Elderly out-of-hospital cardiac arrest has worse outcomes with a family bystander than a non-family bystander

Analysis of Out-of-Hospital First Aid for Recovery of Spontaneous Circulation after Cardiac Arrest in Korea

The characteristics of an individual patient experiencing out-of-hospital cardiac arrest who recovered spontaneous circulation with the assistance of witnesses and paramedics were examined. The analysis of bystander cardiopulmonary resuscitation (CPR) and the professional first aid efforts of paramedics in the pre-hospital environment is pivotal to enhancing the survival rate of out-of-hospital cardiac arrest patients. The data used in this study were extracted from the Korea Centers for Disease Control and Prevention (KCDC) nationally recognized statistics, Acute Heart Failure big data survey. Out-of-hospital cardiac arrest (OHCA) customer data were collected from the Gangwon Fire Headquarters public information database as social management data. The data were analyzed using SPSS 24. The study's results emphasized the significance of offering basic CPR training to the public. This is evident from the fact that 90.5% of the first witnesses in the study performed CPR on OHCA patients, resulting in the recovery of spontaneous circulation (ROSC). The majority of patients with ROSC were male, with the highest age group being 41-50 years. Heart disease, hypertension, and diabetes were common medical conditions. The rate of witnessing cardiac arrest was high. Among the first witnesses, about 78.4% were of cardiac arrest incidents involving family members, co-workers, or acquaintances; 12.2% were on-duty medical healthcare personnel; and 9.5% were off-duty healthcare personnel. Cardiac arrest was treated in 83.8% of cases, with 90% of witnesses performing CPR. The percentage of witnesses that used an automated external defibrillator (AED) was 13.5%. In this study, the rates of ECG monitoring, CPR performance, and defibrillation performed by paramedics were high, but intravascular access and drug administration had a lower rate of performance. The time elapsed depended on the patient's physical fitness. The study found that paramedics had the highest CPC restoration rate in patients with cardiac arrest, followed by EMTs and nurses. Significant differences were observed in cerebral performance scores after care by these paramedics and nurses. To increase the performance of AEDs, more AEDs should be installed in public spaces so that the public can access them conveniently in cases of emergency. In addition, it is necessary to improve the quality of professional first aid physical activity services performed by first-class paramedics.

Application Effect of the China Association For Disaster and Emergency Rescue Medicine - Cardiopulmonary Resuscitation and Automatic Extracorporeal Defibrillation (CADERM-CPR·D) Training in Medical Teaching

Objective In China, the penetration rate of cardiopulmonary resuscitation training is not high and the effect of traditional teaching methods is not good. In this study, the case-guided cardiopulmonary resuscitation training mode was introduced to provide cardiopulmonary resuscitation training to medical students with a certain medical background, using the 2018 technical specifications for cardiopulmonary resuscitation and automatic extracorporeal defibrillation of the China Association for Disaster and Emergency Rescue Medicine. Compared with traditional teaching methods, the application effect of this training method in clinical probation teaching was analyzed. Methods 120 medical students with a certain medical background were randomly divided into the experimental group and the control group, with 60 students in each group. The knowledge, skills, and attitude of the subjects were assessed by questionnaire survey. Results A total of 120 students were included in the study and randomly divided into an experimental group and a control group. The test scores of knowledge, skill, and attitude in the experimental group (38.40±2.775, 19.07±1.118, 14.92±0.962) were significantly higher than those in the control group (32.47±3.615, 14.65±1.338, 12.68±0.930)(P<0.05). Conclusion Case-guided cardiopulmonary resuscitation training of the China Association for Disaster and Emergency Rescue Medicine specifications can improve medical students' knowledge and skills of cardiopulmonary resuscitation, enhance their confidence in treatment, and can be further applied in medical teaching.

A two-point strategy to clarify prognosis in >80 year olds experiencing out of hospital cardiac arrest

BACKGROUND

The global population is aging, with the number of ≥80-year-olds projected to triple over the next 30 years. Rates of out-of-hospital cardiac arrest (OHCA) are also increasing within this age group.

METHODS

The Victorian Ambulance Cardiac Arrest Registry was utilised to identify OHCAs in patients aged ≥80 years between 2002-2021. Predictors of survival to discharge were defined and a prognostic score derived from this cohort.

RESULTS

77,628 patients experienced OHCA of whom 25,269 (32.6%) were ≥80 years (80-90 years = 18,956; 90-100 years = 6,148; >100 years = 209). The number of patients ≥80 years increased over time both absolutely (p = 0.002) and proportionally (p = 0.028). 619 (2.4%) patients survived to discharge without change over time. Older ages had no difference in witnessed OHCA status but were less likely to have shockable rhythm (OR 0.50 (95% CI 0.44-0.57) for 90-100-year-olds, OR 0.28 (95% CI 0.12-0.63) for 90-100-year-olds). If OHCA was witnessed and there was a shockable rhythm then survival was 14%; if one factor was present survival was 5-6% and if neither factor was present, survival was 0.09%. These survival rates enabled derivation of a simplified prognostic assessment score - the '15/5/0' score - highly comparable to a previously-published American cohort.

CONCLUSIONS

Elderly OHCA rates have increased to one-third of caseload. The most important factors predicting survival were whether the OHCA was witnessed and there was a shockable rhythm. We present a simple two-point '15/5/0' prognostic score defining which patients will gain most from advanced resuscitative measures.

Association between the relationship of bystander and neurologic recovery in pediatric out-of-hospital cardiac arrest

AIM

This study aimed to evaluate whether the relationship between bystanders and victims is associated with neurological outcomes in paediatric out-of-hospital cardiac arrest (OHCA).

METHODS

This cross-sectional, retrospective, observational study included patients with non-traumatic paediatric OHCA undergoing emergency medical service treatment between 2014 and 2021. The relationship between bystanders and patients was categorized into first responder, family, and layperson groups. The primary outcome was good neurological recovery. Further sensitivity analyses were conducted subcategorizing the cohort into four groups: first responder, family, friends or colleagues, and layperson, or two groups: family and non-family.

RESULTS

We analysed 1,451 patients. OHCAs in the family group showed lower rate of good neurological outcomes regardless of witness status: 29.4%, 12.3%, and 38.6% in the first responder, family, and layperson groups in the witnessed and 6.7%, 2.0%, and 7.3% in the unwitnessed cohort. Multivariable logistic regression yielded no significant differences between the three groups: the adjusted odds ratios (AOR) and 95% confidence interval (CI) were 0.57 (0.28-1.15) in the family and 1.18 (0.61-2.29) in the layperson compared to the first responder group. The sensitivity analysis yielded a higher probability of good neurologic recovery in the non-family compared to the family member bystander group in witnessed cohort (AOR, 1.96; 95% CI, 1.17-3.30).

CONCLUSION

Paediatric OHCAs had no significant difference between good neurological recovery and the relationship of bystander.

Bystander-witnessed cardiopulmonary resuscitation by nonfamily is associated with neurologically favorable survival after out-of-hospital cardiac arrest in Miyazaki City District

BACKGROUND

Bystander intervention in cases of out-of-hospital cardiac arrest (OHCA) is a key factor in bridging the gap between the event and the arrival of emergency health services at the site. This study investigated the implementation rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) and 1-month survival after OHCA in Miyazaki prefecture and Miyazaki city district as well as compared them with those of eight prefectures in the Kyushu-Okinawa region in Japan. In addition, we analyzed prehospital factors associated with survival outcomes in Miyazaki city district.

METHODS

We used data from an annual report released by the Fire and Disaster Management Agency of Japan (n = 627,982) and the Utstein reporting database in Miyazaki city district (n = 1,686) from 2015 to 2019.

RESULT

Despite having the highest rate of bystander CPR (20.8%), the 1-month survival rate (15.7%) of witnessed OHCA cases of cardiac causes in Miyazaki city district was comparable with that in the eight prefectures between 2015 and 2019. However, rates of survival (10.7%) in Miyazaki prefecture were lower than those in other prefectures. In 1,686 patients with OHCA (74 ± 18 years old, 59% male) from the Utstein reporting database identical to the 5-year study period in Miyazaki city district, binary logistic regression analysis demonstrated that age of the recipient [odds ratio (OR) 0.979, 95% confidential interval (CI) 0.964-0.993, p = 0.004)], witness of the arrest event (OR 7.501, 95% CI 3.229-17.428, p < 0.001), AED implementation (OR 14.852, 95% CI 4.226-52.201, p < 0.001), and return of spontaneous circulation (ROSC) before transport (OR 31.070, 95% CI 16.585-58.208, p < 0.001) predicted the 1-month survival with favorable neurological outcomes. In addition, chest compression at a public place (p < 0.001) and by nonfamily members (p < 0.001) were associated with favorable outcomes (p = 0.015).

CONCLUSIONS

We found differences in 1-month survival rates after OHCA in the Kyushu-Okinawa region of Japan. Our results suggest that on-field ROSC with defibrillation performed by nonfamily bystanders who witnessed the event determines 1-month neurological outcomes after OHCA in Miyazaki city district. Continued education of citizens on CPR techniques and better access to AED devices may improve outcomes.

Type of bystander and rate of cardiopulmonary resuscitation in nursing home patients suffering out-of-hospital cardiac arrest

AIM

We investigated bystander cardiopulmonary resuscitation (CPR) provision rate and survival outcomes of out-of-hospital cardiac arrest (OHCA) patients in nursing homes by bystander type.

METHODS

A population-based observational study was conducted for nursing home OHCAs during 2013-2018. The exposure was the bystander type: medical staff, non-medical staff, or family. The primary outcome was bystander CPR provision rate; the secondary outcomes were prehospital return of spontaneous circulation (ROSC) and survival to discharge. Multivariable logistic regression analysis which corrected for various demographic and clinical characteristics evaluated bystander type impact on study outcomes. Bystander CPR rate trend was investigated by bystander type.

RESULTS

Of 8281 eligible OHCA patients, 26.0%, 70.8%, and 3.2% cases were detected by medical staff, non-medical staff, and family, respectively. Provision rate of bystander CPR was 69.9% and rate of bystander defibrillation was 0.4% in total. Bystander CPR was provided by medical staff, non-medical staff, and families in 74.8%, 68.9%, and 52.1% respectively. Total survival rate was 2.2%, out of which, 3.3% was for medical staff, 3.2% for non-medical staff, and 0.6% for family. Compared to the results of detection by medical staff, the adjusted odds ratios (95% CIs) for provision of bystander CPR were 0.56 (0.49-0.63) for detection by non-medical staff and 0.33 (0.25-0.44) for detection by family. The bystander CPR rates of all three groups increased over time, and among them, the medical staff group increased the most. For prehospital ROSC and survival to discharge, no significant differences were observed according to bystander type.

CONCLUSION

Although OHCA was detected more often by non-medical staff, they provided bystander CPR less frequently than the medical staff did. To improve survival outcome of nursing home OHCA, bundle interventions including increasing the usage of automated external defibrillators and expanding CPR training for non-medical staff in nursing home are needed.

Characteristics of Out of Hospital Cardiac Arrest in the United Arab Emirates

Background:

Out of hospital cardiac arrest is one of the leading causes of death globally. This study aimed to identify the characteristics of out of hospital cardiac arrest patients who were attended and treated by the National Ambulance crew. A lot of studies reported the importance of implementing chain of survival to increase survival rates from cardiac arrest. To be implemented in United Arab Emirates (UAE), it required a detailed study of the community engagement. The study aimed to explore the demography of the incidences, location, age, gender epidemiology of the patients who had their cardiac arrest witnessed along with their Bystander cardiopulmonary resuscitation (CPR) performed prior to the arrival of National Ambulance and public access to an automated external defibrillator. The return of spontaneous circulation was also explored prior to their arrival to the emergency department.

Methods:

The research is a prospective descriptive cohort study of out of hospital cardiac arrest patients attended by National Ambulance between July 2017 and June 2018. The National Ambulance provides emergency medical services for public and private hospitals in the Emirates of Sharjah, Ajman, Ras-al-Khaimah, Fujairah, and Umm Al-Quwain and its clients in Abu Dhabi in UAE. Data for the study were collected by the National Ambulance crew attending the OHCA patients, using a structured questionnaire.

Results:

In this 1-year period, a total of 715 out of hospital cardiac arrest cases were attended by the National Ambulance with higher percentage (77%) of male patients. Resuscitation and transportation were attempted for 95% whereas 5% were pronounced dead on the spot. In this study, the median age of the patients was 50 years. Majority of the patients were Asians 55% (n = 395) followed by Arabs non-UAE citizens 19.4% (n = 139) and UAE citizens 16% (n = 113). Patients facing sudden cardiac arrest in their homes or residences represented 69.9% (n = 500), street and public places 22.5% (n = 161), and workplace 6.8% (n = 49). The percentage of patients who had witnessed cardiac arrest was 51.7% (n = 370) only 197 had CPR performed on them prior to the arrival of National Ambulance. Low public access to AED was found in this population that is 1.8% (n = 13). A majority of the participants in this study had nonshockable rhythms 84.3% (n = 603) whereas shockable rhythms presented on 11% (n = 80). The percentage of patients who had ROSC at the scene or en route to the hospitals was found 9.2% (n = 66).

Conclusion:

In this 1-year study, the result showed that cardiac arrest was recognized and witnessed in about half of the cases, but low bystander CPR was performed. Low public access and use of AED were found. Data on hospitalized and discharged OHCA patients were not available and required further linkage and corporation between ambulance services and hospitals to ensure data continuity of OHCA cases. This study is essential for the implementation of proper chain of survival and reduction in mortality rates in UAE.

Citizen bystander-patient relationship and 1-month outcomes after out-of-hospital cardiac arrest of cardiac origin from the All-Japan Utstein Registry: a prospective, nationwide, population-based, observational study

OBJECTIVES

The presence of a bystander witness is a crucial predictor of patient survival after out-of-hospital cardiac arrest (OHCA). However, the differences in survival and neurological outcomes among different types of citizen bystanders are not well understood.

DESIGN

We analysed data from the All-Japan Utstein Registry, a prospective, nationwide, population-based, observational study that was started in January 2005.

SETTING

The registry includes all patients with OHCA who were transported to the hospital by emergency medical service (EMS) in Japan. The type of citizen bystander was classified as family member, friend, colleague, passerby or other.

PARTICIPANTS

We analysed 210 642 patients in the registry who were 18 years or older and experienced OHCA of cardiac origin witnessed by a citizen bystander between 2005 and 2014.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main outcomes were 1 month survival and 1 month survival with minimal neurological impairment.

RESULTS

Of the citizen bystander-witnessed cases, 65.1% (137 147/210 642) were witnessed by a family member. However, among patients who survived to 1 month and who had a favourable 1 month neurological outcome, much lower proportions (53.9% (10 907/20 239) and 48.9% (5722/11 696)) were witnessed by a family member. Witness by a friend, colleague or passerby was associated with good 1 month neurological function, after controlling for the patient's age, first recorded rhythm, gender, bystander cardiopulmonary resuscitation (CPR), use of a public-access automated external defibrillator, dispatcher instructions, collapse-call time and response time compared with witness by a family member (friend: OR 1.35, 95% CI 1.24 to 1.46, colleague: OR 1.63, 95% CI 1.33 to 1.98, passerby: OR 1.60, 95% CI 1.39 to 1.84).

CONCLUSIONS

One-month survival and favourable1 month neurological outcome of patients with OHCA of cardiac origin witnessed by a family member were worse than those in cases witnessed by a friend, colleague or passerby, independent of the patient characteristics and the response of EMS.

One-year longitudinal study of psychological distress and self-assessed health in survivors of out-of-hospital cardiac arrest

OBJECTIVES

Few studies have investigated the psychological and health-related outcome after out-of-hospital cardiac arrest (OHCA) over time. This longitudinal study aims to evaluate psychological distress in terms of anxiety and depression, self-assessed health and predictors of these outcomes in survivors of OHCA, 3 and 12 months after resuscitation.

METHODS

Recruitment took place from 2008 to 2011 and survivors of OHCA were identified through the national Swedish Cardiopulmonary Resuscitation Registry. Inclusion criteria were age ≥18 years, survival ≥12 months and a Cerebral Performance Category score ≤2. Questionnaires containing the Hospital Anxiety and Depression Scale and European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) were administered at 3 and 12 months after the OHCA. Participants were also asked to report treatment-requiring comorbidities.

RESULTS

Of 298 survivors, 85 (29%) were eligible for this study and 74 (25%) responded. Clinically relevant anxiety was reported by 22 survivors at 3 months and by 17 at 12 months, while clinical depression was reported by 10 at 3 months and 4 at 12 months. The mean EQ-5D-3L index value increased from 0.82 (±0.26) to 0.88 (±0.15) over time. There were significantly less symptoms of psychological distress (p=0.01) and better self-assessed health (p=0.003) at 12 months. Treatment-requiring comorbidity predicted anxiety (OR 4.07, p=0.04), while being female and young age predicted poor health (OR 6.33, p=0.04; OR 0.91, p=0.002) at 3 months. At 12 months, being female was linked to anxiety (OR 9.23, p=0.01) and depression (OR 14.78, p=0.002), while young age predicted poor health (OR 0.93, p=0.003).

CONCLUSION

The level of psychological distress and self-assessed health improves among survivors of OHCA between 3 and 12 months after resuscitation. Higher levels of psychological distress can be expected among female survivors and those with comorbidity, while survivors of young age and who are female are at greater risk of poor health.

Adequacy of bystander actions in unconscious patients: an audit study in the Ghent region (Belgium)

OBJECTIVE

Early recognition and appropriate bystander response has proven effect on the outcome of many critically ill patients, including those in cardiac arrest. We wanted to audit prehospital bystander response in our region and identify areas for improvement.

PATIENTS AND METHODS

We prospectively collected data, including Emergency Medical Services dispatch center audio files, on all patients with a decreased level of consciousness presenting to the Ghent University Hospital prehospital emergency care unit (n = 151). Three trained emergency physicians reviewed the bystander responses, both before and after dispatcher advice was given. Suboptimal actions (SAs) were only withheld if there was 100% consensus.

RESULTS

SAs were recognized in 54 (38%) of the 142 cases, and most often related to delayed (n = 35) or inaccurate (n = 12) alerting of the dispatch center. In seven cases, the aid given was considered suboptimal in itself. Importantly, in 21 (25.9%) of the 81 cases where a clear advice was given by the dispatcher, this advice was ignored. In 12 cases, a general practitioner was present at scene. We recognized SAs in 80% of these cases (8/10; insufficient information, n = 2). Cardiopulmonary resuscitation was started in only 29 (43.3%) of the 67 cases of cardiac arrest where dispatcher-assisted cardiopulmonary resuscitation was indicated at the moment of first Emergency Medical Services call.

CONCLUSION

We audited bystander response for unconscious patients in our region and found a high degree of suboptimal actions. These results should inform policy makers and healthcare professionals and force them to urgently reflect on how to improve the first parts of the chain of survival.

Well-being among survivors of out-of-hospital cardiac arrest: a cross-sectional retrospective study in Sweden

OBJECTIVES

The psychological outcome of out-of-hospital cardiac arrest (OHCA) has been studied more extensively in recent years. Still, not much is known about the well-being among OHCA survivors. In this retrospective cross-sectional study, we aim to investigate post-OHCA well-being among patients with a good neurological outcome, 3 months after the cardiac event. To assess well-being, we analyse the frequency of anxiety, depression, post-traumatic stress disorder (PTSD) and health within this group. Further, we aim to evaluate the importance of five prognostic factors for post-OHCA well-being.

METHODS

Data collection took place between 2008 and 2012, and every OHCA survivor within one region of Sweden, with a cerebral performance category (CPC) score of ≤2 at discharge, was asked to participate. Survivors were identified through the Swedish Cardiopulmonary Resuscitation Registry, and postal questionnaires were sent out 3 months after the OHCA. The survey included Hospital Anxiety and Depression scale (HADS), PTSD Checklist Civilian version (PCL-C) and European Quality of Life 5 Dimensions 3 level (EQ-5D-3L).

RESULTS

Of 298 survivors, 150 were eligible for this study and 94 responded. The mean time from OHCA to follow-up was 88 days. There was no significant difference between respondents and non-respondents in terms of sex, age, cardiac arrest circumstances or in-hospital interventions. 48 participants reported reduced well-being, and young age was the only factor significantly correlated to this outcome (p=0.02). Women reported significantly higher scores in HADS (p=0.001) and PCL-C (p<0.001). Women also reported significantly lower EQ-5D index values (p=0.002) and EQ-visual analogue scale scores (p=0.002) compared with men.

CONCLUSION

Reduced well-being is experienced by half of OHCA survivors with a CPC score ≤2, and young age is negatively correlated to this outcome. The frequency of anxiety and PTSD is higher among women, who also report worse health.

Factors associated with the outcome of out-of-hospital cardiopulmonary arrest among people over 80 years old in Japan

AIM

To determine if termination of resuscitation should be considered for older individuals, we sought to identify factors associated with clinical outcome following out-of-hospital cardiac arrest (OHCA) in people ≥80 years old and over.

METHODS

A prospective, population-based, observational study was conducted for ≥80-year-old individuals who experienced out-of-hospital cardiac arrest and to whom resuscitation was provided by emergency responders between January 1, 2005 and December 31, 2012 (n=377,577). The primary endpoint was 1-month survival. Signal detection analysis was applied to estimate predictive factors among 17 variables.

RESULTS

Among all out-of-hospital cardiac arrest cases, 59.4% were of cardiac origin, and 1-month survival rate was 3.3%. Following signal detection analysis, cases of both cardiac and non-cardiac origin were categorized into three subgroups defined by return of spontaneous circulation (ROSC) and epinephrine use. One-month survival ranged between 1.2 and 41.0% for the three subgroups of cardiac origin and between 2.0 and 41.1% for the three subgroups of non-cardiac origin.

CONCLUSIONS

ROSC was the most significant predictor of 1-month survival among patients with cardiac and non-cardiac OHCA who were ≥80 years old. Absence of ROSC might be an important factor to the termination of resuscitation rule for OHCA in individuals who are ≥80years old.

Effect of Dispatcher-Assisted Cardiopulmonary Resuscitation Program and Location of Out-of-Hospital Cardiac Arrest on Survival and Neurologic Outcome

STUDY OBJECTIVE

We study the effect of a nationwide dispatcher-assisted cardiopulmonary resuscitation (CPR) program on out-of-hospital cardiac arrest outcomes by arrest location (public and private settings).

METHODS

All emergency medical services (EMS)-treated adults in Korea with out-of-hospital cardiac arrests of cardiac cause were enrolled between 2012 and 2013, excluding cases witnessed by EMS providers and those with unknown outcomes. Exposure was bystander CPR categorized into 3 groups: bystander CPR with dispatcher assistance, bystander CPR without dispatcher assistance, and no bystander CPR. The endpoint was good neurologic recovery at discharge. Multivariable logistic regression analysis was performed. The final model with an interaction term was evaluated to compare the effects across settings.

RESULTS

A total of 37,924 patients (31.1% bystander CPR with dispatcher assistance, 14.3% bystander CPR without dispatcher assistance, and 54.6% no bystander CPR) were included in the final analysis. The total bystander CPR rate increased from 30.9% in quarter 1 (2012) to 55.7% in quarter 4 (2014). Bystander CPR with and without dispatcher assistance was more likely to result in higher survival with good neurologic recovery (4.8% and 5.2%, respectively) compared with no bystander CPR (2.1%). The adjusted odds ratios for good neurologic recovery were 1.50 (95% confidence interval [CI] 1.30 to 1.74) in bystander CPR with dispatcher assistance and 1.34 (95% CI 1.12 to 1.60) in bystander CPR without it compared with no bystander CPR. For arrests in private settings, the adjusted odds ratios were 1.58 (95% CI 1.30 to 1.92) in bystander CPR with dispatcher assistance and 1.28 (95% CI 0.98 to 1.67) in bystander CPR without it; in public settings, the adjusted odds ratios were 1.41 (95% CI 1.14 to 1.75) and 1.37 (95% CI 1.08 to 1.72), respectively.

CONCLUSION

Bystander CPR regardless of dispatcher assistance was associated with improved neurologic recovery after out-of-hospital cardiac arrest. However, for out-of-hospital cardiac arrest cases in private settings, bystander CPR was associated with improved neurologic recovery only when dispatcher assistance was provided.

Are two or four hands needed for elderly female bystanders to achieve the required chest compression depth during dispatcher-assisted CPR: a randomized controlled trial

Background

Rescuers are often unable to achieve the recommended 5–6 cm CC depth. The physical limitations of elderly bystanders may affect the quality of CC; thus, we investigated new strategies to improve CC performance.

Methods

We performed a randomized controlled trial in December 2013. Sixty-eight lay rescuers aged 50–75 were randomized to intervention or control pairs (males and females separately). Each pair performed 8 min of DA-CPR on a manikin connected to a PC. Each participant in every pair took turns performing CCs in cycles of 2 min and switched as advised by the dispatcher. In the middle of every 2-min cycle, the dispatcher asked the participants of the intervention group to perform the Andrew’s manoeuvre (to push on the shoulders of the person while he/she performed CCs to achieve deeper CC). Data on the quality of the CCs were analysed for each participant and pair.

Results

The CC depth in the intervention group increased by 6.4 mm (p = 0.002) compared to the control group (54.2 vs. 47.8 mm) due to a significant difference in the female group. The CC depth in the female intervention and control groups was 51.5 and 44.9 mm.

Discussion

The largest group of out-of-hospital cardiac arrest occurred in males over the age of 60 at home, and accordingly, the most likely witness, if any, is the spouse or family member, most frequently an older woman. There is a growing body of evidence that female rescuers are frequently unable to achieve sufficient CC depth compared to male rescuers. In some instances, the adequate depth of the CCs could only be reached using four hands, with the second pair of hands placed on the shoulders of the rescuer performing CPR. 

Conclusion

Andrew’s manoeuvre (four-hands CC) during the simulated DA-CPR significantly improved the performance of elderly female rescuers and helped them to achieve the recommended CC depth.

Improved Survival With Favorable Neurological Outcome in Elderly Individuals With Out-of-Hospital Cardiac Arrest in Japan - A Nationwide Observational Cohort Study

BACKGROUND

There is sparse data regarding the survival and neurological outcome of elderly patients with out-of-hospital cardiac arrest (OHCA).

METHODS AND RESULTS

OHCA patients (334,730) aged ≥75 years were analyzed using a nationwide, prospective, population-based Japanese OHCA database from 2008 to 2012. The overall 1-month survival with favorable neurological outcome (Cerebral Performance Category Scale, category 1 or 2; CPC 1-2) rate was 0.88%. During the study period, the annual 1-month CPC 1-2 rate in whole OHCA significantly improved (0.73% to 0.96%, P for trend <0.001). In particular, outcomes of OHCA patients aged 75 to 84 years and those aged 85 to 94 years significantly improved (0.98% to 1.28%, P for trend=0.01; 0.46% to 0.70%, P for trend <0.001, respectively). However, in OHCA patients aged ≥95 years, the outcomes did not improve. Multivariate logistic regression analysis indicated that younger age, shockable first documented rhythm, witnessed arrest, earlier emergency medical service (EMS) response time, and cardiac etiology were significantly associated with the 1-month CPC 1-2. Under these conditions, elderly OHCA patients who had cardiac etiology, shockable rhythm and had a witnessed arrest had acceptable 1-month CPC1-2 rate; 7.98% in cases where OHCA was witnessed by family, 15.2% by non-family, and 25.6% by EMS.

CONCLUSIONS

The annual 1-month CPC 1-2 rate after OHCA among elderly patients significantly improved, and the resuscitation of elderly patients in a selected population is not futile. (Circ J 2016; 80: 1153-1162).

Degree of exercise intensity during continuous chest compression in upper-body-trained individuals

Background

Although chest-compression-only cardiopulmonary resuscitation (CCO-CPR) is recommended for lay bystanders, fatigue is easily produced during CCO-CPR. If CCO-CPR can be performed at a lower intensity of exercise, higher resistance to fatigue is expected. Since chest compression is considered to be a submaximal upper body exercise in a steady rhythm and since the unit of load for chest compression is expressed as work rate, we investigated the possibility that peak work rate of the upper body determines the level of exercise intensity during CCO-CPR.

Methods

Twelve sedentary individuals (group Se), 11 rugby players (group R), and 11 swimmers (group Sw) performed 10-min CCO-CPR, and heart rate (HR) and rating of perceived exertion (RPE) were measured as indices of exercise intensity. Multiple linear regression analysis was carried out to assess potential relationships of upper body weight, peak lumbar extension force, peak work rate, and peak oxygen uptake recorded during arm-crank exercise with HR and RPE during CCO-CPR.

Results

Values of peak work rate during arm-crank exercise (Peak WR_-AC) in group Se, group R, and group Sw were 108 ± 12, 139 ± 27, and 146 ± 24 watts, respectively. Values of the latter two groups were significantly higher than the value of group Se (group R, P < 0.01; group Sw, P < 0.001). HR during CCO-CPR increased with time, reaching 127.8 ± 17.6, 114.8 ± 16.5, and 118.1 ± 14.2 bpm at the 10th minute in group Se, group R, and group Sw, respectively. On the other hand, RPE during CCO-CPR increased with time, reaching 16.4 ± 1.4, 15.4 ± 1.7, and 13.9 ± 2.2 at the 10th minute in group Se, group R, and group Sw, respectively. Multiple linear regression analysis showed that only peak WR_-AC affects both HR and RPE at the 10th minute of CCO-CPR (HR, r = −0.458; P < 0.01; RPE, r = −0.384, P < 0.05).

Conclusions

The degree of exercise intensity during CCO-CPR is lower in individuals who have a higher peak work rate of the upper body.

Study on the Effectiveness of Cardiopulmonary Resuscitation in Elderly Patients Presenting with Cardiopulmonary Arrest on Arrival

OBJECTIVE

This study was conducted to determine whether a policy of not attempting to resuscitate patients who are 80 years of age and older with cardiopulmonary arrest on arrival is justifiable.

METHODS

The protocol of this study was approved without the need for informed consent by the research ethics board of Gunma University Hospital. We prospectively analyzed patients with cardiopulmonary arrest on arrival that was due to an intrinsic reason who were taken to Gunma University Hospital between January 2013 and March 2014. The patients were divided into two groups: patients who were less than 80 years of age (L group) and those aged 80 years and older (H group). We compared the patients' characteristics, including the etiology of cardiac arrest, and the prognosis between the two groups.

RESULTS

A total of 103 patients with cardiopulmonary arrest on arrival were enrolled. There were no significant differences in the patients' characteristics, such as age, sex, witness and bystander cardiopulmonary resuscitation, and transportation time between the two groups. The return of spontaneous circulation was obtained in 14 patients (25.5%) in the L group and in 9 patients (18.8%) in the H group; however, no significant difference was seen between the two groups. Two patients in the L group were in good neurological condition when they were discharged; however, the other patients did not survive.

CONCLUSION

Even patients 80 years of age and older can be resuscitated to spontaneous circulation. We do not endorse a policy that recommends not performing cardiopulmonary resuscitation based solely on the age of the patient.

Trends in survival among elderly patients with out-of-hospital cardiac arrest: a prospective, population-based observation from 1999 to 2011 in Osaka

BACKGROUND

Little is known about the improvement in out-of-hospital cardiac arrest (OHCA) survival among elderly patients. The aim of this study was to evaluate the trends in the survival after bystander-witnessed OHCA of cardiac origin in this age group.

METHODS

This prospective, population-based, observation of the whole population of Osaka, Japan included consecutive OHCA patients aged ≥65 years with emergency responder resuscitation attempts from January 1999 to December 2011. The primary outcome measure was one-month survival with neurologically favorable outcome, and the trends in the outcome from OHCA were evaluated by location. Multiple logistic regression analysis was used to assess factors that were potentially associated with neurologically favorable outcome.

RESULTS

During the study period, a total of 10,876 bystander-witnessed OHCA of cardiac origin were eligible for our analyses. In whole arrests, the proportion of one-month survival with neurologically favorable outcome improved from 1.4% in 1999 to 4.8% in 2011 (P for trend <0.001). The proportion of neurologically favorable outcome in homes and public places improved from 0.7% in 1999 to 3.2% in 2011 (P for trend <0.001) and from 4.2% in 1999 to 20.9% in 2011 (P for trend <0.001), respectively, whereas, in nursing homes, the proportion of neurologically favorable outcome did not improve. In a multivariate analysis, bystander-initiated cardiopulmonary resuscitation and emergency response time were significant predictors for neurologically favorable outcome.

CONCLUSIONS

In this population, survival from OHCA among elderly patients significantly improved during the study period, but the trends differed by the OHCA location.