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Nacer DT, de Sousa RMC, Miranda AL. Outcomes after Clinical and Traumatic Out-of-Hospital Cardiac Arrest. Arq Bras Cardiol 2023; 120:e20220551. [PMID: 37493651 PMCID: PMC10374265 DOI: 10.36660/abc.20220551] [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: 08/29/2022] [Revised: 02/27/2023] [Accepted: 04/05/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Data on out-of-hospital cardiac arrest are still scarce, very varied, and indicate a poor prognosis for traumatic events. OBJECTIVES To describe the out-of-hospital/in-hospital survival, survival time, and neurological conditions of those treated by advanced life support units and submitted to cardiopulmonary resuscitation and compare the results of clinical and traumatic cardiac arrests. METHODS This is a cohort study carried out in three stages; in the first two, data were collected from the Mobile Emergency Care Service forms and medical records; then, the Brain Performance Category Scale was applied in the third stage. The sample consisted of resuscitated victims aged ≥18 years. Fisher's and log-rank tests were used to compare the causes, considering a significance level of 5%. RESULTS 852 patients were analyzed; 20.66% were hospitalized, 4.23% survived until transfer or discharge, and 58.33% had a favorable outcome one year after arrest. There was an association between pre/in-hospital survival and the nature of the occurrence (p=0.026), but there was no difference between the survival curves (p=0.6). CONCLUSIONS Survival of hospitalization after out-of-hospital cardiac arrest was low; however, most who survived to be discharged achieved a favorable outcome after one year. The survival time of those hospitalized after clinical and traumatic events were similar, but pre-hospital survival was higher among trauma patients.
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Affiliation(s)
- Daiana Terra Nacer
- Universidade de São PauloEscola de EnfermagemSão PauloSPBrasilUniversidade de São Paulo – Escola de Enfermagem, São Paulo, SP – Brasil
| | - Regina Márcia Cardoso de Sousa
- Universidade de São PauloEscola de EnfermagemSão PauloSPBrasilUniversidade de São Paulo – Escola de Enfermagem, São Paulo, SP – Brasil
| | - Anna Leticia Miranda
- Universidade Federal de Minas GeraisFaculdade de MedicinaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Faculdade de Medicina – Campus Saúde, Belo Horizonte, MG – Brasil
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Randjelovic SS, Nikolovski SS, Tijanic JZ, Obradovic IA, Fiser ZZ, Lazic AD, Raffay VI. Out-of-Hospital Cardiac Arrest Prospective Epidemiology Monitoring during the First Five Years of EuReCa Program Implementation in Serbia. Prehosp Disaster Med 2023; 38:1-8. [PMID: 36600667 PMCID: PMC9885433 DOI: 10.1017/s1049023x22002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/10/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Poor outcome is still a challenging concern in patients with out-of-hospital cardiac arrest (OHCA) world-wide and there are large differences between European countries regarding not only incidence rates, but survival rates as well. In 2014, Serbian Resuscitation Council initiated regular data collection on epidemiology of OHCA, according to the European Registry of Cardiac Arrest (EuReCa) study protocol. STUDY OBJECTIVE The aim of this study is to analyze the results of the first five-year period after initiation of EuReCa study protocol elements implementation in OHCA epidemiological data collection in Serbia. METHODS The observed period in this study is about the data on OHCA, collected within the observed area of 16 municipalities covering 1,604,015 citizens, during the period from October 1, 2014 - December 31, 2019. The study included data on all-cause OHCA in both adult and pediatric patients, according to the EuReCa One study protocol, of which all segments were observed. RESULTS Within the study period, 5,196 OHCA patients were observed with annual incidence of 83.60/100,000. Of all registered events, 43.9% were witnessed. The most common collapse location was patient's residence (88.7%). Within the group of initiated cardiopulmonary resuscitation (CPR), cardiac etiology was observed in 80.5% of cases and shockable rhythm in 21.7%. Return of spontaneous circulation (ROSC) prior to hospital admission was significantly more frequently achieved and maintained on admission in witnessed cases, cases occurring out of patient's residence, and in cases with shockable initial rhythm (P <.01). CONCLUSION The OHCA incidence in Serbia is comparable with the incidence in the majority of European countries, and survival rates are now significantly higher in Utstein events compared to previous results from Serbia. Enrolment of witnessing bystanders in initiating CPR measures remains a concern requiring effort towards understanding of CPR initiation importance and education of general population in administering CPR measures.
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Affiliation(s)
| | - Srdjan S. Nikolovski
- University of Belgrade Faculty of Medicine, Belgrade, Serbia; Serbian Resuscitation Council, Novi Sad, Serbia
| | | | - Ivana A. Obradovic
- Department of Anesthesia, Hospital “Sveti Vracevi,”Bijeljina, Bosnia and Herzegovina
| | - Zoran Z. Fiser
- Municipal Institute of Emergency Medicine, Novi Sad, Serbia
| | - Aleksandra D. Lazic
- Serbian Resuscitation Council, Novi Sad, Serbia; Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Violetta I. Raffay
- European University Cyprus, School of Medicine, Department of Medicine, Nicosia, Cyprus
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Scquizzato T, Gamberini L, D'Arrigo S, Galazzi A, Babini G, Losiggio R, Imbriaco G, Fumagalli F, Cucino A, Landoni G, Scapigliati A, Ristagno G, Semeraro F, Bertoncello F, Canalini A, Colelli S, Conti G, Giacometti M, Giuliani G, Graziano A, Mina A, Orazio S, Paoli A, Peratoner A, Pegani C, Roncarati A, Sabetta C, Savastano S, Stella F, Varutti R, Verginella F, Zuliani M. Incidence, characteristics, and outcome of out-of-hospital cardiac arrest in Italy: A systematic review and meta-analysis. Resusc Plus 2022; 12:100329. [DOI: 10.1016/j.resplu.2022.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
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Yu YC, Hsu CW, Hsu SC, Chang JL, Hsu YP, Lin SM, Liu YK. The factor influencing the rate of ROSC for nontraumatic OHCA in New Taipei city. Medicine (Baltimore) 2021; 100:e28346. [PMID: 34967366 PMCID: PMC8718237 DOI: 10.1097/md.0000000000028346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Return of spontaneous circulation (ROSC) from out-of-hospital cardiac arrest (OHCA) is critical for the Emergency Medical Services System. When compared to other developed countries, Taiwan has lower rate of ROSC in OHCA patients.We conducted a retrospective study of cardiac arrest using The Emergency Medical Service Dispatching Center in Northern Taiwan and The Prehospital Care System of New Taipei City Paramedic Service. Patients suffering from nontraumatic OHCA between August of 2019 to February of 2020 were included. We analyzed the cardiopulmonary resuscitation (CPR) quality parameters such as chest compression interruptions, bystander CPR, shockable rhythm, CPR interruption, chest compression fraction (CCF) average, patient transportation in buildings, and adrenaline injection during CPR. Multivariable logistic regression analysis was performed to assess the relationship between potential independent variables and ROSC.In our study, we involved 1265 subjects suffering from nontraumatic OHCA, among which 587 patients met inclusion criteria. We identified that CCF> 0.8, chest compression interruption greater than 3 times, and patient transportation in the building were the most critical factors influencing ROSC. However, patient transportation in a building was identified as a dependent predictor variable (P = .4752).We concluded that CCF > 0.8 and chest compression interruption greater than 3 times were essential factors affecting the CPR ROSC rate. The most significant reason for suboptimal CCF and CPR interruption is patient transportation in a building. Improving the latter point could facilitate high-quality CPR.
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Affiliation(s)
- Yi-Chung Yu
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Emergency Department, Camillian Saint Mary's Hospital Luodong, Yi-Lan, Taiwan
| | - Chin-Wang Hsu
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Chang Hsu
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jin-Lin Chang
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Pin Hsu
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Min Lin
- Fire Department, New Taipei City Government, New Taipei City, Taiwan
| | - Ying-Kuo Liu
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Abstract
In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in and out of hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to inform health system planning and responses to cardiac arrest.
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Effects of a Clinical Simulation Course about Basic Life Support on Undergraduate Nursing Students' Learning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041409. [PMID: 33546328 PMCID: PMC7913518 DOI: 10.3390/ijerph18041409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 12/23/2022]
Abstract
Training in basic life support (BLS) using clinical simulation improves compression rates and the development of cardiopulmonary resuscitation (CPR) skills. This study analyzed the learning outcomes of undergraduate nursing students taking a BLS clinical simulation course. A total of 479 nursing students participated. A pre-test and post-test were carried out to evaluate theoretical knowledge of BLS through questions about anatomical physiology, cardiac arrest, the chain of survival, and CPR. A checklist was used in the simulation to evaluate practical skills of basic CPR. The learning outcomes showed statistically significant differences in the total score of the pre-test and after completing the BLS clinical simulation course (pre-test: 12.61 (2.30), post-test: 15.60 (2.06), p < 0.001). A significant increase in the mean scores was observed after completing the course in each of the four parts of the assessment protocol (p < 0.001). The increase in scores in the cardiac arrest and CPR sections were relevant (Rosenthal’s r: −0.72). The students who had prior knowledge of BLS scored higher on both the pre-test and the post-test. The BLS simulation course was an effective method of teaching and learning BLS skills.
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Abstract
Non-randomised study designs are frequently used by researchers in cardiovascular nursing and allied professions. Baseline differences between the groups to be compared may introduce bias in the results. Methods for causal inference address this issue. One such method is propensity weighting, in which two or more treatments/exposure groups are weighted to make the groups as comparable as possible. As such, it mimics a randomised controlled trial design. In this article, the Twang package is presented for propensity weighting, and its use is exemplified in a study on smoking and cannabis consumption in adults with congenital heart disease.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, South Africa
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Campagna S, Conti A, Dimonte V, Dalmasso M, Starnini M, Gianino MM, Borraccino A. Trends and Characteristics of Emergency Medical Services in Italy: A 5-Years Population-Based Registry Analysis. Healthcare (Basel) 2020; 8:healthcare8040551. [PMID: 33322302 PMCID: PMC7763006 DOI: 10.3390/healthcare8040551] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Emergency Medical Services (EMS) plays a fundamental role in providing good quality healthcare services to citizens, as they are the first responders in distressing situations. Few studies have used available EMS data to investigate EMS call characteristics and subsequent responses. Methods: Data were extracted from the emergency registry for the period 2013–2017. This included call and rescue vehicle dispatch information. All relationships in analyses and differences in events proportion between 2013 and 2017 were tested against the Pearson’s Chi-Square with a 99% level of confidence. Results: Among the 2,120,838 emergency calls, operators dispatched at least one rescue vehicle for 1,494,855. There was an estimated overall incidence of 96 emergency calls and 75 rescue vehicles dispatched per 1000 inhabitants per year. Most calls were made by private citizens, during the daytime, and were made from home (63.8%); 31% of rescue vehicle dispatches were advanced emergency medical vehicles. The highest number of rescue vehicle dispatches ended at the emergency department (74.7%). Conclusions: Our data showed that, with some exception due to environmental differences, the highest proportion of incoming emergency calls is not acute or urgent and could be more effectively managed in other settings than in an Emergency Departments (ED). Better management of dispatch can reduce crowding and save hospital emergency departments time, personnel, and health system costs.
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Affiliation(s)
- Sara Campagna
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
| | - Alessio Conti
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
| | - Valerio Dimonte
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
| | - Marco Dalmasso
- Epidemiology Unit, Local Health Unit TO3, Piedmont Region, 10195 Grugliasco, Italy;
| | - Michele Starnini
- Institute of Scientific Interchange (ISI) Foundation, 10126 Torino, Italy;
| | - Maria Michela Gianino
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
- Correspondence:
| | - Alberto Borraccino
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
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Czapla M, Zielińska M, Kubica-Cielińska A, Diakowska D, Quinn T, Karniej P. Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study. BMC Cardiovasc Disord 2020; 20:288. [PMID: 32532201 PMCID: PMC7291476 DOI: 10.1186/s12872-020-01571-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a common reason for calls for intervention by emergency medical teams (EMTs) in Poland. Regardless of the mechanism, OHCA is a state in which the chance of survival is dependent on rapid action from bystanders and responding health professionals in emergency medical services (EMS). We aimed to identify factors associated with return of spontaneous circulation (ROSC). Methods The medical records of 2137 EMS responses to OHCA in the city of Wroclaw, Poland between July 2017 and June 2018 were analyzed. Results The OHCA incidence rate for the year studied was 102 cases per 100,000 inhabitants. EMS were called to 2317 OHCA events of which 1167 (50.4%) did not have resuscitation attempted on EMS arrival. The difference between the number of successful and failed cardiopulmonary resuscitations (CPRs) was statistically significant (p < 0.001). Of 1150 patients in whom resuscitation was attempted, ROSC was achieved in 250 (27.8%). Rate of ROSC was significantly higher when CPR was initiated by bystanders (p < 0.001). Patients presenting with asystole or pulseless electrical activity (PEA) had a higher risk of CPR failure (86%) than those with ventricular fibrillation/ventricular tachycardia (VF/VT). Patients with VF/VT had a higher chance of ROSC (OR 2.68, 1.86–3.85) than those with asystole (p < 0.001). The chance of ROSC was 1.78 times higher when the event occurred in a public place (p < 0.001). Conclusions The factors associated with ROSC were occurrence in a public place, CPR initiation by witnesses, and presence of a shockable rhythm. Gender, age, and the type of EMT did not influence ROSC. Low bystander CPR rates reinforce the need for further efforts to train the public in CPR.
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Affiliation(s)
- Michał Czapla
- Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Marzena Zielińska
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland.
| | - Anna Kubica-Cielińska
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Diakowska
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Tom Quinn
- Faculty of Health, Social Care and Education Kingston University and St George's, University of London, London, UK
| | - Piotr Karniej
- Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Yi JH, Kim KH, Ahn JS, Kim HS. A simple method for removing initial irregularity of an electrocardiogram during a transient state of a power supply in a defibrillator. Technol Health Care 2020; 28:327-334. [PMID: 32364165 PMCID: PMC7369074 DOI: 10.3233/thc-209033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND: The defibrillator is a device that instantaneously discharges the high energy stored in the capacitor to the human body to help revitalize the heart. The circuit for charging the capacitor uses the same power source as the biosignal measurement unit. Therefore, variation in main power supply voltage, ground noise, and electromagnetic interference from the charging circuit can induce distortion into the biosignal at the initial stage of charging. OBJECTIVE: In this study, a simple method is proposed for removing the initial irregularity of an electrocardiogram due to the transient state of a power supply. METHODS: To evaluate the method, a 1-channel electrocardiogram measurement unit and peripheral units were separated from the main control module using galvanic isolation. An isolated push-pull converter was designed to power the secondary side. The method was tested under steady-state and transient conditions. RESULTS: The obtained results proved that biosignal distortion can be significantly reduced. CONCLUSION: This method could be another simple implementation approach for solving signal distortions due to the transient status of power supplies used in medical devices.
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Affiliation(s)
| | | | | | - Hyung-Sik Kim
- Corresponding author: Hyung Sik Kim, Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Science and Technology, Konkuk University, 268 Chungwon-daero, Chungju-si, Chungbuk-do, 27478, Korea. Tel.: +82 10 3309 3302; E-mail:
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