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Javaudin F, Canon V, Heidet M, Bougouin W, Youssfi Y, Beganton F, Empana JP, Chocron R, Jouven X, Marijon E, Hubert H, Dumas F, Cariou A. HIV status and lay bystander cardiopulmonary resuscitation initiation for witnessed cardiac arrest. Resuscitation 2024:110269. [PMID: 38852828 DOI: 10.1016/j.resuscitation.2024.110269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Early initiation of cardiopulmonary resuscitation (CPR) by bystanders of out-of-hospital cardiac arrest (OHCA) significantly improves survival and neurological outcomes. However, misconceptions about human immunodeficiency virus (HIV) transmission risk during CPR can deter lay bystanders from performing resuscitation. The aim of this study was to compare the rate of CPR initiation by lay bystanders who witnessed OHCA in subjects with and without HIV infection. METHODS We analysed data from the two French cardiac arrest registries (SDEC and RéAC) from 2012 to 2020. We identified HIV-positive individuals from the French National Health Insurance database for the SDEC registry, and directly from the RéAC registry data. We used logistic regression models to assess the association between CPR initiation by lay bystanders and the victim's HIV status. RESULTS Of 58,177 witnessed OHCA cases, 192 (0.3%) occurred in HIV-positive subjects. These individuals were younger, more often male, and presented more shockable initial rhythms compared with subjects without HIV. Overall, there was no difference in the CPR initiation rate according to the HIV status (57.3% vs 47.6%, adjusted odds ratio 1.11, 95% confidence interval 0.83-1.48). The CPR initiation rate also did not differ by location between victims with or without HIV (home: 57.7% vs 45.4%; public places: 56.0% vs 53.6%; p for interaction = 0.46). Survival and neurological outcomes at hospital discharge did not differ based on the HIV status. CONCLUSIONS This study revealed that the rate of CPR initiation by lay bystanders did not differ between HIV and non-HIV subjects during OHCA.
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Affiliation(s)
- François Javaudin
- Paris Sudden Death Expertise Center, 75015 Paris, France; Emergency Department, Nantes University Hospital, 44000 Nantes, France. https://twitter.com/FJavaudin
| | - Valentine Canon
- Université de Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), 59000 Lille, France
| | - Matthieu Heidet
- Assistance Publique - Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, Hôpitaux universitaires Henri Mondor, Créteil, France; Université Paris-Est Créteil (UPEC), EA-3956 (Control in Intelligent Networks [CIR]), Créteil, France
| | - Wulfran Bougouin
- Paris Sudden Death Expertise Center, 75015 Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France; Medical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France; AfterROSC Network, Paris, France
| | - Younès Youssfi
- Paris Sudden Death Expertise Center, 75015 Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France
| | - Frankie Beganton
- Paris Sudden Death Expertise Center, 75015 Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France
| | - Jean-Philippe Empana
- Paris Sudden Death Expertise Center, 75015 Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France
| | - Richard Chocron
- Paris Sudden Death Expertise Center, 75015 Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France; Emergency Department, Georges Pompidou European Hospital, Paris, France
| | - Xavier Jouven
- Paris Sudden Death Expertise Center, 75015 Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France; Cardiology Department, AP-HP, European Georges Pompidou Hospital, 75015 Paris, France
| | - Eloi Marijon
- Paris Sudden Death Expertise Center, 75015 Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France; Cardiology Department, AP-HP, European Georges Pompidou Hospital, 75015 Paris, France
| | - Hervé Hubert
- Université de Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), 59000 Lille, France
| | - Florence Dumas
- Paris Sudden Death Expertise Center, 75015 Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France; Emergency Department, AP-HP, Cochin-Hotel-Dieu Hospital, 75014 Paris, France
| | - Alain Cariou
- Paris Sudden Death Expertise Center, 75015 Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France; AfterROSC Network, Paris, France; Medical Intensive Care Unit, AP-HP, Cochin Hospital, 75014 Paris, France
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Lee DYX, Yau CE, Pek MPP, Xu H, Lim DYZ, Earnest A, Ong MEH, Ho AFW. Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study. Resusc Plus 2024; 18:100610. [PMID: 38524148 PMCID: PMC10960127 DOI: 10.1016/j.resplu.2024.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Background Socioeconomic status (SES) is a well-established determinant of cardiovascular health. However, the relationship between SES and clinical outcomes in long-term out-of-hospital cardiac arrest (OHCA) is less well-understood. The Singapore Housing Index (SHI) is a validated building-level SES indicator. We investigated whether SES as measured by SHI is associated with long-term OHCA survival in Singapore. Methods We conducted an open cohort study with linked data from the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS), and the Singapore Registry of Births and Deaths (SRBD) from 2010 to 2020. We fitted generalized structural equation models, calculating hazard ratios (HRs) using a Weibull model. We constructed Kaplan-Meier survival curves and calculated the predicted marginal probability for each SHI category. Results We included 659 cases. In both univariable and multivariable analyses, SHI did not have a significant association with survival. Indirect pathways of SHI mediated through covariates such as Emergency Medical Services (EMS) response time (HR of low-medium, high-medium and high SHI when compared to low SHI: 0.98 (0.88-1.10), 1.01 (0.93-1.11), 1.02 (0.93-1.12) respectively), and age of arrest (HR of low-medium, high-medium and high SHI when compared to low SHI: 1.02 (0.75-1.38), 1.08 (0.84-1.38), 1.18 (0.91-1.54) respectively) had no significant association with OHCA survival. There was no clear trend in the predicted marginal probability of survival among the different SHI categories. Conclusions We did not find a significant association between SES and OHCA survival outcomes in residential areas in Singapore. Among other reasons, this could be due to affordable healthcare across different socioeconomic classes.
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Affiliation(s)
- Dawn Yi Xin Lee
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Maeve Pin Pin Pek
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, North Carolina, USA
| | - Daniel Yan Zheng Lim
- Data Science and Artificial Intelligence Lab, Singapore General Hospital, Singapore, Singapore
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
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Jouffroy R, Djossou F, Neviere R, Jaber S, Vivien B, Heming N, Gueye P. The chain of survival and rehabilitation for sepsis: concepts and proposals for healthcare trajectory optimization. Ann Intensive Care 2024; 14:58. [PMID: 38625453 PMCID: PMC11019190 DOI: 10.1186/s13613-024-01282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
This article describes the structures and processes involved in healthcare delivery for sepsis, from the prehospital setting until rehabilitation. Quality improvement initiatives in sepsis may reduce both morbidity and mortality. Positive outcomes are more likely when the following steps are optimized: early recognition, severity assessment, prehospital emergency medical system activation when available, early therapy (antimicrobials and hemodynamic optimization), early orientation to an adequate facility (emergency room, operating theater or intensive care unit), in-hospital organ failure resuscitation associated with source control, and finally a comprehensive rehabilitation program. Such a trajectory of care dedicated to sepsis amounts to a chain of survival and rehabilitation for sepsis. Implementation of this chain of survival and rehabilitation for sepsis requires full interconnection between each link. To date, despite regular international recommendations updates, the adherence to sepsis guidelines remains low leading to a considerable burden of the disease. Developing and optimizing such an integrated network could significantly reduce sepsis related mortality and morbidity.
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Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne Billancourt, France.
- Centre de recherche en Epidémiologie et Santé des Populations - U1018 INSERM - Paris Saclay University, Paris, France.
- EA 7329 - Institut de Recherche Médicale et d'Épidémiologie du Sport - Institut National du Sport, de l'Expertise et de la Performance, Paris, France.
- Service de Médecine Intensive Réanimation, Hôpital Universitaire Ambroise Paré, Assistance Publique - Hôpitaux de Paris, and Paris Saclay University, Saclay, France.
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Guyane and Laboratoire Ecosystèmes Amazoniens et Pathologie Tropicale EA 3593, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, France
| | - Rémi Neviere
- Service des Explorations Fonctionnelles Centre Hospitalier Universitaire de Martinique et UR5_3 PC2E Pathologie Cardiaque, toxicité Environnementale et Envenimations (ex EA7525, Université des Antilles, Antilles, France
| | - Samir Jaber
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, University of Montpellier, INSERM U1046, Centre Hospitalier Universitaire Montpellier, Montpellier, 34295, France
| | - Benoît Vivien
- Service d'Anesthésie Réanimation, SAMU de Paris, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nicholas Heming
- Department of Intensive Care, Raymond Poincaré Hospital, Laboratory of Infection & Inflammation - U1173, School of Medicine Simone Veil, FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), APHP University Versailles Saint Quentin - University Paris Saclay, University Versailles Saint Quentin - University Paris Saclay, INSERM, Garches, Garches, 92380, France
| | - Papa Gueye
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, University of the Antilles, French West Indies, Antilles, France
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Chan PS. Drones for Saving Life: Reimagining War Technology. Circ Cardiovasc Qual Outcomes 2024; 17:e010908. [PMID: 38529633 PMCID: PMC11021154 DOI: 10.1161/circoutcomes.124.010908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Paul S Chan
- Saint Luke's Mid-America Heart Institute, University of Missouri, Kansas City
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Silverplats J, Södersved Källestedt ML, Äng B, Strömsöe A. Compliance with cardiopulmonary resuscitation guidelines in witnessed in-hospital cardiac arrest events and patient outcome on monitored versus non-monitored wards. Resuscitation 2024; 196:110125. [PMID: 38272386 DOI: 10.1016/j.resuscitation.2024.110125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/07/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Adherence to cardiopulmonary resuscitation (CPR) guidelines in treatment of in-hospital cardiac arrest (IHCA) have been associated with favourable patient outcome. The aim of this study was to evaluate if compliance with initial CPR guidelines and patient outcome of witnessed IHCA events were associated with the place of arrest defined as monitored versus non-monitored ward. METHODS A total of 956 witnessed IHCA events in adult patients at six hospitals during 2018 to 2019, were extracted from the Swedish Registry of Cardiopulmonary Resuscitation. Initial CPR guidelines were: ≤1 min from collapse to alert of the rapid response team, ≤1 min from collapse to start of CPR, ≤3 min from collapse to defibrillation of shockable rhythm. RESULTS The odds of compliance with guidelines was higher on monitored wards vs non-monitored wards, even after adjustment for factors that could affect staffing and resources. The place of arrest was not a significant factor for sustained return of spontaneous circulation, survival at 30 days, or neurological status at discharge, when adjusting for clinically relevant confounders. Compliance with initial CPR guidelines remained a significant factor for survival to 30 days and favourable neurological outcome at discharge regardless of other confounders. CONCLUSION Compliance with initial CPR guidelines was higher in witnessed IHCA events on monitored wards than on non-monitored wards, which indicates that healthcare professionals in monitored wards are quicker to recognize a cardiac arrest and initiate treatment. When initial CPR guidelines are followed, the place of arrest does not influence patient outcome.
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Affiliation(s)
- Jennie Silverplats
- Department of Health and Welfare, Dalarna University, SE-79188 Falun, Sweden; Department of Anaesthesiology and Intensive Care, Region Dalarna, SE-79285 Mora, Sweden.
| | | | - Björn Äng
- Department of Health and Welfare, Dalarna University, SE-79188 Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-14186 Huddinge, Sweden; Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, SE-79182 Falun, Sweden.
| | - Anneli Strömsöe
- Department of Health and Welfare, Dalarna University, SE-79188 Falun, Sweden; Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, SE-79182 Falun, Sweden; Department of Prehospital Care, Region Dalarna, SE-79129 Falun, Sweden.
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Zègre-Hemsey JK, Cheskes S, Johnson AM, Rosamond WD, Cunningham CJ, Arnold E, Schierbeck S, Claesson A. Challenges & barriers for real-time integration of drones in emergency cardiac care: Lessons from the United States, Sweden, & Canada. Resusc Plus 2024; 17:100554. [PMID: 38317722 PMCID: PMC10838948 DOI: 10.1016/j.resplu.2024.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Importance Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality in the US and Europe (∼600,000 incident events annually) and around the world (∼3.8 million). With every minute that passes without cardiopulmonary resuscitation or defibrillation, the probability of survival decreases by 10%. Preliminary studies suggest that uncrewed aircraft systems, also known as drones, can deliver automated external defibrillators (AEDs) to OHCA victims faster than ground transport and potentially save lives. Objective To date, the United States (US), Sweden, and Canada have made significant contributions to the knowledge base regarding AED-equipped drones. The purpose of this Special Communication is to explore the challenges and facilitators impacting the progress of AED-equipped drone integration into emergency medicine research and applications in the US, Sweden, and Canada. We also explore opportunities to propel this innovative and important research forward. Evidence review In this narrative review, we summarize the AED-drone research to date from the US, Sweden, and Canada, including the first drone-assisted delivery of an AED to an OHCA. Further, we compare the research environment, emergency medical systems, and aviation regulatory environment in each country as they apply to OHCA, AEDs, and drones. Finally, we provide recommendations for advancing research and implementation of AED-drone technology into emergency care. Findings The rates that drone technologies have been integrated into both research and real-life emergency care in each country varies considerably. Based on current research, there is significant potential in incorporating AED-equipped drones into the chain of survival for OHCA emergency response. Comparing the different environments and systems in each country revealed ways that each can serve as a facilitator or barrier to future AED-drone research. Conclusions and relevance The US, Sweden, and Canada each offers different challenges and opportunities in this field of research. Together, the international community can learn from one another to optimize integration of AED-equipped drones into emergency systems of care.
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Affiliation(s)
| | - Sheldon Cheskes
- Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada
| | - Anna M. Johnson
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, United States
| | - Wayne D. Rosamond
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, United States
| | | | - Evan Arnold
- North Carolina State University, Institute for Transportation Research and Education, United States
| | - Sofia Schierbeck
- Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Claesson
- Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Pu Y, Yang G, Chai X. Racial and ethnic disparities in bystander resuscitation for out-of-hospital cardiac arrests. Heart Lung 2024; 64:100-106. [PMID: 38071862 DOI: 10.1016/j.hrtlng.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Bystander-provided cardiopulmonary resuscitation (CRP) influences the survival rates of out-of-hospital cardiac arrests (OHCAs). Disparities on bystander resuscitation measures between Black, Hispanic, Asians and Non-Hispanic White OHCAs is unclear. Examining racial and ethnic differences in bystander resuscitations is essential to better target interventions. METHODS 15,542 witnessed OHCAs were identified between April 1, 2011, and June 30, 2015 using the Resuscitation Outcomes Consortium Epidemiologic Registry 3, a multi-center, controlled trial about OHCAs in the United States and Canada. Multivariable logistic regression model was used to analyze the differences in bystander resuscitation (bystander CRP [B-CPR], CPR plus ventilation, automated external defibrillators/defibrillator application [B-AED/D], or delivery of shocks) and clinical outcomes (death at the scene or en route, return of spontaneous circulation upon first arrival at the emergency department [ROSC-ED], survival until ED discharge [S-ED], survival until hospital discharge [S-HOS], and favorable neurological outcome at discharge) between Black, Hispanic, or Asian victims and Non-Hispanic White victims. RESULTS Compared to OHCA victims in Non-Hispanic Whites, Black, Hispanic, and Asians were less likely to receive B-CPR (adjusted OR: 0.79; 95 % CI: 0.63-0.99), and B-AED/D (adjusted OR: 0.80; 95 % CI: 0.65-0.98) in public locations. And, Black, Hispanic, and Asian OHCAs were less likely to receive bystander resuscitation in street/highway locations and public buildings, and less likely to have better clinical outcomes, including ROSC-ED, S-ED and S-HOS. CONCLUSION Black, Hispanic and Asian victims with witnessed OHCAs are less likely to receive bystander resuscitation and more likely to get worse outcomes than Non-Hispanic White victims.
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Affiliation(s)
- Yuting Pu
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guifang Yang
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiangping Chai
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Horriar L, Rott N, Böttiger BW. Improving survival after cardiac arrest in Europe: The synergetic effect of rescue chain strategies. Resusc Plus 2024; 17:100533. [PMID: 38205146 PMCID: PMC10776426 DOI: 10.1016/j.resplu.2023.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Sudden cardiac arrest is a global problem and is considered the third leading cause of death in industrialized countries. Patient survival rates after out-of-hospital cardiac arrest (OHCA) vary significantly between countries and continents. In particular, the 2021 European Resuscitation Council (ERC) Resuscitation Guidelines place a special focus on the chain of survival of patients after OHCA. As a complex, interconnected approach, the focus is on: Raising awareness for cardiac arrest and lay resuscitation, school children's education in resuscitation "KIDS SAVE LIVES", first responder systems - technologies to engage the community, telephone-assisted resuscitation (telephone-CPR; T-CPR) by dispatchers, and cardiac arrest centers (CAC) for further treatment in specialized hospitals. The Systems Saving Lives approach is a comprehensive strategy that emphasizes the interconnectedness of all links in the chain of survival following an OHCA, with a particular focus on the relationship between the community and emergency medical services (EMS). This system-level approach emphasizes the importance of the connection between all those involved in the chain of survival. It has a high potential to improve overall survival after OHCA. Therefore, it is recommended that these strategies be promoted and expanded in all countries.
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Affiliation(s)
- Lina Horriar
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
| | - Nadine Rott
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine Kerpener Straße 62, 50937 Cologne, Germany
| | - Bernd W. Böttiger
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine Kerpener Straße 62, 50937 Cologne, Germany
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Xu Y, Peng F, Wang S, Yu H. Lower versus higher oxygen targets after resuscitation from out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. J Crit Care 2024; 79:154448. [PMID: 37862956 DOI: 10.1016/j.jcrc.2023.154448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/02/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE To update the existing evidence and gain further insight into effects of lower versus higher oxygen targets on the outcomes in patients resuscitated from out-of-hospital cardiac arrest (OHCA). METHODS We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing lower versus higher oxygen targets on the outcomes among adults resuscitated from OHCA. The primary outcome was short-term survival (in hospital or within 30 days). Subgroup analyses were performed according to timing of study interventions. RESULTS Seven RCTs with 1454 patients were finally included. The short-term survival did not differ between the two groups with a relative risk (RR) of 0.98 (95% CI, 0.86 to 1.11). There were no significant differences in survival at longest follow-up (RR, 1.01; 95% CI, 0.91 to 1.14), favorable neurological outcome (RR, 1.00; 95% CI, 0.91 to 1.11), length of intensive care unit stay (mean difference, -4.94 h; 95% CI, -14.83 to 4.96 h), or risk of re-arrest (RR, 0.68; 95% CI, 0.21 to 2.19). The quality of evidence ranged from moderate to very low. CONCLUSION Current evidence suggests that targeting a lower or higher oxygen therapy in patients after resuscitation from OHCA results in similar short-term survival and other clinical outcomes.
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Affiliation(s)
- Yi Xu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Fei Peng
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Siying Wang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China.
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Tamis-Holland JE, Menon V, Johnson NJ, Kern KB, Lemor A, Mason PJ, Rodgers M, Serrao GW, Yannopoulos D. Cardiac Catheterization Laboratory Management of the Comatose Adult Patient With an Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e274-e295. [PMID: 38112086 DOI: 10.1161/cir.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Out-of-hospital cardiac arrest is a leading cause of death, accounting for ≈50% of all cardiovascular deaths. The prognosis of such individuals is poor, with <10% surviving to hospital discharge. Survival with a favorable neurologic outcome is highest among individuals who present with a witnessed shockable rhythm, received bystander cardiopulmonary resuscitation, achieve return of spontaneous circulation within 15 minutes of arrest, and have evidence of ST-segment elevation on initial ECG after return of spontaneous circulation. The cardiac catheterization laboratory plays an important role in the coordinated Chain of Survival for patients with out-of-hospital cardiac arrest. The catheterization laboratory can be used to provide diagnostic, therapeutic, and resuscitative support after sudden cardiac arrest from many different cardiac causes, but it has a unique importance in the treatment of cardiac arrest resulting from underlying coronary artery disease. Over the past few years, numerous trials have clarified the role of the cardiac catheterization laboratory in the management of resuscitated patients or those with ongoing cardiac arrest. This scientific statement provides an update on the contemporary approach to managing resuscitated patients or those with ongoing cardiac arrest.
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Kim YG, Min K, Jeong JH, Roh SY, Han KD, Shim J, Choi JI, Kim YH. Temporal elevation of blood pressure is associated with increased risk of sudden cardiac arrest. Sci Rep 2024; 14:2289. [PMID: 38280904 PMCID: PMC10821940 DOI: 10.1038/s41598-024-52859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/24/2024] [Indexed: 01/29/2024] Open
Abstract
Hypertension is a known risk factor for sudden cardiac arrest (SCA). However, the role of temporal changes in blood pressure on the risk of SCA is not fully understood. This study was conducted to determine whether a temporal increase or decrease in blood pressure is associated with the risk of SCA. This study was based on nationwide healthcare insurance data. Individuals who underwent nationwide health check-ups in 2009 and 2011 were analyzed. A total of 2,801,153 individuals were evaluated for 8100 SCA events during the 17, 740, 420 person-years of follow-up. In a multivariate analysis, there were linear association between the degree of temporal elevation of systolic blood pressure (SBP) and the risk of SCA: (i) adjusted-hazard ratio (HR) 1.11 (p = 0.001) in 10 ≤ ΔSBP < 20 (mmHg) group; (ii) adjusted-HR 1.40 (p < 0.001) in 20 ≤ ΔSBP < 40 group; and (iii) adjusted-HR 1.88 (p < 0.001) in 40 ≤ ΔSBP group as compared with the reference group (- 10 ≤ ΔSBP < 10). Temporal increase in diastolic blood pressure (DBP) also a showed significant association with SCA risk with the highest risk observed in ∆DBP ≥ 25 group (adjusted-HR 1.61; p < 0.001) as compared with the reference group (- 5 ≤ ΔDBP < 5). The association between SBP and SCA was not affected by age, sex, presence of diabetes mellitus, or baseline SBP. In conclusion, a temporal increase in blood pressure was significantly associated with the occurrence of SCA, and this association was consistent across all subgroups. However, a temporary decrease in blood pressure does not reduce the risk of SCA. Prevention of elevated blood pressure may play an important role in preventing SCA.
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - Kyongjin Min
- Division of Cardiology, Department of Internal Medicine, Incheon Sejong Hospital, Incheon, Republic of Korea
| | - Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Guro Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea.
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea
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12
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Pey V, Doumard E, Komorowski M, Rouget A, Delmas C, Vardon-Bounes F, Poette M, Ratineau V, Dray C, Ader I, Minville V. A locally optimised machine learning approach to early prognostication of long-term neurological outcomes after out-of-hospital cardiac arrest. Digit Health 2024; 10:20552076241234746. [PMID: 38628633 PMCID: PMC11020739 DOI: 10.1177/20552076241234746] [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] [Accepted: 02/07/2024] [Indexed: 04/19/2024] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) represents a major burden for society and health care, with an average incidence in adults of 67 to 170 cases per 100,000 person-years in Europe and in-hospital survival rates of less than 10%. Patients and practitioners would benefit from a prognostication tool for long-term good neurological outcomes. Objective We aim to develop a machine learning (ML) pipeline on a local database to classify patients according to their neurological outcomes and identify prognostic features. Methods We collected clinical and biological data consecutively from 595 patients who presented OHCA and were routed to a single regional cardiac arrest centre in the south of France. We applied recursive feature elimination and ML analyses to identify the main features associated with a good neurological outcome, defined as a Cerebral Performance Category score less than or equal to 2 at six months post-OHCA. Results We identified 12 variables 24 h after admission, capable of predicting a six-month good neurological outcome. The best model (extreme gradient boosting) achieved an AUC of 0.96 and an accuracy of 0.92 in the test cohort. Conclusion We demonstrated that it is possible to build accurate, locally optimised prediction and prognostication scores using datasets of limited size and breadth. We proposed and shared a generic machine-learning pipeline which allows external teams to replicate the approach locally.
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Affiliation(s)
- Vincent Pey
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Emmanuel Doumard
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
| | - Matthieu Komorowski
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Antoine Rouget
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
| | - Fanny Vardon-Bounes
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Michaël Poette
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Valentin Ratineau
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Cédric Dray
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
| | - Isabelle Ader
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
| | - Vincent Minville
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
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Albrecht M, de Jonge RCJ, Dulfer K, Van Gils-Frijters APJM, de Hoog M, Hunfeld M, Kammeraad JAE, Moors XRJ, Nadkarni VM, Buysse CMP. Trends in community response and long-term outcomes from pediatric cardiac arrest: A retrospective observational study. Resuscitation 2024; 194:110045. [PMID: 37952576 DOI: 10.1016/j.resuscitation.2023.110045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
AIM This study aimed to investigate trends over time in pre-hospital factors for pediatric out-of-hospital cardiac arrest (pOHCA) and long-term neurological and neuropsychological outcomes. These have not been described before in large populations. METHODS Non-traumatic arrest patients, 1 day-17 years old, presented to the Sophia Children's Hospital from January 2002 to December 2020, were eligible for inclusion. Favorable neurological outcome was defined as Pediatric Cerebral Performance Categories (PCPC) 1-2 or no difference with pre-arrest baseline. The trend over time was tested with multivariable logistic and linear regression models with year of event as independent variable. FINDINGS Over a nineteen-year study period, the annual rate of long-term favorable neurological outcome, assessed at a median 2.5 years follow-up, increased significantly (OR 1.10, 95%-CI 1.03-1.19), adjusted for confounders. Concurrently, annual automated external defibrillator (AED) use and, among adolescents, initial shockable rhythm increased significantly (OR 1.21, 95% CI 1.10-1.33 and OR 1.15, 95% CI 1.02-1.29, respectively), adjusted for confounders. For generalizability purposes, only the total intelligence quotient (IQ) was considered for trend analysis of all tested domains. Total IQ scores and bystander basic life support (BLS) rate did not change significantly over time. INTERPRETATION Long-term favorable neurological outcome, assessed at a median 2.5 years follow-up, improved significantly over the study period. Total IQ scores did not significantly change over time. Furthermore, AED use (OR 1.21, 95%CI 1.10-1.33) and shockable rhythms among adolescents (OR1.15, 95%CI 1.02-1.29) increased over time.
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Affiliation(s)
- M Albrecht
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - R C J de Jonge
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - K Dulfer
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - A P J M Van Gils-Frijters
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M de Hoog
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M Hunfeld
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - J A E Kammeraad
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - X R J Moors
- Department of Pediatric Anesthesiology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Helicopter Emergency Medical Services, Erasmus MC, Rotterdam, the Netherlands
| | - V M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA., United States
| | - C M P Buysse
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
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14
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Fijačko N, Metličar Š, Štiglic G, Gosak L, Greif R. Using puzzles to teach healthcare students the content of the chain of survival. Resuscitation 2024; 194:110098. [PMID: 38128871 DOI: 10.1016/j.resuscitation.2023.110098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Nino Fijačko
- University of Maribor, Faculty of Health Sciences, Maribor, Slovenia; Maribor University Medical Centre, Maribor, Slovenia.
| | - Špela Metličar
- University of Maribor, Faculty of Health Sciences, Maribor, Slovenia; Medical Dispatch Centre Maribor, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Gregor Štiglic
- University of Maribor, Faculty of Health Sciences, Maribor, Slovenia; University of Maribor, Faculty of Electrical Engineering and Computer Science, Maribor, Slovenia; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Lucija Gosak
- University of Maribor, Faculty of Health Sciences, Maribor, Slovenia
| | - Robert Greif
- ERC Research Net, Niels, Belgium; University of Bern, Bern, Switzerland; Sigmund Freud University Vienna, Faculty of Medicine, Vienna, Austria
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15
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van den Beuken WM, Sayre MR, Olasveengen TM, Sunshine JE. Wolf Creek XVII part 3: Automated cardiac arrest diagnosis. Resusc Plus 2023; 16:100499. [PMID: 38059269 PMCID: PMC10696380 DOI: 10.1016/j.resplu.2023.100499] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Introduction Automated cardiac arrest diagnosis offers the possibility to significantly shorten the interval between onset of out-of-hospital cardiac arrest (OHCA) and notification of EMS, providing the opportunity for earlier resuscitation and possibly increased survival. Methods Automated cardiac arrest diagnosis was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of cardiac arrest resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results Top knowledge gaps include the accuracy of automated OHCA detection technologies and the feasibility and reliability of automated EMS activation. The main barriers to translation are the risk of false positives potentially overburdening EMS, development and application costs of technology and the challenge of integrating new technology in EMS IT systems. The top research priorities are large-scale evaluation studies to measure real world performance and user research regarding the willingness to adopt these technologies. Conclusion Automated cardiac arrest diagnosis has the potential to significantly impact time to resuscitation and survival of OHCA because it could convert unwitnessed events into witnessed events. Validation and feasibility studies are needed. The specificity of the technology must be high not to overburden limited EMS resources. If adequate event classification is achieved, future research could shift toward event prediction, focusing on identifying potential digital biomarkers and signatures of imminent cardiac arrest. Implementation could be challenging due to high costs of development, regulatory considerations and instantiation logistics.
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Affiliation(s)
| | - Michael R. Sayre
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
| | - Theresa M. Olasveengen
- Department of Anesthesia and Intensive Care, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Jacob E. Sunshine
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
- Paul G Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
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16
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Guetterman TC, Forman J, Fouche S, Simpson K, Fetters MD, Nelson C, Mendel P, Hsu A, Flohr JA, Domeier R, Rahim R, Nallamothu BK, Abir M. A cross-stakeholder approach to improving out-of-hospital cardiac arrest survival. Am Heart J 2023; 266:106-119. [PMID: 37709108 DOI: 10.1016/j.ahj.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) affects over 300,000 individuals per year in the United States with poor survival rates overall. A remarkable 5-fold difference in survival-to-hospital discharge rates exist across United States communities. METHODS We conducted a study using qualitative research methods comparing the system of care across sites in Michigan communities with varying OHCA survival outcomes, as measured by return to spontaneous circulation with pulse upon emergency department arrival. RESULTS Major themes distinguishing higher performing sites were (1) working as a team, (2) devoting resources to coordination across agencies, and (3) developing a continuous quality improvement culture. These themes spanned the chain of survival framework for OHCA. By examining the unique processes, procedures, and characteristics of higher- relative to lower-performing sites, we gleaned lessons learned that appear to distinguish higher performers. The higher performing sites reported being the most collaborative, due in part to facilitation of system integration by progressive leadership that is willing to build bridges among stakeholders. CONCLUSIONS Based on the distinguishing features of higher performing sites, we provide recommendations for toolkit development to improve survival in prehospital systems of care for OHCA.
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Affiliation(s)
- Timothy C Guetterman
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Jane Forman
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Qualitative and Mixed Methods Core, Center for Clinical Management Research, U.S. Department of Veterans Affairs, Ann Arbor, MI
| | - Sydney Fouche
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI
| | - Kaitlyn Simpson
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI
| | - Michael D Fetters
- Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
| | | | | | - Antony Hsu
- Trinity Health Ann Arbor Hospital, Ann Arbor, MI
| | - Jessica A Flohr
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI
| | - Robert Domeier
- Trinity Health Ann Arbor Hospital, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Rebal Rahim
- Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Malmo, Sweden
| | - Brahmajee K Nallamothu
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
| | - Mahshid Abir
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; RAND Corporation, Santa Monica, CA; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.
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Jaskiewicz F, Timler D. Attitudes of Asian and Polish Adolescents towards the Use of Ecological Innovations in CPR Training. J Clin Med 2023; 12:6939. [PMID: 37959404 PMCID: PMC10648462 DOI: 10.3390/jcm12216939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/21/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The potential use of manikins made of environmentally friendly materials (biodegradable or easily recycled) could be a milestone in promoting cardiac arrest awareness and mass resuscitation training without the threat of generating large amounts of unprocessable waste. The main aim of the study was to compare the attitude of young adults from Asia and Poland towards cardiopulmonary resuscitation training forms and to evaluate the innovative concept of an ecological resuscitation manikin; Methods: This was a survey-based study conducted during two events in Thailand and Poland in 2023; Results: A total of 226 questionnaires were included in the final analysis. Asian respondents were significantly more likely to choose traditional training than Polish participants (78% vs. 58%, respectively). A manikin that is mainly biodegradable was the most common choice across the entire study group. Young Asians were significantly more likely to choose a traditional stationary course, while Polish respondents were highly significantly more likely to opt for hybrid training (online with practical training provided at the student's home). CONCLUSIONS In the total study group, young people from Poland and parts of Asia are most likely to participate in traditional on-site instructor-led training, but a comparison across groups showed a significant tendency for young Poles to choose a hybrid training option, i.e., a combination of online and hands-on training. Despite some differences, both study groups showed a strong interest in pro-environmental behavior and the use of more ecofriendly solutions than previously used in resuscitation training.
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Affiliation(s)
- Filip Jaskiewicz
- Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, 90-419 Łódź, Poland;
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18
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Gentile FR, Wik L, Isasi I, Baldi E, Aramendi E, Steen-Hansen JE, Fasolino A, Compagnoni S, Contri E, Palo A, Primi R, Bendotti S, Currao A, Quilico F, Vicini Scajola L, Lopiano C, Savastano S. Amplitude spectral area of ventricular fibrillation and defibrillation success at low energy in out-of-hospital cardiac arrest. Intern Emerg Med 2023; 18:2397-2405. [PMID: 37556074 DOI: 10.1007/s11739-023-03386-6] [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: 04/26/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
The optimal energy for defibrillation has not yet been identified and very often the maximum energy is delivered. We sought to assess whether amplitude spectral area (AMSA) of ventricular fibrillation (VF) could predict low energy level defibrillation success in out-of-hospital cardiac arrest (OHCA) patients. This is a multicentre international study based on retrospective analysis of prospectively collected data. We included all OHCAs with at least one manual defibrillation. AMSA values were calculated by analyzing the data collected by the monitors/defibrillators used in the field (Corpuls 3 and Lifepak 12/15) and using a 2-s-pre-shock electrocardiogram interval. We run two different analyses dividing the shocks into three tertiles (T1, T2, T3) based on AMSA values. 629 OHCAs were included and 2095 shocks delivered (energy ranging from 100 to 360 J; median 200 J). Both in the "extremes analysis" and in the "by site analysis", the AMSA values of the effective shocks at low energy were significantly higher than those at high energy (p = 0.01). The likelihood of shock success increased significantly from the lowest to the highest tertile. After correction for age, call to shock time, use of mechanical CPR, presence of bystander CPR, sex and energy level, high AMSA value was directly associated with the probability of shock success [T2 vs T1 OR 3.8 (95% CI 2.5-6) p < 0.001; T3 vs T1 OR 12.7 (95% CI 8.2-19.2), p < 0.001]. AMSA values are associated with the probability of low-energy shock success so that they could guide energy optimization in shockable cardiac arrest patients.
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Affiliation(s)
- Francesca R Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Lars Wik
- Division of Prehospital Emergency Medicine, Oslo University Hospital, National Service of Competence for Prehospital Acute Medicine (NAKOS), Ullevål Hospital, Oslo, Norway
- Prehospital Clinic, Doctor car, Oslo University Hospital HF, Ullevål Hospital, Oslo, Norway
| | - Iraia Isasi
- BioRes Group, University of the Basque Country, Bilbao, Spain
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | | | | | - Alessandro Fasolino
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Enrico Contri
- AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Palo
- AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federico Quilico
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Luca Vicini Scajola
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Clara Lopiano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
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Chan PS, Merritt R, McNally B, Chang A, Al-Araji R, Mawani M, Ahn KO, Girotra S. Bystander CPR and Long-Term Survival in Older Adults With Out-of-Hospital Cardiac Arrest. JACC. ADVANCES 2023; 2:100607. [PMID: 38084207 PMCID: PMC10713355 DOI: 10.1016/j.jacadv.2023.100607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Most studies on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) have focused on in-hospital or short-term survival. OBJECTIVES The purpose of this study was to examine the association between bystander CPR and long-term survival outcomes for OHCA. METHODS Within the Cardiac Arrest Registry to Enhance Survival, we identified 152,653 patients with OHCA ≥65 years of age or older. Using multivariable hierarchical logistic regression, we first examined the association between bystander CPR and in-hospital survival. Then, among those surviving to discharge and linked to Medicare files, we evaluated the association between bystander CPR and long-term mortality over 5 years using multivariable Cox regression. RESULTS Overall, 58,464 (38.3%) received bystander CPR. Patients receiving bystander CPR were more likely to have an OHCA that was witnessed, in a public location, and with an initial shockable rhythm. Bystander CPR was associated with a 24% higher likelihood of surviving to hospital discharge (10.2% vs 5.5%; adjusted relative risk: 1.24 [95% CI: 1.19-1.29]; P < 0.001), and this survival benefit was similar (interaction P = 0.24) for those who were 65 to 74, 75 to 84, and ≥85 years of age. Among patients surviving to hospital discharge (median follow-up of 31 months), bystander CPR was additionally associated with lower long-term mortality vs those without bystander CPR (adjusted hazard ratio: 0.78 [95% CI: 0.73-0.84]; P < 0.001), and this benefit was also consistent across age groups (interaction P = 0.13). CONCLUSIONS In older adults with OHCA, bystander CPR was associated with higher rates of in-hospital survival. This survival benefit was not attenuated by competing mortality risks but increased in magnitude after hospital discharge.
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Affiliation(s)
- Paul S. Chan
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Robert Merritt
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bryan McNally
- Department of Emergency Medicine, Emory University and Rollins School of Public Health, Atlanta, Georgia, USA
| | - Anping Chang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rabab Al-Araji
- Emory University and Rollins School of Public Health, Atlanta, Georgia, USA
| | - Minaz Mawani
- University of Georgia College of Public Health, Atlanta, GA, USA
| | - Ki Ok Ahn
- Department of Medicine, Hanyang University College of Medicine and Myongji Hospital, Seoul, South Korea
| | - Saket Girotra
- University of Texas-Southwestern, Dallas, Texas, USA
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Schnaubelt S, Krammel M. PULS - Austrian Cardiac Arrest Awareness Association: An overview of a multi-tiered and multi-facetted regional initiative to save lives. Resusc Plus 2023; 15:100453. [PMID: 37645620 PMCID: PMC10461014 DOI: 10.1016/j.resplu.2023.100453] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Background Out-of-hospital cardiac arrest with subsequent cardiopulmonary resuscitation (CPR) still leads to dismal outcomes worldwide. The crucial gap between cardiac arrest and advanced life support can only be filled by bystander-CPR. However, knowledge and willingness of the public towards basic life support (BLS) remain low. Global and national initiatives for awareness building and CPR training have produced promising improvements, but an additional focus on regional initiatives might be necessary to truly implement change. Methods and results In order to support other like-minded groups, we present a "coming of age" narrative review of PULS - Austrian Cardiac Arrest Awareness Association, along with a future outlook and "lessons learned". Interviews with past and present employees, members, and functionaries were conducted by the authors. Additionally, the organization's archives were assessed. Conclusion Following current guidelines and the Utstein formula of survival, building a system to save lives is essential to achieve progress concerning cardiac arrest survival and outcomes. As kinds of "regional offices" of global resuscitation efforts, a network of individual local initiatives and organizations such as PULS can carry the respective messages, engage with local key figures of implementation, and keep up perpetual work for cardiac arrest awareness and BLS education.
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Affiliation(s)
- Sebastian Schnaubelt
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Mario Krammel
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- Emergency Medical Service Vienna, Austria
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Hutton J, Puyat JH, Asamoah-Boaheng M, Sobolev B, Lingawi S, Khalili M, Kuo C, Shadgan B, Christenson J, Grunau B. The effect of recognition on survival after out-of-hospital cardiac arrest and implications for biosensor technologies. Resuscitation 2023; 190:109906. [PMID: 37453691 DOI: 10.1016/j.resuscitation.2023.109906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Biosensor technologies have been proposed as a solution to provide recognition and facilitate earlier responses to unwitnessed out-of-hospital cardiac arrest (OHCA) cases. We sought to estimate the effect of recognition on survival and modelled the potential incremental impact of increased recognition of unwitnessed cases on survival to hospital discharge, to demonstrate the potential benefit of biosensor technologies. METHODS We included cases from the British Columbia Cardiac Arrest Registry (2019-2020), which includes Emergency Medical Services (EMS)-assessed OHCAs. We excluded cases that would not have benefitted from early recognition (EMS-witnessed, terminal illness, or do-not-resuscitate). Using a mediation analysis, we estimated the relative benefits on survival of a witness recognizing vs. intervening in an OHCA; and estimated the expected additional number of survivors resulting from increasing recognition alone using a bootstrap logistic regression framework. RESULTS Of 13,655 EMS-assessed cases, 11,412 were included (6314 EMS-treated, 5098 EMS-untreated). Survival to hospital discharge was 191/8879 (2.2%) in unwitnessed cases and 429/2533 (17%) in bystander-witnessed cases. Of the total effect attributable to a bystander witness, recognition accounted for 84% (95% CI: 72, 86) of the benefit. If all previously unwitnessed cases had been bystander witnessed, we would expect 1198 additional survivors. If these cases had been recognized, but no interventions performed, we would expect 912 additional survivors. CONCLUSION Unwitnessed OHCA account for the majority of OHCAs, yet survival is dismal. Methods to improve recognition, such as with biosensor technologies, may lead to substantial improvements in overall survival.
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Affiliation(s)
- Jacob Hutton
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada.
| | - Joseph H Puyat
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada; School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Michael Asamoah-Boaheng
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
| | - Boris Sobolev
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Saud Lingawi
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, British Columbia, Canada; International Collaboration on Repair Discoveries, British Columbia, Canada
| | - Mahsa Khalili
- School of Biomedical Engineering, University of British Columbia, British Columbia, Canada; International Collaboration on Repair Discoveries, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
| | - Calvin Kuo
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, British Columbia, Canada
| | - Babak Shadgan
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, British Columbia, Canada; Department of Orthopedic Surgery, University of British Columbia, British Columbia, Canada
| | - Jim Christenson
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
| | - Brian Grunau
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
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22
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El-Zein RS, Kennedy KF, Chan PS. Out-of-hospital cardiac arrest survival when CPR is initiated by first responders. Resuscitation 2023; 190:109914. [PMID: 37506814 PMCID: PMC10529146 DOI: 10.1016/j.resuscitation.2023.109914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND In most patients with out-of-hospital cardiac arrest (OHCA), cardiopulmonary resuscitation (CPR) is initiated by first responders (non-transporting firefighters or police) or emergency medical service (EMS) personnel. Whether survival outcomes differ when CPR is initiated by first responders vs. EMS is unclear. METHODS Within the CARES registry, we identified 162,896 adult patients with a non-traumatic OHCA in whom CPR was initiated by first responders or EMS during 2013-2021. Using multivariable hierarchical logistic regression to adjust for demographics, cardiac arrest characteristics and time to first CPR, we compared rates of survival to hospital admission and to discharge in patients with CPR initiated by first responders and EMS. RESULTS CPR was initiated by first responders in 70,889 (43.5%) and by EMS in 92,007 (56.5%) patients. Time to first CPR was shorter when first responders initiated CPR (median: 8.0 [5.0-13.0] vs. 10.0 minutes [IQR: 6.0-14.0]; standardized difference 16.1%). The likelihood of survival to hospital admission was similar when CPR was initiated by first responders (27.1% [first responders] vs. 26.8% [EMS]; adjusted OR: 0.98 [0.96, 1.01], P = 0.15) whereas survival rates to discharge were higher with CPR initiated by first responders (9.4% [first responders] vs. 7.7% [EMS]; adjusted OR: 1.17 [1.02, 1.21], P < 0.001). After adjustment for time to first CPR, rates of survival to discharge were similar between the first responder and EMS groups (adjusted OR: 1.04 [1.00-1.08]; P = 0.07). CONCLUSIONS CPR initiated by first responders for OHCA is associated with higher overall survival rates and higher survival was largely mediated by earlier response times.
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Affiliation(s)
- Rayan S El-Zein
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States.
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Ahn C, Oh YT, Park Y, Kim JH, Hwang S, Won M. The Influence of Cardiac Arrest Floor-Level Location within a Building on Survival Outcomes. J Pers Med 2023; 13:1265. [PMID: 37623515 PMCID: PMC10455151 DOI: 10.3390/jpm13081265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
This nationwide, population-based observational study investigated the association between the floor level of out-of-hospital cardiac arrest (OHCA) incidence and survival outcomes in South Korea, notable for its significant high-rise apartment living. Data were collected retrospectively from OHCA patients through the South Korean Out-of-Hospital Cardiac Arrest Surveillance database. The study incorporated cases that included the OHCA's building floor information. The primary outcome assessed was survival to discharge, analyzed using multivariate logistic regression, and the secondary outcome was favorable neurological outcome. Among 36,977 patients, a total of 29,729 patients were included, and 1680 patients were survivors. A weak yet significant correlation between floor level and hospital arrival time was observed. Interestingly, elevated survival rates were noted among patients from higher floors despite extended emergency medical service response times. Multivariate analysis identified age, witnessed OHCA, shockable rhythm, and prehospital return of spontaneous circulation (ROSC) as primary determinants of survival to discharge. The floor level's impact on survival was less substantial than anticipated, suggesting residential emergency response enhancements should prioritize witness interventions, shockable rhythm management, and prehospital ROSC rates. The study underscores the importance of bespoke emergency response strategies in high-rise buildings, particularly in urban areas, and the potential of digital technologies to optimize response times and survival outcomes.
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Affiliation(s)
- Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Young Taeck Oh
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea;
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Jae Hwan Kim
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Sojune Hwang
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Moonho Won
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
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Omatsu K, Uchiyama M, Shimizu U, Ling Y, Okuda S, Koyama Y. Impact of Heavy Snowfall on Emergency Transport and Prognosis of Out-of-Hospital Cardiac Arrest Patients: A Nation-Wide Cohort Study. Prehosp Disaster Med 2023; 38:436-443. [PMID: 37448197 PMCID: PMC10445114 DOI: 10.1017/s1049023x23006040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a significant global cause of mortality, and Emergency Medical Services (EMS) response interval is critical for survival and a neurologically-favorable outcome. Currently, it is unclear whether EMS response interval, neurologically-intact survival, and overall survival differ between snowy and non-snowy periods at heavy snowfall areas. METHODS A nation-wide population-based cohort of OHCA patients, registered from 2017 through 2019 in the All-Japan Utstein Registry, was divided into four groups according to areas (heavy snowfall area or other area) and seasons (winter or non-winter): heavy snowfall-winter, heavy snowfall-non-winter, other area-winter, and other area-non-winter. The first coprimary outcome was EMS response interval, and the secondary coprimary outcome was one-month survival and a neurologically-favorable outcome at one month. RESULTS A total of 337,781 OHCA patients were divided into four groups: heavy snowfall-winter (N = 15,627), heavy snowfall-non-winter (N = 97,441), other area-winter (N = 32,955), and other area-non-winter (N = 191,758). Longer EMS response intervals (>13 minutes) were most likely in the heavy snowfall-winter group (OR = 1.86; 95% CI, 1.76 to 1.97), and also more likely in heavy snowfall areas in non-winter (OR = 1.44; 95% CI, 1.38 to 1.50). One-month survival in winter was worse not only in the heavy snowfall area (OR = 0.86; 95% CI, 0.78 to 0.94) but also in other areas (OR = 0.91; 95% CI, 0.87 to 0.94). One-month neurologically-favorable outcomes were also comparable between heavy snowfall-winter and other area-non-winter groups. CONCLUSIONS This study showed OHCA in heavy snowfall areas in winter resulted in longer EMS response intervals. However, heavy snowfall had little effect on one-month survival or neurologically-favorable outcome at one month.
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Affiliation(s)
- Kentaro Omatsu
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mieko Uchiyama
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Utako Shimizu
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Yiwei Ling
- Bioinformatics Laboratory, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shujiro Okuda
- Bioinformatics Laboratory, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yu Koyama
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
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Santa Cruz Hernando AS, Nieves-Alonso JM, Mjertan A, Gutiérrez Martínez D, Planas Roca A. In-hospital cardiac arrest: Incidence, prognostic factors and results. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:373-380. [PMID: 36940853 DOI: 10.1016/j.redare.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/28/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND AIMS In-hospital cardiac arrest (CA) is a clinical entity with high morbidity and mortality that occurs in up to 2% of hospitalized patients. It is a public health problem with important economic, social, and medical repercussions, and as such its incidence needs to be reviewed and improved. The aim of this study was to determine the incidence of in-hospital CA, return of spontaneous circulation (ROSC), and survival rates at Hospital de la Princesa, and to define the clinical and demographic characteristics of patients with in-hospital CA. PATIENTS AND METHODS Retrospective observational chart review of patients presenting in-hospital CA and treated by anaesthesiologists from the hospital's rapid intervention team. Data were collected over 1 year. RESULTS Forty four patients were included in the study, of which 22 (50%) were women. Mean age was 75.7 years (±15.78 years), and incidence of in-hospital CA was 2.88 per 100,000 hospital admissions. Twenty two patients (50%) achieved ROSC and 11 patients (25%) survived until discharge home. The most prevalent comorbidity was arterial hypertension (63.64%); 66.7% of cases were not witnessed, and only 15.9% presented a shockable rhythm. CONCLUSIONS These results are similar to those reported in other larger studies. We recommend introducing immediate intervention teams and devoting time to training hospital staff in in-hospital CA.
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Affiliation(s)
- Alvar Santa Santa Cruz Hernando
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Clínico San Carlos, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Jesús Manuel Nieves-Alonso
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | - Amadea Mjertan
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
| | - Diego Gutiérrez Martínez
- Servicio de Anestesiología y Reanimación, Médico Adjunto Servicio de Anestesiología y Reanimación del Hospital Universitario Puerta de Hierro, Hospital Universitario de La Princesa, Madrid, Spain
| | - Antonio Planas Roca
- Servicio de Anestesiología y Reanimación, Jefe de Servicio de Anestesiología y Reanimación del Hospital Universitario de La Princesa, Hospital Universitario de La Princesa, Madrid, Spain
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Grubic N, Hill B, Allan KS, Dainty KN, Johri AM, Brooks SC. Community Interventions for Out-of-Hospital Cardiac Arrest in Resource-Limited Settings: A Scoping Review Across Low, Middle, and High-Income Countries. PREHOSP EMERG CARE 2023; 27:1088-1100. [PMID: 37406163 DOI: 10.1080/10903127.2023.2231559] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a major global health challenge, characterized by poor survival outcomes worldwide. Resource-limited settings are burdened with suboptimal emergency response and worse outcomes than high-resource areas. Engaging the community in the response to OHCA has the potential to improve outcomes, although an overview of community interventions in resource-limited settings has not been provided. OBJECTIVE This review evaluated the scope of community-based OHCA interventions in resource-limited settings. METHODS Literature searches in electronic databases (MEDLINE, EMBASE, Global Health, CINAHL, Cochrane Central Register of Controlled Clinical Trials) and grey literature sources were performed. Abstract screening, full-text review, and data extraction of eligible studies were conducted independently by two reviewers. The PCC (Population, Concept, and Context) framework was used to assess study eligibility. Studies that evaluated community-based interventions for laypeople (Population), targeting emergency response activation, cardiopulmonary resuscitation (CPR), or automated external defibrillator (AED) use (Concept) in resource-limited settings (Context) were included. Resource-limited settings were identified by financial pressures (low-income or lower-middle-income country, according to World Bank data on year of publication) or geographical factors (setting described using keywords indicative of geographical remoteness in upper-middle-income or high-income country). RESULTS Among 14,810 records identified from literature searches, 60 studies from 28 unique countries were included in this review. Studies were conducted in high-income (n = 35), upper-middle-income (n = 2), lower-middle-income (n = 22), and low-income countries (n = 1). Community interventions included bystander CPR and/or AED training (n = 34), community responder programs (n = 8), drone-delivered AED networks (n = 6), dispatcher-assisted CPR programs (n = 4), regional resuscitation campaigns (n = 3), public access defibrillation programs (n = 3), and crowdsourcing technologies (n = 2). CPR and/or AED training were the only interventions evaluated in low-income, lower-middle-income, and upper-middle-income countries. CONCLUSIONS Interventions aimed at improving the community response to OHCA in resource-limited settings differ globally. There is a lack of reported studies from low-income countries and certain continental regions, including South America, Africa, and Oceania. Evaluation of interventions other than CPR and/or AED training in low- and middle-income countries is needed to guide community emergency planning and health policies.
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Affiliation(s)
- Nicholas Grubic
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Katherine S Allan
- Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Katie N Dainty
- Patient-Centred Outcomes, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, University of Toronto, Toronto, Ontario, Canada
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
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Albert M, Herlitz J, Rawshani A, Forsberg S, Ringh M, Hollenberg J, Claesson A, Thuccani M, Lundgren P, Jonsson M, Nordberg P. Aetiology and outcome in hospitalized cardiac arrest patients. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead066. [PMID: 37564102 PMCID: PMC10411044 DOI: 10.1093/ehjopen/oead066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/29/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
Aims To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival. Methods and results Observational study with data from national registries. Specific aetiologies (n = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favourable neurological outcome (Cerebral Performance Category scale 1-2) at discharge. Among, 4320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes (P < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24-1.76); pulmonary causes OR 0.36 (CI 0.3-0.44); infection OR 0.25 (CI 0.18-0.33); haemorrhage OR 0.22 (CI 0.16-0.3); and other non-cardiac causes OR 0.56 (CI 0.45-0.69). IHCA caused by myocardial ischemia had the best favourable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03-0.13). Conclusion In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome.
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Affiliation(s)
- Malin Albert
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sune Forsberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Meena Thuccani
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Lundgren
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden
- Functional Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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28
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Primi R, Bendotti S, Currao A, Sechi GM, Marconi G, Pamploni G, Panni G, Sgotti D, Zorzi E, Cazzaniga M, Piccolo U, Bussi D, Ruggeri S, Facchin F, Soffiato E, Ronchi V, Contri E, Centineo P, Reali F, Sfolcini L, Gentile FR, Baldi E, Compagnoni S, Quilico F, Vicini Scajola L, Lopiano C, Fasolino A, Savastano S. Use of Mechanical Chest Compression for Resuscitation in Out-Of-Hospital Cardiac Arrest-Device Matters: A Propensity-Score-Based Match Analysis. J Clin Med 2023; 12:4429. [PMID: 37445464 DOI: 10.3390/jcm12134429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Devices for mechanical cardiopulmonary resuscitation (CPR) are recommended when high quality CPR cannot be provided. Different devices are available, but the literature is poor in direct comparison studies. Our aim was to assess whether the type of mechanical chest compressor could affect the probability of return of spontaneous circulation (ROSC) and 30-day survival in Out-of-Hospital Cardiac Arrest (OHCA) patients as compared to manual standard CPR. METHODS We considered all OHCAs that occurred from 1 January 2015 to 31 December 2022 in seven provinces of the Lombardy region equipped with three different types of mechanical compressor: Autopulse®(ZOLL Medical, MA), LUCAS® (Stryker, MI), and Easy Pulse® (Schiller, Switzerland). RESULTS Two groups, 2146 patients each (manual and mechanical CPR), were identified by propensity-score-based random matching. The rates of ROSC (15% vs. 23%, p < 0.001) and 30-day survival (6% vs. 14%, p < 0.001) were lower in the mechanical CPR group. After correction for confounders, Autopulse® [OR 2.1, 95%CI (1.6-2.8), p < 0.001] and LUCAS® [OR 2.5, 95%CI (1.7-3.6), p < 0.001] significantly increased the probability of ROSC, and Autopulse® significantly increased the probability of 30-day survival compared to manual CPR [HR 0.9, 95%CI (0.8-0.9), p = 0.005]. CONCLUSION Mechanical chest compressors could increase the rate of ROSC, especially in case of prolonged resuscitation. The devices were dissimilar, and their different performances could significantly influence patient outcomes. The load-distributing-band device was the only mechanical chest able to favorably affect 30-day survival.
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Affiliation(s)
- Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, 27100 Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Gianluca Marconi
- Agenzia Regionale dell'Emergenza Urgenza (AREU) Lombardia, 20124 Milan, Italy
| | - Greta Pamploni
- AAT Pavia-Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gianluca Panni
- AAT Brescia-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Degli Spedali Civili di Brescia, 25100 Brescia, Italy
| | - Davide Sgotti
- AAT Brescia-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Degli Spedali Civili di Brescia, 25100 Brescia, Italy
| | - Ettore Zorzi
- AAT Como-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Lariana (CO), 22079 Como, Italy
| | - Marco Cazzaniga
- AAT Como-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Lariana (CO), 22079 Como, Italy
| | - Umberto Piccolo
- AAT Como-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Lariana (CO), 22079 Como, Italy
| | - Daniele Bussi
- AAT Cremona-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, 26100 Cremona, Italy
| | - Simone Ruggeri
- AAT Cremona-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, 26100 Cremona, Italy
| | - Fabio Facchin
- AAT Mantova-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantova, 46100 Mantova, Italy
| | - Edoardo Soffiato
- AAT Mantova-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantova, 46100 Mantova, Italy
| | - Vincenza Ronchi
- AAT Pavia-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Pavia, 27100 Pavia, Italy
| | - Enrico Contri
- AAT Pavia-Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paola Centineo
- AAT Varese-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST dei Sette Laghi, 21100 Varese, Italy
| | - Francesca Reali
- AAT Lodi-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Lodi, 26900 Lodi, Italy
| | - Luigi Sfolcini
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Federico Quilico
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Luca Vicini Scajola
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Clara Lopiano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Alessandro Fasolino
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Simmons KM, McIsaac SM, Ohle R. Impact of community-based interventions on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis. Sci Rep 2023; 13:10231. [PMID: 37353542 PMCID: PMC10290111 DOI: 10.1038/s41598-023-35735-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/23/2023] [Indexed: 06/25/2023] Open
Abstract
Survival following out-of-hospital cardiac arrest (OHCA) remains low, typically less than 10%. Bystander cardiopulmonary resuscitation (CPR) and bystander-AED use have been shown to improve survival by up to fourfold in individual studies. Numerous community-based interventions have been implemented worldwide in an effort to enhance rates of bystander-CPR, bystander-AED use, and improve OHCA survival. This systematic review and meta-analysis aims to evaluate the effect of such interventions on OHCA outcomes. Medline and Embase were systematically searched from inception through July 2021 for studies describing the implementation and effect of one or more community-based interventions targeting OHCA outcomes. Two reviewers screened articles, extracted data, and evaluated study quality using the Newcastle-Ottawa Scale. For each outcome, data were pooled using random-effects meta-analysis. Of the 2481 studies identified, 16 met inclusion criteria. All included studies were observational. They reported a total of 1,081,040 OHCAs across 11 countries. The most common interventions included community-based CPR training (n = 12), community-based AED training (n = 9), and dispatcher-assisted CPR (n = 8). Health system interventions (hospital or paramedical services) were also described in 11 of the included studies. Evidence certainty among all outcomes was low or very low according to GRADE criteria. On meta-analysis, community-based interventions with and without health system interventions were consistently associated with improved OCHA outcomes: rates of bystander-CPR, bystander-AED use, survival, and survival with a favorable neurological outcome. Bystander CPR-14 studies showed a significant increase in post-intervention bystander-CPR rates (n = 285 752; OR 2.26 [1.74, 2.94]; I2 = 99%, and bystander AED use (n = 37 882; OR 2.08 [1.44, 3.01]; I2 = 54%) and durvival-10 studies, pooling survival to hospital discharge and survival to 30 days (n = 79 206; OR 1.59 [1.20, 2.10]; I2 = 95%. The results provide foundational support for the efficacy of community-based interventions in enhancing OHCA outcomes. These findings inform our recommendation that communities, regions, and countries should implement community-based interventions in their pre-hospital strategy for OHCA. Further research is needed to identify which specific intervention types are most effective.
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Affiliation(s)
| | - Sarah M McIsaac
- Department of Critical Care, Department of Anesthesia, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Robert Ohle
- Department of Emergency Medicine, Northern Ontario School of Medicine, Health Sciences North Research Institute, 56 Walford Road, Sudbury, ON, P3E 2H2, Canada.
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Ivankovic J, Bahr N, Meckler GD, Hansen M, Eriksson C, Guise JM. Identifying high cognitive load activities during simulated pediatric cardiac arrest using functional near-infrared spectroscopy. Resusc Plus 2023; 14:100409. [PMID: 37424768 PMCID: PMC10323221 DOI: 10.1016/j.resplu.2023.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Aim To identify specific activities associated with high cognitive load during simulated pediatric out-of-hospital cardiac arrest (POHCA) resuscitation using physiological monitoring with functional near-infrared spectroscopy (fNIRS). Methods We recruited teams of emergency medical services (EMS) responders from fire departments located throughout the Portland, OR metropolitan area to participate in POHCA simulations. Teams consisted of both paramedics and emergency medical technicians (EMTs), with one paramedic serving as the person in charge (PIC). The PIC was outfitted with the OctaMon to collect fNIRS signals from the prefrontal cortex. Signals reported changes in oxygenated and deoxygenated hemoglobin concentrations, which were used to determine moments of increased cognitive activity. Increased cognitive activity was determined by significant increases in oxygenated hemoglobin and decreases in deoxygenated hemoglobin. Significant changes in fNIRS signals were associated with specific concurrent clinical tasks recorded by two independent researchers using video review. Results We recorded cognitive activity of EMS providers in 18 POHCA simulations. We found that a proportion of PIC's experienced relatively high cognitive load during medication administration, defibrillation, and rhythm checks compared to other events. Conclusion EMS providers commonly experienced increased cognitive activity during key resuscitation tasks that were related to safely coordinating team members around calculating and administering medications, defibrillation, and rhythm and pulse checks. Understanding more about activities that require high cognitive demand can inform future interventions that reduce cognitive load.
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Affiliation(s)
- Jonathan Ivankovic
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-466, Portland, OR 97239, USA
| | - Nathan Bahr
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-466, Portland, OR 97239, USA
| | - Garth D Meckler
- Departments of Pediatrics and Emergency Medicine, University of British Columbia, 24-1160 Nicola Street, Vancouver, BC V6G 2E5, Canada
| | - Matthew Hansen
- Department of Emergency Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, HRC 11D01, Portland, OR 97239, USA
| | - Carl Eriksson
- Department of Pediatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, CDRC 1231, Portland, OR 97239, USA
| | - Jeanne-Marie Guise
- Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, East campus- Kirstein 3rd floor- OBGYN, 330 Brookline Ave, Boston, MA 02215, USA
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Baldi E, D'Alto A, Benvenuti C, Caputo ML, Cresta R, Cianella R, Auricchio A. Perceived threats and challenges experienced by first responders during their mission for an out-of-hospital cardiac arrest. Resusc Plus 2023; 14:100403. [PMID: 37287957 PMCID: PMC10242624 DOI: 10.1016/j.resplu.2023.100403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
Aim No study has systematically captured the perceived threat, discomfort or issues experienced by First Responders (FRs). We aimed to report the FRs' experience during a mission for an out-of-hospital cardiac arrest (OHCA) in a ten-year span. Methods We collected all the 40-items questionnaires filled out by the FRs dispatched in Ticino Region (Switzerland) from 01/10/2010 to 31/12/2020. We compared results between FRs alerted by SMS or APP and between professional and citizen FRs. Results 3391 FRs filled the questionnaire. The OHCA information was considered complete more frequently by FRs alerted by APP (85.6% vs 76.8%, p < 0.001), but a challenge in reaching the location was more frequent (15.5% vs 11.4%, p < 0.001), mainly due to wrong GPS coordinate. The FRs initiated/participated in resuscitation in 64.6% and used an AED in 31.9% of OHCAs, without issue in 97.9%. FRs reported a very high-level of satisfaction (97%) in EMS collaboration, but one-third didn't have the possibility to debrief. Citizen FRs used AED more frequently than professional FRs (34.6% vs 30.7%, p < 0.01), but experienced more often difficulties in performing CPR (2.6% vs 1.2%, p = 0.02) and wore more in need to debrief (19.7% vs 13%, p < 0.01). Conclusions We provide a unique picture from the FRs' point of view during a real-life OHCA reporting high-level of satisfaction, great motivation but also the need of systematic debrief. We identified areas of improvements including geolocation accuracy, further training on AED use and support program dedicated to citizen FRs.
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Affiliation(s)
- Enrico Baldi
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia D'Alto
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | | | - Maria Luce Caputo
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland
| | - Roberto Cianella
- Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland
| | - Angelo Auricchio
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Ko BS, Kim YJ, Han KS, Jo YH, Shin J, Park I, Kang H, Lim TH, Hwang SO, Kim WY. Association between the number of prehospital defibrillation attempts and a sustained return of spontaneous circulation: a retrospective, multicentre, registry-based study. Emerg Med J 2023; 40:424-430. [PMID: 37024298 DOI: 10.1136/emermed-2021-212091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Currently, there is no consensus on the number of defibrillation attempts that should be made before transfer to a hospital in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the association between the number of defibrillations and a sustained prehospital return of spontaneous circulation (ROSC). METHODS A retrospective analysis of a multicentre, prospectively collected, registry-based study in Republic of Korea was conducted for OHCA patients with prehospital defibrillation. The primary outcome was sustained prehospital ROSC, and the secondary outcome was a good neurological outcome at hospital discharge, defined as Cerebral Performance Category score 1 or 2. Cumulative incidence of sustained prehospital ROSC and good neurological outcome according to number of defibrillations were examined. Multivariable logistic regression analysis was used to examine whether the number of defibrillations was independently associated with the outcomes. RESULTS Excluding 172 patients with missing data, a total of 1983 OHCA patients who received prehospital defibrillation were included. The median time from arrest to first defibrillation was 10 (IQR 7-15) min. The numbers of patients with sustained prehospital ROSC and good neurological outcome were 738 (37%) and 549 (28%), respectively. Sustained ROSC rates decreased as the number of defibrillation attempts increased from the first to the sixth (16%, 9%, 5%, 3%, 2% and 1%, respectively). The cumulative sustained ROSC rate, and good neurological outcome rate from initial defibrillation to sixth defibrillation were 16%, 25%, 30%, 34%, 36%, 36% and 11%, 18%, 22%, 25%, 26%, 27%, respectively. With adjustment for clinical characteristics and time to defibrillation, a higher number of defibrillations was independently associated with a lower chance of a sustained ROSC (OR 0.81, 95% CI 0.76 to 0.86) and a lower chance of good neurological outcome (OR 0.86, 95% CI 0.80 to 0.92). CONCLUSIONS We observed no significant increase in ROSC after five defibrillations, and no absolute increase in ROSC after seven defibrillations. These data provide a starting point for determination of the optimal defibrillation strategy prior to consideration for prehospital extracorporeal cardiopulmonary resuscitation (ECPR) or conveyance to a hospital with an ECPR capability. TRIAL REGISTRATION NUMBER NCT03222999.
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Affiliation(s)
- Byuk Sung Ko
- Department of Emergency Medicine, Hanyang University College of Medicine, Seongdong-gu, The Republic of Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, The Republic of Korea
| | - Kap Su Han
- Emergency Medicine, Korea University College of Medicine and School of Medicine, Seoul, The Republic of Korea
| | - You Hwan Jo
- Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea
| | - JongHwan Shin
- Emergency Medicine, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seodaemun-gu, The Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seongdong-gu, The Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seongdong-gu, The Republic of Korea
| | - S O Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, The Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, The Republic of Korea
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Del Rios M. AED not applied: Why? Resuscitation 2023; 186:109782. [PMID: 37003512 DOI: 10.1016/j.resuscitation.2023.109782] [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: 04/03/2023]
Affiliation(s)
- Marina Del Rios
- University of Iowa - Carver College of Medicine, Iowa City, Iowa, USA.
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Priscilla Ng T, Wai-Onn Eng S, Xin Rui Ting J, Bok C, Yang Hong Tay G, Yeon Joyce Kong S, Stassen W, Zhang L, Eng Hock Ong M, Blewer AL, Wei Yeo J, Fu Wah Ho A. Global prevalence of basic life support training: A systematic review and meta-analysis. Resuscitation 2023; 186:109771. [PMID: 36934835 DOI: 10.1016/j.resuscitation.2023.109771] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND AND AIMS Out-of-hospital cardiac arrest exerts a large disease burden, which may be mitigated by bystander cardiopulmonary resuscitation and automated external defibrillation. We aimed to estimate the global prevalence and distribution of bystander training among laypersons, which are poorly understood, and to identify their determinants. METHODS We searched electronic databases for cross-sectional studies reporting the prevalence of bystander training from representative population samples. Pooled prevalence was calculated using random-effects models. Key outcome was cardiopulmonary resuscitation training (training within two-years and those who were ever trained). We explored determinants of interest using subgroup analysis and meta-regression. RESULTS 28 studies were included, representing 53,397 laypersons. Among national studies, the prevalence of cardiopulmonary resuscitation training within two-years and among those who were ever trained, and automated external defibrillator training was 10.02% (95% CI 6.60-14.05) and 39.64% (95%CI 29.11-50.67), and 15.70% (95% CI 10.17-22.18) respectively. Subgroup analyses by continent revealed pooled prevalence estimates of 31.58% (95%CI 18.70-46.09), 52.62% (95%CI 38.40-66.63), 18.93 (95%CI 0.00-62.94), 64.97% (95%CI 64.00-65.93), and 50.56% (95%CI 47.57-53.54) in Asia, Europe, Middle East, North America, and Oceania respectively, with significant subgroup differences (p<0.01). A country's income and cardiopulmonary resuscitation training (ever trained) (p=0.033) were positively correlated. Similarly, this prevalence was higher among the employed (p<0.00001) and highly educated (p<0.00001). CONCLUSIONS Large regional variation exists in data availability and bystander training prevalence. Socioeconomic status correlated with prevalence of bystander training, and regional disparities were apparent between continents. Bystander training should be promoted, particularly in Asia, Middle East, and low-income regions. Data availability should be encouraged from under-represented regions.
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Affiliation(s)
- Trina Priscilla Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sean Wai-Onn Eng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joel Xin Rui Ting
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chermaine Bok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, South Africa
| | - Lin Zhang
- Department of Epidemiology and Biostatistics, Shanghai Jiao Tong University School of Public Health, China
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, USA; Department of Population Health Sciences, Duke University School of Medicine, USA; Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore
| | - Jun Wei Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore.
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Kennedy C, Alqudah Z, Stub D, Anderson D, Nehme Z. The effect of the COVID-19 pandemic on the incidence and survival outcomes of EMS-witnessed out-of-hospital cardiac arrest. Resuscitation 2023; 187:109770. [PMID: 36933880 PMCID: PMC10019917 DOI: 10.1016/j.resuscitation.2023.109770] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/26/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
AIM We sought to examine the impact of the COVID-19 pandemic on the incidence and survival outcomes of emergency medical service (EMS)-witnessed out-of-hospital cardiac arrest (OHCA) in Victoria, Australia. METHODS We performed an interrupted time-series analysis of adult EMS-witnessed OHCA patients of medical aetiology. Patients treated during the COVID-19 period (1st March 2020 to 31st December 2021) were compared to a historical comparator period (1st January 2012 and 28th February 2020). Multivariable poisson and logistic regression models were used to examine changes in incidence and survival outcomes during the COVID-19 pandemic, respectively. RESULTS We included 5,034 patients, 3,976 (79.0%) in the comparator period and 1,058 (21.0%) in the COVID-19 period. Patients in the COVID-19 period had longer EMS response times, fewer public location arrests and were significantly more likely to receive mechanical CPR and laryngeal mask airways compared to the historical period (all p < 0.05). There were no significant differences in the incidence of EMS-witnessed OHCA between the comparator and COVID-19 periods (incidence rate ratio 1.06, 95% CI: 0.97-1.17, p = 0.19). Also, there was no difference in the risk-adjusted odds of survival to hospital discharge for EMS-witnessed OHCA occurring during COVID-19 period compared to the comparator period (adjusted odd ratio 1.02, 95% CI: 0.74-1.42; p = 0.90). CONCLUSION Unlike the reported findings in non-EMS-witnessed OHCA populations, changes during the COVID-19 pandemic did not influence incidence or survival outcomes in EMS-witnessed OHCA. This may suggest that changes in clinical practice that sought to limit the use of aerosol generating procedures did not influence outcomes in these patients.
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Affiliation(s)
- Charlotte Kennedy
- Centre for Research & Evaluation, Ambulance Victoria, Victoria, Australia; Department of Paramedicine, Monash University, Victoria, Australia
| | - Zainab Alqudah
- Centre for Research & Evaluation, Ambulance Victoria, Victoria, Australia; Jordan University of Science and Technology, Irbid, Jordan
| | - Dion Stub
- Centre for Research & Evaluation, Ambulance Victoria, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - David Anderson
- Centre for Research & Evaluation, Ambulance Victoria, Victoria, Australia; Department of Paramedicine, Monash University, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Centre for Research & Evaluation, Ambulance Victoria, Victoria, Australia; Department of Paramedicine, Monash University, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
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Obesity Is Indirectly Associated with Sudden Cardiac Arrest through Various Risk Factors. J Clin Med 2023; 12:jcm12052068. [PMID: 36902855 PMCID: PMC10004688 DOI: 10.3390/jcm12052068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Although obesity is a well-established risk factor of cardiovascular event, the linkage between obesity and sudden cardiac arrest (SCA) is not fully understood. Based on a nationwide health insurance database, this study investigated the impact of body weight status, measured by body-mass index (BMI) and waist circumference, on the SCA risk. A total of 4,234,341 participants who underwent medical check-ups in 2009 were included, and the influence of risk factors (age, sex, social habits, and metabolic disorders) was analyzed. For 33,345,378 person-years follow-up, SCA occurred in 16,352 cases. The BMI resulted in a J-shaped association with SCA risk, in which the obese group (BMI ≥ 30) had a 20.8% increased risk of SCA compared with the normal body weight group (18.5 ≤ BMI < 23.0) (p < 0.001). Waist circumference showed a linear association with the risk of SCA, with a 2.69-fold increased risk of SCA in the highest waist circumference group compared with the lowest waist circumference group (p < 0.001). However, after adjustment of risk factors, neither BMI nor waist circumference was associated with the SCA risk. In conclusion, obesity is not independently associated with SCA risk based on the consideration of various confounders. Rather than confining the findings to obesity itself, comprehensive consideration of metabolic disorders as well as demographics and social habits might provide better understanding and prevention of SCA.
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Schnaubelt S, Greif R, Monsieurs K. The chainmail of survival: A modern concept of an adaptive approach towards cardiopulmonary resuscitation. Resuscitation 2023; 184:109707. [PMID: 36709826 DOI: 10.1016/j.resuscitation.2023.109707] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Affiliation(s)
- Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Austria; Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium.
| | - Robert Greif
- University of Bern, Switzerland; School of Medicine, Sigmund Freud University, Vienna, Austria
| | - Koen Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
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Long-term increase in fasting blood glucose is associated with increased risk of sudden cardiac arrest. Cardiovasc Diabetol 2023; 22:38. [PMID: 36805666 PMCID: PMC9940683 DOI: 10.1186/s12933-023-01764-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with various cardiovascular complications, including sudden cardiac arrest (SCA). Furthermore, the severity of DM, as assessed by fasting blood glucose (FBG), is associated with the risk of SCA. However, whether long-term changes in FBG influence on SCA risk remains to be determined. METHODS This study used sequential nationwide health screening data from 2009 and 2011. FBG was measured at each health screening, and ΔFBG was calculated as FBG in 2011-FBG in 2009. RESULTS Overall, 2,801,153 people were analyzed, and the mean follow-up duration was 6.33 years. Compared with the euglycemic group (- 20 ≤ ΔFBG < 20), the 20 ≤ ΔFBG < 40, 40 ≤ ΔFBG < 100, and ΔFBG ≥ 100 groups had increased SCA risks of 25% (adjusted hazard ratio [HR] = 1.25; 95% confidence interval [CI] 1.16-1.35; p < 0.001), 66% (adjusted HR = 1.66; 95% CI 1.49-1.86; p < 0.001), and 2.9-fold (adjusted HR = 2.85; 95% CI 2.37-3.44; p < 0.001), respectively. The association between ΔFBG and SCA was maintained in people with DM but not in people without DM. However, sex, age, blood pressure, and presence of heart failure did not affect the association between ΔFBG and SCA. A decrease in ΔFBG over time was not associated with reduced risk of SCA: the adjusted HR was 1.11 (95% CI 0.98-1.27; p = 0.113) for the ΔFBG < -40 group and 1.12 (95% CI 1.03-1.22; p = 0.009) for the - 40 ≤ ∆FBG < - 20 group. CONCLUSIONS A long-term increase in ΔFBG can be associated with increased risk of SCA in people with DM. However, a long-term decrease in ΔFBG was not associated with reduced risk of SCA. Actions to prevent increase in FBG can have significant effects on public health in terms of SCA prevention.
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Ho AFW, Ting PZY, Ho JSY, Fook-Chong S, Shahidah N, Pek PP, Liu N, Teoh S, Sia CH, Lim DYZ, Lim SL, Wong TH, Ong MEH. The Effect of Building-Level Socioeconomic Status on Bystander Cardiopulmonary Resuscitation: A Retrospective Cohort Study. PREHOSP EMERG CARE 2023; 27:205-212. [PMID: 35363103 DOI: 10.1080/10903127.2022.2061094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Understanding the social determinants of bystander cardiopulmonary resuscitation (CPR) receipt can inform the design of public health interventions to increase bystander CPR. The association of socioeconomic status with bystander CPR is generally poorly understood. We evaluated the relationship between socioeconomic status and bystander CPR in cases of out-of-hospital cardiac arrest (OHCA). METHODS This was a retrospective cohort study based on the Singapore cohort of the Pan-Asian Resuscitation Outcomes Study registry between 2010 and 2018. We categorized patients into low, medium, and high Singapore Housing Index (SHI) levels-a building-level index of socioeconomic status. The primary outcome was receipt of bystander CPR. The secondary outcomes were prehospital return of spontaneous circulation and survival to discharge. RESULTS A total of 12,730 OHCA cases were included, the median age was 71 years, and 58.9% were male. The bystander CPR rate was 56.7%. Compared to patients in the low SHI category, those in the medium and high SHI categories were more likely to receive bystander CPR (medium SHI: adjusted odds ratio [aOR] 1.48, 95% CI 1.30-1.69; high SHI: aOR 1.93, 95% CI 1.67-2.24). High SHI patients had higher survival compared to low SHI patients on unadjusted analysis (OR 1.79, 95% CI 1.08-2.96), but not adjusted analysis (adjusted for age, sex, race, witness status, arrest time, past medical history of cancer, and first arrest rhythm). When comparing high with low SHI, females had larger increases in bystander CPR rates than males. CONCLUSIONS Lower building-level socioeconomic status was independently associated with lower rate of bystander CPR, and females were more susceptible to the effect of low socioeconomic status on lower rate of bystander CPR.
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Affiliation(s)
- Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Prehospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | | | - Jamie Sin Ying Ho
- Academic Foundation Programme, Royal Free London NHS Foundation Trust, London, UK
| | - Stephanie Fook-Chong
- Prehospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Nan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Seth Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Daniel Yan Zheng Lim
- Health Services Research Unit, Medical Board, Singapore General Hospital, Singapore, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ting Hway Wong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Pedrazas-López D, de Pablo-Márquez B, Cunillera-Puértolas O, Almeda-Ortega J. RCParvulari training: A basic life support training methodology applied to 5-year-old students: Effectiveness in a cluster-randomized clinical trail. An Pediatr (Barc) 2023; 98:99-108. [PMID: 36740509 DOI: 10.1016/j.anpede.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/04/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Basic life support training in school age is a topical issue because, with adequate training, any person can help save a life. METHODS Cluster clinical trial with data collection through an ad hoc self-administered, semi-structured questionnaire. The target population encompassed the students aged 4-6 years enrolled in 49 educational centres. The centres were randomly allocated to the intervention or control group. The intervention group was trained with the RCParvulari® methodology, consisting of theoretical and practical training on the first link of the chain of survival. The control group only received theoretical training. We evaluated participants before and immediately after the intervention and between 3 and 12 months post intervention by means of the questionnaire. We assessed the acquisition and retention over time of the knowledge and skills covered in the training compared to previous trainings in both groups. RESULTS A total of 1327 schoolchildren (79% of the target population) participated. The level of knowledge acquired immediately after training and after 3-12 months compared to baseline was significantly better (P < .001) in the intervention group than in the control group, both in early recognition and contacting of emergency services (112) and in remembering the "mouth-nose-eyes" mnemonic. CONCLUSIONS The RCParvulari® methodology significantly contributed to an improved ability to recognize a possible medical emergency, start the chain of survival by alerting an adult and call the 112 emergency number in students in the last year of preschool education.
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Affiliation(s)
- David Pedrazas-López
- Centro de Atención Primaria Sant Andreu de la Barca, Dirección de Atención Primaria Costa de Ponent, Institut Català de la Salut, Sant Andreu de la Barca, Barcelona, Spain
| | | | - Oriol Cunillera-Puértolas
- Unidad de Apoyo a la Investigación de Costa de Ponent, Fundació Institut Universitari per a la Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Cornellà de Llobregat, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Jesús Almeda-Ortega
- Unidad de Apoyo a la Investigación de Costa de Ponent, Fundació Institut Universitari per a la Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Cornellà de Llobregat, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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Ok Ahn K, McNally B, Al-Araji R, Cisneros C, Chan PS. Sex differences in the association between bystander CPR and survival for Out-of-Hospital cardiac arrest. Resuscitation 2023; 182:109603. [PMID: 36162613 DOI: 10.1016/j.resuscitation.2022.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prior studies have identified socio-cultural barriers in laypersons performing high-quality cardiopulmonary resuscitation (CPR) in women. Whether the effect of layperson bystander CPR on survival from out-of-hospital cardiac arrest (OHCA) differs by patients' sex is unknown. METHODS Using data during 2013-2020 from an OHCA registry in the U.S., we identified adult patients with non-traumatic OHCA. The primary outcome was favorable neurological survival and the secondary outcome was survival to discharge. Multivariable logistic regression models evaluated the interaction between patients' sex and bystander CPR with survival, adjusted for patient and cardiac arrest characteristics. RESULTS Of 420,671 patients with OHCA, 151,145 (35.9 %) occurred in women and 269,526 (64.1 %) in men. Rates of layperson bystander CPR were similar between women (38.3 %) and men (40.0 %). Rates of favorable neurological survival were 11.4 % in those with bystander CPR and 5.6 % in those without, but the association between bystander CPR and favorable neurological survival was weaker for women than men (women: adjusted OR, 1.33 [95 % CI: 1.27-1.39]; men: adjusted OR, 1.55 [95 % CI: 1.51-1.61]; interaction p < 0.001)]. Rates of survival to discharge were 13.1 % and 7.3 % in those with and without layperson bystander CPR, and the association between bystander CPR was weaker for women than men (women: adjusted OR, 1.21 [95 % CI: 1.16-1.26]; men: adjusted OR, 1.43 [95 % CI: 1.39-1.47]; interaction p < 0.001). CONCLUSIONS For OHCA, bystander CPR was associated with higher survival in women and men. However, as currently practiced, the association between bystander CPR and higher survival was weaker for women as compared with men.
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Affiliation(s)
- Ki Ok Ahn
- Department of Emergency Medicine, Myongji Hospital and Hanyang University College of Medicine, Goyang, South Korea
| | - Bryan McNally
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
| | | | | | - Paul S Chan
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, MO, USA.
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Jin Y, Chen H, Ge H, Li S, Zhang J, Ma Q. Urban-suburb disparities in pre-hospital emergency medical resources and response time among patients with out-of-hospital cardiac arrest: A mixed-method cross-sectional study. Front Public Health 2023; 11:1121779. [PMID: 36891343 PMCID: PMC9986292 DOI: 10.3389/fpubh.2023.1121779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Aim To investigate (1) the association between pre-hospital emergency medical resources and pre-hospital emergency medical system (EMS) response time among patients with Out-of-hospital cardiac arrest (OHCA); (2) whether the association differs between urban and suburbs. Methods Densities of ambulances and physicians were independent variables, respectively. Pre-hospital emergency medical system response time was dependent variable. Multivariate linear regression was used to investigate the roles of ambulance density and physician density in pre-hospital EMS response time. Qualitative data were collected and analyzed to explore reasons for the disparities in pre-hospital resources between urban areas and suburbs. Results Ambulance density and physician density were both negatively associated with call to ambulance dispatch time, with odds ratios (ORs) 0.98 (95% confidence interval [CI] 0.96-0.99; P = 0.001) and 0.97 (95% CI; 0.93-0.99; P < 0.001), respectively. ORs of ambulance density and physician density in association with total response time were 0.99 (95% CI: 0.97-0.99; P = 0.013) and 0.90 (95% CI: 0.86-0.99; P = 0.048). The effect of ambulance density on call to ambulance dispatch time in urban areas was 14% smaller than that in suburb areas and that on total response time in urban areas was 3% smaller than the effect in suburbs. Similar effects were identified for physician density on urban-suburb disparities in call to ambulance dispatch time and total response time. The main reasons summarized from stakeholders for a lack of physicians and ambulances in suburbs included low income, poor personal incentive mechanisms, and inequality in financial distribution of the healthcare system. Conclusion Improving pre-hospital emergency medical resources allocation can reduce system delay and narrow urban-suburb disparity in EMS response time for OHCA patients.
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Affiliation(s)
- Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China
| | - Hui Chen
- Network Management and Quality Control Department, Beijing Emergency Medical Center, Beijing, China
| | - Hongxia Ge
- Emergency Department, Peking University Third Hospital, Beijing, China
| | - Siwen Li
- Department of Global Health, School of Public Health, Peking University, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China
| | - Jinjun Zhang
- Beijing Emergency Medicine Research Institute, Beijing Emergency Medical Center, Beijing, China
| | - Qingbian Ma
- Emergency Department, Peking University Third Hospital, Beijing, China
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Wloszczynski P, Berger DA, Lee DM, Chen NW, Burla MJ. The Effect of Resuscitation Residents on the Duration of Pre-induction of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest. Cureus 2022; 14:e32050. [PMCID: PMC9710492 DOI: 10.7759/cureus.32050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
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Kerins J, Keay R, Smith SE, Tallentire VR. Assessing team behaviours and time to defibrillation during simulated cardiac arrest: a pilot study of internal medicine trainees. Simul Healthc 2022. [DOI: 10.54531/cope7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Understanding team behaviours leading to successful outcomes in resuscitation could help guide future training. Guidelines recommend defibrillation for shockable rhythm cardiac arrests within 2 minutes. This observational pilot study aimed to determine whether teamwork behaviours among medical trainees differed when time to defibrillation (TTD) was less than 2 minutes, versus 2 minutes or more.
Following ethical approval, groups of six internal medicine trainee (IMT) doctors in Scotland formed an
Twenty-three videos involving 138 trainees were scored using the TEAM tool. Scores ranged from 19–39.5/44 (mean 28.2). Mean TTD was 86.2 seconds (range 24–224), with 17/23 teams achieving defibrillation in under 2 minutes. Those achieving fast TTD achieved higher TEAM scores, and the result was statistically significant (30.1 ± 5.0 vs 22.9 ± 3.3,
This observational pilot study found that improved team performance, as measured by the TEAM tool, was associated with faster defibrillation by IMT doctors in simulated cardiac arrest. It highlighted the importance of adaptability as a team behaviour associated with successful performance, which is of interest to those involved in training high stakes emergency teams.
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Affiliation(s)
- Joanne Kerins
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Rona Keay
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Samantha E Smith
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Victoria R Tallentire
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
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Formación RCParvulari: una metodología de formación en soporte vital básico aplicado al alumnado de 5 años de educación infantil: Efectividad en un ensayo clínico aleatorizado por conglomerados. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Garcia RA, Spertus JA, Girotra S, Nallamothu BK, Kennedy KF, McNally BF, Breathett K, Del Rios M, Sasson C, Chan PS. Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest. N Engl J Med 2022; 387:1569-1578. [PMID: 36300973 PMCID: PMC9760357 DOI: 10.1056/nejmoa2200798] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Differences in the incidence of cardiopulmonary resuscitation (CPR) provided by bystanders contribute to survival disparities among persons with out-of-hospital cardiac arrest. It is critical to understand whether the incidence of bystander CPR in witnessed out-of-hospital cardiac arrests at home and in public settings differs according to the race or ethnic group of the person with cardiac arrest in order to inform interventions. METHODS Within a large U.S. registry, we identified 110,054 witnessed out-of-hospital cardiac arrests during the period from 2013 through 2019. We used a hierarchical logistic regression model to analyze the incidence of bystander CPR in Black or Hispanic persons as compared with White persons with witnessed cardiac arrests at home and in public locations. We analyzed the overall incidence as well as the incidence according to neighborhood racial or ethnic makeup and income strata. Neighborhoods were classified as predominantly White (>80% of residents), majority Black or Hispanic (>50% of residents), or integrated, and as high income (an annual median household income of >$80,000), middle income ($40,000-$80,000), or low income (<$40,000). RESULTS Overall, 35,469 of the witnessed out-of-hospital cardiac arrests (32.2%) occurred in Black or Hispanic persons. Black and Hispanic persons were less likely to receive bystander CPR at home (38.5%) than White persons (47.4%) (adjusted odds ratio, 0.74; 95% confidence interval [CI], 0.72 to 0.76) and less likely to receive bystander CPR in public locations than White persons (45.6% vs. 60.0%) (adjusted odds ratio, 0.63; 95% CI, 0.60 to 0.66). The incidence of bystander CPR among Black and Hispanic persons was less than that among White persons not only in predominantly White neighborhoods at home (adjusted odds ratio, 0.82; 95% CI, 0.74 to 0.90) and in public locations (adjusted odds ratio, 0.68; 95% CI, 0.60 to 0.75) but also in majority Black or Hispanic neighborhoods at home (adjusted odds ratio, 0.79; 95% CI, 0.75 to 0.83) and in public locations (adjusted odds ratio, 0.63; 95% CI, 0.59 to 0.68) and in integrated neighborhoods at home (adjusted odds ratio, 0.78; 95% CI, 0.74 to 0.81) and in public locations (adjusted odds ratio, 0.73; 95% CI, 0.68 to 0.77). Similarly, across all neighborhood income strata, the frequency of bystander CPR at home and in public locations was lower among Black and Hispanic persons with out-of-hospital cardiac arrest than among White persons. CONCLUSIONS In witnessed out-of-hospital cardiac arrest, Black and Hispanic persons were less likely than White persons to receive potentially lifesaving bystander CPR at home and in public locations, regardless of the racial or ethnic makeup or income level of the neighborhood where the cardiac arrest occurred. (Funded by the National Heart, Lung, and Blood Institute.).
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Affiliation(s)
- R Angel Garcia
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - John A Spertus
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Saket Girotra
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Brahmajee K Nallamothu
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Kevin F Kennedy
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Bryan F McNally
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Khadijah Breathett
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Marina Del Rios
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Comilla Sasson
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Paul S Chan
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
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Masterson S, Teljeur C, Cullinan J. Are there socioeconomic disparities in geographic accessibility to community first responders to out-of-hospital cardiac arrest in Ireland? SSM Popul Health 2022; 19:101151. [PMID: 35789763 PMCID: PMC9249950 DOI: 10.1016/j.ssmph.2022.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/08/2021] [Accepted: 06/17/2022] [Indexed: 11/26/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Without appropriate early resuscitation interventions, the prospect of survival is limited. This means that an effective community response is a critical enabler of increasing the number of people who survive. However, while OHCA incidence is higher in more deprived areas, propensity to volunteer is, in general, associated with higher socioeconomic status. In this context, we consider whether there are socioeconomic disparities in geographic accessibility to volunteer community first responders (CFRs) in Ireland, where CFR groups have developed organically and communities self-select to participate. We use geographic information systems and propensity score matching to generate a set of control areas with which to compare established CFR catchment areas. Differences between CFRs and controls in terms of the distribution of catchment deprivation and social fragmentation scores are assessed using two-sided Kolmogorov-Smirnov tests. Overall we find that while CFR schemes are centred in more deprived and socially fragmented areas, beyond a catchment of 4 min there is no evidence of differences in area-level deprivation or social fragmentation. Our findings show that self-selection as a model of CFR recruitment does not lead to more deprived areas being disadvantaged in terms of access to CFR schemes. This means that community-led health interventions can develop to the benefit of community members across the socioeconomic spectrum and may be relevant for other countries and jurisdictions looking to support similar models within communities. Out-of-hospital cardiac arrest (OHCA) is a major cause of unexpected death. OHCA is more prevalent in deprived areas and community response is key for survival. Irish community first responders (CFRs) self-select to participate in CFR schemes. We consider if there are socioeconomic disparities in geographic access to CFRs. Self-selection does not result in deprived areas having worse access to CFR schemes.
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Andréll C, Dankiewicz J, Todorova L, Olanders K, Ullén S, Friberg H. Firefighters as first-responders in out-of-hospital cardiac arrest- a retrospective study of a time-gain selective dispatch system in the Skåne Region, Sweden. Resuscitation 2022; 179:131-140. [PMID: 36028144 DOI: 10.1016/j.resuscitation.2022.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
AIM To analyze the impact of a time-gain selective, first-responder dispatch system on the presence of a shockable initial rhythm (SIR), return of spontaneous circulation (ROSC) and 30-day survival after out-of-hospital cardiac arrest (OHCA). METHOD A retrospective observational study comprising OHCA registry data and dispatch data in the Skåne Region, Sweden (2010-2018). Data were categorized according to dispatch procedures, two ambulances (AMB-only) versus two ambulances and firefighter first-responders (DUAL-dispatch), based on the dispatcher's estimation of a time-gain. Dual dispatch was sub-categorized by arrival of first vehicle (first-responder or ambulance). Logistic regressions were used, additionally with groups matched (1:1) for age, witnessed event, bystander cardiopulmonary resuscitation and ambulance response time. Adjusted and conditional odds-ratios (aOR, cOR) with 95% confidence intervals (CI) are presented. RESULTS Of 3,245 eligible cases, 43% were DUAL-dispatches with first-responders first on scene (FR-first) in 72%. Despite a five-minute median reduction in response time in the FR-first group, no association with SIR was found (aOR 0.83, 95%CI 0.64-1.07) nor improved 30-day survival (aOR 1.03, 95%CI 0.72-1.47). A positive association between ROSC and the FR-first group (aOR 1.25, 95%CI 1.02-1.54) disappeared in the matched analysis (cOR 1.12, 95%CI 0.87-1.43). Time to first monitored rhythm was 7:06 minutes in the FR-first group versus 3:01 in the combined AMB-only/AMB-first groups. CONCLUSION In this time-gain selective first-responder dispatch system, a shorter response time was not associated with increased SIR, improved ROSC rate or survival. Process measures differed between the study groups which could account for the observed findings and requires further investigation.
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Affiliation(s)
- Cecilia Andréll
- Center for Cardiac Arrest, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden. Remissgatan 4, S-22185 Lund, Sweden; Team CPR, Practicum Clinical Skills Centre, Region Skåne, Sweden. Jan Waldenströms gata 24, S-20502 Malmö, Sweden.
| | - Josef Dankiewicz
- Center for Cardiac Arrest, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden. Remissgatan 4, S-22185 Lund, Sweden; Department of Cardiology, Skåne University Hospital, Lund, Sweden. Entrégatan 7, S-221 85 Lund, Sweden
| | - Lizbet Todorova
- Medicine Services University Trust, Region Skåne, SE-221 85, Lund, Sweden
| | - Knut Olanders
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden. Entrégatan 7, S-221 85 Lund, Sweden
| | - Susann Ullén
- Clinical Studies Sweden, Skåne University Hospital, Lund, Sweden. Remissgatan 4, S-221 85 Lund, Sweden
| | - Hans Friberg
- Center for Cardiac Arrest, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden. Remissgatan 4, S-22185 Lund, Sweden; Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden. Carl-Bertil Laurells gata 9, S-205 02 Malmö, Sweden
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Hypertension and diabetes including their earlier stage are associated with increased risk of sudden cardiac arrest. Sci Rep 2022; 12:12307. [PMID: 35854061 PMCID: PMC9296606 DOI: 10.1038/s41598-022-16543-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022] Open
Abstract
Sudden cardiac arrest (SCA) is a medical disaster for both the victim and the society. Despite intrinsic limitations in the management of SCA, primary prevention has been overlooked and risk factors for SCA are not fully understood. We aimed to evaluate whether hypertension and diabetes mellitus (DM), including pre-hypertension and impaired fasting glucose (IFG), are associated with increased risk of SCA. We performed a nationwide population-based analysis using the Korean National Health Insurance Service. People who underwent a national health check-up in 2009 were enrolled. The risk of SCA was evaluated in people with hypertension and DM with a clinical follow-up through December 2018. A total of 4,056,423 people with 33,345,378 person-years of follow-up and 16,352 SCA events were examined. People with hypertension had 65.4% increased risk of SCA (adjusted hazard ratio [HR] = 1.654 [1.572–1.739]; p < 0.001). Pre-hypertension was also associated with 21.3% increased risk of SCA (adjusted HR = 1.213 [1.158–1.272]; p < 0.001). People who had IFG and DM showed 7.5% (adjusted HR = 1.075 [1.035–1.117]; p < 0.001) and 80.1% (adjusted HR = 1.801 [1.731–1.875]; p < 0.001) increased risk of SCA, respectively. People with DM who took anti-diabetic medication showed significantly lower risk of SCA compared with uncontrolled DM patients (fasting glucose ≥ 200 mg/dL) (adjusted HR = 0.625 [0.533–0.733]; p < 0.001). Coexistence of hypertension and DM was associated with an even higher risk of SCA (adjusted HR = 3.078 [2.877–3.293]; p < 0.001). In conclusion, the risk of SCA is significantly higher in people with hypertension and DM, including pre-hypertension and IFG. Adequate control of blood pressure and serum glucose can have a profound impact for the primary prevention of SCA in the general population.
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Silverplats J, Strömsöe A, Äng B, Södersved Källestedt ML. Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors—A survey among in-hospital healthcare professionals. PLoS One 2022; 17:e0271686. [PMID: 35839233 PMCID: PMC9286263 DOI: 10.1371/journal.pone.0271686] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Attitudes towards cardiopulmonary resuscitation (CPR) among in-hospital healthcare professionals (HCPs) are poorly understood. The aim of this study was to evaluate attitudes towards CPR situations among in-hospital HCPs and assess associations with potential influencing factors. Materials and methods A questionnaire was distributed to 3,085 HCPs in 2009 and 2,970 HCPs in 2015–2016. The associations of influencing factors were analyzed using binary logistic regression. Results In the event of a possible cardiac arrest situation, 61% of the HCPs would feel confident in their CPR knowledge, 86% would know what to do, and 60% would be able to take command if necessary. In the latest real-life CPR situation, 30% had been worried about making mistakes or causing complications, 57% had been stressed, and 27% had been anxious. A short time since the latest real-life CPR performance and a high number of previous real-life CPR performances were associated with lower odds of worrying about making mistakes/causing complications, lower odds of feeling stressed or anxious, and higher odds of feeling calm. Regardless of previous real-life CPR experience, there were differences in attitudes between groups of professions, where physicians showed increased odds of worrying about making mistakes/causing complications and nurses showed increased odds of stress. Working on a non-monitored ward meant increased odds of stress and worrying about making mistakes/causing complications. Twelve months or more having passed since the latest CPR training course was associated with increased odds of anxiety. Conclusions Despite HCPs’ generally positive attitudes towards performing CPR in the event of a possible cardiac arrest situation, feelings of stress and anxiety were common in real-life CPR situations. Regular CPR training among all HCPs is a key factor to maintain competence and reduce anxiety. The possible effects of attitudes on performing CPR need to be studied further.
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Affiliation(s)
- Jennie Silverplats
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Anaesthesiology and Intensive Care, Region Dalarna, Mora Hospital, Mora, Sweden
- * E-mail:
| | - Anneli Strömsöe
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Department of Prehospital Care, Region Dalarna, Falun, Sweden
| | - Björn Äng
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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