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Wnent J, Gräsner JT, Fischer M, Ramshorn-Zimmer A, Bohn A, Bein B, Seewald S. The German Resuscitation Registry - Epidemiological data for out-of-hospital and in-hospital cardiac arrest. Resusc Plus 2024; 18:100638. [PMID: 38646091 PMCID: PMC11031786 DOI: 10.1016/j.resplu.2024.100638] [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: 04/23/2024] Open
Abstract
Introduction The German Resuscitation Registry was started in 2007 and collects data on out-of-hospital as well as in-hospital cardiac arrest and resuscitation. It has collected more than 400.000 datasets till today. Methods The German Resuscitation Registry (GRR) is a voluntary quality improvement tool and research tool for out-of-hospital and in-hospital resuscitation as well as in-hospital emergency treatment. It collects data for initial treatment, in-hospital care as well as long-term outcome in an online database. For risk stratification two scores have been developed, published, and implemented. The participants are getting annual and monthly or quarterly reports in addition to the standardized online, 24/7 available analyzing options. An annual public report is published as well. We are reporting on the OHCA annual report of 2022. Results In 2022 the incidence of CPR started or continued by EMS was 77.6/100.000 inhabitants/year. The mean age was 70.2 years and 66.7% were male bystanders who started CPR in 51.3%. The average response time for the first EMS vehicle to arrive on scene was 6:55 min.In 57.9% of the cases, they had a presumed cardiac cause. The primary outcome, return-of-spontaneous circulation (ROSC) was achieved in 42.1%. Discussion With its more than 450.000 included datasets, the GRR is an established tool for quality improvement and research in Germany and internationally. The results for the incidence of OHCA and outcome from 2022 are compared to EuReCa TWO data ranging in the upper third of European countries. Furthermore, the GRR has contributed to increasing knowledge of OHCA by conducting and publishing research e.g. on epidemiology, airway management, and medication of OHCA.
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Affiliation(s)
- Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Fischer
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany
| | - Alexandra Ramshorn-Zimmer
- Division for Medical Management, Department for clinical process management, University Hospital Leipzig, Germany
| | - Andreas Bohn
- City of Munster Fire Department, Munster, Germany
- University Hospital Münster, Department of Anesthesiology, Intensive Care and Pain Medicine, Munster, Germany
| | - Berthold Bein
- Department of Anaesthesiology and Intensive Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
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Primi R, Bendotti S, Currao A, Sechi GM, Marconi G, Pamploni G, Panni G, Sgotti D, Zorzi E, Cazzaniga M, Piccolo U, Bussi D, Ruggeri S, Facchin F, Soffiato E, Ronchi V, Contri E, Centineo P, Reali F, Sfolcini L, Gentile FR, Baldi E, Compagnoni S, Quilico F, Vicini Scajola L, Lopiano C, Fasolino A, Savastano S. Use of Mechanical Chest Compression for Resuscitation in Out-Of-Hospital Cardiac Arrest-Device Matters: A Propensity-Score-Based Match Analysis. J Clin Med 2023; 12:4429. [PMID: 37445464 DOI: 10.3390/jcm12134429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Devices for mechanical cardiopulmonary resuscitation (CPR) are recommended when high quality CPR cannot be provided. Different devices are available, but the literature is poor in direct comparison studies. Our aim was to assess whether the type of mechanical chest compressor could affect the probability of return of spontaneous circulation (ROSC) and 30-day survival in Out-of-Hospital Cardiac Arrest (OHCA) patients as compared to manual standard CPR. METHODS We considered all OHCAs that occurred from 1 January 2015 to 31 December 2022 in seven provinces of the Lombardy region equipped with three different types of mechanical compressor: Autopulse®(ZOLL Medical, MA), LUCAS® (Stryker, MI), and Easy Pulse® (Schiller, Switzerland). RESULTS Two groups, 2146 patients each (manual and mechanical CPR), were identified by propensity-score-based random matching. The rates of ROSC (15% vs. 23%, p < 0.001) and 30-day survival (6% vs. 14%, p < 0.001) were lower in the mechanical CPR group. After correction for confounders, Autopulse® [OR 2.1, 95%CI (1.6-2.8), p < 0.001] and LUCAS® [OR 2.5, 95%CI (1.7-3.6), p < 0.001] significantly increased the probability of ROSC, and Autopulse® significantly increased the probability of 30-day survival compared to manual CPR [HR 0.9, 95%CI (0.8-0.9), p = 0.005]. CONCLUSION Mechanical chest compressors could increase the rate of ROSC, especially in case of prolonged resuscitation. The devices were dissimilar, and their different performances could significantly influence patient outcomes. The load-distributing-band device was the only mechanical chest able to favorably affect 30-day survival.
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Affiliation(s)
- Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, 27100 Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Gianluca Marconi
- Agenzia Regionale dell'Emergenza Urgenza (AREU) Lombardia, 20124 Milan, Italy
| | - Greta Pamploni
- AAT Pavia-Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gianluca Panni
- AAT Brescia-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Degli Spedali Civili di Brescia, 25100 Brescia, Italy
| | - Davide Sgotti
- AAT Brescia-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Degli Spedali Civili di Brescia, 25100 Brescia, Italy
| | - Ettore Zorzi
- AAT Como-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Lariana (CO), 22079 Como, Italy
| | - Marco Cazzaniga
- AAT Como-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Lariana (CO), 22079 Como, Italy
| | - Umberto Piccolo
- AAT Como-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Lariana (CO), 22079 Como, Italy
| | - Daniele Bussi
- AAT Cremona-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, 26100 Cremona, Italy
| | - Simone Ruggeri
- AAT Cremona-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, 26100 Cremona, Italy
| | - Fabio Facchin
- AAT Mantova-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantova, 46100 Mantova, Italy
| | - Edoardo Soffiato
- AAT Mantova-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantova, 46100 Mantova, Italy
| | - Vincenza Ronchi
- AAT Pavia-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Pavia, 27100 Pavia, Italy
| | - Enrico Contri
- AAT Pavia-Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paola Centineo
- AAT Varese-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST dei Sette Laghi, 21100 Varese, Italy
| | - Francesca Reali
- AAT Lodi-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Lodi, 26900 Lodi, Italy
| | - Luigi Sfolcini
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Federico Quilico
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Luca Vicini Scajola
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Clara Lopiano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Alessandro Fasolino
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Advanced and Invasive Cardiopulmonary Resuscitation (CPR) Techniques as an Adjunct to Advanced Cardiac Life Support. J Clin Med 2022; 11:jcm11247315. [PMID: 36555932 PMCID: PMC9781548 DOI: 10.3390/jcm11247315] [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: 10/15/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite numerous promising innovations, the chance of survival from sudden cardiac arrest has remained virtually unchanged for decades. Recently, technological advances have been made, user-friendly portable devices have been developed, and advanced invasive procedures have been described that could improve this unsatisfactory situation. METHODS A selective literature search in the core databases with a focus on randomized controlled trials and guidelines. RESULTS Technical aids, such as feedback systems or automated mechanical cardiopulmonary resuscitation (CPR) devices, can improve chest compression quality. The latter, as well as extracorporeal CPR, might serve as a bridge to treatment (with extracorporeal CPR even as a bridge to recovery). Sonography may be used to improve thoracic compressions on the one hand and to rule out potentially reversible causes of cardiac arrest on the other. Resuscitative endovascular balloon occlusion of the aorta might enhance myocardial and cerebral perfusion. Minithoracostomy, pericardiocentesis, or clamshell thoracotomy might resolve reversible causes of cardiac arrest. CONCLUSIONS It is crucial to identify those patients who may benefit from an advanced or invasive procedure and make the decision to implement the intervention in a timely manner. As with all infrequently performed procedures, sound education and regular training are paramount.
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Yurtsever G, Yamanoglu A, Bora ES, Topal FE. A rare complication of cardiopulmonary resuscitation applied during transportation by ambulance: A case report of flail chest. Turk J Emerg Med 2022; 22:159-162. [PMID: 35936949 PMCID: PMC9355074 DOI: 10.4103/2452-2473.348437] [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: 12/01/2021] [Revised: 01/29/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022] Open
Abstract
Cardiopulmonary resuscitation (CPR) to be applied during patient transfer by ambulance differs from CPR applied in the field or in the hospital in terms of physical condition. Especially the deeper and faster chest compressions recommended in the latest CPR guidelines, when administered during ambulance transport, may result in a further increase in traumatic CPR complications. However, in the current CPR guidelines, there are no clear recommendations regarding additional measures that can be taken to reduce the complications and increase the efficiency of CPR during patient transport. In this study, a case of flail chest that developed after short-term CPR application during ambulance transport is presented. The aim of this study was to evaluate the flail chest complication and solution suggestions that may occur due to chest compressions applied during transportation.
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Affiliation(s)
- Güner Yurtsever
- Department of Emergency Medicine, Izmir Kâtip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Adnan Yamanoglu
- Department of Emergency Medicine, Izmir Kâtip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ejder Saylav Bora
- Department of Emergency Medicine, Izmir Kâtip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Fatih Esad Topal
- Department of Emergency Medicine, Izmir Kâtip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
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Gässler H, Kurka L, Rauch S, Seewald S, Kulla M, Fischer M. Mechanical chest compression devices under special circumstances. Resuscitation 2022; 179:183-188. [PMID: 35738309 DOI: 10.1016/j.resuscitation.2022.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
AIM According to the current resuscitation guidelines, the use of mechanical chest compression devices could be considered under special circumstances like transport with ongoing resuscitation or long-term resuscitation. The aim of this study was to investigate whether survival is improved using mechanical devices under such circumstances. METHODS Out-of-hospital cardiac arrests from all high-quality data centres of the German Resuscitation Registry from 2007 to 2020 were investigated. The use of mechanical devices was compared separately for transport with ongoing resuscitation, prolonged resuscitation (>45 min), and resuscitation with fibrinolytic agents applied. Baseline characteristics, 30-day survival/discharged alive, and neurological function at discharge were analysed descriptively; and 30-day survival/discharged alive was additionally analysed using multivariate logistic regression. RESULTS Overall, patients who were treated with a mechanical device tended to be younger and were significantly more likely to have a witnessed cardiac arrest and a shockable initial rhythm. During the study period, 4,851 patients were transported to hospital with ongoing resuscitation (devices used in 44.2%). The 30-day survival was equal (odds ratio, OR: 1.13, 95%-CI: 0.79-1.60). In 3,920 cases, a resuscitation duration > 45 min was documented (9.5% with device). When a device was used, 30-day survival was significantly increased (OR 2.33, 95%-CI: 1.30-4.15). Fibrinolytic agents were used in 2,106 patients (22.2% with device). Here, 30-day survival was significantly worse with a device (OR: 0.52, 95%-CI: 0.30-0.91). CONCLUSION Mechanical devices are not associated with better survival when used during transport, but rescuer safety could still be an important argument for their use. Devices are associated with better survival in prolonged resuscitation, but worse survival when a fibrinolytic was used.
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Affiliation(s)
- Holger Gässler
- German Armed Forces Hospital Ulm, Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ulm, Germany.
| | - Lara Kurka
- Alb-Fils-Kliniken, Department of Anaesthesiology & Intensive Care Medicine, Göppingen, Germany
| | - Stefan Rauch
- Alb-Fils-Kliniken, Department of Anaesthesiology & Intensive Care Medicine, Göppingen, Germany
| | - Stephan Seewald
- University Hospital Schleswig-Holstein, Department of Anaesthesiology & Intensive Care Medicine and Institute for Emergency Medicine, Kiel, Germany
| | - Martin Kulla
- German Armed Forces Hospital Ulm, Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ulm, Germany
| | - Matthias Fischer
- Alb-Fils-Kliniken, Department of Anaesthesiology & Intensive Care Medicine, Göppingen, Germany
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Schwaiger D, Zanvettor A, Neumayr A, Baubin M. [Add-on-LUCAS2™ resuscitation at NEF Innsbruck]. Anaesthesist 2022; 71:750-757. [PMID: 35389080 PMCID: PMC9525372 DOI: 10.1007/s00101-022-01112-z] [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: 08/11/2021] [Revised: 02/02/2022] [Accepted: 02/24/2022] [Indexed: 11/07/2022]
Abstract
Studienziel Ziele sind die Verlaufsanalyse und der Vergleich mit ausschließlich manuell reanimierten Patienten sowie die Erfassung der Einflussfaktoren bei Patienten, bei denen die mechanische Thoraxkompressionshilfe Lund University Cardiac Assist System (LUCAS2TM) als Add-on-Therapie am Notarzteinsatzfahrzeug (NEF) Innsbruck verwendet wurde. Material und Methodik Retrospektive Verlaufsdatenanalyse von Patienten im Studienzeitraum 01.01.2014 bis 31.12.2019 des NEF Innsbruck aus dem Deutschen Reanimationsregister (GRR), bei denen LUCAS2™ nach notärztlicher Anordnung als Add-on-Therapie verwendet wurde. Ergebnis Bei 653 Reanimationen kam es zu 123 Add-on-LUCAS2™-Anwendungen (18,8 %). Von allen Patienten überlebten 16,2 % die ersten 30 Tage. Mithilfe der Add-on-LUCAS2TM Anwendung überlebten 7,3 % (9/123) aller Add-on-LUCAS2™-Reanimationen bzw. 1,4 % (n = 9) aller CPRs. Bei 8/9 Add-On-LUCAS2™-„30 Tage-Überlebenden“ war der Herz-Kreislauf-Stillstand (HKS) beobachtet, und eine Laien-CPR wurde durchgeführt. Als Primärrhythmus wiesen 8/9 Kammerflimmern auf. Im Vergleich zur ausschließlich manuellen CPR wurde eine Add-on-LUCAS2™-Reanimation hoch signifikant (p < 0,001) häufiger bei jüngeren, bei männlichen Patienten, in der Öffentlichkeit, bei schockbarem Erstrhythmus und beim Transport eingesetzt sowie signifikant häufiger bei beobachteten HKS (p < 0,05). Die 30-Tage-Mortalität bei additiver Lysetherapie betrug 100 %. Diskussion Durch die Verwendung der Add-on-LUCAS2™-CPR kann eine prozentuelle Erhöhung der Überlebensrate erzielt werden und erscheint somit vorteilhaft (1,4 % in dieser Studie). Durch diese kann bei Patienten mit günstigen Prognosefaktoren eine hochwertige HDM auch bei technisch aufwendiger Bergung (Drehleiter, Stiegenhaus, Transport im RTW) durchgeführt und somit ein Transport ermöglicht werden. Jedoch kommt es dabei zu einer höheren Aufnahmerate unter CPR und somit zur Verlagerung der Therapiezielentscheidung in den Schockraum.
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Affiliation(s)
- D Schwaiger
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
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Chiang CY, Lim KC, Lai PC, Tsai TY, Huang YT, Tsai MJ. Comparison between Prehospital Mechanical Cardiopulmonary Resuscitation (CPR) Devices and Manual CPR for Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis. J Clin Med 2022; 11:1448. [PMID: 35268537 PMCID: PMC8911115 DOI: 10.3390/jcm11051448] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
In pre-hospital settings, efficient cardiopulmonary resuscitation (CPR) is challenging; therefore, the application of mechanical CPR devices continues to increase. However, the evidence of the benefits of using mechanical CPR devices in pre-hospital settings for adult out-of-hospital cardiac arrest (OHCA) is controversial. This meta-analysis compared the effects of mechanical and manual CPR applied in the pre-hospital stage on clinical outcomes after OHCA. Cochrane Library, PubMed, Embase, and ClinicalTrials.gov were searched from inception until October 2021. Studies comparing mechanical and manual CPR applied in the pre-hospital stage for survival outcomes of adult OHCA were eligible. Data abstraction, quality assessment, meta-analysis, trial sequential analysis (TSA), and grading of recommendations, assessment, development, and evaluation were conducted. Seven randomized controlled and 15 observational studies were included. Compared to manual CPR, pre-hospital use of mechanical CPR showed a positive effect in achieving return of spontaneous circulation (ROSC) and survival to admission. No difference was found in survival to discharge and discharge with favorable neurological status, with inconclusive results in TSA. In conclusion, pre-hospital use of mechanical CPR devices may benefit adult OHCA in achieving ROSC and survival to admission. With low certainty of evidence, more well-designed large-scale randomized controlled trials are needed to validate these findings.
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Affiliation(s)
- Cheng-Ying Chiang
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan; (C.-Y.C.); (K.-C.L.)
| | - Ket-Cheong Lim
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan; (C.-Y.C.); (K.-C.L.)
| | - Pei Chun Lai
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Tou-Yuan Tsai
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan;
- Department of Emergency Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi City 622, Taiwan
| | - Yen Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan; (C.-Y.C.); (K.-C.L.)
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Safety of mechanical and manual chest compressions in cardiac arrest patients: A systematic review and meta-analysis. Resuscitation 2021; 169:124-135. [PMID: 34699924 DOI: 10.1016/j.resuscitation.2021.10.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 12/24/2022]
Abstract
AIM Summarise the evidence regarding the safety of mechanical and manual chest compressions for cardiac arrest patients. METHODS Two investigators separately screened the articles of EMBASE, PubMed, and Cochrane Central databases. Cohort studies and randomized clinical trials (RCTs) that evaluated the safety of mechanical (LUCAS or AutoPulse) and manual chest compressions in cardiac arrest patients were included. A meta-analysis was performed using a random effects model to calculate the pooled odds ratios (ORs) and their 95% confidence intervals (CIs). The primary outcome was the rate of overall compression-induced injuries. The secondary outcomes included the incidence of life-threatening injuries, skeletal fractures, visceral injuries, and other soft tissue injuries. RESULTS The meta-analysis included 11 trials involving 2,818 patients. A significantly higher rate of overall compression-induced injuries was found for mechanical compressions than manual compressions (OR, 1.29; 95% CI, 1.19-1.41), while there was no significant difference between the two groups in respect of the rate of life-threatening injuries. Furthermore, both modalities shared similar incidences of sternal fractures, vertebral fractures, lung, spleen, and kidney injuries. However, compared to mechanical compressions, manual compressions were shown to present a reduced risk of posterior rib fractures, and heart and liver lesions. CONCLUSIONS The findings suggested that manual compressions could decrease the risk of compression-induced injuries compared to mechanical compressions in cardiac arrest patients. Interestingly, mechanical compressions have not increased the risk of life-threatening injuries, whereas additional high-quality RCTs are needed to further verify the safety of mechanical chest devices. TRIAL REGISTRY INPLASY; Registration number: INPLASY2020110111; URL: https://inplasy.com/.
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Effect of Temporal Difference on Clinical Outcomes of Patients with Out-of-Hospital Cardiac Arrest: A Retrospective Study from an Urban City of Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111020. [PMID: 34769541 PMCID: PMC8582961 DOI: 10.3390/ijerph182111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022]
Abstract
Circadian pattern influence on the incidence of out-of-hospital cardiac arrest (OHCA) has been demonstrated. However, the effect of temporal difference on the clinical outcomes of OHCA remains inconclusive. Therefore, we conducted a retrospective study in an urban city of Taiwan between January 2018 and December 2020 in order to investigate the relationship between temporal differences and the return of spontaneous circulation (ROSC), sustained (≥24 h) ROSC, and survival to discharge in patients with OHCA. Of the 842 patients with OHCA, 371 occurred in the daytime, 250 in the evening, and 221 at night. During nighttime, there was a decreased incidence of OHCA, but the outcomes of OHCA were significant poor compared to the incidents during the daytime and evening. After multivariate adjustment for influencing factors, OHCAs occurring at night were independently associated with lower probabilities of achieving sustained ROSC (aOR = 0.489, 95% CI: 0.285–0.840, p = 0.009) and survival to discharge (aOR = 0.147, 95% CI: 0.03–0.714, p = 0.017). Subgroup analyses revealed significant temporal differences in male patients, older adult patients, those with longer response times (≥5 min), and witnessed OHCA. The effects of temporal difference on the outcome of OHCA may be a result of physiological factors, underlying etiology of arrest, resuscitative efforts in prehospital and in-hospital stages, or a combination of factors.
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The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073636. [PMID: 33807385 PMCID: PMC8036320 DOI: 10.3390/ijerph18073636] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 01/02/2023]
Abstract
High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.
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Seewald S, Dopfer S, Wnent J, Jakisch B, Heller M, Lefering R, Gräsner JT. Differences between manual CPR and corpuls cpr in regard to quality and outcome: study protocol of the comparing observational multi-center prospective registry study on resuscitation (COMPRESS). Scand J Trauma Resusc Emerg Med 2021; 29:39. [PMID: 33632277 PMCID: PMC7905890 DOI: 10.1186/s13049-021-00855-9] [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: 09/04/2020] [Accepted: 02/11/2021] [Indexed: 12/04/2022] Open
Abstract
Background The effect of mechanical CPR is diversely described in the literature. Different mechanical CPR devices are available. The corpuls cpr is a new generation of piston-driven devices and was launched in 2015. The COMPRESS-trial analyzes quality of chest compression and CPR-related injuries in cases of mechanical CPR by the corpuls cpr and manual CPR. Methods This article describes the design and study protocol of the COMPRESS-trial. This observational multi-center study includes all patients who suffered an out-of-hospital cardiac arrest (OHCA) where CPR is attempted in four German emergency medical systems (EMS) between January 2020 and December 2022. EMS treatment, in-hospital-treatment and outcome are anonymously reported to the German Resuscitation Registry (GRR). This information is linked with data from the defibrillator, the feedback system and the mechanical CPR device for a complete dataset. Primary endpoint is chest compression quality (complete release, compression rate, compression depth, chest compression fraction, CPR-related injuries). Secondary endpoint is survival (return of spontaneous circulation (ROSC), admission to hospital and survival to hospital discharge). The trial is sponsored by GS Elektromedizinische Geräte G. Stemple GmbH. Discussion This observational multi-center study will contribute to the evaluation of mechanical chest compression devices and to the efficacy and safety of the corpuls cpr. Trial registration DRKS, DRKS-ID DRKS00020819. Registered 31 July 2020.
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Affiliation(s)
- S Seewald
- Institute for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - S Dopfer
- Elektromedizinische Geräte G. Stemple GmbH, Kaufering, Germany
| | - J Wnent
- Institute for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,School of Medicine, University of Namibia, Windhoek, Namibia
| | | | - M Heller
- Elektromedizinische Geräte G. Stemple GmbH, Kaufering, Germany
| | - R Lefering
- Institute for Research in Operative Medicine, Faculty of Health, University of Witten/ Herdecke, Witten, Germany
| | - J T Gräsner
- Institute for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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12
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Obermaier M, Zimmermann JB, Popp E, Weigand MA, Weiterer S, Dinse-Lambracht A, Muth CM, Nußbaum BL, Gräsner JT, Seewald S, Jensen K, Seide SE. Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human. BMJ Open 2021; 11:e042062. [PMID: 33589455 PMCID: PMC7887349 DOI: 10.1136/bmjopen-2020-042062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Cardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest. METHODS AND ANALYSIS A sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I2-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. ETHICS AND DISSEMINATION No ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42017051633.
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Affiliation(s)
- Manuel Obermaier
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Erik Popp
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Weiterer
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
- Rheinland Klinikum, Lukaskrankenhaus Neuss, Neuss, Germany
| | | | - Claus-Martin Muth
- Department of Anaesthesiology, Ulm University Hospital, Ulm, Germany
| | | | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Svenja E Seide
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
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Tjelmeland IBM, Masterson S, Herlitz J, Wnent J, Bossaert L, Rosell-Ortiz F, Alm-Kruse K, Bein B, Lilja G, Gräsner JT. Description of Emergency Medical Services, treatment of cardiac arrest patients and cardiac arrest registries in Europe. Scand J Trauma Resusc Emerg Med 2020; 28:103. [PMID: 33076942 PMCID: PMC7569761 DOI: 10.1186/s13049-020-00798-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background Variation in the incidence, survival rate and factors associated with survival after cardiac arrest in Europe is reported. Some studies have tried to fill the knowledge gap regarding the epidemiology of out-of-hospital cardiac arrest in Europe but were unable to identify reasons for the reported differences. Therefore, the purpose of this study was to describe European Emergency Medical Systems, particularly from the perspective of country and ambulance service characteristics, cardiac arrest identification, dispatch, treatment, and monitoring. Methods An online questionnaire with 51 questions about ambulance and dispatch characteristics, on-scene management of cardiac arrest and the availability and dataset in cardiac arrest registries, was sent to all national coordinators who participated in the European Registry of Cardiac Arrest studies. In addition, individual invitations were sent to the remaining European countries. Results Participants from 28 European countries responded to the questionnaire. Results were combined with official information on population density. Overall, the number of Emergency Medical Service missions, level of training of personnel, availability of Helicopter Emergency Medical Services and the involvement of first responders varied across and within countries. There were similarities in team training, availability of key resuscitation equipment and permission for ongoing performance of cardiopulmonary resuscitation during transported. The quality of reporting to cardiac arrest registries varied, as well as the data availability in the registries. Conclusions Throughout Europe there are important differences in Emergency Medical Service systems and the response to out-of-hospital cardiac arrest. Explaining these differences is complicated due to significant variation in how variables are reported to and used in registries.
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Affiliation(s)
- Ingvild B M Tjelmeland
- Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany. .,Division of Prehospital Services, Oslo University Hospital, Oslo, Norway. .,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Siobhan Masterson
- The National Ambulance Service Ireland and the National University of Ireland Galway (on behalf of the Out-of-Hospital Cardiac Arrest Register (OHCAR)), Galway, Ireland
| | - Johan Herlitz
- PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Borås, Sweden.,European Resuscitation Council, Niel, Belgium
| | - Jan Wnent
- Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,Department of Anesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany.,School of Medicine, University of Namibia, Windhoek, Namibia
| | - Leo Bossaert
- European Resuscitation Council, Niel, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Fernando Rosell-Ortiz
- European Resuscitation Council, Niel, Belgium.,Servicio de Urgencias y Emergencias 061 de La Rioja, Logroño, Spain
| | - Kristin Alm-Kruse
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Berthold Bein
- Anaesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Hamburg, Germany
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,European Resuscitation Council, Niel, Belgium.,Department of Anesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany
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Carrick RT, Park JG, McGinnes HL, Lundquist C, Brown KD, Janes WA, Wessler BS, Kent DM. Clinical Predictive Models of Sudden Cardiac Arrest: A Survey of the Current Science and Analysis of Model Performances. J Am Heart Assoc 2020; 9:e017625. [PMID: 32787675 PMCID: PMC7660807 DOI: 10.1161/jaha.119.017625] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background More than 500 000 sudden cardiac arrests (SCAs) occur annually in the United States. Clinical predictive models (CPMs) may be helpful tools to differentiate between patients who are likely to survive or have good neurologic recovery and those who are not. However, which CPMs are most reliable for discriminating between outcomes in SCA is not known. Methods and Results We performed a systematic review of the literature using the Tufts PACE (Predictive Analytics and Comparative Effectiveness) CPM Registry through February 1, 2020, and identified 81 unique CPMs of SCA and 62 subsequent external validation studies. Initial cardiac rhythm, age, and duration of cardiopulmonary resuscitation were the 3 most commonly used predictive variables. Only 33 of the 81 novel SCA CPMs (41%) were validated at least once. Of 81 novel SCA CPMs, 56 (69%) and 61 of 62 validation studies (98%) reported discrimination, with median c‐statistics of 0.84 and 0.81, respectively. Calibration was reported in only 29 of 62 validation studies (41.9%). For those novel models that both reported discrimination and were validated (26 models), the median percentage change in discrimination was −1.6%. We identified 3 CPMs that had undergone at least 3 external validation studies: the out‐of‐hospital cardiac arrest score (9 validations; median c‐statistic, 0.79), the cardiac arrest hospital prognosis score (6 validations; median c‐statistic, 0.83), and the good outcome following attempted resuscitation score (6 validations; median c‐statistic, 0.76). Conclusions Although only a small number of SCA CPMs have been rigorously validated, the ones that have been demonstrate good discrimination.
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Affiliation(s)
- Richard T Carrick
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Jinny G Park
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Hannah L McGinnes
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Christine Lundquist
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Kristen D Brown
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - W Adam Janes
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Benjamin S Wessler
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
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15
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Czapla M, Zielińska M, Kubica-Cielińska A, Diakowska D, Quinn T, Karniej P. Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study. BMC Cardiovasc Disord 2020; 20:288. [PMID: 32532201 PMCID: PMC7291476 DOI: 10.1186/s12872-020-01571-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a common reason for calls for intervention by emergency medical teams (EMTs) in Poland. Regardless of the mechanism, OHCA is a state in which the chance of survival is dependent on rapid action from bystanders and responding health professionals in emergency medical services (EMS). We aimed to identify factors associated with return of spontaneous circulation (ROSC). Methods The medical records of 2137 EMS responses to OHCA in the city of Wroclaw, Poland between July 2017 and June 2018 were analyzed. Results The OHCA incidence rate for the year studied was 102 cases per 100,000 inhabitants. EMS were called to 2317 OHCA events of which 1167 (50.4%) did not have resuscitation attempted on EMS arrival. The difference between the number of successful and failed cardiopulmonary resuscitations (CPRs) was statistically significant (p < 0.001). Of 1150 patients in whom resuscitation was attempted, ROSC was achieved in 250 (27.8%). Rate of ROSC was significantly higher when CPR was initiated by bystanders (p < 0.001). Patients presenting with asystole or pulseless electrical activity (PEA) had a higher risk of CPR failure (86%) than those with ventricular fibrillation/ventricular tachycardia (VF/VT). Patients with VF/VT had a higher chance of ROSC (OR 2.68, 1.86–3.85) than those with asystole (p < 0.001). The chance of ROSC was 1.78 times higher when the event occurred in a public place (p < 0.001). Conclusions The factors associated with ROSC were occurrence in a public place, CPR initiation by witnesses, and presence of a shockable rhythm. Gender, age, and the type of EMT did not influence ROSC. Low bystander CPR rates reinforce the need for further efforts to train the public in CPR.
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Affiliation(s)
- Michał Czapla
- Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Marzena Zielińska
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland.
| | - Anna Kubica-Cielińska
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Diakowska
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Tom Quinn
- Faculty of Health, Social Care and Education Kingston University and St George's, University of London, London, UK
| | - Piotr Karniej
- Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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16
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Kim HT, Kim JG, Jang YS, Kang GH, Kim W, Choi HY, Jun GS. Comparison of in-hospital use of mechanical chest compression devices for out-of-hospital cardiac arrest patients: AUTOPULSE vs LUCAS. Medicine (Baltimore) 2019; 98:e17881. [PMID: 31702660 PMCID: PMC6855519 DOI: 10.1097/md.0000000000017881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate the prognostic difference between AUTOPULSE and LUCAS for out-of-hospital cardiac arrest (OHCA) adult patients.A retrospective observational study was performed nationwide. Adult OHCA patients after receiving in-hospital mechanical chest compression from 2012 to 2016 were included. The primary outcomes were sustained return of spontaneous circulation (ROSC) of more than 20 minutes and survival to discharge.Among 142,906 OHCA patients, 820 patients were finally included. In multivariate analysis, female (OR, 0.57; 95% CI, 0.33-0.99), witnessed arrest (OR, 2.10; 95% CI, 1.20-3.69), and arrest cause of non-cardiac origin (OR, 0.25; 95% CI, 0.10-0.62) were significantly associated with the increase in ROSC. LUCAS showed a lower survival than AUTOPULSE (OR, 0.23; 95% CI, 0.06-0.84), although it showed no significant association with ROSC. Percutaneous coronary intervention (OR, 6.30; 95% CI, 1.53-25.95) and target temperature management (TTM; OR, 7.30; 95% CI, 2.27-23.49) were the independent factors for survival. We categorized mechanical CPR recipients by witness to compare prognostic effectiveness of AUTOPULSE and LUCAS. In the witnessed subgroup, female (OR, 0.46; 95% CI, 0.24-0.89) was a prognostic factor for ROSC and shockable rhythm (OR, 5.04; 95% CI, 1.00-25.30), percutaneous coronary intervention (OR, 12.42; 95% CI, 2.04-75.53), and TTM (OR, 9.03; 95% CI, 1.86-43.78) for survival. In the unwitnessed subgroup, no prognostic factors were found for ROSC, and TTM (OR, 99.00; 95% CI, 8.9-1100.62) was found to be an independent factor for survival. LUCAS showed no significant increase in ROSC or survival in comparison with AUTOPULSE in both subgroups.The in-hospital use of LUCAS may have a deleterious effect for survival compared with AUTOPULSE.
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Affiliation(s)
- Hyun Tae Kim
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
| | - Jae Guk Kim
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
- Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Yong Soo Jang
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
| | - Gu Hyun Kang
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
| | - Wonhee Kim
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
| | - Hyun Young Choi
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
| | - Gwang Soo Jun
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul
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Savastano S, Baldi E, Palo A, Raimondi M, Belliato M, Compagnoni S, Buratti S, Cacciatore E, Canevari F, Iotti G, De Ferrari GM, Visconti LO. Load distributing band device for mechanical chest compressions: An Utstein-categories based analysis of survival to hospital discharge. Int J Cardiol 2019; 287:81-85. [PMID: 30929972 DOI: 10.1016/j.ijcard.2019.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/07/2019] [Accepted: 03/18/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE The role of load distributing band device (LDB, AutoPulse®, Zoll Medical Corporation, Chelmsford, MA, USA) in out-of-hospital cardiac arrest is still a matter of debate, with few studies reaching conflicting results available in literature. We sought to assess whether the use of the LBD device could affect survival to hospital discharge in the different Utstein categories. MATERIALS AND METHODS All consecutive patients enrolled in our provincial cardiac arrest registry (Pavia CARe) from January 2015 to December 2017 were included and pre-hospital data were computed as well as survival to hospital discharge. RESULTS Among 1401 resuscitation attempts, the LDB device was used in 235 (17%) patients. The LDB device was significantly more used for shockable cardiac arrest (42.6% vs 13.7%, p < 0.001). The rate of ROSC and of survival to hospital discharge in the LDB group compared to the manual group was 40% vs 17% (p < 0.001) and 10% vs 7% (p = 0.2), respectively. However, after correction for independent predictors of LDB use, LDB device was a strong independent predictor of survival to hospital discharge only for non-shockable witnessed OHCA [n = 624/1401, OR 11.9 (95% CI 1.5-95.2), p = 0.02]. In this categories of patients LDB group showed longer resuscitation time [49.3 min (IQR 37-71) vs 23.6 (IQR 15-35), p < 0.001] and a higher rate of conversion to a shockable rhythm (33/83 = 40% vs 29/541 = 5%, p < 0.001). CONCLUSION Utstein categories-based analysis showed that the LDB device positively affect survival to hospital discharge for non-shockable witnessed cardiac arrests with a neutral effect for shockable rhythms.
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Affiliation(s)
- Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; School of Cardiovascular Disease, University of Pavia; Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Maurizio Raimondi
- UOC Anestesia e Rianimazione, Ospedale di Voghera ASST provincia di Pavia, Italy
| | - Mirko Belliato
- UOC Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Buratti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; School of Cardiovascular Disease, University of Pavia; Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Cacciatore
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Giorgio Iotti
- UOC Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gaetano M De Ferrari
- School of Cardiovascular Disease, University of Pavia; Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Intensive Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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