognition. Further research is required with a focus on the Emergency Medical Service call interaction of patients who are alive at the time of the Emergency Medical Service call and who later deteriorate into OHCA. PROSPERO registration: CRD42019155458.
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Affiliation(s)
- Kim Kirby
- South Western Ambulance Service NHS Foundation Trust, Eagle Way, Exeter EX2 7HY, United Kingdom
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
- Corresponding author at: South Western Ambulance Service NHS Foundation Trust, Eagle Way, Exeter EX2 7HY, United Kingdom.
| | - Sarah Voss
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
| | - Emma Bird
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
| | - Jonathan Benger
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
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10
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Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study. Resusc Plus 2021; 8:100168. [PMID: 34661179 PMCID: PMC8502955 DOI: 10.1016/j.resplu.2021.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/21/2022] Open
Abstract
Aims Emergency medical service (EMS) may detect seizure-like activity in addition to agonal breathing in out-of-hospital cardiac arrest (OHCA). This study investigates the incidence and predictors of seizure-like activity in nontraumatic, EMS-witnessed OHCA and their association with clinical outcomes. Methods This prospective study explored EMS-recorded concomitant signs/symptoms that lead to the requirement of advanced life support in patients with nontraumatic, EMS-witnessed OHCA. Seizure-like activity includes abnormal/tonic movements and eyeball deviation. Sudden OHCA was defined by the absence of signs/symptoms of impending cardiac arrest at EMS contact or progressive circulatory/respiratory depressions after the EMS contact. Neurologically favorable outcomes were defined as the cerebral performance category score of 1 or 2 at discharge. Results From April 2012 to March 2020, 465 patients were studied. The incidence of seizure-like activity at cardiac arrest onset was 12.7% (59/465) in all patients with nontraumatic, EMS-witnessed OHCA. Seizure-like activity was common during shockable initial rhythm; in patients with “sudden” OHCA; and in patients who were younger, male, or had a presumed cardiac etiology. In a boosting tree, shockable initial rhythm, “sudden” OHCA, and presumed cardiac etiology were major factors that predicted the incidence of seizure-like activity. Multivariate logistic regression models including and excluding OHCA characteristics revealed that both seizure-like activity and agonal breathing recorded during EMS-witnessed OHCA were associated with favorable outcomes. Conclusions Seizure-like activity is a major sign/symptom of the onset of “sudden” cardiac arrest of presumed cardiac etiology, particularly in patients with shockable initial rhythms. Such activity were significantly associated with neurologically favorable outcomes.
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11
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdóttir H, Perkins GD. [Basic life support]. Notf Rett Med 2021; 24:386-405. [PMID: 34093079 PMCID: PMC8170637 DOI: 10.1007/s10049-021-00885-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), cardiopulmonary resuscitation (CPR) quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M. Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italien
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Mailand, Italien
- Department of Pathophysiology and Transplantation, University of Milan, Mailand, Italien
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finnland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moskau, Russland
| | - Koenraad G. Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerpen, Belgien
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nikosia, Zypern
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- West Midlands Ambulance Service, DY5 1LX Brierly Hill, West Midlands Großbritannien
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Hildigunnur Svavarsdóttir
- Akureyri Hospital, Akureyri, Island
- Institute of Health Science Research, University of Akureyri, Akureyri, Island
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- University Hospitals Birmingham, B9 5SS Birmingham, Großbritannien
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Abstract
PURPOSE OF REVIEW To discuss different approaches to citizen responder activation and possible future solutions for improved citizen engagement in out-of-hospital cardiac arrest (OHCA) resuscitation. RECENT FINDINGS Activating volunteer citizens to OHCA has the potential to improve OHCA survival by increasing bystander cardiopulmonary resuscitation (CPR) and early defibrillation. Accordingly, citizen responder systems have become widespread in numerous countries despite very limited evidence of their effect on survival or cost-effectiveness. To date, only one randomized trial has investigated the effect of citizen responder activation for which the outcome was bystander CPR. Recent publications are of observational nature with high risk of bias. A scoping review published in 2020 provided an overview of available citizen responder systems and their differences in who, when, and how to activate volunteer citizens. These differences are further discussed in this review. SUMMARY Implementation of citizen responder programs holds the potential to improve bystander intervention in OHCA, with advancing technology offering new improvement possibilities. Information on how to best activate citizen responders as well as the effect on survival following OHCA is warranted to evaluate the cost-effectiveness of citizen responder programs.
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdottir H, Perkins GD. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation 2021; 161:98-114. [PMID: 33773835 DOI: 10.1016/j.resuscitation.2021.02.009] [Citation(s) in RCA: 243] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), CPR quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italy
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; West Midlands Ambulance Service and Midlands Air Ambulance, Brierly Hill, West Midlands DY5 1LX, United Kingdom
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hildigunnur Svavarsdottir
- Akureyri Hospital, Akureyri, Iceland; Institute of Health Science Research, University of Akureyri, Akureyri, Iceland
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; University Hospitals Birmingham, Birmingham B9 5SS, United Kingdom
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Machine learning can support dispatchers to better and faster recognize out-of-hospital cardiac arrest during emergency calls: A retrospective study. Resuscitation 2021; 162:218-226. [PMID: 33689794 DOI: 10.1016/j.resuscitation.2021.02.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 02/06/2023]
Abstract
AIM Fast recognition of out-of-hospital cardiac arrest (OHCA) by dispatchers might increase survival. The aim of this observational study of emergency calls was to (1) examine whether a machine learning framework (ML) can increase the proportion of calls recognizing OHCA within the first minute compared with dispatchers, (2) present the performance of ML with different false positive rate (FPR) settings, (3) examine call characteristics influencing OHCA recognition. METHODS ML can be configured with different FPR settings, i.e., more or less inclined to suspect an OHCA depending on the predefined setting. ML OHCA recognition within the first minute is evaluated with a 1.5 FPR as the primary endpoint, and other FPR settings as secondary endpoints. ML was exposed to a random sample of emergency calls from 2018. Voice logs were manually audited to evaluate dispatchers time to recognition. RESULTS Of 851 OHCA calls, the ML recognized 36% (n = 305) within 1 min compared with 25% (n = 213) by dispatchers. The recognition rate at any time during the call was 86% for ML and 84% for dispatchers, with a median time to recognition of 72 versus 94 s. OHCA recognized by both ML and dispatcher showed a 28 s mean difference in favour of ML (P < 0.001). ML with higher FPR settings reduced recognition times. CONCLUSION ML recognized a higher proportion of OHCA within the first minute compared with dispatchers and has the potential to be a supportive tool during emergency calls. The optimal FPR settings need to be evaluated in a prospective study.
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Tangpaisarn T, Srinopparatanakul T, Artpru R, Kotruchin P, Ienghong K, Apiratwarakul K. Unrecognized Out of Hospital Cardiac Arrest Symptoms during Thailand’s Emergency Medical Services. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: To improve survival rate, the main focus of adult cardiac arrest management includes rapid recognition, prompt administration of cardiopulmonary resuscitation (CPR), defibrillation for shockable rhythms, post-return of spontaneous circulation (ROSC) care, and identification and treatment of underlying causes. This study aimed to identify the determinants of unrecognized cardiac arrest, and to study the recognition rate of out-of-hospital cardiac arrest (OHCA) by emergency medical services call handlers.
METHODS: We included OHCA patients who were transferred to hospital via Emergency Medical Services (EMS) of Srinagarind hospital, Khon Kaen, Thailand, from 1st January 2020 to 31st December 2020. The primary outcome was to identify symptoms that lead to an unrecognized cardiac arrest by the EMS call handlers. Secondary outcomes were to identify the recognition rate of OHCA by emergency medical services call handlers, and assess the outcome of CPR performed on OHCA patients.
RESULTS: There were a total of 58 patients in the present study, 26 patients (44.8%) and 32 patients (55.2%) belonged to the unrecognized and recognized cardiac arrest groups, respectively. The most common symptoms that led to unrecognized cardiac arrest were a state of unconsciousness (46.2%), major trauma (15.4%), and seizure-like activity (11.5%). The rate of ROSC was higher in the unrecognized cardiac arrest group (34.6% vs. 15.6%) but the rate of survival to hospital discharge was higher in the recognized cardiac arrest group (6.3% vs 0%).
CONCLUSIONS: Falling unconscious is the most common symptom of unrecognized OHCA cases seen by EMS in Thailand. Basic life support, especially an immediate assessment of a patient’s respiratory status should be taught in health programs in school or through public service channels.
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Riou M, Ball S, Morgan A, Gallant S, Perera N, Whiteside A, Bray J, Bailey P, Finn J. 'I think he's dead': A cohort study of the impact of caller declarations of death during the emergency call on bystander CPR. Resuscitation 2021; 160:1-6. [PMID: 33444705 DOI: 10.1016/j.resuscitation.2021.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/04/2020] [Accepted: 01/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In emergency calls for out-of-hospital cardiac arrest (OHCA), dispatchers are instrumental in the provision of bystander cardiopulmonary resuscitation (CPR) through the recruitment of the caller. We explored the impact of caller perception of patient viability on initial recognition of OHCA by the dispatcher, rates of bystander CPR and early patient survival outcomes. METHODS We conducted a retrospective cohort study of 422 emergency calls where OHCA was recognised by the dispatcher and resuscitation was attempted by paramedics. We used the call recordings, dispatch data, and electronic patient care records to identify caller statements that the patient was dead, initial versus delayed recognition of OHCA by the dispatcher, caller acceptance to perform CPR, provision of bystander-CPR, prehospital return of spontaneous circulation (ROSC), and ROSC on arrival at the Emergency Department. RESULTS Initial recognition of OHCA by the dispatcher was more frequent in cases with a declaration of death by the caller than in cases without (92%, 73/79 vs. 66%, 227/343, p < 0.001). Callers who expressed such a view (19% of cases) were more likely to decline CPR (38% vs. 10%, adjusted odds ratio 4.59, 95% confidence interval 2.49-8.52, p < 0.001). Yet, 15% (12/79) of patients described as non-viable by callers achieved ROSC. CONCLUSION Caller statements that the patient is dead are helpful for dispatchers to recognise OHCA early, but potentially detrimental when recruiting the caller to perform CPR. There is an opportunity to improve the rate of bystander-CPR and patient outcomes if dispatchers are attentive to caller statements about viability.
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Affiliation(s)
- Marine Riou
- Centre de Recherche en Linguistique Appliquée (CeRLA), Université Lumière Lyon 2, Lyon, 69007, France; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia.
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance WA, Belmont, WA 6104, Australia
| | - Alani Morgan
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia
| | - Sheryl Gallant
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia
| | - Nirukshi Perera
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia
| | | | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance WA, Belmont, WA 6104, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance WA, Belmont, WA 6104, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
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Seaman KG. Implement to impact cardiac arrest survival: Telephone CPR Saves Lives. Resuscitation 2020; 156:265-267. [DOI: 10.1016/j.resuscitation.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022]
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