Evaluation of the willingness to perform cardiopulmonary resuscitation (CPR) with automated external defibrillator (AED) among Hong Kong Chinese using the theory of planned behaviour framework: an online cross-sectional survey

Introduction

Bystander cardiopulmonary resuscitation (CPR) and defibrillation by an automated external defibrillator (AED) in out-of-hospital cardiac arrest (OHCA) events were low in Hong Kong (HK). This study evaluated the willingness and associated factors of performing CPR with AED in HK using the theory of planned behaviour (TPB).

Methods

A total of 1449 responses from HK Chinese aged 15-64 years were collected in a cross-sectional online survey using convenience sampling on social media including Facebook, Instagram and WhatsApp. Three TPB determinants, namely attitude, subjective norm and perceived behavioural control; and perceived barriers were asked using 5-point Likert scales. Associations between each predictor and willingness to perform CPR with AED were evaluated using univariate ordinal regressions. Predictive models were constructed using hierarchical multiple ordinal regressions (MOR) to explore associated predictors and the adjusted OR (ORadj).

Results

There were 44.8% and 47.8% of respondents who were willing to perform CPR and use AED, respectively. Young adults aged 18-25 years demonstrated the lowest willingness to perform CPR (ORadj=0.63, 95% CI 0.42 to 0.94, p=0.023). Knowledge level was not associated with either CPR or AED willingness, thus was eliminated in backward selection in the MOR. Attitude, subjective norm and perceived behavioural control were all positively associated with both willingness (all ORadj>1.5, p<0.001), while perceived barriers were associated with CPR willingness only (ORadj=0.77, 95% CI 0.66 to 0.91, p=0.002).

Conclusions

Utilisation of the TPB framework in CPR and AED community education would fill the 'know-do' gap and enhance the community's willingness to perform CPR and use an AED.

Good Samaritan Law and bystander cardiopulmonary resuscitation: Cross-sectional study of 1223 first-aid learners in Hong Kong

Background:

Similar to many Asian cities, there is no statutory provision for the determination of the duty borne by bystander first aiders when assisting victims in Hong Kong.

Objectives:

The aim of this study was to explore the views of a Good Samaritan Law by first-aid learners in Hong Kong.

Methods:

A cross-sectional survey was conducted among first-aid course participants from the two largest training providers in Hong Kong using a self-administered questionnaire.

Results:

In total, 1223 questionnaires were completed and returned. Only 12.1% (147/1211) of participants have ever heard of Good Samaritan Law. After a short description of Good Samaritan Law was provided, 71.4% (848/1188) agreed or strongly agreed on a Likert-type scale that a Good Samaritan Law is necessary; 95.2% (1148/1223) support the enactment of a Good Samaritan Law in Hong Kong.

Conclusion:

The majority of first-aid learners in Hong Kong supported the enactment of Good Samaritan Law. Overcoming the fear of litigation and improving bystander cardiopulmonary resuscitation rate is a priority for improving survival rates from sudden cardiac arrest in Hong Kong.

Role of Sodium Bicarbonate in Resuscitation of out-of-Hospital Cardiac Arrest

Objective

To report the use of sodium bicarbonate (SB) in out-of-hospital cardiac arrest (OHCA) and to explore the role of sodium bicarbonate in resuscitation of OHCA in terms of restoration of spontaneous circulation (ROSC) and survival, and existence of dose-dependent relationship, especially in those with prolonged arrest.

Design

Retrospective cohort study.

Setting

Emergency department of two regional hospitals in a cluster of Hong Kong.

Methods

Adult patients aged at least 18 years old who presented to the study centres with non-traumatic OHCA in the period between March 2013 and December 2013 were included. Cases in which resuscitations were considered medically futile or not actually performed were excluded. Those with do-not-resuscitate (DNR) order or advance directives, those who were death before arrival with postmortem changes, and those who developed ROSC before or within 15 minutes of arrival were excluded from the study. Patients with known poisoning from tricyclic antidepressant or other sodium channel blockers were excluded from analysis if any. The primary outcome of this study was ROSC. Other outcome variables included survival to hospital admission (STA) and survival to hospital discharge (STD).

Results

A total of 489 patients were included during the study period for analysis. We found that patients who received sodium bicarbonate injection (SB group) during CPR had a higher percentage of ROSC than those who did not (no-SB group) (60.8% vs 22.5%; p<0.001). The survival-to-admission rate was higher in the SB group (56.8%) compared with the contrary (21.4%). The difference of survival-to-discharge between the two groups did not reach statistical significance (4.1% in SB group and 2.9% in the no-SB group; p=0.484). The rate of ROSC was found to be dose dependent, being higher in higher dose of SB administration. The ROSC rate increased from no-SB (22.4%) to 57.1% if given 50 ml SB, and further to 64.1% if given ≥100 ml SB.

Conclusions

Our study shows that the use of sodium bicarbonate in the CPR of OHCA is beneficial in ROSC. The effect is dose dependent, with better results in higher dose (>100 ml) of sodium bicarbonate; however, we fail to demonstrate its benefit for prolonged CPR cases (>30 minutes). (Hong Kong j.emerg. med. 2015;22:281-290)

Comparison of Clinical Prediction Rules for Termination of Resuscitation of Out-of-Hospital Cardiac Arrests on Arrival to Emergency Department

Objective

To compare the discriminative capacities of various termination of resuscitation (TOR) rules in the prediction of futile resuscitation in the emergency department (ED).

Design

Prospective cohort study.

Setting

2 public hospitals in a cluster in Hong Kong.

Methods

The data were obtained from a Cardiac Arrest Registry of the EDs of two hospitals, including consecutive adult patients suffering from non-traumatic out-of-hospital cardiac arrest from 1st August 2010 to 30th June 2012. Those with return of spontaneous circulation before ED arrival and cases without resuscitation in the EDs were excluded. The modified basic life support (BLS), modified advanced life support (ALS) and neurologic TOR rules were applied to the cohort. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated. The outcome measures were survival to hospital admission (STA) and survival to discharge (STD).

Results

Totally 1125 cases were included. The mean age was 72.4. Return of spontaneous circulation and STA occurred in 302 patients and 9 had STD. Regarding the outcome of STD, the modified ALS and neurologic TOR rules had outperformed the modified BLS rule. The specificity and PPV were 100% for both rules in predicting death when the rules suggested TOR. Regarding the outcome of STA, the neurologic TOR rule had the highest specificity [84.4%; 95% confident interval (CI): 79.7-88.2%] and PPV (84.5%; 95% CI: 79.8-88.3%).

Conclusions

The modified ALS and neurologic TOR rules have similar discriminative capacities to predict STD. The neurologic TOR rule has the highest ability to predict STA in the ED. (Hong Kong j.emerg.med. 2013;20:343-351)

Outcome and Prognostic Factors of Patients in Out-Of-Hospital Cardiac Arrests Presenting with Non-Shockable Rhythm in Hong Kong

Objective

To obtain the recent local epidemiological data and evaluate factors associated with outcomes of adult patients in non-traumatic non-shockable out-of-hospital-cardiac-arrest (OHCA) in Hong Kong.

Methods

It was a cross-sectional study lasting for nine months (from July 2009 to March 2010) in two emergency departments (ED) which served a population of 1.1 million. All non-traumatic OHCA patients aged equal or greater than 18 years presented with non-shockable cardiac rhythms to ED without postmortem changes were included. The pre-hospital factors, managements and outcomes were recorded in a standardised data entry form at the time of patient consultation. Logistic regression was used to evaluate the relationship between survival to admission (STA) and various prognostic factors.

Results

A total of 348 patients fulfilled the inclusion criteria. The mean age was 75.9 years old. Overall, there were 61 patients (17.5%) with restoration of spontaneous circulation and 58 patients (16.7%) had STA. The survival to hospital discharge (STD) rate was 0.86% (3 patients). Factors independently associated with better prognosis in terms of STA were initial pulseless electrical activity arrest (PEA) rhythm in ED (OR=4.72, 95% CI 2.30-9.69), witnessed arrest (OR=8.00, 95% CI 3.38-18.96) and non-cardiac cause of arrest (OR=2.17, 95% CI 1.00-4.67).

Conclusion

STA for adults presenting with non-traumatic non-shockable OHCA in our centre is 16.7%. Witnessed non-shockable OHCA patients presenting with initial PEA arrest rhythm and with a presumed non-cardiac in etiology are significantly associated with higher STA rate.

A Six-Year Prospective Study of Out-of-Hospital Cardiac Arrest Managed by a Voluntary Ambulance Organisation

Objective

To obtain a database on the epidemiology of prehospital cardiac arrest and its management by a voluntary ambulance service, with the view for developing future strategies and service improvement.

Design

A 6-year prospective study from December 1998 to November 2004, using the Utstein-style template.

Setting

A voluntary ambulance service in Hong Kong.

Subjects and methods

Ambulance members had to complete and submit a specially designed data form after managing a cardiac arrest case, together with the ambulance run record and the automated external defibrillator (AED) computer printout, if appropriate.

Main outcome measures

Survival to hospital discharge and return of spontaneous circulation after resuscitation.

Results

A total of 72 cardiac arrests occurred during the period, with patients' age ranging from 29 to 106 years (mean 73.4). Most cardiac arrests occurred at home (46 or 63.9%). There were 58 witnessed cardiac arrests (80.5%), but bystander cardiopulmonary resuscitation (CPR) was started in only nine cases (15.5%) before the arrival of the ambulance crew. Six patients had evidence of rigor mortis or dependent lividity on ambulance arrival. For the 61 patients with electrocardiogram strips, the initial presenting rhythm on the AED was asystole in 45 (73.8%), pulseless electrical activity in 5 (8.2%), and ventricular fibrillation (VF) in 11 (18.0%). The median call-to-arrival time for VF cases (4.0 minutes) was significantly shorter than that of non-VF rhythms (8.5 minutes) [Mann-Whitney U test p=0.008]. Five patients had return of spontaneous circulation after resuscitation, but only one survived to hospital discharge.

Conclusions

Bystander CPR and ambulance response time are two areas requiring urgent improvement in our locality. As the majority of cardiac arrests occurred at home, the cost-effectiveness of public access defibrillation for Hong Kong is unclear. However, strategic placement of AED at high incidence' locations should be seriously considered.

Outcome Predictors of Patients in Out-Of-Hospital Cardiac Arrests with Pre-Hospital Defibrillation in Hong Kong

Objective

To report the epidemiology, outcomes and the predictors of survival in patients with out-of-hospital cardiac arrest (OHCA) with pre-hospital shockable cardiac rhythms in Hong Kong.

Methods

It was a prospective study based on data from the cardiac arrest registry of emergency departments (ED) in two regional hospitals in Hong Kong from 1st August 2010 to 31st January 2012. All non-traumatic patients aged 18 years or above presented with OHCA with shockable pre-hospital cardiac rhythm and received pre-hospital defibrillation were included. The characteristics of patients, pre-hospital data, management and outcomes were recorded in a standardised form compatible with Utstein template at the time of patient consultation. Binominal logistic regression was applied to evaluate the relationship between survival to admission (STA) and patients' variables.

Results

A total of 135 patients fulfilled the inclusion criteria. The mean age was 67.0 years old. The STA rate was 34.8% and the survival to discharge (STD) rate was 6.7%. Factors independently associated with better prognosis in terms of STA were presence of bystander cardiopulmonary resuscitation (CPR) (OR 5.76, 95% CI=1.08-30.5), restoration of spontaneous circulation (ROSC) before arrival to ED (OR 43.94, 95% CI= 4.19-460.43) and short time from calling emergency medical services (EMS) to first defibrillation (OR 0.82, 95% CI=0.70-0.96).

Conclusion

STA rate for adults presenting with shockable OHCA in our study was 34.8%. Patients with shockable OHCA with bystander CPR, short call-to-shock time and achieved ROSC before arrival to ED are significantly associated with higher STA rate.

A Prospective Investigation into the Epidemiology of In-Hospital Cardiopulmonary Resuscitation Using the International Utstein Reporting Style

Introduction

The Utstein template has been used to guide the assessment and study of cardiopulmonary resuscitation (CPR) in many countries. This article used the Utstein templates for cardiac arrest and resuscitation registries to evaluate outcomes of CPR at Hainan Provincial People's Hospital (HPPH), China.

Methods

A prospective observational study using Utstein CPR registry form to evaluate the epidemiological characteristics and outcomes of 511 resuscitation cases in the emergency department, HPPH.

Results

A total of 511 CPR patients registered were studied. Higher cardiac arrest rates were observed for the group of patients who were 40-70 years old. In preexisting chronic diseases, cardiovascular diseases (190, 37.2%) cerebrovascular diseases (48, 9.4%) and respiratory diseases (39, 7.6%) were common in the recruited patients. (173, 33.9%) of the cardiac arrest patients had underlying cardiac causes, of which 109 (21.3%) had acute myocardial infarct (AMI). Eighty (15.7%) patients had ventricular fibrillation as the first witnessed arrest rhythm. The return of spontaneous circulation (ROSC) and survival to discharge rates were 47.0% and 13.5% in the in-hospital cardiac arrest (IHCA) group but 16.7% and 4.7% in out-of-hospital cardiac arrest (OHCA) group (p<0.01) respectively.

Conclusions

This study indicated that the cardiovascular diseases, cerebrovascular diseases, and respiratory diseases were the most common preexisting chronic diseases. Myocardial infarct, stroke and trauma were the most common precipitation cause of cardiac arrest in the recruited patients. The rate of ROSC and survival to discharge for the patients with IHCA were higher than the ones with OHCA, but figures were still low. (Hong Kong j.emerg.med. 2011;18:391-396)

Outcomes of Cardiac Arrest in Residential Care Homes for the Elderly in Hong Kong

OBJECTIVE

Studies done in the 1990's suggested nursing home residents with cardiac arrest had minimal chance of survival and resuscitation was not recommended. More recent studies showed opposing results. In Hong Kong, the proportion of elderly living in the residential care homes for the elderly is increasing. There is no study of out-of-hospital cardiac arrest outcomes in this population. This study aimed at evaluating the prognosis of out-of-hospital cardiac arrest occurring in the residential care homes for the elderly. It is hoped that the findings may inform the local emergency medical service concerning the issue of futility of resuscitating the residents with cardiac arrest in the residential care homes.

METHODS

This study was a retrospective analysis of a database of all patients aged 65 years or above with atraumatic out-of-hospital cardiac arrest and who were attended by the emergency medical service in a 12-month period. Data in the database were prospectively collected by the emergency medical service. The characteristics of patients and cardiac arrests, timeliness of the emergency medical service, and survival were analyzed. Comparison was made between elderly living in and not living in the residential care homes. Predictors of survival were evaluated with logistic regression.

RESULTS

3919 patients aged ≥ 65 years were analyzed. There were 1506 cases of cardiac arrest occurring in the residential care homes for the elderly. Resuscitation was discontinued at the emergency department in over 70% of these cases. The survival to hospital admission rate and the 30-day survival rate were 9.6% and 0.3% respectively. Both were lower than patients not residing in the residential care homes. Younger age, witnessed arrest, bystander defibrillation, and shorter call to ED interval were associated with higher chance of surviving to hospital admission.

CONCLUSION

Elderly suffering from cardiac arrest in residential care homes had a poor chance of survival. Except age, witnessed arrest, bystander defibrillation, and call to ED interval are modifiable predictors of survival. It is inappropriate to declare that resuscitating elderly in residential care homes is futile unless those factors have been fully addressed.

Recognition and Treatment of Out-of-Hospital Cardiac Arrests by Non-Emergency Ambulance Services in Singapore

Introduction: Prompt recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) and defibrillation is necessary for good outcomes from out-of-hospital cardiac arrest (OHCA). This study aims to describe the recognition and treatment of OHCA in patients conveyed by non-emergency ambulance services (EAS) in Singapore. Materials and Methods: This is a multi-centre, retrospective chart review, of cases presenting to public emergency departments (EDs), conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. The study was from October 2002 to August 2009. The following variables were examined: ability to recognise cardiac arrest, whether CPR was carried out by the ambulance crew and whether an automated external defibrillator (AED) was applied. Results: Eighty-six patients were conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. Mean age was 63 years (SD 21.8), 70.9% were males. A total of 53.5% of arrests occurred in the ambulance while 70.9% were found to be asystolic upon ED arrival. Seven patients had a known terminal illness. Survival to discharge was 3.5%. Cardiac arrest went unrecognised by the ambulance crew in 38 patients (44.2%). CPR was performed in 35 patients (40.7%) of the 86 patients and AED was applied in only 10 patients (11.6%). Conclusion: We found inadequate recognition and delayed initiation of treatment for OHCA. Possible reasons include a lack of training in patient monitoring and detection of cardiac arrest, lack of CPR training, lack of confidence in performing CPR, lack of AEDs on ambulances and lack of training in their use. Key words: Automated external defibrillator (AED), Cardiopulmonary resuscitation (CPR), Emergency medical services, Prehospital

On the Use of Home Node Bs for Emergency Telemedicine Applications in Various Indoor Environments

The use of emergency telemedicine applications at the site of a medical emergency event provides a multitude of benefits, both from the perspective of the patient and the emergency care providers. Innovations in rich multimedia telemedicine solutions further enhances the aforementioned benefits, but places more stringent quality-of-service demands on the underlying mobile networks. In this paper, the authors present a proposal for a complementary solution for rapid provisioning of mobile broadband data connectivity for emergency telemedicine applications in indoor environments. The proposed solution relies on the exploitation of existing femtocellular network resources available at emergency sites in various residential building types. Simulations carried out for a UMTS network environment demonstrate significant improvements in terms of achievable throughput for the emergency mobile terminal device when access to UMTS Home Node Bs available in the building is allowed for emergencies compared to macro Node B access only.