Time to bystander cardiopulmonary resuscitation by patient sex for out-of-hospital cardiac arrest

BACKGROUND

Delays in bystander cardiopulmonary resuscitation (CPR) are associated with worse out-of-hospital cardiac arrest (OHCA) outcomes. Whether disparities exist in time to CPR between women and men is unknown.

METHODS

We included witnessed OHCAs treated with bystander CPR from the Cardiac Arrest Registry Enhancing Survival between 2013-2021. The primary outcome was time to first bystander CPR, and secondary outcomes were survival to hospital discharge and favorable neurological survival. Hierarchical ordinal regression was used to model time to first CPR, which estimates the odds of having a 2-minute longer delay (from 0 to ≥10 minutes) in receiving bystander CPR. The model included sex, age, race, location of arrest, cardiac arrest etiology, day of week, and season as fixed effects and EMS agency as a random effect to account for clustering of patients within an agency.

RESULTS

Of 78,043 patients with a witnessed OHCA that received bystander CPR, 25,197 (32.3%) were women. The median [IQR] time to first bystander CPR was 2 [1,5] minutes for both women and men. In adjusted analysis, time to bystander CPR was similar in men and women (p = 0.26). Moreover, there was a statistically significantly graded inverse association between time to bystander CPR and survival.

CONCLUSION

For patients with witnessed OHCA that received bystander CPR, women and men had similar times to CPR, although 5-minute or greater delays in initiating CPR was not uncommon. Delays in bystander CPR in OHCA were associated with worse survival outcomes.

Impact of a national initiative to provide civilian cardiopulmonary resuscitation training courses on the rates of bystander intervention by citizens and survival after out-of-hospital cardiac arrest

BACKGROUND

The impact of a national initiative to provide cardiopulmonary resuscitation (CPR) education to the public on the rates of citizen-initiated CPR and survival following out-of-hospital cardiac arrest (OHCA) remains uncertain.

METHODS

We examined 358,025 cases of citizen-witnessed OHCA with presumed cardiac origin, recorded in the Japanese nationwide registry from 2005 to 2020. We assessed the relationship between the number of individuals certified in CPR courses, citizen interventions, and neurologically favorable survival at one month.

RESULTS

The cumulative number of certified citizens has linearly increased from 9,930,327 in 2005 to 34,938,322 in 2020 (incidence rate ratio for annual number = 1.03, p < 0.001), encompassing 32.3% of the Japanese population aged 15 and above. Similarly, the prevalence of citizen-initiated CPR has consistently increased from 40.6% in 2005 to 56.8% in 2020 (P for trend < 0.001). Greater citizen CPR engagement was significantly associated with better outcome in initial shockable rhythm patients [chest compression only: odds ratio (OR) 1.24; 95% confidence interval (CI) 1.02-1.51; P = 0.029; chest compression with rescue breathing: OR 1.33; 95% CI 1.08-1.62; P = 0.006; defibrillation with chest compression: OR 2.27; 95% CI 1.83-2.83; P < 0.001; defibrillation with chest compression and rescue breathing: OR 2.15; 95% CI 1.70-2.73; P < 0.001 vs. no citizen CPR].

CONCLUSIONS

The incidence of citizen-initiated CPR across Japan has consistently and proportionately increased with the rising number of individuals certified in CPR courses. Greater citizen CPR involvement has been linked to neurologically favorable survival, particularly in cases with an initial shockable rhythm.

Out-of-hospital cardiac arrest outcomes when law enforcement arrives before emergency medical services

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.

Parental perceptions of the importance of pediatric out-of-hospital cardiopulmonary resuscitation for the survival rate in Saudi Arabia: a cross-sectional survey

BACKGROUND

Pediatric out-of-hospital cardiac arrest is associated with high morbidity and mortality rates. Cardiopulmonary resuscitation (CPR), the practice of chest compressions combined with rescue breathing, is crucial for the success of out-of-hospital resuscitation after sudden cardiac arrest. Thus, imparting the requisite knowledge and skills to parents/caregivers can significantly enhance survival rates. This study investigated parental awareness of the impact of out-of-hospital pediatric CPR on survival rates in Saudi Arabia.

METHODS

This cross-sectional study was conducted using an online questionnaire administered to Saudi parents from all regions of the Kingdom of Saudi Arabia. Data were collected using the convenience sampling method, as the questionnaire was distributed via social media platforms. The questionnaire consisted of five parts: (1) demographic data, (2) questions about parents' perception of basic life support (BLS), (3) evaluation of parents' knowledge of the impact of prehospital CPR on survival rates, (4) measurement of parents' competency in performing pediatric CPR, and (5) assessment of whether parents' confidence was affected by prior training. Statistical analyses were conducted using the chi-squared test or Fisher's exact test, and the t-test was used to compare the mean scores of the groups of parents with medical and non-medical professional backgrounds.

RESULTS

A total of 1,065 individuals responded to the survey. The respondents' mean age was 41 ± 0.2 years and 46.5% were men. We found that 73.9% of respondents had no prior experience with BLS, 87% had never taken a BLS course, and 61% did not know where to find one. The majority of participants agreed that bystander CPR contributes to overall survival rates, and 77% agreed to the importance of BLS training. Medical professionals showed a higher percentage of agreement on the importance of BLS than those from non-medical backgrounds (90% vs. 76%, p = 0.036), especially parents of high-risk children.

CONCLUSION

This study showed evidence of interest in CPR and BLS training in Saudi parents, despite the low levels of knowledge regarding BLS training.

Sociodemographic factors associated with paediatric out-of-hospital cardiac arrest: A systematic review

BACKGROUND

Paediatric out-of-hospital cardiac arrest (POHCA) is associated with poor survival and severe neurological sequelae. We conducted a systematic review on the impact of sociodemographic factors across different stages of POHCA.

METHODS

We searched MEDLINE, EMBASE, and Web of Science from database inception to October 2022. We included studies examining the association between sociodemographic factors (i.e., race, ethnicity, migrant status and socioeconomic status [SES]) and POHCA risk, bystander cardiopulmonary resuscitation (CPR) provision, bystander automated external defibrillator (AED) application, survival (at or 30-days post-discharge), and neurological outcome. We synthesized the data qualitatively.

RESULTS

We screened 11,097 citations and included 18 articles (arising from 15 studies). There were 4 articles reporting on POHCA risk, 5 on bystander CPR provision, 3 on bystander AED application, 13 on survival, and 6 on neurological outcome. In all studies on POHCA risk, significant differences were found across racial groups, with minority populations being disproportionately impacted. There were no articles reporting on the association between SES and POHCA risk. Bystander CPR provision was consistently associated with race and ethnicity, with disparities impacting Black and Hispanic children. The association between bystander CPR provision and SES was variable. There was little evidence of socioeconomic or racial disparities in studies on bystander AED application, survival, and neurological outcome, particularly across adjusted analyses.

CONCLUSIONS

Race and ethnicity are likely associated with POHCA risk and bystander CPR provision. These findings highlight the importance of prioritizing at-risk groups in POHCA prevention and intervention efforts. Further research is needed to understand underlying mechanisms.

Association between bystander intervention and emergency medical services and the return of spontaneous circulation in out-of-hospital cardiac arrests occurring at a train station in the Tokyo metropolitan area: A retrospective cohort study

Aim

The purpose of this study was to stratify patients who achieved return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) with bystander procedures pre-emergency medical service (EMS) arrival and those who achieved ROSC with procedures post-EMS arrival, compare outcomes at 1-month, and identify factors associated with pre-EMS-arrival-ROSC.

Methods

A retrospective cohort analysis of OHCAs occurring at stations in the Tokyo metropolitan area between 2014 and 2018 was conducted. Subjects were stratified by ROSC phase (categorized as pre- and post-EMS arrival and non-ROSC). Survival at 1-month post-OHCA and the percentage of favourable neurological function in each ROSC phase were analysed. In addition, factors associated with Pre-EMS-arrival-ROSC were identified using multivariable logistic regression analysis. The time of occurrence of OHCA was classified into four-time categories as follows. Rush hour on morning [7:00-9:00], Rush hour on evening [17:00-21:00], Daytime [9:00-17:00], and Night or Early morning [21:00-7:00].

Results

Among the 63,089 OHCA in the dataset, 702 were analysed. At 1-month after OHCA occurrence, Pre-EMS-arrival ROSC had higher survival rates than post-EMS-arrival ROSC (86.8% vs. 54.1%) and CPC1-2 rates (73.6% vs. 38.5%). Pre-EMS-arrival ROSC was associated (adjusted odds ratio [95% confidence interval]) with non-older-adult patients (1.59 [1.05-2.43]), witnessed OHCA (1.82 [1.03-3.31]), evening rush-hour (17:00-21:00; 2.08 [1.05-4.11]), conventional CPR (33.42 [7.82-868.44]), hands-only CPR (17.06 [4.30-436.48]), bystander defibrillation performed once (3.31 [1.59-6.99]).

Conclusions

In an OHCA at a station in Tokyo, ROSC achieved with bystander treatment alone had a better outcome at 1-month compared to ROSC with EMS intervention.

Racial and ethnic disparities in the provision of bystander CPR after witnessed out-of-hospital cardiac arrest in the United States

OBJECTIVE

To evaluate the association between race/ethnicity and the odds of receiving bystander cardiopulmonary resuscitation (bCPR) after witnessed out-of-hospital cardiac arrest (OHCA).

METHODS

For this cross-sectional retrospective study, data were obtained from the National Emergency Medical Services Information System database for adults (≥18 years) with a witnessed non-traumatic OHCA in the year 2021. Patients were separated into two groups including Black/Hispanic and White. The primary outcome was the odds of receiving bCPR. We excluded traumatic etiology, do-not-resuscitate orders, and arrest in a healthcare facility or wilderness location. Multiple logistic regression controlling for known covariates was utilized and analyses were stratified by public versus non-public location, median household income, and rural, suburban, or urban setting.

RESULTS

A total of 64,007 witnessed OHCAs were included. When compared to White, the Black/Hispanic group were younger (62 vs 67 years) and more often female (40% vs 33%), in neighborhoods with the lowest median household income (31% vs 13%) and in an urban setting (92% vs 80%). Overall, bystander CPR rates were 60% and 67% for the Black/Hispanic and White groups, respectively. Multiple logistic regression stratified by OHCA location found that the Black/Hispanic group had a decreased odds of receiving bCPR compared to the White group both in the home (adjusted OR [aOR] 0.77; 95% CI 0.74-0.81) and in public (aOR 0.69; 95% CI 0.64-0.76). This difference persisted throughout neighborhoods of different socioeconomic status and across the rural-urban spectrum.

CONCLUSIONS

Racial/ethnic disparities exist for Black and Hispanic persons in the odds of receiving bCPR after a witnessed non-traumatic OHCA regardless of public or private setting, neighborhood income level, or population density.

Clinical outcomes following out-of-hospital cardiac arrest: The minute-by-minute impact of bystander cardiopulmonary resuscitation

AIMS

The time-dependent prognostic role of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients has not been described with great precision, especially for neurologic outcomes. Our objective was to assess the association between bystander CPR, emergency medical service (EMS) response time, and OHCA patients' outcomes.

METHODS

This cohort study used the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registries. Bystander-witnessed adult OHCA treated by EMS were included. The primary outcome was survival to hospital discharge and secondary outcome was survival with a good neurologic outcome (modified Rankin scale 0-2). Multivariable logistic regression models were used to assess the associations and interactions between bystander CPR, EMS response time and clinical outcomes.

RESULTS

Out of 229,637 patients, 41,012 were included (18,867 [46.0%] without bystander CPR and 22,145 [54.0%] with bystander CPR). Bystander CPR was independently associated with higher survival (adjusted odds ratio [AOR] = 1.70 [95%CI 1.61-1.80]) and survival with a good neurologic outcome (AOR = 1.87 [95%CI 1.70-2.06]), while longer EMS response times were independently associated with lower survival to hospital discharge (each additional minute of EMS response time: AOR = 0.92 [95%CI 0.91-0.93], p < 0.001) and lower survival with a good neurologic outcome (AOR = 0.88 [95%CI 0.86-0.89], p < 0.001). There was no interaction between bystander CPR and EMS response time's association with survival (p = 0.12) and neurologic outcomes (p = 0.65).

CONCLUSIONS

Although bystander CPR is associated with an immediate increase in odds of survival and of good neurologic outcome for OHCA patients, it does not influence the negative association between longer EMS response time and survival and good neurologic outcome.

Improved ROSC rates in out-of-hospital cardiac arrest patients after introduction of a text message alert system for trained volunteers

OBJECTIVE

To evaluate whether a text message (TM) alert system for trained volunteers contributed to early cardiopulmonary resuscitation, the use of automated external defibrillators (AEDs), return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest (OHCA) patients in a region with above-average survival rates.

DESIGN

Data on all OHCA patients in 2012 (non-TM group) were compared with those of all OHCA patients in 2018 (TM group). The association of the presence of a TM alert system with ROSC and survival was assessed with multivariate regression analyses.

RESULTS

TM responders reached 42 OHCA patients (15.9%) earlier than the first responders or ambulance. They connected 31 of these 42 OHCA patients (73.8%) to an AED before the ambulance arrived, leading to a higher percentage of AEDs being attached in 2018 compared to the 2012 non-TM group (55% vs 46%, p = 0.03). ROSC was achieved more often in the TM group (61.0% vs 29.4%, p < 0.01). Three-month and 1‑year survival did not differ significantly between the two groups (29.3% vs 24.3%, p = 0.19, and 25.9% vs 23.5%, p = 0.51). Multivariate regression analyses confirmed the positive association of ROSC with the TM alert system (odds ratio 1.49, 95% confidence interval 1.02‑2.19, p = 0.04).

CONCLUSION

A TM alert system seems to improve the chain of survival; because TM responders reached patients early, AEDs were attached more often and more OHCA patients achieved ROSC. However, the introduction of a TM alert system was not associated with improved 3‑month or 1‑year survival in a region with above-average survival rates.

Sex difference in the association between type of bystander CPR and clinical outcomes in patients with out of hospital cardiac arrest

Background

A recent study suggested that women with out-of-hospital cardiac arrest have a smaller survival benefit with bystander cardiopulmonary resuscitation than men. We evaluated whether this weaker association between bystander cardiopulmonary resuscitation and survival in women is related to dispatcher-assisted vs unassisted bystander cardiopulmonary resuscitation.

Methods

In a national registry in the Republic of Korea, we identified adult patients with out-of-hospital cardiac arrest during 2013-2018. The main exposure was type of bystander cardiopulmonary resuscitation (categorized as none, dispatcher-assisted, and unassisted). The primary outcome was favourable neurological survival. Multivariable logistic regression evaluated for an interaction between sex and type of bystander cardiopulmonary resuscitation.

Results

Of 93,245 patients with out-of-hospital cardiac arrest, there were 31,578 (33.9%) women and 61,667 (66.1%) men. Overall, both types of bystander cardiopulmonary resuscitation were associated with favourable neurological survival (unassisted: adjusted OR, 1.81 [95% CI: 1.66-1.98]; dispatcher-assisted: adjusted OR, 1.44 [95% CI: 1.33-1.56]). When unassisted cardiopulmonary resuscitation was administered, the association between bystander cardiopulmonary resuscitation and favourable neurological survival was similar between women and men: adjusted ORs of 1.59 (95% CI: 1.30-1.95) in women and 1.88 (95% CI: 1.71-2.08) in men; interaction p = 0.65). In contrast, when dispatcher-assisted cardiopulmonary resuscitation was administered, the association differed by sex: adjusted ORs of 1.08 (95% CI: 0.90-1.92) in women and 1.55 (95% CI: 1.42-1.69) in men; interaction p < 0.0002).

Conclusions

Dispatcher-assisted cardiopulmonary resuscitation was associated with favourable neurological survival in men but not in women whereas unassisted bystander cardiopulmonary resuscitation was associated with favourable neurological survival in women and men.

Dispatcher-assisted conventional cardiopulmonary resuscitation and outcomes for paediatric out-of-hospital cardiac arrests

AIM

As asphyxial cardiac arrest is more common than cardiac arrest from a primary cardiac event in paediatric cardiac arrest, effective ventilation is important during paediatric cardiopulmonary resuscitation (CPR). We aimed to determine optimal dispatcher-assisted CPR instructions for bystanders after paediatric out-of-hospital cardiac arrest (OHCA).

METHODS

We analysed the records of 8172 children who received bystander dispatcher-assisted CPR. Data were obtained from an All-Japan Utstein-style registry from 2005 to 2017. Patients were divided into conventional CPR and compression-only CPR groups. The primary study endpoint was 1-month neurologically intact survival, defined as a Cerebral Performance Category score of 1 or 2 (CPC 1-2).

RESULTS

The 1-month CPC 1-2 rate was significantly higher in the dispatcher-assisted conventional CPR group than in the dispatcher-assisted compression-only CPR group (before propensity score matching, 5.7% [175/3077] vs. 3.1% [160/5095], p < 0.0001, adjusted odds ratio 2.48, 95% confidence interval 1.19-3.22; after propensity score matching, 6.0% [156/2618] vs. 2.6% [69/2618], p < 0.0001, adjusted odds ratio 2.42, 95% confidence interval 1.76-3.32). In most subgroup analyses after matching, dispatcher-assisted conventional CPR had a higher CPC 1-2 rate than dispatcher-assisted compression-only CPR; however, CPC 1-2 rates were similar between the two groups for patients with an initial shockable rhythm, those with total prehospital CPR time ≥ 20 min, those receiving public access defibrillation, advanced airway management, or adrenaline administration.

CONCLUSION

Within the limitations of this retrospective observational study, dispatcher-assisted conventional CPR was preferable to dispatcher-assisted compression-only CPR as optimal CPR instructions for coaching callers to perform bystander CPR.

Protocol for a cohort study of the impact of the COVID-19 pandemic on the rate and incidence of bystander cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest

Background

Survival after out-of-hospital cardiac arrest (OHCA) is dependent on early recognition, early cardiopulmonary resuscitation (CPR) and early defibrillation. The purpose of CPR is to maintain some blood flow until the arrival of the emergency medical services (EMS). Our concern is that the COVID-19 pandemic has had a negative effect on the number of patients who get CPR before EMS arrival. The aim of this study is to compare the incidence of bystander CPR during the pandemic with data from before the pandemic.

Methods

The protocol is for a retrospective cohort study where data from existing registries will be used. All participating registries will share aggregated data from 2017 to 2020, and the study team will compare the results from 2020 to results from 2017 to 2019. Due to the General Data Protection Regulation, each participating registry will check for completeness and plausibility, and perform all aggregation of data locally. In the following analysis different registries will be considered as random samples and analysed by means of a generalized linear mixed effects model with Poisson distribution for the outcome, the population covered as offsets, and different registries as random factors.

Discussion

This study does not present the prospect of direct benefit to the patient, but does provide an opportunity to gain a better understanding of the epidemiology of bystander CPR for OHCA patients during a pandemic. By comparing data during the pandemic with already collected information in established registries we believe we can gain valuable information about changes in public response to out-of-hospital cardiac arrest.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13049-021-00890-6.

Impact of community initiatives on non-EMS bystander CPR rates in West Yorkshire between 2014 and 2018

AIM

Bystander CPR rates have steadily increased in England between 2014 and 2018. In West Yorkshire, there have been two important developments during this time. We aimed to describe whether postcode districts (PCDs) with more cumulative annual 'Restart a Heart' (RSAH) and/or Community First Responder (CFR) scheme activity between 2014 and 2018 were associated with greater improvements in non-EMS bystander CPR rates for out-of-hospital cardiac arrest (OHCA) when compared with PCDs in the same region with lesser or no such historic activity during the same time period.

METHOD

We collated data from the OHCA Outcomes Registry for all non-EMS witnessed OHCA in West Yorkshire treated by Yorkshire Ambulance Service. We analysed clusters of PCDs with high and low levels of RSAH and CFR activity between 2014 and 2018 using descriptive statistics, and comparisons were made between groups using chi-square and t-test.

RESULTS

The reported bystander CPR rate for non-EMS witnessed OHCA cases for West Yorkshire rose from 38.4% in 2014 to 69.7% in 2018. The largest increases were seen in PCDs with high RSAH activity (+34.3%) and in the combination of high RSAH and low CFR activity (+38.5%). There was no significant difference when considering the interaction between RSAH and CFR groups.

CONCLUSION

The data infers the possibility of a non-significant association between improved non-EMS bystander CPR rates and RSAH training and CFR scheme activity. We recommend coordinated mass training, in particular for children in regions where CPR is not a mandatory part of the school curriculum.

The interplay between bystander cardiopulmonary resuscitation and ambient temperature on neurological outcome after cardiac arrest: A nationwide observational cohort study

BACKGROUND

At lower ambient temperature, patients with out-of-hospital cardiac arrest (OHCA) easily experience hypothermia. Hypothermia has shown to improve the rate of successful return of spontaneous circulation (ROSC) in animal models. We hypothesized that lower temperature affects the impact of bystander cardiopulmonary resuscitation (CPR) on the increased odds of a favorable neurological outcome post-OHCA.

METHODS

This study used information collected by the prospective, nationwide, Utstein registry to examine data from 352,689 adult patients who experienced OHCA from 2012 to 2016 in Japan. The primary outcome was a 1-month favorable neurological outcomes. Multivariable logistic regression analyses were conducted to test the impact of bystander CPR according to the temperature on the favorable outcome.

RESULTS

A total of 201,111 patients with OHCA were included in the complete case analysis. The lower temperature group had lower proportions of receiving bystander CPR (46.5 vs. 47.9%) and having favorable outcome (2.1 vs 2.8%) than those in the higher group. Multivariable analysis revealed that bystander CPR at lower temperatures was significantly associated with favorable outcomes (adjusted odds ratio, 1.22; 95% CI, 1.09-1.37), whereas bystander CPR at higher temperatures was not associated with favorable outcomes (1.02; 0.92-1.13). The nonlinear relationship using a spline curve in the multivariable model revealed that odds ratio of favorable neurological outcomes associated with bystander CPR increased as the temperature decreased.

CONCLUSION

Bystander CPR was associated with favorable neurological outcomes at lower temperatures. The odds of a favorable outcome associated with bystander CPR increased as the temperature decreased.

Increasing the shockable rhythm and survival rate by dispatcher-assisted cardiopulmonary resuscitation in Japan

Purpose

This study aimed to examine the effectiveness of cardiopulmonary resuscitation (CPR) directions by dispatchers. We analysed the relationship of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) with favourable cerebral function, shockable rhythm rate, and emergency medical service (EMS) arrival time.

Methods

This nationwide study was based on CPR statistical data of out-of-hospital cardiac arrest (OHCA) patients (n = 629,471) from 1 January 2011 to 31 December 2015, and included 107,669 patients with bystander-witnessed cardiogenic cardiac arrest.The primary outcome was good brain function prognosis after 1 month, while the secondary outcome was the rate of shockable rhythm on ECG at the time of EMS arrival.EMS arrival time at the site was stratified into 7 min, 8-10 min, and 11-20 min using tertiles. Adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were estimated using multivariate logistic regression analysis to assess the association between DA-BCPR and outcomes in each tertile.

Results

There were 37,269 (35%), 18,109 (17%), and 52,291 (49%) patients in the DA-BCPR, Only-BCPR, and no-BCPR groups, respectively. Compared to No-BCPR, DA-BCPR was associated with favourable neurological outcomes regardless of the time from 119 call to EMS contact (AOR, 1.56, 2.01, 1.82; 95% CI, 1.43-1.71, 1.80-2.24, 1.52-2.19; ≤7 min, 8-10 min, and 11-20 min, respectively). DA-BCPR showed association with the shockable rhythm rate upon EMS arrival regardless of the time 119 call to EMS contact (AOR, 1.30, 1.60, 1.90; 95% CI, 1.23-1.38, 1.51-1.70, 1.75-2.06; ≤7 min, 8-10 min, and 11-20 min, respectively).

Conclusion

Providing dispatcher assistance with CPR to 119 callers improves the long-term outcome regardless of the patient's age and EMS response time. Thus, encouraging dispatchers to promote BCPR is important for increasing the shockable rhythm rate and improving the brain function prognosis.

Comparison between dispatcher-assisted bystander CPR and self-led bystander CPR in out-of-hospital cardiac arrest (OHCA)

INTRODUCTION

Bystander cardiopulmonary resuscitation (CPR) is an important prognostic factor for outcome in out-of-hospital cardiac arrest (OHCA). The dispatcher-assisted (DA) bystander CPR program has increased the rate of bystander CPR by targeting bystanders with a lower level of CPR training. We evaluated the effects of dispatcher-assisted bystander CPR and self-led bystander CPR.

METHODS

A retrospective analysis was performed using a nationwide OHCA database from 2014 to 2018. Adult EMS-treated OHCA patients with presumed cardiac origin were enrolled. OHCAs were classified into 3 groups according to the type of bystander CPR (DA bystander CPR vs. self-led bystander CPR vs. no bystander CPR) provided. The primary outcome was good neurologic recovery at hospital discharge. A multivariable logistic regression model was used to estimate the association between the type of bystander CPR and outcomes.

RESULTS

A total of 91,557 eligible OHCA patients was enrolled in the final analysis. The proportion of patients with favorable neurologic outcomes was highest with self-led bystander CPR (9.0% for self-led bystander CPR, 5.2% for DA bystander CPR and 3.2% for no bystander CPR, p < 0.01). Self-led bystander CPR was associated with better neurological recovery than DA bystander CPR (aOR with 95% CI (DA-CPR as reference): 0.63 (0.58-0.69) for no bystander CPR, 1.28 (1.17-1.40) for self-led bystander CPR).

CONCLUSION

Although DA CPR was associated with better neurologic outcomes than no bystander CPR, good neurologic outcomes were most strongly associated with self-led bystander CPR.

Importance of "Telephone Cardiopulmonary Resuscitation" in out-of-Hospital Cardiac Arrest in India

Background:

Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality in developing countries such as India. Most cardiac arrests happen outside the hospital and are associated with poor survival rates due to delay in recognition and in performing early cardiopulmonary resuscitation (CPR). Community CPR training and telephone CPR (T-CPR) in the dispatch centers have been shown to increase bystander CPR rates and survival.

Objectives:

The aim of this study is to identify the significance of T-CPR in OHCA and to discuss its implementation in the health system to improve OHCA outcomes in India.

Materials and Methods:

A descriptive research study methodology was adopted following a literature search.

Results:

The search criterion “Cardiovascular diseases” resulted in 162, “Out-side hospital cardiac arrest” in 50; For a comprehensive overview, these publications were evaluated looking for data on T-CPR incidence, criteria for detecting OHCA by emergency medical dispatchers, sensitivity and specificity, and BCPR.

Conclusion:

This current research stresses the scale and seriousness of the implementation of T-CPR in OHCA in India.

Spontaneous trigger words associated with confirmed out-of-hospital cardiac arrest: a descriptive pilot study of emergency calls

BACKGROUND

According to the International Liaison Committee on Resuscitation (ILCOR), the trigger words used by callers that are associated with cardiac arrest constitute a scientific knowledge gap. This study was designed to find hypothetical trigger words in emergency calls in order to improve the specificity of out-of-hospital cardiac arrest recognition.

METHODS

In this descriptive pilot study conducted in a Finnish hospital district, linguistic contents of 80 emergency calls of dispatcher-suspected or EMS-encountered out-of-hospital cardiac arrests between January 1, 2017 and May 31, 2017 were analysed. Spontaneous trigger words used by callers were transcribed and grouped into 36 categories. The association between the spontaneous trigger words and confirmed true cardiac arrests was tested with logistic regression.

RESULTS

Of the suspected cardiac arrests, 51 (64%) were confirmed as true cardiac arrests when ambulance personnel met the patient. A total of 291 spontaneous trigger words were analysed. 'Is not breathing' (n = 9 [18%] in the true cardiac arrest group vs n = 1 [3%] in the non-cardiac arrest group, odds ratio [OR] 6.00, 95% confidence interval [CI] 0.72-50.0), 'the patient is blue' (n = 9 [18%] vs n = 1 [3%], OR 6.00, 95% CI 0.72-50.0), 'collapsed or fallen down' (n = 12 [24%] vs n = 2 [7%], OR 4.15, 95% CI 0.86-20.1) and 'is wheezing' (n = 17 [33%] vs n = 5 [17%], OR 2.40, 95% CI 0.78-7.40) were frequently used to describe true cardiac arrest. 'Is snoring' was associated with a false suspicion of cardiac arrest (n = 1 [2%] vs n = 6 [21%], OR 0.08, 95% CI 0.009-0.67).

CONCLUSIONS

In our pilot study, no trigger word was associated with confirmed cardiac arrest. 'Is wheezing' was a frequently used spontaneous trigger word among later confirmed cardiac arrest victims.

The influence of past experiences on future willingness to perform bystander cardiopulmonary resuscitation

Background

The influence of past familial experiences of receiving cardiopulmonary resuscitation (CPR) and medical help in various cardiac arrest and nonfatal cardiac events toward willingness to “pay it forward” by helping the next cardiac arrest victim was explored.

Methods

Using a validated questionnaire, 6248 participants were asked to rate their willingness to perform bystander chest compression with mouth-to-mouth ventilation and chest compression-only CPR. Their past familial experiences of receiving cardiopulmonary resuscitation (CPR) and medical help in various cardiac arrest and nonfatal cardiac events were also recorded.

Results

Kruskal-Wallis test with post hoc Dunn’s pairwise comparisons showed that the following were significantly more willing to perform CPR with mouth-to-mouth ventilation: familial experience of “nonfatal cardiac events” (mean rank = 447) vs “out-of-hospital cardiac arrest with no CPR” (mean rank = 177), U = 35442.5, z = −2.055, p = 0.04; “in-hospital cardiac arrest and successful CPR” (mean rank = 2955.79) vs “none of these experiences” (mean rank = 2468.38), U = 111903, z = −2.60, p = 0.01; and “in-hospital cardiac arrest with successful CPR” (mean rank = 133.45) vs “out-of-hospital arrest with no CPR” (mean rank = 112.36), U = 4135.5, z = −2.06, p = 0.04. For compression-only CPR, Kruskal-Wallis test with multiple runs of Mann-Whitney U tests showed that “nonfatal cardiac events” group was statistically higher than the group with “none of these experiences” (mean rank = 3061.43 vs 2859.91), U = 1194658, z = −2.588, p = 0.01. The groups of “in-hospital cardiac arrest with successful CPR” and “in-hospital cardiac arrest with transient return of spontaneous circulation” were the most willing groups to perform compression-only CPR.

Conclusion

Prior familial experiences of receiving CPR and medical help, particularly among those with successful outcomes in a hospital setting, seem to increase the willingness to perform bystander CPR.

'We're going to do CPR': A linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement

BACKGROUND

In emergency ambulance calls for out-of-hospital cardiac arrest (OHCA), dispatcher-assisted cardiopulmonary resuscitation (CPR) plays a crucial role in patient survival. We examined whether the language used by dispatchers to initiate CPR had an impact on callers' agreement to perform CPR.

METHODS

We analysed 424 emergency calls relating to cases of paramedic-confirmed OHCA where OHCA was recognised by the dispatcher, the caller was with the patient, and resuscitation was attempted by paramedics. We investigated the linguistic choices used by dispatchers to initiate CPR, and the impact of those choices on caller agreement to perform CPR.

RESULTS

Overall, CPR occurred in 85% of calls. Caller agreement was low (43%) when dispatchers used terms of willingness ("do you want to do CPR?"). Caller agreement was high (97% and 84% respectively) when dispatchers talked about CPR in terms of futurity ("we are going to do CPR") or obligation ("we need to do CPR"). In 38% (25/66) of calls where the caller initially declined CPR, the dispatcher eventually secured their agreement by making several attempts at initiating CPR.

CONCLUSION

There is potential for increased agreement to perform CPR if dispatchers are trained to initiate CPR with words of futurity and/or obligation.

Association between the centralization of dispatch centers and dispatcher-assisted cardiopulmonary resuscitation programs: A natural experimental study

OBJECTIVES

We aimed to evaluate the associations between the centralization of dispatch centers and dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) for out-of-hospital cardiac arrest (OHCA) patients.

METHODS

All emergency medical services (EMS)-treated adults in Gyeonggi province (34 fire departments covering 43 counties, with a population of 12.6 million) with OHCAs of cardiac etiology were enrolled between 2013 and 2016, excluding cases witnessed by EMS providers. In Gyeonggi province, 34 agency-based dispatch centers were sequentially integrated into two province-based central dispatch centers (north and south) between November 2013 and May 2016. Exposure was the centralization of the dispatch centers. Endpoint variables were BCPR and dispatcher-provided CPR instructions. Generalized linear mixed models for multilevel regression analyses were performed.

RESULTS

Overall, 11,616 patients (5060 before centralization and 6556 after centralization) were included in the final analysis. The OHCAs that occurred during the after-centralization period were more likely to receive BCPR (62.6%, 50.6% BCPR-with-DA and 12.0% BCPR-without-DA) than were those that occurred before-centralization period (44.6%, 16.6% BCPR-with-DA and 28.1% BCPR-without-DA) (p < 0.01, adjusted OR: 1.59 (1.38-1.83), adjusted rate difference: 9.1% (5.0-13.2)). For dispatcher-provided CPR instructions, OHCAs diagnosed at a higher rate during the after-centralization period than during the before-centralization period (67.4% vs. 23.1%, p < 0.01, adjusted OR: 4.57 (3.26-6.42), adjusted rate difference: 30.3% (26.4-34.2)). The EMS response time was not different between the groups (p=0.26).

CONCLUSIONS

The centralization of dispatch centers was associated with an improved bystander CPR rate and dispatcher-provided CPR instructions for OHCA patients.

An Inappropriate Shock Case Early after Implantation of a Subcutaneous Cardiac Defibrillator by Subcutaneous Entrapped Air

A 17-year-old woman was resuscitated from cardiac arrest due to ventricular fibrillation and was diagnosed with concealed long QT syndrome. She underwent subcutaneous implantable cardiac defibrillator (S-ICD) implantation at our hospital. The device electrogram immediately after implantation was normal. Four days after implantation, she received an inappropriate shock. The device interrogation revealed a continuous baseline shift and frequent oversensing for low amplitude signals, followed by a shock. A chest radiograph in the orthogonal view showed entrapped subcutaneous air surrounding the distal electrode. Entrapped subcutaneous air can cause inappropriate shocks in the early period after S-ICD implantation.

Regional variation in functional outcome after out-of-hospital cardiac arrest across 47 prefectures in Japan

BACKGROUND

Although prior work reported regional variation in survival after out-of-hospital cardiac arrest (OHCA), mechanisms of the variation have not been fully investigated. We sought to evaluate regional variation in favourable functional outcome after OHCA across 47 prefectures in Japan as our primary aim. We also evaluated the associations between favourable functional outcome and the numbers of basic life support (BLS) providers and public access automated external defibrillators (AEDs) within each prefecture as our secondary aim.

METHODS

Using the All-Japan Utstein Registry, a nationwide prospective, population-based OHCA database, we identified 97,408 patients with OHCA of medical origin across 47 prefectures in 2014. Primary outcome was 1-month survival with favourable functional outcome, defined as Cerebral Performance Category (CPC) scale 1 or 2. We fitted multivariable hierarchical logistic regression models (patients nested within prefectures) to adjust for potential confounding factors at patient- and prefecture-level and clustering of patients within prefectures. We calculated median odds ratios (ORs) from the hierarchical models to quantify the outcome variation at prefecture-level. We also evaluated the associations between OHCA outcome and the numbers of BLS providers and public access AEDs within each prefecture, using the hierarchical models.

RESULTS

A total of 2246 patients (2.3%) had 1-month survival with favourable functional outcome. The unadjusted rates of 1-month survival with favourable functional outcome in each prefecture ranged from 1.1% to 4.1% (median OR = 1.29; 95% credible interval, 1.20-1.40) and the adjusted rates varied from 0.9% to 3.5% (median OR = 1.34; 95% credible interval, 1.24-1.48). We observed no associations between 1-month survival with favourable functional outcome and the numbers of BLS providers (correlation coefficient = -0.25; 95% confidence interval [CI], -0.50 to 0.04; p = 0.09) and public access AEDs (correlation coefficient = -0.27; 95% CI, -0.51 to 0.02; p = 0.07) within prefectures.

CONCLUSIONS

We found substantial regional variation in favourable functional outcome after OHCA of medical origin that was not explained by the numbers of BLS providers and public access AEDs within each prefecture.

Compression-only life support (COLS) for cardiopulmonary resuscitation by layperson outside the hospital

The cardiopulmonary resuscitation (CPR) guidelines of compression-only life support (COLS) for management of the victim with cardiopulmonary arrest in adults provide a stepwise algorithmic approach for optimal outcome of the victim outside the hospital by untrained laypersons. These guidelines have been developed to recommend practical, uniform and acceptable resuscitation algorithms across India. As resuscitation data of the Indian population are inadequate, these guidelines have been based on international literature. The guidelines have been recommended after discussion among Indian experts and the recommendations modified to ensure its practical applicability across the country. The COLS emphasises on early recognition of cardiac arrest and activation, early chest compression and early transfer to medical facility. The guidelines emphasise avoidance of any interruption of chest compression, and thus relies primarily on chest compression-only CPR by laypersons.

Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival

BACKGROUND

Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated with bystander CPR, return of spontaneous circulation (ROSC), and 30-day survival. Our secondary aim was to identify patient-, setting-, and dispatcher-related predictors of OHCA recognition.

METHODS

We performed an observational study of all OHCA patients' emergency calls in the Capital Region of Denmark from 01/01/2013-31/12/2013. OHCAs were collected from the Danish Cardiac Arrest Registry and the Mobile Critical Care Unit database. Emergency call recordings were identified and evaluated. Multivariable logistic regression analyses were applied to all OHCAs and witnessed OHCAs only to analyse the association between OHCA recognition and bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of OHCA recognition.

RESULTS

We included 779 emergency calls in the analyses. During the emergency calls, 70.1% (n=534) of OHCAs were recognised; OHCA recognition was positively associated with bystander CPR (odds ratio [OR]=7.84, 95% confidence interval [CI]: 5.10-12.05) in all OHCAs; and ROSC (OR=1.86, 95% CI: 1.13-3.06) and 30-day survival (OR=2.80, 95% CI: 1.58-4.96) in witnessed OHCA. Predictors of OHCA recognition were addressing breathing (OR=1.76, 95% CI: 1.17-2.66) and callers located by the patient's side (OR=2.16, 95% CI: 1.46-3.19).

CONCLUSIONS

Recognition of OHCA during emergency calls was positively associated with the provision of bystander CPR, ROSC, and 30-day survival in witnessed OHCA.

Timely bystander CPR improves outcomes despite longer EMS times

OBJECTIVES

This study aimed to determine the impact of bystander CPR on clinical outcomes in patients with increasing response time from collapse to EMS response.

METHODS

A population-based observational study was conducted in patients with witnessed out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology from 2012 to 2014. The time interval from collapse to CPR by EMS providers was categorized into quartile groups: fastest group (<4min), fast group (4 to <8min), late group (8 to <15min), and latest group (15 to <30min). The primary outcome was hospital discharge and the secondary outcome was survival with good neurological outcome. Multivariable logistic regression analysis was performed to evaluate the interaction between bystander CPR and the time interval from collapse to CPR by EMS providers.

RESULTS

A total of 15,354 OHCAs were analyzed. Bystander CPR was performed in 8591 (56.0%). Survival to hospital discharge occurred in 1632 (10.6%) and favorable neurological outcome in 996 (6.5%). In an interaction model of bystander CPR, compared to the fastest group, adjusted odds ratios (AORs) (95% CIs) for survival to discharge were 0.89 (0.66-1.20) in the fast group, 0.76 (0.57-1.02) in the late group, and 0.52 (0.37-0.73) in the latest group. For favorable neurological outcome, AORs were 1.12 (0.77-1.62) in the fast group, 0.90 (0.62-1.30) in the late group, 0.59 (0.38-0.91) in the latest group.

CONCLUSION

The survival from OHCA decreases as the ambulance response time increases. The increase in mortality and worsening neurologic outcomes appear to be mitigated in those patients who receive bystander CPR.

Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival-An evaluation of 548 emergency calls

BACKGROUND

This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPR_prior) versus during the emergency call following dispatcher-assisted CPR (CPR_during) - was associated with return of spontaneous circulation (ROSC) and 30-day survival. The secondary aim was to identify predictors of CPR_prior.

METHODS

This observational study evaluated out-of-hospital cardiac arrests (OHCA) occurring in the Capital Region of Denmark from 01.01.2013 to 31.12.2013. OHCAs were linked to emergency medical dispatch centre records and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPR_prior.

RESULTS

The study included 548 emergency calls for OHCA patients receiving bystander CPR, 34.9% (n=191) in the CPR_prior group and 65.1% (n=357) in the CPR_during group. Multivariable analyses showed no difference in ROSC (OR=0.88, 95% CI: 0.56-1.38) or 30-day survival (OR=1.14, 95% CI: 0.68-1.92) between CPR_prior and CPR_during. Predictors positively associated with CPR_prior included witnessed OHCA and healthcare professional bystanders. Predictors negatively associated with CPR_prior included residential location, solitary bystanders, and bystanders related to the patient.

CONCLUSIONS

The majority of bystander CPR (65%) was initiated during the emergency call, following dispatcher-assisted CPR instructions. Whether bystander CPR was initiated prior to emergency call versus during the emergency call following dispatcher-assisted CPR was not associated with ROSC or 30-day survival. Dispatcher-assisted CPR was especially beneficial for the initiation of bystander CPR in residential areas.