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Enomoto Y, Tsutsumi Y, Kido T, Nagatomo K, Tsuchiya A, Inoue Y. Association between helicopter medical services for pediatric trauma patients and mortality: Systematic review and meta-analysis. Am J Emerg Med 2024; 85:196-201. [PMID: 39278027 DOI: 10.1016/j.ajem.2024.09.015] [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: 07/02/2024] [Revised: 09/03/2024] [Accepted: 09/08/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND Helicopter emergency medical services (HEMS) have become widespread around the world. However, previous studies of the influence of HEMS on mortality were limited to adult patients only and showed inconsistent and heterogeneous results. This study aimed to examine the association between HEMS and mortality among pediatric emergencies compared to ground emergency medical service (GEMS). METHODS We searched relevant databases (MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials) and included articles in any language. The most recent search was on January 4th, 2024. We included prospective observational cohort studies or clinical trials that compared HEMS with GEMS in pediatric patients. We excluded any study that did not compare two or more groups of participants. Two pairs of researchers blindly screened studies and evaluated risk of bias using the Risk of Bias in Nonrandomized Studies of Interventions tool. We conducted this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were extracted by four independent reviewers. We calculated the odds ratio using the random-effects model. The primary outcome was mortality. RESULTS Our search strategy yielded 1454 results. Of these, seven observational studies met our eligibility criteria; no RCT met the criteria. All studies targeted trauma patients only. HEMS was associated with lower mortality (Odds ratio 0.66, 95 % CI 0.59 to 0.74). Inconsistency between trials was determined to be low due to low heterogeneity (I2 = 0 %). In a subgroup analysis conducted with and without physicians on the HEMS staff, we found no significant differences (I2 = 0 %, p = 0.71). CONCLUSION Our systematic review and meta-analysis, which was limited to trauma pediatric trauma patients, revealed that HEMS deployment correlated with decreased mortality. Further research is necessary to more effectively measure the potential influence and applicability of HEMS for pediatric emergencies.
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Affiliation(s)
- Yuki Enomoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Ibaraki, Japan; Department of Pediatrics, University of Tsukuba hospital, Ibaraki, Japan
| | - Yusuke Tsutsumi
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan; Human Health Science, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takahiro Kido
- Department of Pediatrics, University of Tsukuba hospital, Ibaraki, Japan
| | - Kazuki Nagatomo
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Ibaraki, Japan
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Kanagawa, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Ibaraki, Japan
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Maurer H, Masterson S, Tjelmeland IBM, Strömsöe A, Ortiz FR, Gräsner JT, Wnent J. EuReCa - The European Registry of Cardiac Arrest and the related studies. Resusc Plus 2024; 19:100666. [PMID: 38827274 PMCID: PMC11143888 DOI: 10.1016/j.resplu.2024.100666] [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: 06/04/2024] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major health issue throughout Europe. Due to limited knowledge about the epidemiology of OHCA in Europe, in 2011, the European Registry of Cardiac Arrest (EuReCa) project was established. Initially based on existing resuscitation registries in a few countries, the network expanded and in October 2014 the EuReCa ONE study was launched, bringing together 27 countries and showing that appropriate data acquisition (10,682 cases submitted) is feasible within Europe. EuReCa TWO was conducted from October to December 2017 and included 37,054 cases. EuReCa THREE data collection was carried out from September to November 2022 and data analysis is currently being conducted. EuReCa TWO and THREE studies generated more robust data, with both studies covering 3-month periods in 28 countries, respectively. While EuReCa TWO focused on the bystander, EuReCa THREE investigated the impact of time-related aspects (time from call to scene, time at scene, transport times and other) on resuscitation outcomes. EuReCa is a network supporting countries in their ambition to establishing continuously running registries as quality management tools and for scientific work.
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Affiliation(s)
- Holger Maurer
- University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Siobhán Masterson
- National Ambulance Service and National University of Ireland Galway (on behalf of the Out-of-Hospital Cardiac Arrest Register (OHCAR)), Ireland
| | - Ingvild Beathe Myrhaugen Tjelmeland
- Division of Prehospital Services, Oslo University Hospital, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Anneli Strömsöe
- School of Education, Health and Social Studies, Dalarna University, S-79188 Falun, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, S-79182 Falun, Sweden
- Department of Prehospital Care, Region of Dalarna, S-79129 Falun, Sweden
| | - Fernando Rosell Ortiz
- Servicio de Emergencias 061, Centro de Investigación Biomédica de La Rioja (CIBIR), C/ Piqueras 96, Hospital San Pedro, 26005 Logroño, Spain
| | - Jan-Thorsten Gräsner
- University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Holzkoppelweg 8-12, 24118 Kiel, Germany
- University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Arnold-Heller-Str. 3, Haus R3, 24105 Kiel, Germany
| | - Jan Wnent
- University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Holzkoppelweg 8-12, 24118 Kiel, Germany
- University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Arnold-Heller-Str. 3, Haus R3, 24105 Kiel, Germany
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Katzenschlager S, Elshaer A, Metelmann B, Metelmann C, Thilakasiri K, Karageorgos V, Barry T, Alm-Kruse K, Karim H, Maurer H, Kramer-Johansen J, Orlob S. Top 5 barriers in cardiac arrest research as perceived by international early career researchers - A consensus study. Resusc Plus 2024; 18:100608. [PMID: 38524147 PMCID: PMC10957401 DOI: 10.1016/j.resplu.2024.100608] [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
Aim of the study Cardiac arrest research has not received as much scientific attention as research on other topics. Here, we aimed to identify cardiac arrest research barriers from the perspective of an international group of early career researchers. Methods Attendees of the 2022 international masterclass on cardiac arrest registry research accompanied the Global Out-of-Hospital Cardiac Arrest Registry collaborative meeting in Utstein, Norway, and used an adapted hybrid nominal group technique to obtain a diverse and comprehensive perspective. Barriers were identified using a web-based questionnaire and discussed and ranked during an in-person follow-up meeting. After each response was discussed and clarified, barriers were categorized and ranked over two rounds. Each participant scored these from 1 (least significant) to 5 (most significant). Results Nine participants generated 36 responses, forming seven overall categories of cardiac arrest research barriers. "Allocated research time" was ranked first in both rounds. "Scientific environment", including appropriate mentorship and support systems, ranked second in the final ranking. "Resources", including funding and infrastructure, ranked third. "Access to and availability of cardiac arrest research data" was the fourth-ranked barrier. This included data from the cardiac arrest registries, medical devices, and clinical studies. Finally, "uniqueness" was the fifth-ranked barrier. This included ethical issues, patient recruitment challenges, and unique characteristics of cardiac arrest. Conclusion By identifying cardiac arrest research barriers and suggesting solutions, this study may act as a tool for stakeholders to focus on helping early career researchers overcome these barriers, thus paving the road for future research.
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Affiliation(s)
- Stephan Katzenschlager
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Ahmed Elshaer
- The Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bibiana Metelmann
- Department of Anaesthesiology, Greifswald University Medicine, Greifswald, Germany
| | - Camilla Metelmann
- Department of Anaesthesiology, Greifswald University Medicine, Greifswald, Germany
| | - Kaushila Thilakasiri
- Oxford University Hospitals NHS Trust Oxford UK, Postgraduate Institute of Medicine, UK
- University of Colombo, Ministry of Health, Sri Lanka
| | - Vlasios Karageorgos
- Cardiopulmonary Resuscitation Lab, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Kristin Alm-Kruse
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hritul Karim
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Holger Maurer
- Department of Anesthesiology and Intensive Care Medicine, University of Luebeck, Luebeck, Germany
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) , Norway
- Norwegian Cardiac Arrest Registry, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Simon Orlob
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
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Baig MNA, Khan N, Naseer R, Akhter S, Shaikh AJ, Razzak JA. Pakistan's Emergency Medical Services (EMS) system & out-of-hospital-cardiac-arrest (OHCA): A narrative review of an EMS system of a low middle income country in context of OHCA. Resusc Plus 2024; 18:100627. [PMID: 38590447 PMCID: PMC11000191 DOI: 10.1016/j.resplu.2024.100627] [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: 04/10/2024] Open
Abstract
Pakistan's Emergency Medical Services (EMS) are a critical component of its healthcare system, providing pre-hospital emergency care across a nation with over 220 million people. This article explores the evolutionary journey of Pakistan's EMS, highlighting both the challenges it faces and the strides it has made, with a specific emphasis on patients experiencing out-of-hospital cardiac arrest (OHCA). To extract relevant information, we searched MEDLINE & Embase data bases using MeSH terms "Emergency Medical Services" OR "EMS" AND "Out-of-Hospital-Cardiac-Arrest" OR "OHCA" AND "Pakistan". In addition, we also retrieved information from the EMS leadership in Pakistan through e-mails. We delve into the significance of key performance indicators for OHCA, advocate for the establishment of OHCA registries to improve patient outcomes, address regional disparities in pre-hospital care, and acknowledge the gradual progress of the EMS system.
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Affiliation(s)
- Mirza Noor Ali Baig
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
- Centre of Excellence for Trauma & Emergencies, The Aga Khan University, Karachi, Pakistan
| | - Nadeemullah Khan
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Abid Jalaluddin Shaikh
- Sindh Emergency Service Rescue 1122, Rehabilitation Department, Government of Sindh, Pakistan
| | - Junaid Abdul Razzak
- Centre of Excellence for Trauma & Emergencies, The Aga Khan University, Karachi, Pakistan
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Alm-Kruse K, Gjerset GM, Tjelmeland IB, Isern CB, Kramer-Johansen J, Garratt AM. How do survivors after out-of-hospital cardiac arrest perceive their health compared to the norm population? A nationwide registry study from Norway. Resusc Plus 2024; 17:100549. [PMID: 38292469 PMCID: PMC10825523 DOI: 10.1016/j.resplu.2023.100549] [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: 10/16/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Self-perceived health status data is usually collected using patient-reported outcome measures. Information from the patients' perspective is one of the important components in planning person-centred care. The study aimed to compare EQ-5D-5L in survivors after out-of-hospital cardiac arrest (OHCA) with data for Norwegian population controls. Secondary aim included comparing characteristics of respondents and non-respondents from the OHCA population. Methods In this cross-sectional survey, 714 OHCA survivors received an electronic EQ-5D-5L questionnaire 3-6 months following OHCA. EQ-5D-5L assesses for five dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with five-point descriptive scales and overall health on a visual analogue scale from 0 (worst) to 100 (best) (EQ VAS). Results are used to calculate the EQ index ranging from -0.59 (worst) to 1 (best). Patient responses were matched for age and sex with existing data from controls, collected through a postal survey (response rate 26%), and compared with Chi-square tests or t-tests as appropriate. Results Of 784 OHCA survivors, 714 received the EQ-5D-5L, and 445 (62%) responded. Respondents had higher rates of shockable first rhythm and better cerebral performance category scores than the non-respondents. OHCA survivors reported poorer health compared to controls as assessed by EQ-5D-5L dimensions, the EQ index (0.76 ± 0.24 vs 0.82 ± 0.18), and EQ VAS (69 ± 21 vs 79 ± 17), except for the pain/discomfort dimension. Conclusions Norwegian OHCA survivors reported poorer health than the general population as assessed by the EQ-5D-5L. PROMs use in this population can be used to inform follow-up and health care delivery.
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Affiliation(s)
- Kristin Alm-Kruse
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunhild M. Gjerset
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology and Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Ingvild B.M. Tjelmeland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Cecilie B. Isern
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Andrew M. Garratt
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway
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Renberg M, Dahlberg M, Gellerfors M, Rostami E, Günther M. Prehospital and emergency department airway management of severe penetrating trauma in Sweden during the past decade. Scand J Trauma Resusc Emerg Med 2023; 31:85. [PMID: 38001526 PMCID: PMC10675952 DOI: 10.1186/s13049-023-01151-4] [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: 08/25/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prehospital tracheal intubation (TI) is associated with increased mortality in patients with penetrating trauma, and the utility of prehospital advanced airway management is debated. The increased incidence of deadly violence in Sweden warrants a comprehensive evaluation of current airway management for patients with penetrating trauma in the Swedish prehospital environment and on arrival in the emergency department (ED). METHODS This was an observational, multicenter study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 included in the Swedish national trauma register (SweTrau) between 2011 and 2019. We investigated the frequency and characteristics of prehospital and ED TI, including 30-day mortality and patient characteristics associated with TI. RESULT Of 816 included patients, 118 (14.5%) were intubated prehospitally, and 248 (30.4%) were intubated in the ED. Patients who were intubated prehospitally had a higher ISS, 33 (interquartile range [IQR] 25, 75), than those intubated in the ED, 25 (IQR 18, 34). Prehospital TI was associated with a higher associated mortality, OR 4.26 (CI 2.57, 7.27, p < 0.001) than TI in the ED, even when adjusted for ISS (OR 2.88 [CI 1.64, 5.14, p < 0.001]). Hemodynamic collapse (≤ 40 mmHg) and low GCS score (≤ 8) were the characteristics most associated with prehospital TI. Traumatic cardiac arrests (TCAs) occurred in 154 (18.9%) patients, of whom 77 (50%) were intubated prehospitally and 56 (36.4%) were intubated in the ED. A subgroup analysis excluding TCA showed that patients with prehospital TI did not have a higher mortality rate than those with ED TI, OR 2.07 (CI 0.93, 4.51, p = 0.068), with OR 1.39 (0.56, 3.26, p = 0.5) when adjusted for ISS. CONCLUSION Prehospital TI was associated with a higher mortality rate than those with ED TI, which was specifically related to TCA; intubation did not affect mortality in patients without cardiac arrest. Mortality was high when airway management was needed, regardless of cardiac arrest, thereby emphasizing the challenges posed when anesthesia is needed. Several interventions, including whole blood transfusions, the implementation of second-tier EMS units and measures to shorten scene times, have been initiated in Sweden to counteract these challenges.
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Affiliation(s)
- Mattias Renberg
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken, 10, S1 SE-118 83, Stockholm, Sweden.
| | - Martin Dahlberg
- Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Gellerfors
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Rapid Response Car, Capio, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Swedish Air Ambulance (SLA), Mora, Sweden
| | - Elham Rostami
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Mattias Günther
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken, 10, S1 SE-118 83, Stockholm, Sweden
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Barry T, Kasemiire A, Quinn M, Deasy C, Bury G, Masterson S, Segurado R, Murphy A. Outcomes of out-of-hospital cardiac arrest in Ireland 2012-2020: Protocol for an observational study. HRB Open Res 2023; 6:17. [PMID: 37662479 PMCID: PMC10474347 DOI: 10.12688/hrbopenres.13699.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 09/05/2023] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a leading cause of preventable mortality that now affects almost 3,000 people each year in Ireland. Survival is low at 6-7%, compared to a European average of 8%. The Irish Out-of-Hospital Cardiac Registry (OHCAR) prospectively gathers data on all OHCA in Ireland where emergency medical services attempted resuscitation.The Irish health system has undergone several developments that are relevant to OHCA care in the period 2012-2020. OHCAR data provides a means of exploring temporal trends in OHCA incidence, care, and outcomes over time. It also provides a means of exploring whether system developments were associated with a change in key outcomes.This research aims to summarise key trends in available OHCAR data from the period 2012 - 2020, to explore and model predictors of bystander CPR, bystander defibrillation, and survival, and to explore the hypothesis that significant system level temporal developments were associated with improvements in these outcomes. Methods The following protocol sets out the relevant background and research approach for an observational study that will address the above aims. Key trends in available OHCAR data (2012 - 2020) will be described and evaluated using descriptive summaries and graphical displays. Multivariable logistic regression will be used to model predictors of 'bystander CPR', 'bystander defibrillation' and 'survival to hospital discharge' and to explore the effects (if any) of system level developments in 2015/2016 and the COVID-19 pandemic (2020) on these outcomes. Discussion The findings of this research will be used to understand temporal trends in the care processes and outcomes for OHCA in Ireland over the period 2012-2020. The results can further be used to optimise future health system developments for OHCA in both Ireland and internationally.
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Affiliation(s)
- Tomás Barry
- UCD School of Medicine, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
| | - Alice Kasemiire
- UCD Centre for Support and Training in Analysis and Research, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
| | - Martin Quinn
- Out-of-Hospital Cardiac Arrest Register, National Ambulance Service, Donegal, D24 XNP2, Ireland
| | - Conor Deasy
- School of Medicine, University College Cork, Cork, County Cork, T12 CY82, Ireland
| | - Gerard Bury
- UCD School of Medicine, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Services Executive, Dublin, D24 XNP2, Ireland
| | - Ricardo Segurado
- UCD Centre for Support and Training in Analysis and Research, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
| | - Andrew Murphy
- Discipline of General Practice, University of Galway, Galway, County Galway, H91 TK33, Ireland
| | - Out-of-Hospital Cardiac Arrest Registry Steering Group
- UCD School of Medicine, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
- UCD Centre for Support and Training in Analysis and Research, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Leinster, D04 V1W8, Ireland
- Out-of-Hospital Cardiac Arrest Register, National Ambulance Service, Donegal, D24 XNP2, Ireland
- School of Medicine, University College Cork, Cork, County Cork, T12 CY82, Ireland
- National Ambulance Service, Health Services Executive, Dublin, D24 XNP2, Ireland
- Discipline of General Practice, University of Galway, Galway, County Galway, H91 TK33, Ireland
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Škufca Sterle M, Podbregar M. A Motorcycle Paramedic Increases the Survival Rate of Patients after OHCA. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1708. [PMID: 37893426 PMCID: PMC10608770 DOI: 10.3390/medicina59101708] [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: 08/30/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Despite advancements in modern medicine, the survival rate of patients after out-of-hospital cardiac arrest (OHCA) remains low. The proportion of OHCA patients who could be saved under ideal circumstances is unknown. A significant portion of patients experience cardiac arrest due to irreversible conditions. The survival of patients with reversible causes depends on the prompt initiation of basic life support (BLS) and early defibrillation. In order to increase the chances of survival, the motorcycle paramedic (MP) project was implemented in Ljubljana in 2003. The MP is equipped with an AED. In the case of OHCA with a shockable rhythm, he performs defibrillation before the arrival of the emergency medical team (EMT). The aim of this study was to evaluate whether the MP, by reducing response times to OHCA patients, increases the survival and outcome of these patients compared to the EMT. Materials and Methods: A retrospective analysis of OHCA cases within the area covered by Ljubljana Emergency Medical Service (EMS) was conducted for the period from January 2003 to December 2022. Instances where the MP arrived at the scene before the EMT were considered MP interventions and classified as the MP group; all other interventions were classified as the EMT group. Results: Between January 2003 and December 2022, the EMT performed resuscitation on 3352 patients. In 316 cases, the MP was simultaneously activated and arrived at the scene before the EMT. The response time in the MP group was shorter compared to the EMT group (7.7 ± 4.1 min vs. 9.9 ± 6.5 min, p < 0.001). In 16 patients, return of spontaneous circulation (ROSC) was achieved before the arrival of the EMT. The MP group had a higher ROSC rate, a larger proportion of patients were discharged from the hospital and there were more patients with a good neurological outcome compared to the EMT group (44.3% vs. 36.9%, p = 0.009; 18.7% vs. 13.0%, p = 0.005; 15.9% vs. 10.6%, p = 0.004, respectively). Conclusion: This study has demonstrated that the implementation of the MP into the EMS in Ljubljana has resulted in shorter response times, an increased survival rate and improved neurological outcome for OHCA patients.
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Affiliation(s)
- Mateja Škufca Sterle
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Emergency Care Department, Community Health Center Ljubljana, 1000 Ljubljana, Slovenia
| | - Matej Podbregar
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Intensive Care, General Hospital Celje, 3000 Celje, Slovenia
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Lockhart-Bouron M, Baert V, Leteurtre S, Hubert H, Recher M. Association between out-of-hospital cardiac arrest and survival in paediatric traumatic population: results from the French national registry. Eur J Emerg Med 2023; 30:186-192. [PMID: 37040661 DOI: 10.1097/mej.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Trauma is an important cause of paediatric out-of-hospital cardiac arrest (OHCA) with a high mortality rate. The first aim of this study was to compare the survival rate at day 30 and at hospital discharge following paediatric traumatic and medical OHCA. The second aim was to compare the rates of return of spontaneous circulation and survival rates at hospital admission (Day 0). This multicentre comparative post-hoc study was conducted between July 2011 and February 2022 based on the French National Cardiac Arrest Registry data. All patients aged <18 years with OHCA were included in the study. Patients with traumatic aetiology were matched with those with medical aetiology using propensity score matching. Endpoint was the survival rate at day 30. There were 398 traumatic and 1061 medical OHCAs. Matching yielded 227 pairs. In non-adjusted comparisons, days 0 and 30 survival rates were lower in the traumatic aetiology group than in the medical aetiology group [19.1% vs. 24.0%, odds ratio (OR) 0.75, 95% confidence interval (CI) 0.56-0.99, and 2.0% vs. 4.5%, OR 0.43, 95% CI, 0.20-0.92, respectively]. In adjusted comparisons, day 30 survival rate was lower in the traumatic aetiology group than in the medical aetiology group (2.2% vs. 6.2%, OR 0.36, 95% CI, 0.13-0.99). In this post-hoc analysis, paediatric traumatic OHCA was associated with a lower survival rate than medical cardiac arrest.
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Affiliation(s)
- Marguerite Lockhart-Bouron
- Department of Pediatric Intensive Care, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Univ. Lille
| | - Valentine Baert
- Department of Pediatric Intensive Care, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Univ. Lille
- Department of French National Out-of-Hospital Cardiac Arrest Registry Research Group - Registre électronique des Arrêts Cardiaques, Lille, France
| | - Stéphane Leteurtre
- Department of Pediatric Intensive Care, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Univ. Lille
| | - Hervé Hubert
- Department of Pediatric Intensive Care, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Univ. Lille
- Department of French National Out-of-Hospital Cardiac Arrest Registry Research Group - Registre électronique des Arrêts Cardiaques, Lille, France
| | - Morgan Recher
- Department of Pediatric Intensive Care, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Univ. Lille
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Casarini E, Wolthers SA, Ringgren KB, Blomberg SNF, Christensen HC. AED applied, not recommending defibrillation - A validation study of the new variable AED in the Danish Cardiac Arrest Registry. Resuscitation 2023; 186:109725. [PMID: 36764572 DOI: 10.1016/j.resuscitation.2023.109725] [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: 12/04/2022] [Revised: 01/11/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
AIM This study aimed to design and implement a new variable, the automated external defibrillator (AED) variable, within the Danish Cardiac Arrest Registry. The introduction of the new variable aims to investigate and solve the challenges of reporting out-of-hospital cardiac arrests. METHODS This validation study examined all patients with out-of-hospital cardiac arrest from 2016 to 2019. Their medical records were reviewed to establish a variable for AED. All patients with an AED applied were included, and comparative analyses were carried out. The primary outcome was 30-day survival, and the secondary outcome was the return of spontaneous circulation (ROSC) at any time. RESULTS A total of 1576 cases were included; of those, 747 cases had an AED applied and received a shock, and in 829 cases, an AED was applied without delivering a shock. Most defibrillated patients were witnessed by bystanders n = 541, (72%). They presented a higher number of ROSC (57%) and higher 30-day survival, (35,2%) compared to patients who were not defibrillated. Of this group, only 47% patients were witnessed; 18% survived more than 30 days, p < 0.001. When comparing AED present with no AED present, the AED group were significantly more likely to be witnessed by bystanders and to have cardiopulmonary resuscitation by bystanders. No significant differences were found regarding the initial rhythm between the two groups. 30-day survival rate was 20% in the AED group compared to 14% in the non-AED group, yielding an OR of 1.14 (95% CI 1.20-1.66). CONCLUSION This study highlights the differences between OHCA patients receiving defibrillation and those not receiving defibrillation after AED placement. These differences emphasise the need for uniform reporting of out-of-hospital cardiac arrest. This study showed improvement in the completeness of the registration of OHCA by implementing the AED variable. However, a future effort to improve registration completeness is needed.
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Affiliation(s)
- Eleonora Casarini
- Copenhagen Emergency Medical Services, Telegrafvej 5, 2750 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Signe Amalie Wolthers
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Prehospital Center Region Zealand, Næstved, Denmark.
| | | | - Stig Nikolaj Fasmer Blomberg
- Copenhagen Emergency Medical Services, Telegrafvej 5, 2750 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Telegrafvej 5, 2750 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Does One Size Fit All? External Validation of the rCAST Score to Predict the Hospital Outcomes of Post-Cardiac Arrest Patients Receiving Targeted Temperature Management. J Clin Med 2022; 12:jcm12010242. [PMID: 36615040 PMCID: PMC9821639 DOI: 10.3390/jcm12010242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
The revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) score was proposed to predict neurologic outcomes and mortality among out-of-hospital cardiac arrest (OHCA) patients. However, it has rarely been validated outside Japan. Therefore, this study aimed to investigate this issue. All adult patients admitted to our medical intensive care unit for targeted temperature management (TTM) between July 2015 and July 2021 were enrolled. Their medical records were retrieved, and rCAST scores were calculated. A total of 108 post-cardiac arrest syndrome (PCAS) patients who received TTM were analyzed. According to the rCAST score, 49.1%, 50.0%, and 0.9% of the patients were classified as low, moderate, and high severity, respectively. The areas under the curves for the rCAST score were 0.806 (95% confidence interval [CI]: 0.719-0.876) and 0.794 (95% CI: 0.706-0.866) to predict poor neurologic outcomes and mortality at day 28, respectively. In contrast to the original report, only low-severity patients had favorable neurologic outcomes. The rCAST score showed moderate accuracy in our OHCA patients with PCAS who received TTM to predict poor neurologic outcomes and mortality at day 28.
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Oelrich R, Kjoelbye JS, Rosenkrantz O, Barfod C. Rendezvous between ambulances and prehospital physicians in the Capital Region of Denmark: a descriptive study. Scand J Trauma Resusc Emerg Med 2022; 30:52. [PMID: 36221109 PMCID: PMC9552492 DOI: 10.1186/s13049-022-01040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In a two-tier Emergency Medical Services response system with ambulances and physician-staffed rapid response vehicles, both units are ideally dispatched simultaneously when a physician is needed. However, when advanced resources are dispatched secondarily, a meeting point (rendezvous) is established to reduce time to advanced care. This study aims to assess the extent of rendezvous tasks, patient groups involved and physician contribution when rendezvous is activated between the primary ambulances and rapid response vehicles in the Capital Region of Denmark. METHODS We analysed prehospital electronic patient record data from all rendezvous cases in the Capital Region of Denmark in 2018. Variables included the number of times rendezvous was activated, patient demographics, dispatch criteria, on-scene diagnosis, and prehospital treatment. RESULT Ambulances requested rendezvous 2340 times, corresponding to 1.3% of all ambulance tasks and 10.7% of all rapid response vehicle dispatches. The most frequently used dispatch criterion was unclear problem n = 561 (28.8%), followed by cardiovascular n = 439 (22.5%) and neurological n = 392 (20.1%). The physician contributed with technical skills like medication n = 760 (39.0%) and advanced airway management n = 161 (8.3%), as well as non-technical skills like team leading during advanced life support n = 152 (7.8%) and decision to end futile treatment and death certificate issuance n = 73 (3.7%). CONCLUSION Rendezvous between ambulances and physician-staffed rapid response vehicles was activated in 1.3% of all ambulance cases corresponding to 10.7% of all RRV dispatches in 2018. The three largest patient groups in rendezvous presented cardiovascular, neurological, and respiratory problems. The prehospital physician contributed with technical skills like medication and advanced airway management as well as non-technical skills like team leading during advanced life support and ending futile treatment. The high percentage of dispatch criterion unclear problem illustrates the challenge of precise dispatch and optimal use of prehospital resources. Therefore, it seems necessary to have a safe and rapid rendezvous procedure to cope with this uncertainty.
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Affiliation(s)
- Roselil Oelrich
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark.
| | - Julie Samsoee Kjoelbye
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Oscar Rosenkrantz
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark
| | - Charlotte Barfod
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Dankert A, Kraxner J, Breitfeld P, Bopp C, Issleib M, Doehn C, Bathe J, Krause L, Zöllner C, Petzoldt M. Is Prehospital Assessment of qSOFA Parameters Associated with Earlier Targeted Sepsis Therapy? A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11123501. [PMID: 35743570 PMCID: PMC9224632 DOI: 10.3390/jcm11123501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND This study aimed to determine whether prehospital qSOFA (quick sequential organ failure assessment) assessment was associated with a shortened 'time to antibiotics' and 'time to intravenous fluid resuscitation' compared with standard assessment. METHODS This retrospective study included patients who were referred to our Emergency Department between 2014 and 2018 by emergency medical services, in whom sepsis was diagnosed during hospitalization. Two multivariable regression models were fitted, with and without qSOFA parameters, for 'time to antibiotics' (primary endpoint) and 'time to intravenous fluid resuscitation'. RESULTS In total, 702 patients were included. Multiple linear regression analysis showed that antibiotics and intravenous fluids were initiated earlier if infections were suspected and emergency medical services involved emergency physicians. A heart rate above 90/min was associated with a shortened time to antibiotics. If qSOFA parameters were added to the models, a respiratory rate ≥ 22/min and altered mentation were independent predictors for earlier antibiotics. A systolic blood pressure ≤ 100 mmHg and altered mentation were independent predictors for earlier fluids. When qSOFA parameters were added, the explained variability of the model increased by 24% and 38%, respectively (adjusted R² 0.106 versus 0.131 for antibiotics and 0.117 versus 0.162 for fluids). CONCLUSION Prehospital assessment of qSOFA parameters was associated with a shortened time to a targeted sepsis therapy.
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Affiliation(s)
- André Dankert
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
- Correspondence:
| | - Jochen Kraxner
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Philipp Breitfeld
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Clemens Bopp
- Department of Anesthesiology and Intensive Care Medicine, German Military Hospital Hamburg, Lesserstrasse 180, 22049 Hamburg, Germany;
| | - Malte Issleib
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Christoph Doehn
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Janina Bathe
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany;
| | - Christian Zöllner
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Martin Petzoldt
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
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Gamberini L, Tartivita CN, Guarnera M, Allegri D, Baroncini S, Scquizzato T, Tartaglione M, Alberto Mazzoli C, Chiarini V, Picoco C, Coniglio C, Semeraro F, Gordini G. External validation and insights about the calibration of the return of spontaneous circulation after cardiac arrest (RACA) score. Resusc Plus 2022; 10:100225. [PMID: 35403069 PMCID: PMC8983431 DOI: 10.1016/j.resplu.2022.100225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/12/2022] [Accepted: 03/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background The return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score was developed as a tool to predict ROSC probability (pROSC) based on easily available information and it could be useful to compare the performances of different EMS agencies or the effects of eventual interventions. We performed an external validation of the RACA score in a cohort of out of hospital cardiac arrest (OHCA) patients managed by the EMS of the metropolitan city of Bologna, Italy. Methods We analyzed data from 2,310 OHCA events prospectively collected between January 2009 and June 2021. Discrimination was assessed with the area under the ROC curve (AUROC), while the calibration belts were used for the comparison of observed versus expected ROSC rates. The AUROCs from our cohort and other validation cohorts were compared using a studentized range test. Results The AUROC for the study population was 0.691, comparable to that described by previous validation studies. Despite an acceptable overall calibration, we found a poor calibration for asystole and low pROSC ranges in PEA and shockable rhythms. The model showed a good calibration for patients aged over 80, while no differences in performance were found when evaluating events before and after the implementation of 2015 ERC guidelines. Conclusions Despite AUROC values being similar in different validation studies for RACA score, we suggest separating the different rhythms when assessing ROSC probability with the RACA score, especially for asystole.
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Schriefl C, Schoergenhofer C, Buchtele N, Mueller M, Poppe M, Clodi C, Ettl F, Merrelaar A, Boegl MS, Steininger P, Holzer M, Herkner H, Schwameis M. Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest. J Pers Med 2022; 12:jpm12060876. [PMID: 35743661 PMCID: PMC9225634 DOI: 10.3390/jpm12060876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The clinical value of a prognostic score depends on its out-of-sample validity because inaccurate outcome prediction can be not only useless but potentially fatal. We aimed to evaluate the out-of-sample validity of a recently developed and highly accurate Korean prognostic score for predicting neurologic outcome after cardiac arrest in an independent, plausibly related sample of European cardiac arrest survivors. Methods: Analysis of data from a European cardiac arrest center, certified in compliance with the specifications of the German Council for Resuscitation. The study sample included adults with nontraumatic out-of-hospital cardiac arrest admitted between 2013 and 2018. Exposure was the PROgnostication using LOGistic regression model for Unselected adult cardiac arrest patients in the Early stages (PROLOGUE) score, including 12 clinical variables readily available at hospital admission. The outcome was poor 30-day neurologic function, as assessed using the cerebral performance category scale. The risk of a poor outcome was calculated using the PROLOGUE score regression equation. Predicted risk deciles were compared to observed outcome estimates in a complete-case analysis, a best-case analysis, and a multiple-data-imputation analysis using the Markov chain Monte Carlo method. Results: A total of 1051 patients (median 61 years, IQR 50–71; 29% female) were analyzed. A total of 808 patients (77%) were included in the complete-case analysis. The PROLOGUE score overestimated the risk of poor neurologic outcomes in the range of 40% to 100% predicted risk, involving 63% of patients. The model fit did not improve after missing data imputation. Conclusions: In a plausibly related sample of European cardiac arrest survivors, risk prediction by the PROLOGUE score was largely too pessimistic and failed to replicate the high accuracy found in the original study. Using the PROLOGUE score as an example, this study highlights the compelling need for independent validation of a proposed prognostic score to prevent potentially fatal mispredictions.
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Affiliation(s)
- Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | | | - Nina Buchtele
- Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Anne Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Magdalena Sophie Boegl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Philipp Steininger
- Emergency Department, Clinic Hietzing, Vienna Healthcare Group, 1130 Vienna, Austria;
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
- Correspondence:
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
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Non-Invasive Ventilation as a Therapy Option for Acute Exacerbations of Chronic Obstructive Pulmonary Disease and Acute Cardiopulmonary Oedema in Emergency Medical Services. J Clin Med 2022; 11:jcm11092504. [PMID: 35566628 PMCID: PMC9102097 DOI: 10.3390/jcm11092504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
In this observational prospective multicenter study conducted between October 2016 and October 2018, we tested the hypothesis that the use of prehospital non-invasive ventilation (phNIV) to treat patients with acute respiratory insufficiency (ARI) caused by severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and acute cardiopulmonary oedema (ACPE) is effective, time-efficient and safe. The data were collected at four different physician response units and three admitting hospitals in a German EMS system. Patients with respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease and acute cardiopulmonary oedema were enrolled. A total of 545 patients were eligible for the final analysis. Patients were treated with oxygen supplementation, non-invasive ventilation or invasive mechanical ventilation. The primary outcomes were defined as changes in the clinical parameters and the in-hospital course. The secondary outcomes included time efficiency, peri-interventional complications, treatment failure rate, and side-effects. Oxygenation under phNIV improved equally to endotracheal intubation (ETI), and more effectively in comparison to standard oxygen therapy (SOT) (paO2 SOT vs. non-invasive ventilation (NIV) vs. ETI: 82 mmHg vs. 125 mmHg vs. 135 mmHg, p-value SOT vs. NIV < 0.0001). In a matched subgroup analysis phNIV was accompanied by a reduced time of mechanical ventilation (phNIV: 1.8 d vs. ETI: 4.2 d) and a shortened length of stay at the intensive care unit (3.4 d vs. 5.8 d). The data support the hypothesis that the treatment of severe AECOPD/ACPE-induced ARI using prehospital NIV is effective, time efficient and safe. Compared to ETI, a matched comparison supports the hypothesis that prehospital implementation of NIV may provide benefits for an in-hospital course.
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Tjelmeland IBM, Alm-Kruse K, Grasner JT, Isern CB, Jakisch B, Kramer-Johansen J, Renzing N, Wnent J, Seewald S. Importance of reporting survival as incidence: a cross-sectional comparative study on out-of-hospital cardiac arrest registry data from Germany and Norway. BMJ Open 2022; 12:e058381. [PMID: 35177465 PMCID: PMC8860078 DOI: 10.1136/bmjopen-2021-058381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Health registries are a unique source of information about current practice and can describe disease burden in a population. We aimed to understand similarities and differences in the German Resuscitation Registry (GRR) and the Norwegian Cardiac Arrest Registry (NorCAR) and compare incidence and survival for patients resuscitated after out-of-hospital cardiac arrest. DESIGN A cross-sectional comparative analysis reporting incidence and outcome on a population level. SETTING We included data from the cardiac arrest registries in Germany and Norway. PARTICIPANTS Patients resuscitated between 1 January 2015 and 31 December 2019 were included, resulting in 29 222 cases from GRR and 16 406 cases from NorCAR. From GRR, only emergency medical services (EMS) reporting survival information for patients admitted to the hospital were included. PRIMARY AND SECONDARY OUTCOME MEASURES This study focused on the EMS systems, the registries and the patients included in both registries. The results compare the total incidence, incidence of patients resuscitated by EMS, and the incidence of survival. RESULTS We found an incidence of 68 per 100 000 inhabitants in GRR and 63 in NorCAR. The incidence of patients treated by EMS was 67 in GRR and 53 in NorCAR. The incidence of patients arriving at a hospital was higher in GRR (24.3) than in NorCAR (15.1), but survival was similar (8 in GRR and 7.8 in NorCAR). CONCLUSION GRR is a voluntary registry, and in-hospital information is not reported for all cases. NorCAR has mandatory reporting from all EMS and hospitals. EMS in Germany starts treatment on more patients and bring a higher number to hospital, but we found no difference in the incidence of survival. This study has improved our knowledge of both registries and highlighted the importance of reporting survival as incidence when comparing registries.
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Affiliation(s)
- Ingvild Beathe Myrhaugen Tjelmeland
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin Alm-Kruse
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Jan-Thorsten Grasner
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Cecilie Benedicte Isern
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Barbara Jakisch
- Organization & Corporate Development, imland gGmbH, Rendsburg, Schleswig-Holstein, Germany
| | - Jo Kramer-Johansen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Niels Renzing
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- University of Namibia School of Medicine, Windhoek, Namibia
| | - Stephan Seewald
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Randomized Comparison of Two New Methods for Chest Compressions during CPR in Microgravity-A Manikin Study. J Clin Med 2022; 11:jcm11030646. [PMID: 35160097 PMCID: PMC8836939 DOI: 10.3390/jcm11030646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/17/2022] Open
Abstract
Background: Although there have been no reported cardiac arrests in space to date, the risk of severe medical events occurring during long-duration spaceflights is a major concern. These critical events can endanger both the crew as well as the mission and include cardiac arrest, which would require cardiopulmonary resuscitation (CPR). Thus far, five methods to perform CPR in microgravity have been proposed. However, each method seems insufficient to some extent and not applicable at all locations in a spacecraft. The aim of the present study is to describe and gather data for two new CPR methods in microgravity. Materials and Methods: A randomized, controlled trial (RCT) compared two new methods for CPR in a free-floating underwater setting. Paramedics performed chest compressions on a manikin (Ambu Man, Ambu, Germany) using two new methods for a free-floating position in a parallel-group design. The first method (Schmitz–Hinkelbein method) is similar to conventional CPR on earth, with the patient in a supine position lying on the operator’s knees for stabilization. The second method (Cologne method) is similar to the first, but chest compressions are conducted with one elbow while the other hand stabilizes the head. The main outcome parameters included the total number of chest compressions (n) during 1 min of CPR (compression rate), the rate of correct chest compressions (%), and no-flow time (s). The study was registered on clinicaltrials.gov (NCT04354883). Results: Fifteen volunteers (age 31.0 ± 8.8 years, height 180.3 ± 7.5 cm, and weight 84.1 ± 13.2 kg) participated in this study. Compared to the Cologne method, the Schmitz–Hinkelbein method showed superiority in compression rates (100.5 ± 14.4 compressions/min), correct compression depth (65 ± 23%), and overall high rates of correct thoracic release after compression (66% high, 20% moderate, and 13% low). The Cologne method showed correct depth rates (28 ± 27%) but was associated with a lower mean compression rate (73.9 ± 25.5/min) and with lower rates of correct thoracic release (20% high, 7% moderate, and 73% low). Conclusions: Both methods are feasible without any equipment and could enable immediate CPR during cardiac arrest in microgravity, even in a single-helper scenario. The Schmitz–Hinkelbein method appears superior and could allow the delivery of high-quality CPR immediately after cardiac arrest with sufficient quality.
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Bray J, Howell S, Ball S, Doan T, Bosley E, Smith K, Dicker B, Faddy S, Thorrowgood M, Swain A, Thomas A, Wilson A, Shipp C, Walker T, Bailey P, Finn J. The epidemiology of out-of-hospital cardiac arrest in Australia and New Zealand: A binational report from the Australasian Resuscitation Outcomes Consortium (Aus-ROC). Resuscitation 2022; 172:74-83. [PMID: 35077857 DOI: 10.1016/j.resuscitation.2022.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/04/2022] [Accepted: 01/15/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Australasian Resuscitation Outcomes Consortium (Aus-ROC) out-of-hospital cardiac arrest (OHCA) Epistry (Epidemiological Registry) now covers 100% of Australia and New Zealand (NZ). This study reports and compares the Utstein demographics, arrest characteristics and outcomes of OHCA patients across our region. METHODS We included all OHCA cases throughout 2019 as submitted to the Epistry by the eight Australian and two NZ emergency medical services (EMS). We calculated crude and age-standardised incidence rates and performed a national and EMS regional comparison. RESULTS We obtained data for 31,778 OHCA cases for 2019: 26,637 in Australia and 5,141 in NZ. Crude incidence was 107.9 per 100,000 person-years in Australia and 103.2/100,000 in NZ. Overall, the majority of OHCAs occurred in adults (96%), males (66%), private residences (76%), were unwitnessed (63%), of presumed medical aetiology (83%), and had an initial monitored rhythm of asystole (64%). In non-EMS-witnessed cases, 38% received bystander CPR and 2% received public defibrillation. Wide variation was seen between EMS regions for all OHCA demographics, arrest characteristics and outcomes. In patients who received an EMS-attempted resuscitation (13,664/31,778): 28% (range across EMS=13.1% to 36.7%) had return of spontaneous circulation (ROSC) at hospital arrival and 13% (range across EMS=9.9% to 20.7%) survived to hospital discharge/30-days. Survival in the Utstein comparator group (bystander-witnessed in shockable rhythm) varied across the EMS regions between 27.4% to 42.0%. CONCLUSION OHCA across Australia and NZ has varied incidence, characteristics and survival. Understanding the variation in survival and modifiable predictors is key to informing strategies to improve outcomes.
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Affiliation(s)
- Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Western Australia, Australia.
| | - Stuart Howell
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Western Australia, Australia; St John Western Australia, Western Australia, Australia
| | - Tan Doan
- Queensland Ambulance Service, Queensland, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Queensland, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| | - Bridget Dicker
- St John New Zealand, Auckland, New Zealand; Auckland University of Technology, Auckland, New Zealand
| | | | | | - Andy Swain
- Wellington Free Ambulance, Wellington, New Zealand
| | | | | | | | | | - Paul Bailey
- St John Western Australia, Western Australia, Australia
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Western Australia, Australia; St John Western Australia, Western Australia, Australia
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20
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To ventilate or not to ventilate during bystander CPR - A EuReCa TWO analysis. Resuscitation 2021; 166:101-109. [PMID: 34146622 DOI: 10.1016/j.resuscitation.2021.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/25/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). METHOD In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. RESULTS A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17-1.83). CONCLUSION In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both.
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Lippert F, Moore F. Measure to improve - and more to be done. Resuscitation 2021; 163:184-185. [PMID: 33887402 DOI: 10.1016/j.resuscitation.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Freddy Lippert
- Copenhagen Emergency Medical Services and University of Copenhagen, Denmark.
| | - Fionna Moore
- South East Cost Ambulance Service NHS Foundation Trust, United Kingdom
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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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Bylow H, Rawshani A, Claesson A, Lepp M, Herlitz J. Characteristics and outcome after out-of-hospital cardiac arrest with the emphasis on workplaces: an observational study from the Swedish Registry of Cardiopulmonary Resuscitation. Resusc Plus 2021; 5:100090. [PMID: 34223355 PMCID: PMC8244450 DOI: 10.1016/j.resplu.2021.100090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/17/2020] [Accepted: 01/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background Characteristics and outcome in out-of-hospital cardiac arrest (OHCA) occurring at workplaces is sparsely studied. Aim To describe (1) the characteristics and 30-day survival of OHCAs occurring at workplaces in comparison to OHCAs at other places and (2) factors associated with survival after OHCAs at workplaces. Methods Data on OHCAs were obtained from the Swedish Registry of Cardiopulmonary Resuscitation from 1 January 2008 to 31 December 2018. Characteristics and factors associated with survival were analysed with emphasis on the location of OHCAs. Results Among 47,685 OHCAs, 529 cases (1%) occurred at workplaces. Overall, in the fully adjusted model, all locations of OHCA, with the exception of crowded public places, displayed significantly lower probability of survival than workplaces. Exhibiting a shockable rhythm was the strongest predictor of survival among patients with OHCAs at workplaces; odds ratio (95% CI) 5.80 (2.92-12.31). Odds ratio for survival for women was 2.08 (95% CI 1.07-4.03), compared with men. At workplaces other than private offices, odds ratio for survival was 0.41 (95% CI 0.16-0.95) for cases who did not receive bystander CPR, as compared to those who did receive CPR. Among patients who were found in a shockable rhythm were 23% defibrillated before arrival of ambulance, which was more frequent than in any other location. Conclusion Out-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital. An initial shockable cardiac rhythm was the strongest predictor of survival for OHCA at workplaces.
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Affiliation(s)
- Helene Bylow
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Corresponding author.
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Claesson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, Stockholm, Sweden
| | - Margret Lepp
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Østfold University College, Halden, Norway
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre of Registers Västra Götaland, Gothenburg, Sweden
- Prehospen-Centre of Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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