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Lupton JR, Johnson E, Prigmore B, Daya MR, Jui J, Thompson K, Nuttall J, Neth MR, Sahni R, Newgard CD. Out-of-hospital cardiac arrest outcomes when law enforcement arrives before emergency medical services. Resuscitation 2024; 194:110044. [PMID: 37952574 PMCID: PMC10842836 DOI: 10.1016/j.resuscitation.2023.110044] [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: 09/14/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Law enforcement (LE) professionals are often dispatched to out-of-hospital cardiac arrests (OHCA) to provide early cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) application with mixed evidence of a survival benefit. Our objective was to comprehensively evaluate LE care in OHCA. METHODS This is a secondary analysis of adults with non-traumatic OHCA not witnessed by EMS and without bystander AED use from 2018-2021. Our primary outcome was survival with Cerebral Perfusion Category score ≤ 2 (functional survival). Our exposures included: LE On-scene Only (without providing care); LE CPR Only (without applying an AED); LE Ideal Care (ensuring CPR and AED application). Our control group had no LE arrival before EMS. We performed multivariable logistic regression analyses adjusting for confounders and stratified our analyses by patients with and without bystander CPR. RESULTS There were 2569 adult, non-traumatic OHCAs from 2018-2021 meeting inclusion criteria. There were no differences in the odds of functional survival for LE On-scene Only (adjusted odds ratio [95% CI]: 1.28 [0.47-3.45]), LE CPR Only (1.26 [0.80-1.99]), or LE Ideal Care (1.36 [0.79-2.33]). In patients without bystander CPR, LE Ideal Care had significantly higher odds of functional survival (2.01 [1.06-3.81]) compared to no LE on-scene, with no significant associations for LE On-scene Only or LE CPR Only. There were no significant differences by LE care in patients already receiving bystander CPR. CONCLUSIONS LE arrival before EMS and ensuring both CPR and AED application is associated with significantly improved functional survival in OHCA patients not already receiving bystander CPR.
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Affiliation(s)
- Joshua R Lupton
- Department of Emergency Medicine, Oregon Health & Science University, USA.
| | - Erika Johnson
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Brian Prigmore
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Kathryn Thompson
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | | | - Matthew R Neth
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Ritu Sahni
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Craig D Newgard
- Department of Emergency Medicine, Oregon Health & Science University, USA
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Pérez-Regueiro I, Carcedo-Argüelles L, Menéndez-Angulo P, Guinea-Rivera R, Lana A. Time trend, willingness and knowledge of law enforcement agencies officers to act as first responders in out-of-hospital cardiac arrests. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:826-828. [PMID: 37543190 DOI: 10.1016/j.rec.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/13/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Irene Pérez-Regueiro
- Servicio de Atención Médica de Urgencias de Asturias (SAMU-Asturias), Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Lucía Carcedo-Argüelles
- Unidad de Cuidados Intensivos, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Paula Menéndez-Angulo
- Departamento de Medicina, Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Rocío Guinea-Rivera
- Servicio de Atención Médica de Urgencias de Asturias (SAMU-Asturias), Oviedo, Asturias, Spain
| | - Alberto Lana
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain; Departamento de Medicina, Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, Oviedo, Asturias, Spain.
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Jean Louis C, Cildoz M, Echarri A, Beaumont C, Mallor F, Greif R, Baigorri M, Reyero D. Police as first reponders improve out-of-hospital cardiac arrest survival. BMC Emerg Med 2023; 23:102. [PMID: 37670267 PMCID: PMC10481462 DOI: 10.1186/s12873-023-00876-w] [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: 02/17/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Police forces are abundant circulating and might arrive before the emergency services to Out-of-Hospital-Cardiac-Arrest victims. If properly trained, they can provide basic life support and early defibrillation within minutes, probably increasing the survival of the victims. We evaluated the impact of local police as first responders on the survival rates of out-of-hospital cardiac arrest victims in Navarra, Spain, over 7 years. METHODS A retrospective analysis of an ongoing Out-of-Hospital Cardiac registry to compare the characteristics and survival of Out-of-Hospital-Cardiac-Arrest victims attended to in first place by local police, other first responders, and emergency ambulance services between 2014 and 2020. RESULTS Of 628 cases, 73.7% were men (aged 68.9 ± 15.8), and 26.3% were women (aged 65,0 ± 14,7 years, p < 0.01). Overall survival of patients attended to by police in the first place was 17.8%, other first responders 17.4% and emergency services 13.5% with no significant differences (p > 0.1). Time to initiating cardiopulmonary resuscitation is significant for survival. When police arrived first and started CPR before the emergency services, they arrived at a mean of 5.4 ± 3 min earlier (SD = 3.10). This early police intervention showed an increase in the probability of survival by 10.1%. CONCLUSIONS The privileged location and the sole amount of personnel of local police forces trained in life support and their fast delivery of defibrillators as first responders can improve the survival of out-of-hospital cardiac arrest victims.
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Affiliation(s)
- Clint Jean Louis
- Emergency Advanced Ambulance Physician, Prehospital Emergency Services, Navarra Health Services, Avenida Pamplona No.2. 4ª, Barañain, Navarra España, 31010, Spain.
- Regional Coordinator Cardiac-Arrest Code, Citizen Empowerment Program, Navarra Health Services, Pamplona, Navarra, Spain.
- European Resuscitation Council (ERC) Research NET, Brussels, Belgium.
| | - Marta Cildoz
- Department of Statistics and Operational Research, Public University of Navarra, Pamplona, Navarra, Spain
| | - Alfredo Echarri
- Emergency Advanced Ambulance Physician, Prehospital Emergency Services, Navarra Health Services, Avenida Pamplona No.2. 4ª, Barañain, Navarra España, 31010, Spain
- Head of Emergency Transportation Services, Prehospital Emergency Services, Navarra Health Services, Pamplona, Navarra, Spain
| | - Carlos Beaumont
- Emergency Physician, Emergency Department, University Hospital of Navarra, Pamplona, Navarra, Spain
| | - Fermin Mallor
- Department of Statistics and Operational Research, Public University of Navarra, Pamplona, Navarra, Spain
| | - Robert Greif
- European Resuscitation Council (ERC) Research NET, Brussels, Belgium
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Miguel Baigorri
- Department of Statistics and Operational Research, Public University of Navarra, Pamplona, Navarra, Spain
| | - Diego Reyero
- Emergency Advanced Ambulance Physician, Prehospital Emergency Services, Navarra Health Services, Avenida Pamplona No.2. 4ª, Barañain, Navarra España, 31010, Spain
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Gaisendrees C, Jaeger D, Kalra R, Kosmopoulos M, Harkins K, Marquez A, Hodgson L, Kollmar L, Bartos J, Yannopoulos D. The Minnesota first-responder AED project: Aiming to increase survival in out-of-hospital cardiac arrest. Resusc Plus 2023; 15:100437. [PMID: 37576444 PMCID: PMC10416018 DOI: 10.1016/j.resplu.2023.100437] [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: 08/15/2023] Open
Abstract
There are 350,000 out-of-hospital cardiac arrest (OHCA) cases annually in the United States of America. Using automated external defibrillators (AEDs) has increased survival in cardiac arrests (CA) with an initial shockable rhythm. Thus, guidelines recommend complete geographical coverage with AEDs. To fill in the gaps in Minnesota, the Center for Resuscitation Medicine at the University of Minnesota raised an $18.8 million grant from the Helmsley Charitable Trust to supply law enforcement first responders with AEDs and, thus, increase survival rates after OHCA by reducing the time to first shock. This report elaborates on the decision-making, fundraising, and logistic strategy required to reach statewide AED coverage. Methods The baseline need for AEDs was analyzed using a questionnaire sent out to state law enforcement agencies, state patrols, city and county agencies, and tribal agencies in 2021. Furthermore, OHCA cases of 2021 were reviewed. The combination of this information led to an action plan to equip and train all agencies throughout the state's eight regions with AEDs. Results The electronic survey was initially sent out to 358 agencies. The initial response rate was 77% (n = 276). This resulted in a total need of 8300 AEDs to be deployed over three years (2022-2025). As of 2023, over 4769 AEDs have been distributed, covering 237 sites. Conclusion By equipping first responders with AED systems, the Center for Resuscitation Medicine aims to shorten the gap in statewide AED coverage, thus increasing the chances of survival after OHCA.
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Affiliation(s)
- Christopher Gaisendrees
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Germany
| | - Deborah Jaeger
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
- INSERM U 1116, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Rajat Kalra
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Kimberly Harkins
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Alexandra Marquez
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Lucinda Hodgson
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Loren Kollmar
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Jason Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
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Berglund E, Byrsell F, Forsberg S, Nord A, Jonsson M. Are first responders first? The rally to the suspected out-of-hospital cardiac arrest. Resuscitation 2022; 180:70-77. [PMID: 36162614 DOI: 10.1016/j.resuscitation.2022.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Time is the crucial factor in the "chain of survival" treatment concept for out-of-hospital cardiac arrest (OHCA). We aimed to measure different response time intervals by comparing emergency medical system (EMS), fire fighters and smartphone aided volunteer responders. METHODS In two large Swedish regions, volunteer responders were timed from the alert until they arrived at the scene of the suspected OHCA. The first arriving volunteer responders who tried to fetch an automated external defibrillator (AED-responder) and who ran to perform bystander cardiopulmonary resuscitation (CPR-responder) were compared to both the first arriving EMS and fire fighters. Three-time intervals were measured, from call to dispatch, the unit response time (from dispatch to arrival) and the total response time. RESULTS During 22 months, 2631 suspected OHCAs were included. The median time from call to dispatch was in minutes 1.8 (95% CI = 1.7-1.8) for EMS, 2.9 (95% CI = 2.8-3.0) for fire-fighters and 3.0 (95% CI = 2.9-3.1) for volunteer responders. The median unit response time was 8.3 (95% CI = 8.1-8.5) for EMS, 6.8 (95% CI = 6.7-6.9) for fire fighters and 6.0 (95% CI = 5.7-6.2) for AED-responders and 4.6 (95% CI = 4.5-4.8) for CPR-responders. The total response time was 10.4 (95% CI = 10.1-10.6) for EMS, 10.2 (95% CI = 9.9-10.4) for fire fighters, 9.6 (95% CI = 9.1-9.8) for AED-responders and 8.2 (95% CI = 8.0-8.3) for CPR-responders. CONCLUSION First arriving volunteer responders had the shortest unit response time when compared to both fire fighters and EMS, however this advantage was reduced by delays introduced at the dispatch center. Earlier automatic dispatch should be considered in further studies.
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Affiliation(s)
- E Berglund
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden.
| | - F Byrsell
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden
| | - S Forsberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden
| | - A Nord
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden
| | - M Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden
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Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Koster RW. AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest. Resuscitation 2020; 150:170-177. [PMID: 32045663 DOI: 10.1016/j.resuscitation.2020.01.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND For out-of-hospital cardiac arrest (OHCA) in residential areas, a dispatcher driven alert-system using text messages (TM-system) directing local rescuers (TM-responders) to OHCA patients was implemented and the desired density of automated external defibrillators (AEDs) or TM-responders investigated. METHODS We included OHCA cases with the TM-system activated in residential areas between 2010-2017. For each case, densities/km2 of activated AEDs and TM-responders within a 1000 m circle were calculated. Time intervals between 112-call and first defibrillation were calculated. RESULTS In total, 813 patients (45%) had a shockable initial rhythm. In 17% a TM-system AED delivered the first shock. With increasing AED density, the median time to shock decreased from 10:59 to 08:17 min. (p < 0.001) and shocks <6 min increased from 6% to 12% (p = 0.024). Increasing density of TM-responders was associated with a decrease in median time to shock from 10:59 to 08:20 min. (p < 0.001) and increase of shocks <6 min from 6% to 13% (p = 0.005). Increasing density of AEDs and TM-responders resulted in a decline of ambulance first defibrillation by 19% (p = 0.016) and 22% (p = 0.001), respectively. First responder AED defibrillation did not change significantly. Densities of >2 AEDs/km2 did not result in further decrease of time to first shock but >10 TM-responders/km2 resulted in more defibrillations <6 min. CONCLUSION With increasing AED and TM-responder density within a TM-system, time to defibrillation in residential areas decreased. AED and TM-responders only competed with ambulances, not with first responders. The recommended density of AEDs and TM-responders for earliest defibrillation is 2 AEDs/km2 and >10 TM-responders/km2.
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Affiliation(s)
- Remy Stieglis
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands.
| | - Jolande A Zijlstra
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands
| | - Frank Riedijk
- Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands
| | - Martin Smeekes
- Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands
| | | | - Rudolph W Koster
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands
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Hasselqvist-Ax I, Nordberg P, Svensson L, Hollenberg J, Joelsson-Alm E. Experiences among firefighters and police officers of responding to out-of-hospital cardiac arrest in a dual dispatch programme in Sweden: an interview study. BMJ Open 2019; 9:e030895. [PMID: 31753873 PMCID: PMC6887046 DOI: 10.1136/bmjopen-2019-030895] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The objective of this study was to explore firefighters' and police officers' experiences of responding to out-of-hospital cardiac arrest (OHCA) in a dual dispatch programme. DESIGN A qualitative interview study with semi-structured, open-ended questions where critical incident technique (CIT) was used to collect recalled cardiac arrest situations from the participants' narratives. The interviews where transcribed verbatim and analysed with inductive content analysis. SETTING The County of Stockholm, Sweden. PARTICIPANTS Police officers (n=10) and firefighters (n=12) participating in a dual dispatch programme with emergency medical services in case of suspected OHCA of cardiac or non-cardiac origin. RESULTS Analysis of 60 critical incidents was performed resulting in three consecutive time sequences (preparedness, managing the scene and the aftermath) with related categories, where first responders described the complexity of the cardiac arrest situation. Detailed information about the case and the location was crucial for the preparedness, and information deficits created stress, frustration and incorrect perceptions about the victim. The technical challenges of performing cardiopulmonary resuscitation and managing the airway was prominent and the need of regular team training and education in first aid was highlighted. CONCLUSIONS Participating in dual dispatch in case of suspected OHCA was described as a complex technical and emotional process by first responders. Providing case discussions and opportunities to give, and receive feedback about the case is a main task for the leadership in the organisations to diminish stress among personnel and to improve future OHCA missions.
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Affiliation(s)
- Ingela Hasselqvist-Ax
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Per Nordberg
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Mark DB, Hansen SM, Starks ML, Cummings ML. Drone-Based Automatic External Defibrillators for Sudden Death? Do We Need More Courage or More Serenity? Circulation 2019. [PMID: 28630265 DOI: 10.1161/circulationaha.117.027888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel B Mark
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (D.B.M., S.M.H., M.L.S.); Department of Clinical Epidemiology, Aalborg University Hospital, Denmark (S.M.H.); and Duke Robotics, Duke Pratt School of Engineering, Durham, NC (M.L.C.).
| | - Steen M Hansen
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (D.B.M., S.M.H., M.L.S.); Department of Clinical Epidemiology, Aalborg University Hospital, Denmark (S.M.H.); and Duke Robotics, Duke Pratt School of Engineering, Durham, NC (M.L.C.)
| | - Monique L Starks
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (D.B.M., S.M.H., M.L.S.); Department of Clinical Epidemiology, Aalborg University Hospital, Denmark (S.M.H.); and Duke Robotics, Duke Pratt School of Engineering, Durham, NC (M.L.C.)
| | - Mary L Cummings
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (D.B.M., S.M.H., M.L.S.); Department of Clinical Epidemiology, Aalborg University Hospital, Denmark (S.M.H.); and Duke Robotics, Duke Pratt School of Engineering, Durham, NC (M.L.C.)
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Hansen SM, Hansen CM, Fordyce CB, Dupre ME, Monk L, Tyson C, Torp-Pedersen C, McNally B, Vellano K, Jollis J, Granger CB. Association Between Driving Distance From Nearest Fire Station and Survival of Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2018; 7:e008771. [PMID: 30571383 PMCID: PMC6404193 DOI: 10.1161/jaha.118.008771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Firefighter first responders dispatched in parallel with emergency medical services (EMS) personnel for out‐of‐hospital cardiac arrests (OHCA) can provide early defibrillation to improve survival. We examined whether survival following first responder defibrillation differed according to driving distance from nearest fire station to OHCA site. Methods and Results From the CARES (Cardiac Arrest Registry to Enhance Survival) registry, we identified non‐EMS witnessed OHCAs of presumed cardiac cause from 2010 to 2014 in Durham, Mecklenburg, and Wake counties, North Carolina. We used logistic regression to estimate the association between calculated driving distances (≤1, 1–1.5, 1.5–2, and >2 miles) and survival to hospital discharge following first responder defibrillation compared with defibrillation by EMS personnel. In total, 5020 OHCAs were included in the study. First responders more often applied the first automated external defibrillators at the shortest distances (≤1 mile) versus longest distances (>2 miles) (53.4% versus 46.6%, respectively, P<0.001). When compared with EMS defibrillation, first responder defibrillation within 1 mile and 1 to 1.5 miles of the nearest fire station was associated with increased survival to hospital discharge (odds ratio 2.01 [95% confidence interval 1.46–2.78] and odds ratio 1.61 [95% confidence interval 1.10–2.35], respectively). However, at the longest distances (1.5–2.0 and >2.0 miles), survival following first responder defibrillation did not differ from EMS defibrillation (odds ratio 0.77 [95% confidence interval 0.48–1.21] and odds ratio 0.97 [95% confidence interval 0.67–1.41], respectively). Conclusions Shorter driving distance from nearest fire station to OHCA location was associated with improved survival following defibrillation by first responders. These results suggest that the location of first responder units should be considered when organizing prehospital systems of OHCA care.
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Affiliation(s)
- Steen M Hansen
- 1 Duke Clinical Research Institute Duke University Durham NC.,3 Department of Clinical Epidemiology Aalborg University Hospital Aalborg Denmark
| | | | - Christopher B Fordyce
- 4 Division of Cardiology University of British Columbia Vancouver British Columbia Canada
| | - Matthew E Dupre
- 1 Duke Clinical Research Institute Duke University Durham NC.,2 Department of Population Health Sciences Duke University Durham NC
| | - Lisa Monk
- 1 Duke Clinical Research Institute Duke University Durham NC
| | - Clark Tyson
- 1 Duke Clinical Research Institute Duke University Durham NC
| | | | - Bryan McNally
- 5 Emory University School of Medicine Atlanta GA.,6 Rollins School of Public Health Emory University Atlanta GA
| | | | - James Jollis
- 1 Duke Clinical Research Institute Duke University Durham NC
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Zijlstra JA, Koster RW, Blom MT, Lippert FK, Svensson L, Herlitz J, Kramer-Johansen J, Ringh M, Rosenqvist M, Palsgaard Møller T, Tan HL, Beesems SG, Hulleman M, Claesson A, Folke F, Olasveengen TM, Wissenberg M, Hansen CM, Viereck S, Hollenberg J. Different defibrillation strategies in survivors after out-of-hospital cardiac arrest. Heart 2018; 104:1929-1936. [PMID: 29903805 DOI: 10.1136/heartjnl-2017-312622] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/31/2018] [Accepted: 04/17/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival. METHODS We performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded. RESULTS A total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm. CONCLUSION Survivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.
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Affiliation(s)
- Jolande A Zijlstra
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Freddy K Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Leif Svensson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Johan Herlitz
- Department of Metabolism and Cardiovascular Research, Institute of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Mattias Ringh
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Mårten Rosenqvist
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Thea Palsgaard Møller
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Hanno L Tan
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Stefanie G Beesems
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel Hulleman
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Andreas Claesson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Theresa Mariero Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Carolina Malta Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Soren Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Hollenberg
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
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12
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Ringh M, Hollenberg J, Palsgaard-Moeller T, Svensson L, Rosenqvist M, Lippert FK, Wissenberg M, Malta Hansen C, Claesson A, Viereck S, Zijlstra JA, Koster RW, Herlitz J, Blom MT, Kramer-Johansen J, Tan HL, Beesems SG, Hulleman M, Olasveengen TM, Folke F. The challenges and possibilities of public access defibrillation. J Intern Med 2018; 283:238-256. [PMID: 29331055 DOI: 10.1111/joim.12730] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in-hospital. With the development of automated external defibrillators (AEDs), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most Western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCAs take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society.
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Affiliation(s)
- M Ringh
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - J Hollenberg
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - T Palsgaard-Moeller
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - L Svensson
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - M Rosenqvist
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - F K Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - M Wissenberg
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - C Malta Hansen
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - A Claesson
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - S Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - J A Zijlstra
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - R W Koster
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - J Herlitz
- Institute of Internal Medicine, Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M T Blom
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - J Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Air Ambulance Department, Oslo, Norway.,Department of Anaesthesiology Oslo University Hospital and University of Oslo, Oslo, Norway
| | - H L Tan
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - S G Beesems
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - M Hulleman
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - T M Olasveengen
- Department of Anaesthesiology Oslo University Hospital and University of Oslo, Oslo, Norway
| | - F Folke
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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13
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Bækgaard JS, Viereck S, Møller TP, Ersbøll AK, Lippert F, Folke F. The Effects of Public Access Defibrillation on Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review of Observational Studies. Circulation 2017; 136:954-965. [PMID: 28687709 DOI: 10.1161/circulationaha.117.029067] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/07/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Despite recent advances, the average survival after out-of-hospital cardiac arrest (OHCA) remains <10%. Early defibrillation by an automated external defibrillator is the most important intervention for patients with OHCA, showing survival proportions >50%. Accordingly, placement of automated external defibrillators in the community as part of a public access defibrillation program (PAD) is recommended by international guidelines. However, different strategies have been proposed on how exactly to increase and make use of publicly available automated external defibrillators. This systematic review aimed to evaluate the effect of PAD and the different PAD strategies on survival after OHCA. METHODS PubMed, Embase, and the Cochrane Library were systematically searched on August 31, 2015 for observational studies reporting survival to hospital discharge in OHCA patients where an automated external defibrillator had been used by nonemergency medical services. PAD was divided into 3 groups according to who applied the defibrillator: nondispatched lay first responders, professional first responders (firefighters/police) dispatched by the Emergency Medical Dispatch Center (EMDC), or lay first responders dispatched by the EMDC. RESULTS A total of 41 studies were included; 18 reported PAD by nondispatched lay first responders, 20 reported PAD by EMDC-dispatched professional first responders (firefighters/police), and 3 reported both. We identified no qualified studies reporting survival after PAD by EMDC-dispatched lay first responders. The overall survival to hospital discharge after OHCA treated with PAD showed a median survival of 40.0% (range, 9.1-83.3). Defibrillation by nondispatched lay first responders was associated with the highest survival with a median survival of 53.0% (range, 26.0-72.0), whereas defibrillation by EMDC-dispatched professional first responders (firefighters/police) was associated with a median survival of 28.6% (range, 9.0-76.0). A meta-analysis of the different survival outcomes could not be performed because of the large heterogeneity of the included studies. CONCLUSIONS This systematic review showed a median overall survival of 40% for patients with OHCA treated by PAD. Defibrillation by nondispatched lay first responders was found to correlate with the highest impact on survival in comparison with EMDC-dispatched professional first responders. PAD by EMDC-dispatched lay first responders could be a promising strategy, but evidence is lacking.
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Affiliation(s)
- Josefine S Bækgaard
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.).
| | - Søren Viereck
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.)
| | - Thea Palsgaard Møller
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.)
| | - Annette Kjær Ersbøll
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.)
| | - Freddy Lippert
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.)
| | - Fredrik Folke
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.)
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14
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Automated external defibrillator and operator performance in out-of-hospital cardiac arrest. Resuscitation 2017; 118:140-146. [PMID: 28526495 DOI: 10.1016/j.resuscitation.2017.05.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/28/2017] [Accepted: 05/14/2017] [Indexed: 11/20/2022]
Abstract
AIM An increasing number of failing automated external defibrillators (AEDs) is reported: AEDs not giving a shock or other malfunction. We assessed to what extent AEDs are 'failing' and whether this had a device-related or operator-related cause. METHODS We studied analysis periods from AEDs used between January 2012 and December 2014. For each analysis period we assessed the correctness of the (no)-shock advice (sensitivity/specificity) and reasons for an incorrect (no)-shock advice. If no shock was delivered after a shock advice, we assessed the reason for no-shock delivery. RESULTS We analyzed 1114 AED recordings with 3310 analysis periods (1091 shock advices; 2219 no-shock advices). Sensitivity for coarse ventricular fibrillation was 99% and specificity for non-shockable rhythm detection 98%. The AED gave an incorrect shock advice in 4% (44/1091) of all shock advices, due to device-related (n=15) and operator-related errors (n=28) (one unknown). Of these 44 shock advices, only 2 shocks caused a rhythm change. One percent (26/2219) of all no-shock advices was incorrect due to device-related (n=20) and operator-related errors (n=6). In 5% (59/1091) of all shock advices, no shock was delivered: operator failed to deliver shock (n=33), AED was removed (n=17), operator pushed 'off' button (n=8) and other (n=1). Of the 1073 analysis periods with a shockable rhythm, 67 (6%) did not receive an AED shock. CONCLUSION Errors associated with AED use are rare (4%) and when occurring are in 72% caused by the operator or circumstances of use. Fully automatic AEDs may prevent the majority of these errors.
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15
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Hansen SM, Brøndum S, Thomas G, Rasmussen SR, Kvist B, Christensen A, Lyng C, Lindberg J, Lauritsen TLB, Lippert FK, Torp-Pedersen C, Hansen PA. Home Care Providers to the Rescue: A Novel First-Responder Programme. PLoS One 2015; 10:e0141352. [PMID: 26509532 PMCID: PMC4625014 DOI: 10.1371/journal.pone.0141352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022] Open
Abstract
AIM To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA). METHODS We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark. RESULTS Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED. CONCLUSION Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival.
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Affiliation(s)
- Steen M. Hansen
- Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stig Brøndum
- Hjerteforeningen, Danish Heart Foundation, Copenhagen, Denmark
| | - Grethe Thomas
- The Danish Foundation TrygFonden, Copenhagen, Denmark
| | - Susanne R. Rasmussen
- KORA, Danish Institute for Local and Regional Government Research, Aarhus, Denmark
| | - Birgitte Kvist
- Department of Health and Nursing, Municipality of Frederikshavn, North Denmark Region, Frederikshavn, Denmark
| | | | - Charlotte Lyng
- Home Care Organization, Municipality of Frederikshavn, North Denmark Region, Frederikshavn, Denmark
| | - Jan Lindberg
- Prehospital Care Organization, North Denmark Region, Aalborg, Denmark
| | - Torsten L. B. Lauritsen
- Department of Anaesthesia, The Juliane Marie Centre, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | | | - Poul A. Hansen
- Prehospital Care Organization, North Denmark Region, Aalborg, Denmark
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Zijlstra JA, Stieglis R, Riedijk F, Smeekes M, van der Worp WE, Koster RW. Local lay rescuers with AEDs, alerted by text messages, contribute to early defibrillation in a Dutch out-of-hospital cardiac arrest dispatch system. Resuscitation 2014; 85:1444-9. [DOI: 10.1016/j.resuscitation.2014.07.020] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/21/2014] [Accepted: 07/28/2014] [Indexed: 11/30/2022]
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