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Uehara K, Tagami T, Hyodo H, Takagi G, Ohara T, Yasutake M. The ABC (Age, Bystander, and Cardiogram) score for predicting neurological outcomes of cardiac arrests without pre-hospital return of spontaneous circulation: A nationwide population-based study. Resusc Plus 2024; 19:100673. [PMID: 38881598 PMCID: PMC11177075 DOI: 10.1016/j.resplu.2024.100673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/11/2024] [Accepted: 05/19/2024] [Indexed: 06/18/2024] Open
Abstract
Aim We previously proposed the ABC score to predict the neurological outcomes of cardiac arrest without prehospital return of spontaneous circulation (ROSC). Using nationwide population-based data, this study aimed to validate the ABC score through various resuscitation guideline periods. Methods We analysed cases with cardiac arrest due to internal causes and failure to achieve prehospital ROSC in the All-Japan Utstein Registry. Patients from the 2007-2009, 2012-2014, and 2017-2019 periods were classified into the 2005, 2010, and 2015 guideline groups, respectively. Neurological outcomes were assessed using cerebral performance categories (CPCs) one month after the cardiac arrest. We defined CPC 1-2 as a favourable outcome. We evaluated the test characteristics of the ABC score, which could range from 0 to 3. Results Among the 162,710, 186,228, and 190,794 patients in the 2005, 2010, and 2015 guideline groups, 0.7%, 0.8%, and 0.9% of the patients had CPC 1-2, respectively. The proportions of CPC 1-2 were 2.9%, 3.6%, and 4.6% in patients with ABC scores of 2 and were 9.5%, 13.3%, and 16.8% in patients with ABC scores of 3, respectively. Among patients with ABC scores of 0, 0.2%, 0.1%, and 0.2%, all had CPC 1-2, respectively. The areas under the receiver operating characteristic curves for the ABC score were 0.798, 0.822, and 0.828, respectively. Conclusions The ABC score had acceptable discrimination for neurological outcomes in patients without prehospital ROSC in the three guideline periods.
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Affiliation(s)
- Kazuyuki Uehara
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Hideya Hyodo
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Gen Takagi
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Toshihiko Ohara
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Masahiro Yasutake
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
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2
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Hayashi M, Iwasaki Y. Addressing out-of-hospital cardiac arrest with current technology advances: Breaking the deadlock with a mobile network. J Arrhythm 2024; 40:753-766. [PMID: 39139868 PMCID: PMC11317685 DOI: 10.1002/joa3.13103] [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: 05/07/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 08/15/2024] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a global public health problem, with survival rates remaining low at around 10% or less despite widespread cardiopulmonary resuscitation (CPR) training and availability of automated external defibrillators (AEDs). This is partly due to the challenges of knowing when and where a sudden OHCA occurs and where the nearest AED is located. In response, countries around the world have begun to use network technology-based smartphone applications. These applications are activated by emergency medical service dispatchers and alert preregistered volunteer first responders (VFRs) to nearby OHCAs using Global Positioning System localization. Accumulating evidence, although mostly from observational studies, shows their effectiveness in increasing the rate of bystander CPR, defibrillation, and patient survival. Current guidelines recommend the use of these VFR alerting systems, and the results of ongoing randomized trials are awaited for further dissemination. This article also proposed the concept of a life-saving mobile network (LMN), which uses opportunistic network and wireless sensor network technologies to create a dynamic mesh network of potential victims, rescuers, and defibrillators. The LMN works by detecting a fatal arrhythmia with a wearable sensor device, localizing the victim and the nearest AED with nearby smartphones, and notifying VFRs through peer-to-peer communication. While there are challenges and limitations to implementing the LMN in society, this innovative network technology would reduce the tragedy of sudden cardiac death from OHCA.
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Affiliation(s)
- Meiso Hayashi
- Humanities and Social Sciences 2College of Arts and Sciences, The University of TokyoTokyoJapan
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
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Redlener M, Buckler DG, Sondheim SE, Yeturu SK, Loo GT, Munjal KG, Jarvis J, Crowe RP. A National Assessment of EMS Performance at the Response and Agency Level. PREHOSP EMERG CARE 2024; 28:719-726. [PMID: 38347669 DOI: 10.1080/10903127.2023.2283886] [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: 05/25/2023] [Accepted: 11/12/2023] [Indexed: 07/02/2024]
Abstract
BACKGROUND In 2019, the National EMS Quality Alliance (NEMSQA) established a suite of 11 evidence-based EMS quality measures, yet little is known regarding EMS performance on a national level. Our objective was to describe EMS performance at a response and agency level using the National EMS Information System (NEMSIS) dataset. METHODS The 2019 NEMSIS research dataset of all EMS 9-1-1 responses in the United States was utilized to calculate 10 of 11 NEMSQA quality measures. Measure criteria and pseudocode was implemented to calculate the proportion meeting measure criteria and 95% confidence intervals across all encounters and for each anonymized agency. We omitted Pediatrics-03b because the NEMSIS national dataset does not report patient weight. Agency level analysis was subsequently stratified by call volume and urbanicity. RESULTS Records from 9,679 agencies responding to 26,502,968 9-1-1 events were analyzed. Run-level average performance ranged from 12% for Safety-01 (encounter documented as initial response without the use of lights and siren to 82% for Pediatrics-02 (documented respiratory assessment in pediatric patients with respiratory distress) At the agency level, significant variation in measure performance existed by agency size and by urbanicity. At the individual agency performance analysis, Trauma-04 (trauma patients transported to trauma center) had the lowest agency-level performance with 47% of agencies reporting 0% of eligible runs with documented transport to a trauma center. CONCLUSION There is a wide range of performance in key EMS quality measures across the United States that demonstrate a need to identify strategies to improve quality and equity of care in the prehospital environment, system performance and data collection.
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Affiliation(s)
- Michael Redlener
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - David G Buckler
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Samuel E Sondheim
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Sai Kaushik Yeturu
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - George T Loo
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kevin G Munjal
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
- Care2U, New York City, New York
| | | | - Remle P Crowe
- Clinical and Operational Research, ESO, Austin, Texas
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4
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Rea TD. Resuscitation From Out-of-Hospital Cardiac Arrest: Location, Location, Location. J Am Coll Cardiol 2023; 82:1789-1791. [PMID: 37879783 DOI: 10.1016/j.jacc.2023.09.798] [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] [Received: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Thomas D Rea
- University of Washington Department of Medicine and the Division of Emergency Medical Services - Seattle & King County, Seattle, Washington, USA.
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5
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Yoshimura H, Yamamoto C, Sawano T, Nishikawa Y, Saito H, Nonaka S, Zhao T, Ito N, Tashiro S, Ozaki A, Oikawa T, Tsubokura M. Impact of lifting the mandatory evacuation order after the Fukushima Daiichi Nuclear Power Plant accident on the emergency medical system: a retrospective observational study at Minamisoma City with machine learning analysis. BMJ Open 2023; 13:e067536. [PMID: 37015790 PMCID: PMC10083807 DOI: 10.1136/bmjopen-2022-067536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES This study aimed to identify factors that delayed emergency medical services (EMS) in evacuation order zones after the 2011 Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant accident and to investigate how the lifting of the evacuation affected these factors over time. DESIGN This research was a retrospective observational study. The primary outcome measure was onsite EMS time. A gradient boosting model and a decision tree were used to find the boundary values for factors that reduce EMS. SETTING The target area was Minamisoma City, Fukushima, Japan that was partly designated as an evacuation order zone after the 2011 Fukushima disaster, which was lifted due to decreased radiation. PARTICIPANTS This study included patients transferred by EMS from 1 January 2013 through 31 October 2018. Patients who were not transported and those transported for community events, interhospital patient transfer and natural disasters were excluded. OUTCOME MEASURES This study evaluated the total EMS time using on-site time which is the time from arrival at the scene to departure to the destination, and other independent factors. RESULTS The total number of transports was 12 043. The decision tree revealed that the major factors that prolonged onsite time were time of day and latitude, except for differences by year. While latitude was a major factor in extending on-site time until 2016, the effect of latitude decreased and that of time of day became more significant since 2017. The boundary was located at N37.695° latitude. CONCLUSIONS The onsite time delay in EMS in evacuation order zones is largely due to regional factors from north to south and the time of day. However, the north-south regional factor decreased with the lifting of evacuation orders.
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Affiliation(s)
- Hiroki Yoshimura
- School of Medicine, Hiroshima University, Hiroshima, Japan
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Chika Yamamoto
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
- Department of Internal Medicine, Soma Central Hospital, Soma, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
- Department of Gastroenterology, Soma Central Hospital, Soma, Japan
| | - Saori Nonaka
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tianchen Zhao
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naomi Ito
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Satoshi Tashiro
- Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Akihiko Ozaki
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima, Japan
| | - Tomoyoshi Oikawa
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Japan
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COVID-19 Lockdown and Bystander Cardiopulmonary Resuscitation: all associations are local. Resuscitation 2023; 186:109780. [PMID: 36990140 PMCID: PMC10041817 DOI: 10.1016/j.resuscitation.2023.109780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
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Nasimi F, Yazdchi M. LDIAED: A lightweight deep learning algorithm implementable on automated external defibrillators. PLoS One 2022; 17:e0264405. [PMID: 35213628 PMCID: PMC8880955 DOI: 10.1371/journal.pone.0264405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/06/2022] [Indexed: 11/28/2022] Open
Abstract
Differentiating between shockable and non-shockable Electrocardiogram (ECG) signals would increase the success of resuscitation by the Automated External Defibrillators (AED). In this study, a Deep Neural Network (DNN) algorithm is used to distinguish 1.4-second segment shockable signals from non-shockable signals promptly. The proposed technique is frequency-independent and is trained with signals from diverse patients extracted from MIT-BIH, MIT-BIH Malignant Ventricular Ectopy Database (VFDB), and a database for ventricular tachyarrhythmia signals from Creighton University (CUDB) resulting, in an accuracy of 99.1%. Finally, the raspberry pi minicomputer is used to load the optimized version of the model on it. Testing the implemented model on the processor by unseen ECG signals resulted in an average latency of 0.845 seconds meeting the IEC 60601-2-4 requirements. According to the evaluated results, the proposed technique could be used by AED’s.
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Affiliation(s)
- Fahimeh Nasimi
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | - Mohammadreza Yazdchi
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
- * E-mail:
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Maximum expected survival rate model for public access defibrillator placement. Resuscitation 2021; 170:213-221. [PMID: 34883217 DOI: 10.1016/j.resuscitation.2021.11.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
AIM Mathematical optimization of automated external defibrillator (AED) placement has demonstrated potential to improve survival of out-of-hospital cardiac arrest (OHCA). Existing models mostly aim to improve accessibility based on coverage radius and do not account for detailed impact of delayed defibrillation on survival. We aimed to predict OHCA survival based on time to defibrillation and developed an AED placement model to directly maximize the expected survival rate. METHODS We stratified OHCAs occurring in Singapore (2010-2017) based on time to defibrillation and developed a regression model to predict the Utstein survival rate. We then developed a novel AED placement model, the maximum expected survival rate (MESR) model. We compared the performance of MESR with a maximum coverage model developed for Canada that was shown to be generalizable to other settings (Denmark). The survival gain of MESR was assessed through 10-fold cross-validation for placement of 20 to 1000 new AEDs in Singapore. Statistical analysis was performed using χ2 and McNemar's tests. RESULTS During the study period, 15,345 OHCAs occurred. The power-law approximation with R2 of 91.33% performed best among investigated models. It predicted a survival of 54.9% with defibrillation within the first two minutes after collapse that was reduced by more than 60% without defibrillation within the first 4 minutes. MESR outperformed the maximum coverage model with P-value < 0.05 (<0.0001 in 22 of 30 experiments). CONCLUSION We developed a novel AED placement model based on the impact of time to defibrillation on OHCA outcomes. Mathematical optimization can improve OHCA survival.
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Yamamoto C, Sawano T, Nishikawa Y, Ozaki A, Shimada Y, Morita T, Zhao T, Hasegawa A, Oikawa T, Tsubokura M. Evaluation of the emergency medical system in an area following lifting of the mandatory evacuation order after the Fukushima Daiichi Nuclear Power Plant accident: A retrospective cross-sectional observational study. Medicine (Baltimore) 2021; 100:e26466. [PMID: 34160451 PMCID: PMC8238363 DOI: 10.1097/md.0000000000026466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
Following the lifting of the evacuation order due to the Fukushima Daiichi Nuclear Power Plant accident, the medical demand and emergency medical system (EMS) in the area where the evacuation orders were lifted have not been well-investigated. This study aimed to evaluate the emergency transportation in such areas and compare the differences with areas that had minimal impact.Using the local EMS transport records, the characteristics of patients who were transferred by an EMS vehicle in Minamisoma City were collected between July 12, 2016 and July 31, 2018, and were compared between former evacuation zones and outside the evacuation zones in the city.The number of emergency transports in the study period in Minamisoma City were 325 cases in the area where the evacuation orders were lifted and 4307 cases in the other areas. The total EMS time was significantly longer in the area where the evacuation order was lifted (48 ± 16 minutes) than in the other areas (40 ± 15 minutes) (P < .001). In the analysis of each component of EMS times, the transport time, which is the time from departure from the patient's location to arrival at a hospital, was significantly longer in the former evacuation zone than in the other areas (16 ± 9 vs 9 ± 9 minutes, P < .001), suggesting that transport time contributed to the longer EMS response times.In areas where the evacuation orders were lifted, the EMS transport time was significantly longer than that in the area outside the former evacuation zone; correspondingly, the total EMS time significantly increased in the former evacuation zone. A plausible reason for this may be the closure of local medical facilities following the evacuation order after the nuclear accident.
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Affiliation(s)
- Chika Yamamoto
- Department of Emergency, Minamisoma Municipal General Hospital
- Division of Disaster and Radiation Medical Sciences, Fukushima Medical University
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation
- Department of Radiation Health Management, Fukushima Medical University School of Medicine
- Research Center for Community Health, Minamisoma Municipal General Hospital
| | - Yoshitaka Nishikawa
- Department of Internal Medicine, Soma Central Hospital, Fukushima
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto
| | - Akihiko Ozaki
- Research Center for Community Health, Minamisoma Municipal General Hospital
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation
| | - Yuki Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Fukushima
| | - Tomohiro Morita
- Department of Internal Medicine, Soma Central Hospital, Fukushima
| | - Tianchen Zhao
- Department of Radiation Health Management, Fukushima Medical University School of Medicine
| | - Arifumi Hasegawa
- Department of Radiation Disaster Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tomoyoshi Oikawa
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Fukushima
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine
- Research Center for Community Health, Minamisoma Municipal General Hospital
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Wouters A, Scheldeman L, Plessers S, Peeters R, Cappelle S, Demaerel P, Van Paesschen W, Ferdinande B, Dupont M, Dens J, Janssens S, Ameloot K, Lemmens R. Added Value of Quantitative Apparent Diffusion Coefficient Values for Neuroprognostication After Cardiac Arrest. Neurology 2021; 96:e2611-e2618. [PMID: 33837117 DOI: 10.1212/wnl.0000000000011991] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the prognostic value of brain MRI in addition to clinical and electrophysiologic variables in patients post-cardiac arrest (CA), we explored data from the randomized Neuroprotect Post-CA trial (NCT02541591). METHODS In this trial, brain MRIs were prospectively obtained. We calculated receiver operating characteristic (ROC) curves for the average apparent diffusion coefficient (ADC) value and percentage of brain voxels with an ADC value <650 × 10-6 mm2/s and <450 × 10-6 mm2/s. We constructed multivariable logistic regression models with clinical characteristics, EEG, somatosensory evoked potentials (SSEP), and ADC value as independent variables to predict good neurologic recovery. RESULTS In 79/102 patients, MRI data were available and in 58/79 patients all other data were available. At 180 days post-CA, 25/58 (43%) patients had good neurologic recovery. In univariable analysis of all tested MRI measures, average ADC value in the postcentral cortex had the highest accuracy to predict good neurologic recovery, with an area under the ROC curve (AUC) of 0.78. In the most optimal multivariable model, which also included corneal reflexes and EEG, this measure remained an independent predictor of good neurologic recovery (AUC 0.96, false-positive 27%). This model provided a more accurate prediction compared to the most optimal combination of EEG, corneal reflexes, and SSEP (p = 0.03). CONCLUSIONS Adding information on brain MRI in a multivariable model may improve the prediction of good neurologic recovery in patients post-CA. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that MRI ADC features predict neurologic recovery in patients post-CA.
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Affiliation(s)
- Anke Wouters
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium.
| | - Lauranne Scheldeman
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Sam Plessers
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Ronald Peeters
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Sarah Cappelle
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Philippe Demaerel
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Wim Van Paesschen
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Bert Ferdinande
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Matthias Dupont
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Jo Dens
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Stefan Janssens
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Koen Ameloot
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Robin Lemmens
- From the Departments of Neurology (A.W., L.S., S.P., R.L.), Radiology (R.P., S.C., P.D.), and Cardiology (S.J., K.A.), University Hospitals Leuven; Laboratory of Neurobiology (A.W., L.S., R.L.), Center for Brain & Disease Research, VIB; Department of Neurosciences (A.W., L.S., R.L.), Experimental Neurology and Leuven Brain Institute, University of Leuven, Belgium; Department of Neurology (A.W.), Academic Medical Center, University of Amsterdam, the Netherlands; Translational MRI, Department of Imaging and Pathology (R.P., S.C., P.D.), and Laboratory for Epilepsy Research, Department of Neurosciences (W.V.P.), KU Leuven, Belgium; Department of Cardiology (B.F., M.D., J.D., K.A.), Ziekenhuis Oost-Limburg, Genk; and Faculty of Medicine and Life Sciences (J.D., K.A.), Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
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Choi HJ, Noh H. Successful defibrillation using double sequence defibrillation: Case reports. Medicine (Baltimore) 2021; 100:e24992. [PMID: 33725873 PMCID: PMC7969327 DOI: 10.1097/md.0000000000024992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Defibrillation is effective and the most common treatment for ventricular fibrillation (VF) and pulseless ventricular tachycardia in patients with cardiac arrest. PATIENT CONCERNS Recently we experienced 3 cases refractory ventricular fibrillation (RVF) which was successfully terminated with double sequence defibrillation (DSD) in our emergency department, so we'd like to report and discuss it. DIAGNOSIS Cardiac arrest. INTERVENTIONS A single defibrillation 200J was performed twice for patients with ventricular fibrillation in the initial rhythm of the emergency room. At the same time, intubation and intravenous access were achieved and epinephrine and amiodarone were administered. The 400J DSD was performed on RVF patients with sustained VFs, despite several trials of 150-200J defibrillation and adherence to advanced cardiac life support. OUTCOMES All three RVF patients recovered spontaneous circulation after DSD. CONCLUSION The three cases we have shown are small, but DSD improves the chance of spontaneous circulation. Therefore it is suggested that attempts of DSD to patients with RVF, especially in the prehospital stages as a way to improve the return of spontaneous circulation.
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Affiliation(s)
- Hyo Jeong Choi
- Department of Emergency Medical Technology, Sun Moon University. 70, Asan-si, Chungcheongnam-do
| | - Hyun Noh
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Bucheon-si, Gyeonggi-do, KR
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12
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Lo YH, Siu YCA. Evaluation of prognostic prediction models for out-of-hospital cardiac arrest. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920966912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: Accurate prognostic prediction of out-of-hospital cardiac arrest is challenging but important for the emergency team and patient’s family members. A number of prognostic prediction models specifically designed for out-of-hospital cardiac arrest are developed and validated worldwide. Objective: This narrative review provides an overview of the prognostic prediction models out-of-hospital cardiac arrest patients for use in the emergency department. Discussion: Out-of-hospital cardiac arrest prognostic prediction models are potentially useful in clinical, administrative and research settings. Development and validation of such models require prehospital and hospital predictor and outcome variables which are best in the standardised Utstein Style. Logistic regression analysis is traditionally employed for model development but machine learning is emerging as the new tool. Examples of such models available for use in the emergency department include ROSC After Cardiac Arrest, CaRdiac Arrest Survival Score, Utstein-Based Return of Spontaneous Circulation, Out-of-Hospital Cardiac Arrest, Cardiac Arrest Hospital Prognosis and Cardiac Arrest Survival Score. The usefulness of these models awaits future studies.
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Affiliation(s)
- Yat Hei Lo
- Accident & Emergency Department, Ruttonjee and Tang Shiu Kin Hospital, Wanchai, Hong Kong
| | - Yuet Chung Axel Siu
- Accident & Emergency Department, Ruttonjee and Tang Shiu Kin Hospital, Wanchai, Hong Kong
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13
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Møller SG, Wissenberg M, Møller-Hansen S, Folke F, Malta Hansen C, Kragholm K, Bundgaard Ringgren K, Karlsson L, Lohse N, Lippert F, Køber L, Gislason G, Torp-Pedersen C. Regional variation in out-of-hospital cardiac arrest: Incidence and survival — A nationwide study of regions in Denmark. Resuscitation 2020; 148:191-199. [DOI: 10.1016/j.resuscitation.2020.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/04/2020] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
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Does second EMS unit response time affect outcomes of OHCA in multi-tiered system? A nationwide observational study. Am J Emerg Med 2020; 42:161-167. [PMID: 32111405 DOI: 10.1016/j.ajem.2020.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/13/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The time dependence of a multi-tier response for out-of-hospital cardiac arrest (OHCA) is unclear. The aim of this study was to evaluate the time-dependent effect of EMS response type in a multi-tiered system on the clinical outcomes of OHCA. METHODS Adult EMS-treated OHCA of presumed cardiac etiology who were not witnessed by EMS between January 2015 and December 2017 were included. The main exposure was EMS response type: single-tier response, early multi-tier response (0-18 min from call to second EMS arrival), and late multi-tier response (19 min from call to second EMS arrival). The primary outcome was good neurologic recovery at the time of discharge from the hospital. Multivariate logistic regression analysis was performed, adjusting for patient-community and prehospital variables. RESULTS Among 54,436 patients, 29,995 patients (55.1%), 21,552 patients (39.6%), and 2889 patients (5.3%) were treated by single-tiered EMS, early multi-tiered EMS, and late multi-tiered EMS, respectively. Good neurological recovery and survival to discharge were more frequent in the early multi-tiered response group (6.4% and 9.7%) than in the single-tiered response group (4.8% and 7.5%) or late multi-tiered response group (3.1% and 5.8%). Compared to the single-tiered response group, the early multi-tiered response group was more likely to have good neurological recovery (adjusted OR, 95% CI: 1.15 [1.06-1.26]), but the late multi-tiered response group was less likely to have good neurological recovery (adjusted OR, 95% CI: 0.76 [0.61-0.96]). CONCLUSION In our basic to intermediate-tiered EMS system, early multi-tier response was associated with improved survival and good neurological recovery.
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Pätz T, Stelzig K, Pfeifer R, Pittl U, Thiele H, Busch HJ, Reinhard I, Wolfrum S. Age-associated outcomes after survived out-of-hospital cardiac arrest and subsequent target temperature management. Acta Anaesthesiol Scand 2019; 63:1079-1088. [PMID: 31206587 DOI: 10.1111/aas.13386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/21/2019] [Accepted: 04/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The registry of the German Society of Intensive Care and Emergency Medicine was founded to analyze outcome of modern post-resuscitation care. METHODS A total of 902 patients were analyzed in this retrospective, multicenter, and population-based observational trial on individuals suffering from out-of-hospital cardiac arrest. All patients had return of spontaneous circulation (ROSC) and received TTM after admitted to an intensive care unit. Outcome was focused on age and analyzed by creating 4 subgroups (<65, 65-74, 75-84, ≥85 years). Twenty-eight day and 180-day survival and a favorable neurological outcome according to the Cerebral Performance Category scale were evaluated as clinical endpoints. RESULTS At 28-day and 180-day follow-up, 44.8% and 53.4% of all patients had died, respectively. The evaluation of survival rate by age category revealed a higher mortality, but not an unfavorable neurological prognosis with increasing age. In multiple stepwise regressions, age, time to ROSC, bystander resuscitation, and cardiac cause of cardiac arrest were associated with increased chance of 180-day survival and, in addition, bystander resuscitation, time of hypoxia, and a defibrillation performed by emergency medical service were associated with a favorable neurological outcome at 180-day follow-up. CONCLUSION Increasing age was associated with a higher mortality, but not with an unfavorable neurological outcome. The majority of survivors had a favorable neurologic outcome 6 months after cardiac arrest.
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Affiliation(s)
- Toni Pätz
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care MedicineLübeck Germany
| | - Katharina Stelzig
- Emergency Department University Hospital of Schleswig‐Holstein Lübeck Germany
| | - Rüdiger Pfeifer
- Clinic for Internal Medicine University of Jena Jena Germany
| | - Undine Pittl
- Department of Internal Medicine/Cardiology Heart Center Leipzig – University Hospital Leipzig Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig – University Hospital Leipzig Germany
| | - Hans-Jörg Busch
- University Emergency Center University of Freiburg Freiburg Germany
| | - Iris Reinhard
- Department of Biostatistics Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University Mannheim Germany
| | - Sebastian Wolfrum
- Emergency Department University Hospital of Schleswig‐Holstein Lübeck Germany
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Del Rios M, Weber J, Pugach O, Nguyen H, Campbell T, Islam S, Stein Spencer L, Markul E, Bunney EB, Vanden Hoek T. Large urban center improves out-of-hospital cardiac arrest survival. Resuscitation 2019; 139:234-240. [DOI: 10.1016/j.resuscitation.2019.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 11/28/2022]
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Oren NC, Chang E, Yang CWY, Lee SK. Brain Diffusion Imaging Findings May Predict Clinical Outcome after Cardiac Arrest. J Neuroimaging 2019; 29:540-547. [PMID: 31107566 DOI: 10.1111/jon.12626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE We aim to correlate the patterns of brain diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) map in post cardiac arrest (PCA) patients with clinical outcomes. METHODS Thirty-eight adult patients with PCA (mean age, 52.8 years; range 18-87 years) whose DWI obtained within 5 days of PCA were retrospectively reviewed. The visual DWI/ADC map categories include: Group 1: Normal; Group 2a: Mild [restricted diffusion (RD) < 1/3 cortical involvement (CI)]); Group 2b: Moderate (RD 1/3 > and < 2/3 CI); Group 2c: Severe (RD > 2/3 CI); and Group 3: Embolic (scattered, discrete foci of RD). Clinical outcomes were categorized according to cerebral performance categories (CPC) and modified Rankin scale (mRS). RESULTS The most common DWI/ADC map pattern was Group 1 (28.9%, n = 11). The incidence of other DWI patterns such as Group 2a, 2b, 2c, and 3 were 21% (n = 8), 10.5% (n = 4), 21% (n = 8), and 18.4% (n = 7), respectively. Twenty-seven patients (71%) were CPC-5/mRS-6 and died or were category CPC-4/mRS-5, and 4 patients were CPC-1/mRS 0-1 (10.5%). Interobserver agreement for visual classification of DWI/ADC map patterns was excellent (kappa = .8795). There was moderate positive correlation between clinical outcomes and visual DWI classification (r = .461, P = .00358). The positive predictive value of this qualitative classification on DWI/ADC in predicting a poor clinical outcome (CPC-4/mRS-5 and CPC-5/mRS-6) was 81.4 % in the presence of restricted diffusion. CONCLUSION Simple visual categorization system using DWI/ADC map may be helpful and practical in estimating the clinical outcome of PCA patients.
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Affiliation(s)
- Nisa Cem Oren
- Department of Radiology, The University of Chicago Medical Center, Chicago, Illinois
| | - Edwina Chang
- Department of Radiology, The University of Chicago Medical Center, Chicago, Illinois
| | - Carina Wei-Yee Yang
- Department of Radiology, The University of Chicago Medical Center, Chicago, Illinois
| | - Seon-Kyu Lee
- Montefiore Medical Center, Department of Radiology, Albert Einstein College of Medicine, Bronx, New York
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19
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Leung L, Lo C, Tong H. Prehospital Resuscitation of Out-of-Hospital Cardiac Arrest in Queen Mary Hospital. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790000700401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Management of out-of-hospital cardiac arrest is a major task of the accident and emergency department. The aim of this study is to evaluate the efficacy of prehospital resuscitation of out-of-hospital cardiac arrest in Hong Kong and identify areas for improvement. It was a prospective descriptive study of adults with non-traumatic out-of-hospital cardiac arrest who were admitted to the Accident and Emergency Department of Queen Mary Hospital by the ambulance service from March 15, 1999 to October 15, 1999. Patient characteristics and the response times of the ambulance service were recorded according to the Utstein style. One hundred and thirty patients were included. The overall immediate survival rate was 14.6% and the overall survival to discharge rate was 1.54%. The outcome of out-of-hospital cardiac arrest is poor. Every link in the chain of survival has to be improved.
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Affiliation(s)
- Lp Leung
- Queen Mary Hospital, Accident and Emergency Department, Pokfulam, Hong Kong
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20
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Annathurai A, Fook-Chong S, Lee S, Cheng S, Lee C, Shahidah N, Koh Z, Ong M. Use of a Load Distributing Band Device (with Ventilation Prompts) during Cardiopulmonary Resuscitation. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Over-ventilation can compromise coronary perfusion pressures during cardiopulmonary resuscitation (CPR) and should be minimised. We compared ventilations during manual and mechanical (load-distributing band - LDB) CPR, which gives ventilation prompts. Our primary objective was to compare the ventilation rate between manual CPR and LDB-CPR. Method This was a phased, non-randomised study at a tertiary hospital emergency department. All out-of-hospital, non-traumatic cardiac arrest adult patients during the study period from February 2007 till July 2008 were eligible. Pregnant females and patients aged less than 18 years of age were excluded. Ventilation rates in the first and second 5 minutes segments were recorded. Over-ventilation was defined as ventilation rate above 12 breaths per minute. All data analyses were performed with SPSS, version 17.0. Mean differences with 95% confidence interval (CI) were compared between the 2 treatment groups. Results From February 2007 till August 2007, there were 29 patients with manual CPR; and from September 2007 till July 2008, there were 62 with LDB-CPR. In the first 5 minutes of CPR, the proportion of patients that were over-ventilated, was 27.6% (manual) and 4.8% (LDB) (difference = 22.7%; 95% CI: 3.5-46.4%). In the next 5 minutes, the proportion of patients that were over-ventilated was 37.9% and 1.6% for manual and mechanical CPR respectively (difference = 36.3%; 95% CI: 16.5-58.9%). Conclusion Over-ventilation is reduced significantly in LDB-CPR compared to manual CPR during the first and second 5 minutes of resuscitation.
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Affiliation(s)
- A Annathurai
- Singapore General Hospital, Department of Emergency Medicine, Singapore
| | | | - Sh Lee
- Seoul National University, Seoul, Korea
| | - Sy Cheng
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - C Lee
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - N Shahidah
- Singapore General Hospital, Department of Emergency Medicine, Singapore
| | - Zx Koh
- Singapore General Hospital, Department of Emergency Medicine, Singapore
| | - Meh Ong
- Singapore General Hospital, Department of Emergency Medicine, Singapore
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Kim SE, Lee SJ, Noh H, Lee DH, Kim CW. Is There Any Difference in Cardiopulmonary Resuscitation Performance According to Different Instructional Models of Cardiopulmonary Resuscitation Education for Junior and Senior High School Students? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study aims to determine whether or not cardiopulmonary resuscitation (CPR) skills differ according to different instructional models for CPR education and training for junior and senior high school students. Methods This was a prospective and randomised study including 519 junior and senior high school students. After the lecture on CPR, students practiced the skill on the manikin. Group 1 used model 1 and Group 2 used model 2 for practical training and practical skills and CPR performance quality were evaluated. Results Data from skill tests were analysed in 229 students in group 1 and 210 students in group 2. The total score of sequence skill tests was 17.8±2.0 points. During 2 cycles, no chest elevation was observed in 33.3% and was significantly lower in group 1. There were no significant differences in the frequency of proper ventilation and in ventilation volume between the 2 groups. Excessive ventilation was more frequently observed in group 1 and insufficient ventilation was observed more frequently in group 2. The percentage of the frequency of a proper chest compression rate was 80.5±31.2% and there were no significant differences in proper and insufficient depths, mean rate and recoil of the chest in chest compression between the 2 groups. Conclusions There were differences in CPR skills according to different CPR training manikins. Therefore, certain conditions seem to be considered in selection of instructional models for CPR psychomotor skills. (Hong Kong j.emerg.med. 2011;18:375-382)
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Affiliation(s)
- SE Kim
- Myongji Hospital, Department of Emergency Medicine, Seoul, Korea; Noh Hyun, MD
| | - SJ Lee
- Myongji Hospital, Department of Emergency Medicine, Seoul, Korea; Noh Hyun, MD
| | - H Noh
- Myongji Hospital, Department of Emergency Medicine, Seoul, Korea; Noh Hyun, MD
| | - DH Lee
- Myongji Hospital, Department of Emergency Medicine, Seoul, Korea; Noh Hyun, MD
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Fujii T, Nagamatsu H, Nakano M, Ohno Y, Nakazawa G, Shinozaki N, Yoshimachi F, Ikari Y. Clinical outcomes in patients with acute hemodynamic collapse supported by extracorporeal life support. Intern Emerg Med 2017; 12:1207-1214. [PMID: 27665579 DOI: 10.1007/s11739-016-1542-3] [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] [Received: 05/29/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
Although extracorporeal life support (ECLS) is utilized for acute hemodynamic collapse, clinical outcomes for such patients are uncertain. The present study examined 30-day clinical outcomes in patients treated with ECLS for acute hemodynamic collapse, and determined the factors associated with 30-day mortality in patients who required ECLS for cardiopulmonary arrest (CPA). A total of 200 patients, in whom emergency ECLS was utilized for acute hemodynamic collapse from 2006 to 2015, were analyzed retrospectively. The impact of CPA on all-cause 30-day death in the overall population was examined by multivariable logistic regression analysis; comparisons were made between 30-day survivors (n = 78) and non-survivors (n = 122). In addition, clinical factors associated with 30-day survival for patients in whom ECLS was utilized for CPA (n = 139) were examined. All-cause 30-day mortality in the overall study population was 61 % (122/200). CPA was the most common cause of ECLS requirement (70 %), and the factor associated strongest with death at 30-days (OR 3.31, 95 % CI 1.75-6.36, P < 0.01). Witnessed CPA with bystander cardiopulmonary resuscitation (CPR) (OR 4.33, 95 % CI 1.08-29.1, P = 0.04) and a less than 40 min interval between CPA and ECLS (OR 3.49, 95 % CI 1.39-9.02, P < 0.01) were suggested as factors associated with 30-day survival in CPA patients. CPA as a trigger of ECLS was a strong contributor to 30-day death in patients in whom emergency ECLS was utilized. However, witnessed CPA with bystander CPR and a less than 40 min interval from CPA to start of ECLS were suggested as factors associated with survival in these CPA patients.
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Affiliation(s)
- Toshiharu Fujii
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Hirofumi Nagamatsu
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Masataka Nakano
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Yohei Ohno
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Gaku Nakazawa
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Norihiko Shinozaki
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Fuminobu Yoshimachi
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Yuji Ikari
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
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El Sayed M, Al Assad R, Abi Aad Y, Gharios N, Refaat MM, Tamim H. Measuring the impact of emergency medical services (EMS) on out-of-hospital cardiac arrest survival in a developing country: A key metric for EMS systems' performance. Medicine (Baltimore) 2017; 96:e7570. [PMID: 28723789 PMCID: PMC5521929 DOI: 10.1097/md.0000000000007570] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) can be used to evaluate the overall performance of the emergency medical services' (EMS) system. This study assessed the impact of EMS on OHCA survival rates in a setting where the prehospital system is underdeveloped.A retrospective chart review was carried out over a 5-year period of all adult OHCA patients admitted to the emergency department (ED) of a tertiary care center in Lebanon.A total of 271 patients with OHCA (179 [66.1%] men, mean age of 69.9 [standard deviation = 15.0 years] were enrolled. The most common OHCA location was residence/home (58.7%). The majority of arrests were witnessed (51.7%) with 6.1% witnessed by EMS; 211 patients (75.6%) were transported to the ED by EMS. Prehospital cardiopulmonary resuscitation (CPR) was done by EMS for 43.2% of the patients, whereas only 4.4% received CPR from a family member/bystander. Prehospital automated external defibrillator use was documented in 1.5% of cases in the prehospital setting. Only 2 patients had return of spontaneous circulation prior to ED arrival. Most patients (96.7%) were resuscitated in the ED. Patients presented to the ED mostly in asystole (79.3%). Forty-three patients (15.9%) survived to hospital admission and 13 (4.8%) were discharged alive with over half of them (53.8%) had a good neurological outcome upon discharge (cerebral performance category 1 or 2).Survival of EMS-treated OHCA victims in Lebanon is not as expected. Medical oversight of EMS activities is needed to link EMS activities to clinical outcomes and improve survival from cardiac arrest in Lebanon.
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Affiliation(s)
- Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center
| | - Reem Al Assad
- Department of Emergency Medicine, American University of Beirut Medical Center
| | - Yasmin Abi Aad
- Department of Internal Medicine, American University of Beirut Medical Center
| | - Nour Gharios
- Department of Internal Medicine, American University of Beirut Medical Center
| | - Marwan M. Refaat
- Department of Internal Medicine, American University of Beirut Medical Center
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
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Brugaletta S, Scalone G, Dantas AP, Ortega-Paz L, Garabito M, Roqué M, Martin V, Masotti M, Freixa X, Sabaté M. Endothelial function impairment in STEMI patients with out-of-hospital cardiac arrest under therapeutic hypothermia treatment. Int J Cardiol 2017; 232:70-75. [DOI: 10.1016/j.ijcard.2017.01.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/30/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
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Takamura A, Ito S, Maruyama K, Ryo Y, Saito M, Fujimura S, Ishiura Y, Hori A. Quality of basic life support education and automated external defibrillator setting in schools in Ishikawa, Japan. Pediatr Int 2017; 59:352-356. [PMID: 27589486 DOI: 10.1111/ped.13155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/04/2016] [Accepted: 08/30/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Automated external defibrillators (AED) have been installed in schools in Japan since 2004, and the government strongly recommends teaching basic life support (BLS). We therefore examined the quality of BLS education and AED installation in schools. METHODS We conducted a prefecture-wide questionnaire survey of all primary and junior high schools in 2016, to assess BLS education and AED installation against the recommendations of the Japan Circulation Society. The results were analyzed using descriptive statistics and chi-squared test. RESULTS In total, 195 schools out of 315 (62%) responded, of which 38% have introduced BLS education for children. BLS training was held in a smaller proportion of primary schools (18%) than junior high schools (86%). More than 90% of primary school staff had undergone BLS training in the previous 2 years. The most common locations of AED were the gymnasium (32%) followed by entrance hall (28%), staffroom (25%), and infirmary (12%). The reasons given for location were that it was obvious (34%), convenient for staff (32%), could be used out of hours (17%), and the most likely location for a heart attack (15%). Approximately 18% of schools reported that it takes >5 min to reach the AED from the furthest point. CONCLUSION BLS training, AED location, and understanding of both are not sufficient to save children's lives efficiently. Authorities should make recommendations about the correct number of AED, and their location, and provide more information to improve the quality of BLS training in schools.
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Affiliation(s)
- Akiteru Takamura
- Department of Medical Education, Kanazawa Medical University, Uchinada, Japan.,Department of Community Medicine, Kanazawa Medical University, Uchinada, Japan.,Clinical Simulation Centre, Kanazawa Medical University, Uchinada, Japan.,Department of Family Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Sayori Ito
- Faculty of Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Kaori Maruyama
- Faculty of Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Yusuke Ryo
- Faculty of Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Manami Saito
- Faculty of Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Shuhei Fujimura
- Faculty of Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Yuna Ishiura
- Clinical Simulation Centre, Kanazawa Medical University, Uchinada, Japan
| | - Ariyuki Hori
- Department of Medical Education, Kanazawa Medical University, Uchinada, Japan
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Morita T, Tsubokura M, Furutani T, Nomura S, Ochi S, Leppold C, Takahara K, Shimada Y, Fujioka S, Kami M, Kato S, Oikawa T. Impacts of the 2011 Fukushima nuclear accident on emergency medical service times in Soma District, Japan: a retrospective observational study. BMJ Open 2016; 6:e013205. [PMID: 27683521 PMCID: PMC5051455 DOI: 10.1136/bmjopen-2016-013205] [Citation(s) in RCA: 8] [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: 11/04/2022] Open
Abstract
OBJECTIVE To assess the influence of the 3.11 triple disaster (earthquake, tsunami and nuclear accident) on the emergency medical service (EMS) system in Fukushima. METHODS Total EMS time (from EMS call to arrival at a hospital) was assessed in the EMS system of Soma district, located 10-40 km north of the nuclear plant, from 11 March to 31 December 2011. We defined the affected period as when total EMS time was significantly extended after the disasters compared with the historical control data from 1 January 2009 to 10 March 2011. To identify risk factors associated with the extension of total EMS time after the disasters, we investigated trends in 3 time segments of total EMS time; response time, defined as time from an EMS call to arrival at the location, on-scene time, defined as time from arrival at the location to departure, and transport time, defined as time from departure from the location to arrival at a hospital. RESULTS For the affected period from week 0 to week 11, the median total EMS time was 36 (IQR 27-52) minutes, while that in the predisaster control period was 31 (IQR 24-40) min. The percentage of transports exceeding 60 min in total EMS time increased from 8.2% (584/7087) in the control period to 22.2% (151/679) in the affected period. Among the 3 time segments, there was the most change in transport time (standardised mean difference: 0.41 vs 0.13-0.17). CONCLUSIONS EMS transport was significantly delayed for ∼3 months, from week 1 to 11 after the 3.11 triple disaster. This delay may be attributed to malfunctioning emergency hospitals after the triple disaster.
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Affiliation(s)
- Tomohiro Morita
- Department of Internal Medicine, Soma Central Hospital, Soma City, Fukushima, Japan
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Masaharu Tsubokura
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Tomoyuki Furutani
- Faculty of Policy Management, Keio University, Fujisawa, Kanagawa, Japan
| | - Shuhei Nomura
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sae Ochi
- Department of Internal Medicine, Soma Central Hospital, Soma City, Fukushima, Japan
| | - Claire Leppold
- Department of Research, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
| | - Kazuhiro Takahara
- Fire Suppression Division, the Soma Regional Fire Department, Minamisoma City, Fukushima, Japan
| | - Yuki Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
| | - Sho Fujioka
- Department of Gastroenterology, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
| | - Masahiro Kami
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
| | - Shigeaki Kato
- Department of Radiation Protection, Soma Central Hospital, Soma City, Fukushima, Japan
| | - Tomoyoshi Oikawa
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
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Abstract
Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation, and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and postmortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD patients. Institution of a national registry of SCD in the young will provide data that will help to answer these questions.
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Affiliation(s)
- Michael Ackerman
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.)
| | - Dianne L Atkins
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.)
| | - John K Triedman
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.).
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Sadrawi M, Sun WZ, Ma MHM, Dai CY, Abbod MF, Shieh JS. Cardiopulmonary Resuscitation Pattern Evaluation Based on Ensemble Empirical Mode Decomposition Filter via Nonlinear Approaches. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4750643. [PMID: 27529068 PMCID: PMC4977385 DOI: 10.1155/2016/4750643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/31/2016] [Accepted: 06/26/2016] [Indexed: 11/20/2022]
Abstract
Good quality cardiopulmonary resuscitation (CPR) is the mainstay of treatment for managing patients with out-of-hospital cardiac arrest (OHCA). Assessment of the quality of the CPR delivered is now possible through the electrocardiography (ECG) signal that can be collected by an automated external defibrillator (AED). This study evaluates a nonlinear approximation of the CPR given to the asystole patients. The raw ECG signal is filtered using ensemble empirical mode decomposition (EEMD), and the CPR-related intrinsic mode functions (IMF) are chosen to be evaluated. In addition, sample entropy (SE), complexity index (CI), and detrended fluctuation algorithm (DFA) are collated and statistical analysis is performed using ANOVA. The primary outcome measure assessed is the patient survival rate after two hours. CPR pattern of 951 asystole patients was analyzed for quality of CPR delivered. There was no significant difference observed in the CPR-related IMFs peak-to-peak interval analysis for patients who are younger or older than 60 years of age, similarly to the amplitude difference evaluation for SE and DFA. However, there is a difference noted for the CI (p < 0.05). The results show that patients group younger than 60 years have higher survival rate with high complexity of the CPR-IMFs amplitude differences.
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Affiliation(s)
- Muammar Sadrawi
- Department of Mechanical Engineering and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, Chung-Li 32003, Taiwan
| | - Wei-Zen Sun
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chun-Yi Dai
- Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei 100, Taiwan
| | - Maysam F. Abbod
- Department of Electronic and Computer Engineering, Brunel University London, Uxbridge UB8 3PH, UK
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, Chung-Li 32003, Taiwan
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Weinberg G, O'Connor M. Focus on Physiology to Improve Cardiopulmonary Resuscitation. Anesth Analg 2016; 122:587-589. [PMID: 26891383 DOI: 10.1213/ane.0000000000001115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Guy Weinberg
- From the Department of Anesthesiology, University of Illinois, Jesse Brown VA, Chicago, Illinois; and Department of Critical Care and Anesthesia, University of Chicago, Chicago, Illinois
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Kim TH, Hong KJ, Sang Do S, Kim CH, Song SW, Song KJ, Ro YS, Ahn KO, Jang DB. Quality between mechanical compression on reducible stretcher versus manual compression on standard stretcher in small elevator. Am J Emerg Med 2016; 34:1604-9. [PMID: 27318749 DOI: 10.1016/j.ajem.2016.05.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Manual cardiopulmonary resuscitation (CPR) during vertical transport in small elevators using standard stretcher for out-of-hospital cardiac arrest can raise concerns with diminishing quality. Mechanical CPR on a reducible stretcher (RS-CPR) that can be shortened in the length was tested to compare the CPR quality with manual CPR on a standard stretcher (SS-CPR). METHODS A randomized crossover manikin simulation was designed. Three teams of emergency medical technicians were recruited to perform serial CPR simulations using two different protocols (RS-CPR and SS-CPR) according to a randomization; the first 6 minutes of manual CPR at the scene was identical for both scenarios and two different protocols during vertical transport in a small elevator followed on a basis of cross-over assignment. The LUCAS-2 Chest Compression System (Zolife AB, Lund, Sweden) was used for RS-CPR. CPR quality was measured using a resuscitation manikin (Resusci Anne QCPR, Laerdal Medical, Stavanger, Norway) in terms of no flow fraction, compression depth, and rate (median and IQR). RESULTS A total of 42 simulations were analyzed. CPR quality did not differ significantly at the scene. No flow fraction (%) was significantly lower when the stretcher was moving in RS-CPR then SS-CPR (36.0 (33.8-38.7) vs 44.0 (36.8-54.4), P< .01). RS-CPR showed significantly better quality than SS-CPR; 93.2 (50.6-95.6) vs 14.8 (0-20.8) for adequate depth (P< 0.01), and 97.5 (96.6-98.2) vs 68.9(43.4-78.5) for adequate rate (P< .01). CONCLUSION Mechanical CPR on a reducible stretcher during vertical transport showed significant improvement in CPR quality in terms of no-flow fraction, compression depth, and rate compared with manual CPR on a standard stretcher.
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Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Shin Sang Do
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Chu Hyun Kim
- Department of Emergency Medicine, Inje University Seoul Pak Hospital, Seoul, Korea.
| | - Sung Wook Song
- Department of Emergency Medicine, Jeju National University Hospital, Jejudo, Korea.
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
| | - Ki Ok Ahn
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
| | - Dayea Beatrice Jang
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
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Greif R. “The ERC considers these new resuscitation guidelines to be the most effective and easily learned interventions that can be supported by current knowledge, research and experience.” Koen Monsieurs, Secretary of ILCOR and ERC Board Director guidelines. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2015.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries. J Formos Med Assoc 2015; 115:628-38. [PMID: 26596689 DOI: 10.1016/j.jfma.2015.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/PURPOSE Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. METHODS A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. RESULTS Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5%) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5%) cities performed 4 minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR. CONCLUSION International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.
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Daniłowicz-Szymanowicz L, Szwoch M, Dąbrowska-Kugacka A, Dudziak M, Kozłowski D, Raczak G. Usefulness of microvolt T-wave alternans testing in the assessment of all-cause mortality and life-threatening ventricular arrhythmia risk in patients with left ventricular dysfunction. Arch Med Sci 2015; 11:945-51. [PMID: 26528334 PMCID: PMC4624729 DOI: 10.5114/aoms.2013.37936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/15/2013] [Accepted: 09/23/2013] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Patients with left ventricular ejection fraction (LVEF) ≤ 35% are eligible for implantable cardioverter-defibrillator (ICD) placement in the primary prevention of sudden cardiac death. Nevertheless, other risk factors facilitating the selection of individuals with highest mortality are still sought. The aim of the study was to verify the usefulness of microvolt T-wave alternans (MTWA) testing in the assessment of all-cause mortality and life-threatening ventricular arrhythmias (EVENTs) in these patients. Previous data from the literature are inconclusive. MATERIAL AND METHODS Patients with LVEF ≤ 35% were eligible if they did not have a history of sustained ventricular arrhythmias, and were treated with β-blockers. Participants underwent MTWA testing and were subsequently followed. RESULTS The group consisted of 139 patients. MTWA results were classified as non-negative (MTWA_non-neg) in 93 and negative (MTWA_neg) in 46 patients. During the 14.3 ±8.6 months of follow-up, EVENTs were observed in 21 patients. The 1-year EVENT rate was 16.4% among MTWA_non-neg patients, and 2.6% among MTWA_neg patients (p = 0.006). The sensitivity of the MTWA test was 95.24%, the specificity - 38.14%, the positive predictive value - 21.51% and the negative predictive value - 97.83%. CONCLUSIONS In the group of patients with left ventricular systolic dysfunction, with the exclusion of patients with the history of life-threatening ventricular arrhythmia and individuals not being on chronic β-adrenolytic therapy, the abnormal result of MTWA testing is associated with significantly increased risk of all-cause mortality and life-threatening ventricular arrhythmia during 1 year of follow-up, thus identifying the individuals at the highest risk.
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Affiliation(s)
| | - Małgorzata Szwoch
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Maria Dudziak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
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Chesters A, Harris T, Hodgetts TJ, Keefe N. Survival to Discharge After Cardiac Arrest Attended by a Doctor-Paramedic Helicopter Emergency Medical Service: An Utstein-style Multiservice Review of 1085 Activations. J Emerg Med 2015; 49:439-47. [PMID: 26168871 DOI: 10.1016/j.jemermed.2015.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/19/2015] [Accepted: 05/14/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presentation of outcomes after cardiac arrest presented by emergency medical service and in-hospital teams in the Utstein style allows for comparative analysis of populations and systems. Essex and Herts Air Ambulance Trust (EHAAT) and the East Anglian Air Ambulance (EAAA) are doctor-plus-paramedic prehospital care teams that respond to a large number of medical cardiac arrests. OBJECTIVE To report the outcomes of medical cardiac arrests according to the Utstein style. METHODS Retrospective database analysis and hospital follow-up of all cardiac arrests attended by either service over a 31-month period. Traumatic cardiac arrests were excluded. PRIMARY OUTCOME survival and cerebral performance category at discharge from the hospital. RESULTS There were 429 patients attended by the two services; 193 patients achieved return of spontaneous circulation, which was sustained at the time of handover to the hospital team. Of 140 patients for whom complete follow-up was available, the overall survival rate was 50.7%, 86% of whom had a Cerebral Performance Category of 1 or 2. The overall survival-to-discharge rate for all patients attended was 11.7%. CONCLUSION Benchmarking of performance is essential to understand reasons for variability, and to allow individual systems to reflect on their own practices. We have described 31 months of data that pertain to medical cardiac arrest cases attended by our services and demonstrated a comparable survival rate to discharge with good neurological outcome.
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Affiliation(s)
| | - Tim Harris
- Department of Emergency Medicine, Queen Mary, University of London and Bart's Health NHS Trust, London, UK; East Anglian Air Ambulance, Norwich, UK
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Lee SE, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B. Combined ECG, Echocardiographic, and Biomarker Criteria for Diagnosing Acute Myocardial Infarction in Out-of-Hospital Cardiac Arrest Patients. Yonsei Med J 2015; 56:887-94. [PMID: 26069108 PMCID: PMC4479854 DOI: 10.3349/ymj.2015.56.4.887] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Acute coronary lesions commonly trigger out-of-hospital cardiac arrest (OHCA). However, the prevalence of coronary artery disease (CAD) in Asian patients with OHCA and whether electrocardiogram (ECG) and other findings might predict acute myocardial infarction (AMI) have not been fully elucidated. MATERIALS AND METHODS Of 284 consecutive resuscitated OHCA patients seen between January 2006 and July 2013, we enrolled 135 patients who had undergone coronary evaluation. ECGs, echocardiography, and biomarkers were compared between patients with or without CAD. RESULTS We included 135 consecutive patients aged 54 years (interquartile range 45-65) with sustained return of spontaneous circulation after OHCA between 2006 and 2012. Sixty six (45%) patients had CAD. The initial rhythm was shockable and non-shockable in 110 (81%) and 25 (19%) patients, respectively. ST-segment elevation predicted CAD with 42% sensitivity, 87% specificity, and 65% accuracy. ST elevation and/or regional wall motion abnormality (RWMA) showed 68% sensitivity, 52% specificity, and 70% accuracy in the prediction of CAD. Finally, a combination of ST elevation and/or RWMA and/or troponin T elevation predicted CAD with 94% sensitivity, 17% specificity, and 55% accuracy. CONCLUSION In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion could detect 94% of CADs. However, compared with ECG only criteria, the combined criterion failed to improve diagnostic accuracy with a lower specificity.
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Affiliation(s)
- Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Youn Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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An exploration of attitudes toward bystander cardiopulmonary resuscitation in university students in Tianjin, China: A survey. Int Emerg Nurs 2015; 24:28-34. [PMID: 26095753 DOI: 10.1016/j.ienj.2015.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/20/2015] [Accepted: 05/26/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite the importance of early effective bystander cardiopulmonary resuscitation (CPR) to improve survival rates from out-of-hospital cardiac arrest, the attitudes toward performing, learning and disseminating CPR in university students of China are still unclear. METHODS AND AIMS To assess the attitudes regarding performing, learning and disseminating bystander CPR in university students of China. RESULTS The results indicated that except for the scenario where the victim was their own family member or close friend, all other scenarios showed a relatively dismally lower rate of positive response. Besides, it showed a greater willingness to perform chest compression only CPR (CC) than chest compression with mouth-to-mouth ventilation (CCMV) (P < 0.05). Females were more willing to perform CC across seven of the hypothetic scenarios than males. University students of medical-related specialties (45.3%) than university students of non-medical specialties (29.9%) were more willing to perform bystander CPR (P < 0.05). The top four reasons for being unwilling to perform bystander CPR were lack of confidence (32.9%), fear of legal disputes (17.2%), fear of disease transmission (16.0%) and feeling embarrassed (14.0%). 92.6% of respondents wanted to learn CPR and 80.3% of respondents were willing to disseminate CPR. CONCLUSIONS CPR technique, victim's status, respondent's specialty and respondent's gender affected the attitudes of respondents toward performing bystander CPR. The top four reasons for being unwilling to perform bystander CPR were lack of confidence, fear of legal disputes, fear of disease transmission and feeling embarrassed. However, the key reason for being unwilling to perform bystander CPR differed in different specialties and particularly 'feeling embarrassment' might be a cultural phenomenon. The attitudes toward learning and disseminating CPR were positive and affected by respondent's gender and specialty.
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Putting class IIb recommendations to the test: the influence of unwitnessed and Non-VT/VF arrests on resource consumption and outcomes in therapeutic hypothermia and targeted temperature management. Crit Pathw Cardiol 2015; 13:78-81. [PMID: 24827885 DOI: 10.1097/hpc.0000000000000011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Therapeutic hypothermia (TH) and targeted temperature management improve neurologic recovery, and survival for patients resuscitated from witnessed out-of-hospital ventricular tachycardia (VT) and ventricular fibrillation (VF) cardiac arrest. The American Heart Association recently gave a class IIb recommendation for the use of TH for non-VT/VF and unwitnessed arrests. We explored changes in baseline characteristics, resource use, and outcomes after expanding indications for TH at our institution based on these guidelines. Fifty-six consecutive patients treated with TH for out-of-hospital cardiac arrest were retrospectively evaluated based on whether they received treatment before (protocol 1) or after (protocol 2) broadening inclusion criteria. In protocol 1, TH was indicated after a witnessed VT/VF arrest. In protocol 2, TH was indicated for unwitnessed arrests, pulseless electrical activity, or asystole. Both populations undergoing TH had similarly extensive medical comorbidities and consumed considerable hospital resources. Overall, 64% of the patients from both protocols died in the hospital, although nominally lower mortality was seen in patients treated under protocol 1 compared with protocol 2 (59% vs. 67%, P = 0.57). Lower mortality was observed after VT/VF than after pulseless electrical activity or asystole (47% vs. 93% vs. 56%, P = 0.017). No patient survived following an unwitnessed arrest, and age (odds ratio per 10 years = 2.59; 95% confidence interval, 1.34-4.81) was independently associated with increased mortality. In an evolving field where best practice is still poorly defined, these data, along with future prospective studies in larger populations, should help to enhance care delivery and optimize cost-effectiveness strategies.
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Drabek T, Kochanek PM. Improving outcomes from resuscitation: from hypertension and hemodilution to therapeutic hypothermia to H2. Circulation 2014; 130:2133-5. [PMID: 25366996 DOI: 10.1161/circulationaha.114.013566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Tomas Drabek
- From the University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Spaite DW, Bobrow BJ, Stolz U, Berg RA, Sanders AB, Kern KB, Chikani V, Humble W, Mullins T, Stapczynski JS, Ewy GA. Statewide Regionalization of Postarrest Care for Out-of-Hospital Cardiac Arrest: Association With Survival and Neurologic Outcome. Ann Emerg Med 2014; 64:496-506.e1. [DOI: 10.1016/j.annemergmed.2014.05.028] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 05/21/2014] [Accepted: 05/27/2014] [Indexed: 11/27/2022]
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Ströhle M, Paal P, Strapazzon G, Avancini G, Procter E, Brugger H. Defibrillation in rural areas. Am J Emerg Med 2014; 32:1408-12. [PMID: 25224021 DOI: 10.1016/j.ajem.2014.08.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 07/18/2014] [Accepted: 08/19/2014] [Indexed: 02/03/2023] Open
Abstract
AIM OF THE STUDY Automated external defibrillation (AED) and public access defibrillation (PAD) have become cornerstones in the chain of survival in modern cardiopulmonary resuscitation. Most studies of AED and PAD have been performed in urban areas, and evidence is scarce for sparsely populated rural areas. The aim of this review was to review the literature and discuss treatment strategies for out-of-hospital cardiac arrest in rural areas. METHODS A Medline search was performed with the keywords automated external defibrillation (617 hits), public access defibrillation (256), and automated external defibrillator public (542). Of these 1415 abstracts and additional articles found by manually searching references, 92 articles were included in this nonsystematic review. RESULTS Early defibrillation is crucial for survival with good neurological outcome after cardiac arrest. Rapid defibrillation can be a challenge in sparsely populated and remote areas, where the incidence of cardiac arrest is low and rescuer response times can be long. The few studies performed in rural areas showed that the introduction of AED programs based on a 2-tier emergency medical system, consisting of Basic Life Support and Advanced Life Support teams, resulted in a decrease in collapse-to-defibrillation times and better survival of patients with out-of-hospital cardiac arrest. CONCLUSIONS In rural areas, introducing AED programs and a 2-tier emergency medical system may increase survival of out-of-hospital cardiac arrest patients. More studies on AED and PAD in rural areas are required.
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Affiliation(s)
- Mathias Ströhle
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
| | - Peter Paal
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; International Commission for Mountain Emergency Medicine, ICAR MEDCOM.
| | - Giacomo Strapazzon
- International Commission for Mountain Emergency Medicine, ICAR MEDCOM; EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy.
| | - Giovanni Avancini
- EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy.
| | - Emily Procter
- EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy.
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine, ICAR MEDCOM; EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy.
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Shao F, Li CS, Liang LR, Li D, Ma SK. Outcome of out-of-hospital cardiac arrests in Beijing, China. Resuscitation 2014; 85:1411-7. [PMID: 25151546 DOI: 10.1016/j.resuscitation.2014.08.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 08/04/2014] [Accepted: 08/06/2014] [Indexed: 11/28/2022]
Abstract
AIM The purpose of this study was to assess the outcome of out-of-hospital cardiac arrests (OHCAs) in Beijing, China. METHODS In this prospective study, data were collected according to the Utstein style on all cases of OHCA that occurred between January and December 2012 in urban areas covered by Beijing Emergency Medical Services (EMS). The cases were followed-up for 1 year. RESULTS Out of the 9897 OHCAs recorded, cardiopulmonary resuscitation (CPR) was initiated in 2421 patients (24.4%). Among the CPR-receivers (n=2421), 1804 patients (74.5%) had collapsed at home, while 375 patients (15.5%) at a public place. The average time interval from call to EMS arrival at the collapse location was 16 min (range, 4-43 min). Of the 1693 OHCA cases with cardiac aetiology, 1246 cases (73.6%) were witnessed, and basic CPR was performed by bystanders before arrival of the EMS personnel in 193 patients (11.4%). Of the OHCAs with cardiac aetiology, 1054 patients (62.3%) had asystole, 131 patients (7.7%) had shockable rhythms, restoration of spontaneous circulation was achieved in 85 patients (5.0%), 71 patients (4.2%) were admitted to the hospital alive, and of the 22 patients (1.3%) who were discharged alive, 17 patients (1%) had good neurological outcomes. At 1 year post-OHCA, 17 patients were alive. CONCLUSION In the urban areas of Beijing with EMS services, survival rate after OHCA was unsatisfactory. Improvements are required in every link of the 'chain of survival'.
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Affiliation(s)
- Fei Shao
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chun Sheng Li
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Li Rong Liang
- Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dou Li
- Beijing Emergency Medical Center, Beijing, China
| | - Sheng Kui Ma
- Beijing Red Cross Emergency Rescue Center, Beijing, China
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Angel N, Li L, Dosdall DJ. His bundle activates faster than ventricular myocardium during prolonged ventricular fibrillation. PLoS One 2014; 9:e101666. [PMID: 25036418 PMCID: PMC4103805 DOI: 10.1371/journal.pone.0101666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022] Open
Abstract
Background The Purkinje fiber system has recently been implicated as an important driver of the rapid activation rate during long duration ventricular fibrillation (VF>2 minutes). The goal of this study is to determine whether this activity propagates to or occurs in the proximal specialized conduction system during VF as well. Methods and Results An 8×8 array with 300 µm spaced electrodes was placed over the His bundles of isolated, perfused rabbit hearts (n = 12). Ventricular myocardial (VM) and His activations were differentiated by calculating Laplacian recordings from unipolar signals. Activation rates of the VM and His bundle were compared and the His bundle conduction velocity was measured during perfused VF followed by 8 minutes of unperfused VF. During perfused VF the average VM activation rate of 11.04 activations/sec was significantly higher than the His bundle activation rate of 6.88 activations/sec (p<0.05). However from 3–8 minutes of unperfused VF the His system activation rate (6.16, 5.53, 5.14, 5.22, 6.00, and 4.62 activations/sec significantly faster than the rate of the VM (4.67, 3.63, 2.94, 2.24, 3.45, and 2.31 activations/sec) (p<0.05). The conduction velocity of the His system immediately decreased to 94% of the sinus rate during perfused VF then gradually decreased to 67% of sinus rhythm conduction at 8 minutes of unperfused VF. Conclusion During prolonged VF the activation rate of the His bundle is faster than that of the VM. This suggests that the proximal conduction system, like the distal Purkinje system, may be an important driver during long duration VF and may be a target for interventional therapy.
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Affiliation(s)
- Nathan Angel
- Comprehensive Arrhythmia Research & Management Center, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States of America
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States of America
| | - Li Li
- Comprehensive Arrhythmia Research & Management Center, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Derek J. Dosdall
- Comprehensive Arrhythmia Research & Management Center, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States of America
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States of America
- Center for Engineering Innovation, University of Utah, Salt Lake City, UT, United States of America
- * E-mail:
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Hubert H, Tazarourte K, Wiel E, Zitouni D, Vilhelm C, Escutnaire J, Cassan P, Gueugniaud PY. Rationale, Methodology, Implementation, and First Results of the French Out-of-hospital Cardiac Arrest Registry. PREHOSP EMERG CARE 2014; 18:511-9. [DOI: 10.3109/10903127.2014.916024] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eftestøl T, Eilevstjønn J, Steen PA. Advanced life support therapy on out-of-hospital cardiac arrest patients: an engineering perspective. Expert Rev Cardiovasc Ther 2014; 1:203-13. [PMID: 15030281 DOI: 10.1586/14779072.1.2.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the USA alone, several hundred thousand people die of sudden cardiac arrests each year. Basic life support, defined as chest compressions and ventilations, and early defibrillation are the only factors proven to increase the survival of patients with out-of-hospital cardiac arrest and are key elements in the chain of survival defined by the American Heart Association. The current cardiopulmonary resuscitation guidelines treat all patients the same but studies show a need for more individualization of treatment. This review focusses on ideas on how to strengthen the weak parts of the chain of survival including the ability to measure the effects of therapy, improve time efficiency and optimize the sequence and quality of the various components of cardiopulmonary resuscitation.
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Affiliation(s)
- Trygve Eftestøl
- Stavanger University College, Department of Electrical and Computer Engineering, Norway.
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Martínez-Rubio A, Gusi G, Guillaumet E, Cazorla M, Galán S, Bagà R, Guilera E, Bonastre M, Raimón Gumà J, Anguera I, Ibars S, Ochagavia A, Mestre J, Font J, Saura P, Dalmases M, Blanch L, Artigas A. The fully automatic external cardioverter defibrillator: reality of a new meaningful scenario for in-hospital cardiac arrests. Expert Rev Med Devices 2014; 2:33-9. [PMID: 16293026 DOI: 10.1586/17434440.2.1.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sudden cardiac death is an unresolved problem which causes significant mortality and morbidity in both the community and in-hospital setting. Cardiac arrest is often caused by ventricular tachyarrhythmias which may be mostly interrupted by cardioversion or defibrillation. The single most critical factor for survival is the response time. Over the last 30 years, there have been virtually no procedural changes in the way hospitals address in-hospital resuscitation. A unique device has been developed that eliminates human intervention and assures defibrillation therapy is administered in seconds. This is accomplished with a fully automatic, external bedside monitor defibrillator designed to be prophylactically attached to hospitalized patients at risk of ventricular tachyarrhythmia. The safety and efficacy of the device has been demonstrated in multicenter US and European trials. Thus, this device allows a new scenario which may increase survival and enables meaningful redistribution of health resources.
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Affiliation(s)
- Antoni Martínez-Rubio
- Hospital de Sabadell, Department of Cardiology, Fund. Universitaria Parc Taulí, Parc Taulí s/n, E-08208 Sabadell, Barcelona, Spain.
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TUAN TACHUAN, LO MENTZUNG, LIN YENNJIANG, HSIEH WANHSIN, LIN CHEN, HUANG NORDENE, LO LIWEI, CHAO TZEFAN, LIAO JONAN, HSIEH YUCHENG, WU TSUJUEY, CHEN SHIHANN. The Use of Signal Analyses of Ventricular Tachycardia Electrograms to Predict the Response of Antitachycardia Pacing in Patients with Implantable Cardioverter-Defibrillators. J Cardiovasc Electrophysiol 2014; 25:411-417. [DOI: 10.1111/jce.12340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/11/2013] [Accepted: 11/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
- TA-CHUAN TUAN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
- Division of Cardiology, Taipei Municipal Gan-Dau Hospital; Taipei Taiwan
| | - MEN-TZUNG LO
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
| | - YENN-JIANG LIN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - WAN-HSIN HSIEH
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
- Medical Biodynamics Program; Division of Sleep Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts USA
| | - CHEN LIN
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Palo Alto California USA
| | - NORDEN E. HUANG
- Research Center for Adaptive Data Analysis; Analysis and Center for Dynamical Biomarkers and Translational Medicine; National Central University; Jhongli Taiwan R.O.C
| | - LI-WEI LO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - TZE-FAN CHAO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - JO-NAN LIAO
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
| | - YU-CHENG HSIEH
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Center; Taichung Veterans General Hospital; Taichung Taiwan
| | - TSU-JUEY WU
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Center; Taichung Veterans General Hospital; Taichung Taiwan
| | - SHIH-ANN CHEN
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine and Institute of Clinical Medicine; National Yang-Ming University; School of Medicine; Taipei Taiwan
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Brown KM, Macias CG, Dayan PS, Shah MI, Weik TS, Wright JL, Lang ES. The Development of Evidence-based Prehospital Guidelines Using a GRADE-based Methodology. PREHOSP EMERG CARE 2013; 18 Suppl 1:3-14. [DOI: 10.3109/10903127.2013.844871] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ornato JP, Peberdy MA. Applying lessons from commercial aviation safety and operations to resuscitation. Resuscitation 2013; 85:173-6. [PMID: 24215731 DOI: 10.1016/j.resuscitation.2013.10.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/08/2013] [Accepted: 10/27/2013] [Indexed: 11/24/2022]
Abstract
Both commercial aviation and resuscitation are complex activities in which team members must respond to unexpected emergencies in a consistent, high quality manner. Lives are at stake in both activities and the two disciplines have similar leadership structures, standard setting processes, training methods, and operational tools. Commercial aviation crews operate with remarkable consistency and safety, while resuscitation team performance and outcomes are highly variable. This commentary provides the perspective of two physician-pilots showing how commercial aviation training, operations, and safety principles can be adapted to resuscitation team training and performance.
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Affiliation(s)
- Joseph P Ornato
- Virginia Commonwealth University, Department of Emergency Medicine, Main Hospital, 2nd Floor, Suite 500, 1250 East Marshall Street, Richmond, VA 23298-0401, United States; Richmond Ambulance Authority, Richmond Fire & EMS, Henrico Fire, United States.
| | - Mary Ann Peberdy
- Virginia Commonwealth University, Department of Emergency Medicine, Main Hospital, 2nd Floor, Suite 500, 1250 East Marshall Street, Richmond, VA 23298-0401, United States; Departments of Internal Medicine (Cardiology) and Emergency Medicine, United States.
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Sideris G, Magkoutis N, Sharma A, Rees J, McKnite S, Caldwell E, Sarraf M, Henry P, Lurie K, Garcia S, Yannopoulos D. Early coronary revascularization improves 24h survival and neurological function after ischemic cardiac arrest. A randomized animal study. Resuscitation 2013; 85:292-8. [PMID: 24200891 DOI: 10.1016/j.resuscitation.2013.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/05/2013] [Accepted: 10/15/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Survival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. We hypothesize that early coronary reperfusion will improve 24h-survival and neurological outcomes. METHODS Total occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5min, VF was induced and left untreated for 8min. If return of spontaneous circulation (ROSC) was achieved within 15min (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45min (group A) or 4h (group B) of LAD occlusion. Animals without ROSC after 15min of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45min of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10min of CPR had been performed. Primary endpoints for groups A and B were 24-h survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion. RESULTS Early compared to late reperfusion improved survival (10/11 versus 4/10, p=0.02), mean CPC (1.4±0.7 versus 2.5±0.6, p=0.017), LVEF (43±13 versus 32±9%, p=0.01), troponin I (37±28 versus 99±12, p=0.005) and CK-MB (11±4 versus 20.1±5, p=0.031) at 24-h after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C. CONCLUSIONS Early reperfusion after ischemic cardiac arrest improved 24h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.
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Affiliation(s)
- Georgios Sideris
- Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France.
| | - Nikolaos Magkoutis
- Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France
| | - Alok Sharma
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Jennifer Rees
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Scott McKnite
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Emily Caldwell
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Mohammad Sarraf
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Patrick Henry
- Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France
| | - Keith Lurie
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Santiago Garcia
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Demetris Yannopoulos
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States.
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Papalexopoulou K, Chalkias A, Dontas I, Pliatsika P, Giannakakos C, Papapanagiotou P, Aggelina A, Moumouris T, Papadopoulos G, Xanthos T. Education and age affect skill acquisition and retention in lay rescuers after a European Resuscitation Council CPR/AED course. Heart Lung 2013; 43:66-71. [PMID: 24246726 DOI: 10.1016/j.hrtlng.2013.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/29/2013] [Accepted: 09/29/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine whether education and age affect skill acquisition and retention in lay rescuers after a European Resuscitation Council (ERC) CPR/AED course. BACKGROUND Because of the importance of bystander CPR/AED skills in the setting of cardiac arrest, acquisition and retention of resuscitation skills has gained a great amount of interest. METHODS The ERC CPR/AED course format for written and practical evaluation was used. Eighty lay people were trained and evaluated at the end of the course, as well as at one, three, and six months. RESULTS Retention of CPR/AED skills improved over time, recording the lowest practical scores at one month after initial training and the lowest written scores at initial training. In practical evaluation scores, when examined longitudinally, age presented a significant adverse effect and higher background education presented a non-significant positive effect. Moreover, regarding written evaluation scores, when examined longitudinally, education presented a significant positive effect while age did not significantly correlate with written scores. CONCLUSIONS Education and age affected retention of CPR/AED skills in lay rescuers. Also, our results suggest that the ERC CPR/AED course format may be poorly designed to discriminate between participants with different levels of practical and written resuscitation skills and merit a thorough investigation in future studies.
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Affiliation(s)
- Konstantina Papalexopoulou
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Athanasios Chalkias
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
| | - Ioannis Dontas
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Paraskevi Pliatsika
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Charalampos Giannakakos
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Panagiotis Papapanagiotou
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Afroditi Aggelina
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Theodoros Moumouris
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Georgios Papadopoulos
- University of Ioannina, School of Medicine, Department of Anesthesiology, Ioannina, Greece
| | - Theodoros Xanthos
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
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