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Jung E, Ryu HH, Ro YS, Shin SD. Association between scene time interval and clinical outcomes according to key Utstein factors in out-of-hospital cardiac arrest. Medicine (Baltimore) 2022; 101:e32351. [PMID: 36595744 PMCID: PMC9794257 DOI: 10.1097/md.0000000000032351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
There is no consensus on the appropriate length of time spent on the scene by emergency medical services. Hence, our study aimed to investigate the association between the scene time interval (STI) and clinical outcomes of out-of-hospital cardiac arrest (OHCA) and determine whether this association is affected by key Utstein factors-witness status, bystander cardiopulmonary resuscitation, and initial electrocardiogram rhythm. This study is a cross-sectional study, using data between 2017 and 2020 from a nationwide, population-based, prospective registry of OHCA. The primary exposure is the STI, which was categorized into 3 groups: short (0 < STI ≤ 12 min), middle (13 ≤ STI ≤ 16 min), long (17 ≤ STI ≤ 30 min). The main outcome was good neurological recovery. Multivariable logistic regression and interaction analyses were performed to estimate the effect of STIs on study outcomes according to key Utstein factors. Witnessed, bystander cardiopulmonary resuscitation, and an initial shockable rhythm were associated with high survival to discharge and good neurological recovery, whereas prolonged STI was associated with low survival to discharge and poor neurological recovery. In patients with witnessed arrest, increased STI caused a more rapid decrease in survival to discharge than in non-witnessed cases (witnessed arrest: 0.56 (0.51-0.62) in middle STI and 0.33 (0.30-0.37) in long STI, non-witnessed arrest: 0.72 (0.61-0.85) in middle STI and 0.53 (0.45-0.62) in long STI. In patients with an initial shockable rhythm, increased STI caused a more rapid decrease in survival to discharge and neurological recovery than in initial non-shockable cases. Longer STIs were associated with poorer OHCA outcomes, and this trend was further emphasized in patients with witnessed OHCA and OHCA with an initial shockable rhythm.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
- * Correspondence: Hyun Ho Ryu, Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, Korea (e-mail: )
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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Devanand NA, Ruknuddeen MI, Soar N, Edwards S. Withdrawal of life-sustaining therapy in intensive care unit patients following out-of-hospital cardiac arrest: An Australian metropolitan ICU experience. Heart Lung 2022; 56:96-104. [PMID: 35810678 DOI: 10.1016/j.hrtlng.2022.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Withdrawal of life-sustaining therapy is a common phenomenon following out-of-hospital cardiac arrest. The clinical practices surrounding withdrawal of life-sustaining therapy remain unclear and warrant further inspection due to their reported impact on post-cardiac arrest mortality. OBJECTIVES To determine factors associated with withdrawal of life-sustaining therapy (WLST) in intensive care unit (ICU) patients following out-of-hospital cardiac arrest (OHCA). METHODS A retrospective review of ICU patients' clinical records following OHCA was conducted from January 2010 to December 2015. Demographic features, cardiac arrest characteristics, and targeted temperature management practices were compared between patients with and without WLST. We dichotomised WLST into early (ICU length of stay <72 h) and late (ICU length of stay ≥72 h). Factors independently associated with WLST were determined by multivariable binary logistic regression. RESULTS The study cohort included 260 post-OHCA ICU patients. The mean age was 58 years, and majority were males (178, 68%); 145 (56%) underwent WLST, with the majority undergoing early WLST (89, 61%). Status myoclonus was the strongest independent factor associated with early WLST (OR 42.53, 95% CI 4.97-363.60; p < 0.001). Glasgow Coma Scale (GCS) motor response of <4 on day three post-OHCA was the strongest factor associated with delayed WLST (OR 48.76, 95% CI 11.87-200.27; p < 0.0001). CONCLUSION The majority of deaths in ICU patients post-OHCA occurred following early WLST. Status myoclonus and a GCS motor response of <4 on day three post-OHCA are independently associated with WLST.
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Affiliation(s)
- N A Devanand
- Intensive Care Unit, Level 4, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia.
| | - M I Ruknuddeen
- Intensive Care Unit, Level 2, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112, Australia
| | - N Soar
- Intensive Care Unit, Level 2, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112, Australia
| | - S Edwards
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA 5000, Australia
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Holmström L, Reinier K, Toft L, Halperin H, Salvucci A, Jui J, Chugh SS. Out-of-hospital cardiac arrest with onset witnessed by emergency medical services: Implications for improvement in overall survival. Resuscitation 2022; 175:19-27. [PMID: 35421535 PMCID: PMC10306322 DOI: 10.1016/j.resuscitation.2022.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 01/18/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) remains a major public health problem. Even in high-income countries, survival rates have plateaued in the range of ten percent, stimulating an ongoing interest in developing novel approaches to resuscitation. Emergency Medical Services (EMS)-witnessed OHCAs constitute a subgroup of overall OHCA that occur after the arrival of EMS, leading to rapid initiation of resuscitation and significantly improved survival. In this narrative review we summarize and interpret recent developments in knowledge of EMS-witnessed OHCA regarding prevalence, demographics, location, circumstances, survival outcomes and clinical profile. We examine the possibility of informing novel resuscitation approaches and enhancing mechanistic knowledge by studying EMS-witnessed OHCA, with the goal of improving overall survival from OHCA.
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Affiliation(s)
- Lauri Holmström
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States; Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Lorrel Toft
- Department of Medicine, Cardiology, University of Nevada, Reno School of Medicine, United States
| | - Henry Halperin
- Division of Cardiology, The Johns Hopkins University, United States
| | - Angelo Salvucci
- Ventura County Health Care Agency, Ventura, CA, United States
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States; Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States.
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Gowens P, Smith K, Clegg G, Williams B, Nehme Z. Global variation in the incidence and outcome of emergency medical services witnessed out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2022; 175:120-132. [PMID: 35367317 DOI: 10.1016/j.resuscitation.2022.03.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/04/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023]
Abstract
AIM OF THE REVIEW To examine global variation in the incidence and outcomes of emergency medical services (EMS) witnessed out-of-hospital cardiac arrest (OHCA). DATA SOURCES We systematically reviewed four electronic databases for studies between 1990 and 5th April 2021 reporting EMS-witnessed OHCA populations. Studies were included if they reported sufficient data to calculate the primary outcome of survival to hospital discharge or 30-day survival. Random-effects models were used to pool incidence and survival outcomes, and meta-regression was used to examine sources of heterogeneity. Study quality was appraised using the Joanna Briggs Institute critical appraisal tools. RESULTS The search returned 1178 non-duplicate titles of which 66 articles comprising 133,981 EMS-witnessed patients treated by EMS across 33 countries were included. All but one study was observational and only 12 studies (18%) were deemed to be at low risk of bias. The pooled incidence of EMS-treated cases was 4.1 per 100,000 person-years (95% CI: 3.5, 4.7), varying almost 4-fold across continents. The pooled proportion of survivors to hospital discharge or 30-days was 20% overall (95% CI: 18%, 22%; I2 = 98%), 43% (95% CI: 37%, 49%; I2 = 94%) for initial shockable rhythms and 6% (95% CI: 5%, 8%; I2 = 79%) for initial non-shockable rhythms. In the meta-regression analysis, only region and aetiology were significantly associated with survival. When compared to studies from North America, pooled survival was significantly higher in studies from Europe (14% vs. 26%; p = 0.04) and Australasia (14% vs. 31%, p < 0.001). CONCLUSION We identified significant global variation in the incidence and survival outcome of EMS-witnessed OHCA. Further research is needed to understand the factors contributing to these variations.
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Affiliation(s)
- Paul Gowens
- Research Development and Innovation Hub, Scottish Ambulance Service, Edinburgh, Scotland; Resuscitation Research Group, University of Edinburgh, Edinburgh, Scotland
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Gareth Clegg
- Research Development and Innovation Hub, Scottish Ambulance Service, Edinburgh, Scotland; Resuscitation Research Group, University of Edinburgh, Edinburgh, Scotland
| | - Brett Williams
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
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Rea T, Kudenchuk PJ, Sayre MR, Doll A, Eisenberg M. Out of hospital cardiac arrest: Past, present, and future. Resuscitation 2021; 165:101-109. [PMID: 34166740 DOI: 10.1016/j.resuscitation.2021.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
Advances in resuscitation following out-of-hospital cardiac arrest (OHCA) provide an opportunity to improve public health. This review reflects on past developments, present status, and future possibilities using the science-education-implementation framework of the Utstein Formula and the clinical framework of the links in the chain of survival. With the discovery of CPR and defibrillation in the mid 20th century, resuscitation developed a scientific construct for progress. Systems of emergency community response provided operational efficiency to treat OHCA. Contemporary resuscitation involves integrated interventions in the chain of survival: early recognition, early CPR, early defibrillation, expert and timely advanced life support and hospital care, and multidimensional rehabilitation. Implementation of scientific advances is especially challenging given the unexpected nature of OHCA, the need for time-sensitive interventions, and the substantial collective of stakeholders involved in the chain of survival. Systematic measurement provides the foundation to evaluate performance and guide implementation initiatives. For many systems, telecommunicator CPR and high-performance CPR by emergency professionals are accessible, near-term programs to improve OHCA outcome. Smart technologies that activate, coordinate, and/or coach community "volunteers" to accelerate early CPR and defibrillation have conceptual promise, though robust implementation has been achieved by only a handful of systems. Longer-term strategies may leverage technology to develop a high-fidelity "life-detector" or engineer and disseminate a specialized consumer defibrillator designed to bridge care until arrival of professional response.
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Affiliation(s)
- Thomas Rea
- Department of Medicine, University of Washington, United States
| | | | - Michael R Sayre
- Department of Emergency Medicine, University of Washington, United States
| | - Ann Doll
- Resuscitation Academy, United States
| | - Mickey Eisenberg
- Department of Emergency Medicine, University of Washington, United States.
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Apiratwarakul K, Ruamsuk P, Suzuki T, Celebi I, Tiamkao S, Bhudhisawasdi V, Ienghong K. Development of Emergency Medical Services Amid 5 Years’ Experience at a Medical School in Thailand. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The development of emergency medical services (EMSs) in Thailand is divided into two phases following the enactment of the Emergency Medical Act in 2007 aimed at making the work model more systematic. However, the amount of EMS operations has not been well studied.
AIM: The aim of this study was to describe the pattern of EMS operations throughout a 5-year period.
METHODS: A retrospective, single-centered study at a medical school hospital in Thailand. Data were gathered from the EMS database at Srinagarind Hospital throughout the years 2016–2020.
RESULTS: A total of 10,384 EMS operations were examined over a 5-year period (2016–2020). The mean age of patients in 2016 was 40.2 ± 3.5 years, and 55.3% (n = 1178) were male. Operations were most commonly performed during the afternoon shift (4.00 p.m.–0.00 a.m.) 41.0%, 38.6%, 39.5%, 39.2%, and 50.8%, respectively. The amount of EMS members had a tendency to increase in number throughout the 5 years of study (p = 0.022). The average times from 1669 center call receipt to arrival on scene (response time) for 2016 and 2020 were 8.52 ± 2.20 min and 5.52 ± 3.02 min, respectively (p < 0.001).
CONCLUSION: The development of EMS at Srinagarind Hospital took place with an increase in the age of patients, number of operations in the afternoon shift, and EMS members, yet with a decrease in response times.
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Nolan JP, Ornato JP, Parr MJA, Perkins GD, Soar J. Resuscitation highlights in 2020. Resuscitation 2021; 162:1-10. [PMID: 33577963 DOI: 10.1016/j.resuscitation.2021.01.037] [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: 01/31/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This review is the latest in a series of regular annual reviews undertaken by the editors and aims to highlight some of the key papers published in Resuscitation during 2020. The number of papers submitted to the Journal in 2020 increased by 25% on the previous year.MethodsHand-searching by the editors of all papers published in Resuscitation during 2020. Papers were selected based on then general interest and novelty and were categorised into general themes.ResultsA total of 103 papers were selected for brief mention in this review.ConclusionsResuscitation science continues to evolve rapidly and incorporate all links in the chain of survival.
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Affiliation(s)
- J P Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG, UK.
| | - J P Ornato
- Department of Emergency Medicine, Virginia Commonwealth University Health, Richmond, VA, USA.
| | - M J A Parr
- Intensive Care, Liverpool and Macquarie University Hospitals, University of New South Wales and Macquarie University, Sydney, Australia.
| | - G D Perkins
- Critical Care Medicine, University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, CV4 7AL, UK.
| | - J Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
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