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Blewer AL, Bigham BL, Kaplan S, Del Rios M, Leary M. Gender, Socioeconomic Status, Race, and Ethnic Disparities in Bystander Cardiopulmonary Resuscitation and Education-A Scoping Review. Healthcare (Basel) 2024; 12:456. [PMID: 38391831 PMCID: PMC10887971 DOI: 10.3390/healthcare12040456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Social determinants are associated with survival from out-of-hospital sudden cardiac arrest (SCA). Because prompt delivery of bystander CPR (B-CPR) doubles survival and B-CPR rates are low, we sought to assess whether gender, socioeconomic status (SES), race, and ethnicity are associated with lower rates of B-CPR and CPR training. METHODS This scoping review was conducted as part of the continuous evidence evaluation process for the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care as part of the Resuscitation Education Science section. We searched PubMed and excluded citations that were abstracts only, letters or editorials, and pediatric studies. RESULTS We reviewed 762 manuscripts and identified 24 as relevant; 4 explored gender disparities; 12 explored SES; 11 explored race and ethnicity; and 3 had overlapping themes, all of which examined B-CPR or CPR training. Females were less likely to receive B-CPR than males in public locations. Observed gender disparities in B-CPR may be associated with individuals fearing accusations of inappropriate touching or injuring female victims. Studies demonstrated that low-SES neighborhoods were associated with lower rates of B-CPR and CPR training. In the US, predominantly Black and Hispanic neighborhoods were associated with lower rates of B-CPR and CPR training. Language barriers were associated with lack of CPR training. CONCLUSION Gender, SES, race, and ethnicity impact receiving B-CPR and obtaining CPR training. The impact of this is that these populations are less likely to receive B-CPR, which decreases their odds of surviving SCA. These health disparities must be addressed. Our work can inform future research, education, and public health initiatives to promote equity in B-CPR knowledge and provision. As an immediate next step, organizations that develop and deliver CPR curricula to potential bystanders should engage affected communities to determine how best to improve training and delivery of B-CPR.
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Affiliation(s)
- Audrey L Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Blair L Bigham
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5R 0A3, Canada
- Scarborough Health Network Research Institute, Toronto, ON M1P 2T7, Canada
| | - Samantha Kaplan
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC 27710, USA
| | - Marina Del Rios
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Marion Leary
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
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Joyner BL. Out-of-Hospital Cardiac Arrests: Adding to the Complexity. J Am Heart Assoc 2023; 12:e031000. [PMID: 37721157 PMCID: PMC10547285 DOI: 10.1161/jaha.123.031000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Benny L. Joyner
- Department of PediatricsUniversity of North Carolina at Chapel HillChapel HillNC
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Gupta K, Raj R, Asaki SY, Kennedy K, Chan PS. Comparison of Out-of-Hospital Cardiac Arrest Outcomes Between Asian and White Individuals in the United States. J Am Heart Assoc 2023; 12:e030087. [PMID: 37493009 PMCID: PMC10547294 DOI: 10.1161/jaha.123.030087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/12/2023] [Indexed: 07/27/2023]
Abstract
Background Disparities in bystander cardiopulmonary resuscitation (CPR) and survival have been reported for Black and Hispanic individuals with out-of-hospital cardiac arrest (OHCA). Whether Asian individuals have lower rates of bystander CPR and survival for OHCA, as compared with White individuals, remains unknown. Methods and Results Within the US-based CARES (Cardiac Arrest Registry to Enhance Survival), we identified 278 989 OHCAs in Asian and White individuals during 2013 to 2021. Using hierarchical Poisson logistic regression with emergency medical service agency modeled as a random effect and patient and OHCA characteristics as fixed effects, we compared rates of bystander CPR, survival to discharge, and favorable neurological survival between Asian and White individuals with OHCA. Overall, 14 835 (5.3%) OHCAs occurred in Asian individuals. Compared with White individuals with OHCA, Asian individuals were older (67.0±17.6 versus 62.8±16.9 years) and were less likely to have drug overdose as the cause of OHCA (1.3% versus 6.6%) and a shockable arrest rhythm (19.2% versus 22.4%). Layperson bystander CPR rates were similar between Asian and White individuals (42.6% versus 42.1%; adjusted relative risk for Asian individuals, 0.99 [95% CI, 0.97-1.02]; P=0.69). However, rates of survival to discharge were lower in Asian individuals with OHCA (8.2% versus 10.3%; adjusted relative risk 0.92 [0.86-0.98] P=0.006). Similarly, the rate of favorable neurological survival was lower for Asian individuals (6.5% versus 8.7%; adjusted relative risk, 0.85 [0.79-0.91]; P<0.001). Conclusions Despite similar rates of bystander CPR, Asian individuals with OHCA have lower survival rates than White individuals with OHCA. The reasons for the lower survival rate deserve further study to determine whether there are disparities in resuscitation care between Asian and White individuals with OHCA.
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Affiliation(s)
- Kashvi Gupta
- Saint Luke’s Mid America Heart InstituteKansas CityMOUSA
- University of Missouri Kansas CityKansas CityMOUSA
| | - Rohan Raj
- Pembroke Hill High SchoolKansas CityMOUSA
| | | | - Kevin Kennedy
- Saint Luke’s Mid America Heart InstituteKansas CityMOUSA
| | - Paul S. Chan
- Saint Luke’s Mid America Heart InstituteKansas CityMOUSA
- University of Missouri Kansas CityKansas CityMOUSA
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Sutton TS, Bailey DL, Rizvi A, Al-Araji R, Kasliwala Q, Nero T, Scalzo M, Panza G, Mather JF, Orlando R, Hashim S, McKay RG. Racial and Ethnic Disparities in the Treatment and Outcomes for Witnessed Out-of-Hospital Cardiac Arrest in Connecticut. Resuscitation 2023:109850. [PMID: 37230326 DOI: 10.1016/j.resuscitation.2023.109850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Racial and ethnic disparities in the treatment and outcomes for witnessed out-of-hospital cardiac arrest (OHCA) in the United States have been previously described. We sought to characterize disparities in pre-hospital care, overall survival, and survival with favorable neurological outcomes following witnessed OHCA in the state of Connecticut. METHODS We performed a cross-sectional study to compare pre-hospital treatment and outcomes for White versus Black and Hispanic (Minority) OHCA patients submitted from Connecticut to the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2021. Primary outcomes included bystander CPR use, bystander automated external defibrillator (AED) use with attempted defibrillation, overall survival, and survival with favorable cerebral function. RESULTS 2,809 patients with witnessed OHCA were analyzed (924 Black or Hispanic; 1885 White). Minorities had lower rates of bystander CPR (31.4% vs 39.1%, P=0.002) and bystander AED placement with attempted defibrillation (10.5% vs 14.4%, P=0.004), with lower rates of survival to hospital discharge (10.3% vs 14.8%, P=0.001) and survival with favorable cerebral function (65.3% vs 80.2%, P=0.003). Minorities were less likely to receive bystander CPR in communities with median annual household income >$80, 000 (OR, 0.56; 95% CI, 0.33 - 0.95; P=0.030) and in integrated neighborhoods (OR, 0.70; 95% CI, 0.52 - 0.95; P=0.020). CONCLUSIONS Black and Hispanic Connecticut patients with witnessed OHCA have lower rates of bystander CPR, attempted AED defibrillation, overall survival, and survival with favorable neurological outcomes compared to White patients. Minorities were less likely to receive bystander CPR in affluent and integrated communities.
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Affiliation(s)
| | | | - Asad Rizvi
- Department of Cardiology, Hartford Hospital
| | | | | | - Thomas Nero
- Department of Cardiology, St Vincent's Medical Center
| | | | - Gregory Panza
- Department of Research Administration, Hartford Hospital
| | - Jeff F Mather
- Department of Research Administration, Hartford Hospital
| | | | - Sabet Hashim
- Department of Cardiac Surgery, Hartford Hospital
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5
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Mori Y, Iio Y, Aoyama Y, Kozai H, Tanaka M, Aoike M, Kawamura H, Seguchi M, Tsurudome M, Ito M. Willingness and Predictors of Bystander CPR Intervention in the COVID-19 Pandemic: A Survey of Freshmen Enrolled in a Japanese University. Int J Environ Res Public Health 2022; 19:15770. [PMID: 36497845 PMCID: PMC9737097 DOI: 10.3390/ijerph192315770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has decreased bystander cardiopulmonary resuscitation (BCPR) intervention rates. The purpose of this study was to elucidate the willingness of university freshmen to provide BCPR during the COVID-19 pandemic and the predictors thereof. A cross-sectional survey of 2789 newly enrolled university students was conducted after the end of the sixth wave of the COVID-19 epidemic in Japan; predictors of willingness to provide BCPR were assessed by regression analysis. Of the 2534 participants 1525 (60.2%) were willing to intervene and provide BCPR during the COVID-19 pandemic. Hesitancy due to the anxiety that CPR intervention might result in poor prognosis was a negative predictor of willingness. In contrast, anxiety about the possibility of infection during CPR intervention did not show a negative impact. On the other hand, interest in CPR and willingness to participate in a course, confidence in CPR skills, awareness of automated external defibrillation, and knowledge of CPR during the COVID-19 pandemic, were also positive predictors. This study suggests that the barrier to willingness to intervene with BCPR during a COVID-19 pandemic is not fear of infection, but rather hesitation due to the possibility of poor prognosis from the intervention. The significance of conducting this study during the COVID-19 epidemic is great, and there is an urgent need for measures to overcome hesitation regarding BCPR.
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Affiliation(s)
- Yukihiro Mori
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Center for Nursing Practicum Support, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Yoko Iio
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Yuka Aoyama
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Department of Clinical Engineering, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Hana Kozai
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Mamoru Tanaka
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Makoto Aoike
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Hatsumi Kawamura
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Manato Seguchi
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Masato Tsurudome
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
| | - Morihiro Ito
- Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
- Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai 487-8501, Aichi, Japan
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Liou FY, Tsai MS, Kuo LK, Hsu HH, Lai CH, Lin KC, Huang WC. A Study on the Outcome of Targeted Temperature Management Comparing Cardiac Arrest Patients Who Received Bystander Cardiopulmonary Resuscitation With Those Who Did Not, Using the Nationwide TIMECARD Multicenter Registry. Front Med (Lausanne) 2022; 9:779781. [PMID: 35492359 PMCID: PMC9043113 DOI: 10.3389/fmed.2022.779781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Targeted temperature management (TTM) is associated with decreased mortality and improved neurological function after cardiac arrest. Additionally, studies have shown that bystander cardiopulmonary resuscitation (BCPR) doubled the survival of patients with out-of-hospital cardiac arrest (OHCA) compared to patients who received no BPCR (no-BCPR). However, the outcome benefits of BCPR on patients who received TTM are not fully understood. Therefore, this study aimed to investigate the outcome differences between BCPR and no-BCPR in patients who received TTM after cardiac arrest. Methods The Taiwan Network of Targeted Temperature Management for Cardiac Arrest (TIMECARD) multicenter registry established a study cohort and a database for patients receiving TTM between January 2013 and September 2019. A total of 580 patients were enrolled and divided into 376 and 204 patients in the BCPR and no-BCPR groups, respectively. Results Compared to the no-BCPR group, the BCPR group had a better hospital discharge and survival rate (42.25 vs. 31.86%, P = 0.0305). The BCPR group also had a better neurological outcome at hospital discharge. It had a higher average GCS score (11.3 vs. 8.31, P < 0.0001) and a lower average Glasgow-Pittsburgh cerebral performance category (CPC) scale score (2.14 vs. 2.98, P < 0.0001). After undertaking a multiple logistic regression analysis, it was found that BCPR was a significant positive predictor for in-hospital survival (OR = 0.66, 95% CI: 0.45-0.97, P = 0.0363). Conclusions This study demonstrated that BCPR had a positive survival and neurological impact on the return of spontaneous circulation (ROSC) in patients receiving TTM after cardiac arrest.
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Affiliation(s)
- Fang-Yu Liou
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Education Center, National Cheng Kung University, Tainan, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Li-Kuo Kuo
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Hsin-Hui Hsu
- Department of Critical Care Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Kun-Chang Lin
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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7
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Goto Y, Funada A, Maeda T, Goto Y. Association of dispatcher-assisted cardiopulmonary resuscitation with initial shockable rhythm and survival after out-of-hospital cardiac arrest. Eur J Emerg Med 2022; 29:42-48. [PMID: 34334769 PMCID: PMC8691373 DOI: 10.1097/mej.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND IMPORTANCE Bystander cardiopulmonary resuscitation (CPR) and initial shockable rhythm are crucial predictors of survival after out-of-hospital cardiac arrest (OHCA). However, the relationship between dispatcher-assisted CPR (DA-CPR) and initial shockable rhythm is not completely elucidated. OBJECTIVE To examine the association of DA-CPR with initial shockable rhythm and outcomes. DESIGN, SETTING AND PARTICIPANTS This nationwide population-based observational study conducted in Japan included 59 688 patients with witnessed OHCA of cardiac origin after excluding those without bystander CPR. Patients were divided into DA-CPR (n = 42 709) and CPR without dispatcher assistance (unassisted CPR, n = 16 979) groups. OUTCOME MEASURES AND ANALYSIS The primary outcome measure was initial shockable rhythm, and secondary outcome measures were 1-month survival and neurologically intact survival. A Cox proportional hazards model adjusted for collapse-to-first-rhythm-analysis time and multivariable logistic regression models were used after propensity score (PS) matching to compare the incidence of initial shockable rhythm and outcomes, respectively. MAIN RESULTS Among all patients (mean age 76.7 years), the rates of initial shockable rhythm, 1-month survival and neurologically intact survival were 20.8, 10.7 and 7.0%, respectively. The incidence of initial shockable rhythm in the DA-CPR group (20.4%, 3462/16 979) was significantly higher than that in the unassisted CPR group (18.5%, 3133/16 979) after PS matching (P < 0.0001). However, no significant differences were found between the two groups with respect to the incidence of initial shockable rhythm in the Cox proportional hazards model [adjusted hazard ratio of DA-CPR for initial shockable rhythm compared with unassisted CPR, 0.99; 95% confidence interval (CI), 0.97-1.02, P = 0.56]. No significant differences were observed in the survival rates in the two groups after PS matching [10.8% (1833/16 979) vs. 10.3% (1752/16 979), P = 0.16] and neurologically intact survival rates [7.3% (1233/16 979) vs. 6.8% (1161/16 979), P = 0.13]. The multivariable logistic regression model showed no significant differences between the groups with regard to survival (adjusted odds ratio of DA-CPR compared with unassisted CPR: 1.00; 95% CI, 0.89-1.13, P = 0.97) and neurologically intact survival (adjusted odds ratio: 1.12; 95% CI, 0.98-1.29, P = 0.14). CONCLUSION DA-CPR after OHCA had the same independent association with the likelihood of initial shockable rhythm and 1-month meaningful outcome as unassisted CPR.
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Affiliation(s)
- Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa
| | - Akira Funada
- Department of Cardiology, Osaka Saiseikai Senri Hospital, Suita
| | - Tetsuo Maeda
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa
| | - Yumiko Goto
- Department of Cardiology, Yawata Medical Center, Komatsu, Japan
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Murasaka K, Yamashita A, Owada H, Wato Y, Inaba H. Association between the types of bystander cardiopulmonary resuscitation and the survival with good neurologic outcome of preschool pediatric out-of-hospital cardiac arrest cases in Japan: A propensity score matching analysis using an extended nationwide database. Front Pediatr 2022; 10:1075983. [PMID: 36819193 PMCID: PMC9929575 DOI: 10.3389/fped.2022.1075983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/30/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pediatric out-of-hospital cardiac arrests (OHCAs) are frequently associated with a respiratory etiology. Despite the high proportion of preschool children with OHCAs, very few studies on this special population exist. This study characterizes the epidemiologic features of preschool pediatric OHCAs and analyzes the advantage of conventional (ventilations with chest compressions) bystander cardiopulmonary resuscitation (CPR) over compression-only bystander CPR (BCPR) on the one-month post-event neurological status of the patient. METHODS Japanese nationwide databases for all ambulance transport events and OHCAs occurring during a 4-year period between 2016 and 2019 were combined, totalling 3,608 patient events. Children ≤6-years-old were included; physician- and EMS-witnessed events, no prehospital resuscitation effort events, and neonatal patient events were excluded. Neurologically favorable 1-month survival rates were compared among groups using univariate and multivariate analyses before and after propensity score matching. RESULTS From the combined database, 2,882 pediatric OHCAs meeting selection criteria were categorized as no BCPR (984), compression-only BCPR (1,428), and conventional BCPR (470). The proportion of bystander-witnessed cases was low (22.3%). Most OHCA witnesses were family members (88.5%), and most OHCAs occurred at home (88.0%). The neurologically favorable 1-month survival rates were: no BCPR 2.4%, compression only, 3.2%, and conventional 6.6% (P < 0.01). Multivariate logistic regression analysis before and after matching showed that conventional BCPR was associated with higher neurologically favorable 1-month survival than compression-only BCPR. Subgroup analyses after matching demonstrated that conventional BCPR was associated with better outcomes in nonmedical (adjusted odds ratio; 95% confidence interval, 2.83; 1.09-7.32) and unwitnessed OHCA cases (3.42; 1.09-10.8). CONCLUSIONS Conventional CPR is rarely performed by bystanders in preschool pediatric OHCA. However, conventional BCPR results in neurologically favorable outcomes in nonmedical and unwitnessed cases.
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Affiliation(s)
- Kenshi Murasaka
- Department of Emergency Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Akira Yamashita
- Department of Cardiology, Noto General Hospital, Nanao, Japan
| | - Hitoshi Owada
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Yukihiro Wato
- Department of Emergency Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Hideo Inaba
- Department of Emergency Medicine, Kanazawa Medical University, Uchinada, Japan.,Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Kanazawa University, Kanazawa, Japan
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Scapigliati A, Zace D, Matsuyama T, Pisapia L, Saviani M, Semeraro F, Ristagno G, Laurenti P, Bray JE, Greif R. Community Initiatives to Promote Basic Life Support Implementation-A Scoping Review. J Clin Med 2021; 10:jcm10245719. [PMID: 34945015 PMCID: PMC8703423 DOI: 10.3390/jcm10245719] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Early intervention of bystanders (the first links of the chain of survival) have been shown to improve survival and good neurological outcomes of patients suffering out-of-hospital cardiac arrest (OHCA). Many initiatives have been implemented to increase the engagement of communities in early basic life support (BLS) and cardiopulmonary resuscitation (CPR), especially of lay people with no duty to respond. A better knowledge of the most effective initiatives might help improve survival and health system organization. Aim of the scoping review: To assess the impact of specific interventions involving lay communities on bystander BLS rates and other consistent clinical outcomes, and to identify relevant knowledge gaps. METHODS This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We performed a literature search using the PubMed, EMBASE, and Cochrane databases until 1 February 2021. The screening process was conducted based on predefined inclusion/exclusion criteria, and for each included study, we performed data extraction focusing on the type of intervention implemented, and the impact of these interventions on the specific OHCAs outcomes. RESULTS Our search strategy identified 19 eligible studies, originating mainly from the USA (47.4%) and Denmark (21%). The type of intervention included in 57.9% of cases was a community CPR training program, in 36.8% bundled interventions, and in 5.3% mass-media campaigns. The most commonly reported outcome for OHCAs was bystander CPR rate (94.7%), followed by survival to hospital discharge (36.8%), proportion of people trained (31.6%), survival to hospital discharge with good neurological outcome (21%), and Return of Spontaneous Circulation (10.5%). Community training programs and bundled interventions improved bystander CPR in most of the included studies. CONCLUSION Based on the results of our scoping review, we identified the potential benefit of community initiatives, such as community training in BLS, even as part of bundled intervention, in order to improve bystander CPR rates and patient outcomes.
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Affiliation(s)
- Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (L.P.); (M.S.)
- Italian Resuscitation Council, 40128 Bologna, Italy; (D.Z.); (F.S.); (G.R.)
- Correspondence: ; Tel.: +39-630154507
| | - Drieda Zace
- Italian Resuscitation Council, 40128 Bologna, Italy; (D.Z.); (F.S.); (G.R.)
- Section of Hygiene, University Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Luca Pisapia
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (L.P.); (M.S.)
| | - Michela Saviani
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (L.P.); (M.S.)
| | - Federico Semeraro
- Italian Resuscitation Council, 40128 Bologna, Italy; (D.Z.); (F.S.); (G.R.)
- Department of Anaesthesia and Intensive Care and EMS, Maggiore Hospital Bologna, 40133 Bologna, Italy
| | - Giuseppe Ristagno
- Italian Resuscitation Council, 40128 Bologna, Italy; (D.Z.); (F.S.); (G.R.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Patrizia Laurenti
- Section of Hygiene, University Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Janet E. Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3400, Australia;
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- School of Medicine, Sigmund Freud University Vienna, 1020 Vienna, Austria
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Ebunlomo EO, Gerik L, Ramon R. Save a Life: Implementation and Evaluation of a Community-Focused CPR Education Program in Houston, Texas. J Prim Care Community Health 2021; 12:2150132721998249. [PMID: 33648361 PMCID: PMC7930652 DOI: 10.1177/2150132721998249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Over 350 000 people in the United States experience out-of-hospital cardiac arrest (OHCA) annually—and almost 90% die as a result. However, survival varies widely between counties, ranging from 3.4% to 22.0%—a disparity that the American Heart Association (AHA) largely attributes to variation in rates of bystander CPR. Studies show that regions with low rates of bystander CPR have low rates of CPR training, making CPR training initiatives a high-priority intervention to reduce OHCA mortality. In Houston, Texas, researchers have identified census tracts with higher OCHA incidence and lower rates of bystander CPR. We developed a free, annual Hands-Only CPR bilingual health education program central to these high-risk neighborhoods. In 5 years, this collaborative effort trained over 2700 individuals. In 2016, 2017, and 2018, we conducted a process evaluation to assess fidelity, dose delivered, and dose received. We also conducted an outcome evaluation using the Kirkpatrick Model for Training Evaluation to assess participants’ reactions and learning. Overall, the program yielded positive outcomes. Of the 261 respondents (from 314 attendees), 63% were first-time learners. The majority (87%) were satisfied with the event and 85% felt that information was presented clearly and concisely. Pre- and post-knowledge assessments showed a 51% increase in the proportion of respondents who could correctly identify the steps for Hands-Only CPR. This program exemplifies how collaborative education can impact a community’s health status. Leveraging each partner’s resources and linkages with the community can enhance the reach and sustainability of health education initiatives.
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Affiliation(s)
- Ebun O Ebunlomo
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Laura Gerik
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Rene Ramon
- American Heart Association, Houston, TX, USA
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11
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Guo N, Hampton MD. Improve Bystander Cardiopulmonary Resuscitation in the Chinese Community. Int Q Community Health Educ 2020; 41:309-314. [PMID: 32631151 DOI: 10.1177/0272684x20942073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Though many community cardiopulmonary resuscitation (CPR) training classes are available throughout the United States, disparities exist in training and receipt of bystander CPR for Chinese immigrants with limited English proficiency. To increase the number of persons prepared to respond to a cardiac emergency, a Chinese language CPR training program was offered in the community in collaboration with the Stanford Department of Community Partnership. Program leaders imported the American Heart Association approved Chinese version of Heartsaver® for Adult CPR and AED from the China Mainland to make the training accessible to Chinese immigrants with LEP. In 2018, two CPR training events were conducted with 47 participants. All participants successfully demonstrated bystander (hands-only) CPR skills with 91% of participants reporting confidence and 97% willingness to perform CPR. As the first known CPR class offered in the Chinese language in the San Francisco Bay Area using official AHA products, this project provides valuable information regarding community interest and feasibility for expanding this educational program.
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Affiliation(s)
- Ningning Guo
- Center for Education and Professional Development, Stanford Health Care, Palo Alto, California, United States
| | - Michelle DeCoux Hampton
- San Jose State University, The Valley Foundation School of Nursing, San Jose, California, United States
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12
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Sato N, Matsuyama T, Kitamura T, Hirose Y. Disparities in Bystander Cardiopulmonary Resuscitation Performed by a Family Member and a Non-family Member. J Epidemiol 2020; 31:259-264. [PMID: 32307352 PMCID: PMC7940978 DOI: 10.2188/jea.je20200068] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Although bystander cardiopulmonary resuscitation (BCPR) plays an essential role in out-of-hospital cardiac arrest (OHCA) care, little is known about the bystander-patient relationship in the actual setting. This study aimed to assess the disparities in BCPR performed by a family member and that performed by a non-family member. Methods This population-based observational study involved all adult patients with witnessed OHCAs of medical origin in Niigata City, Japan, between January 2012 and December 2016, according to the Utstein style. We used logistic regression analysis to assess the association between the witnessing person and the probability of providing BCPR. Next, among those who received BCPR, we sought to investigate the difference between BCPR performed by family and that performed by non-family members in terms of whether those who witnessed the arrests actually performed BCPR. Results During the study period, 818 were eligible for this analysis, with 609 (74.4%) patients witnessed by family and 209 (25.6%) patients witnessed by non-family members. Multivariable logistic regression analysis showed that OHCA patients witnessed by family were less likely to receive BCPR compared to those witnessed by non-family members (260/609 [42.7%] versus 119/209 [56.9%], P = 0.017). Among the witnessed patients for whom BCPR was performed, the proportion of BCPR actually performed by a family member was lower than that performed by a non-family member (242/260 [93.1%] versus 116/119 [97.5%], P = 0.011). Conclusions In this community-based observational study, we found that a witnessing family member is less likely to perform BCPR than a witnessing non-family member.
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Affiliation(s)
- Nobuhiro Sato
- Department of Emergency and Critical Care Medicine, Niigata City General Hospital
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Services, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | - Yasuo Hirose
- Department of Emergency and Critical Care Medicine, Niigata City General Hospital
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13
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Hirlekar G, Jonsson M, Karlsson T, Bäck M, Rawshani A, Hollenberg J, Albertsson P, Herlitz J. Comorbidity and bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Heart 2020; 106:1087-1093. [PMID: 31974211 PMCID: PMC7361004 DOI: 10.1136/heartjnl-2019-315954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/07/2019] [Accepted: 12/13/2019] [Indexed: 11/03/2022] Open
Abstract
Objective Cardiopulmonary resuscitation (CPR) performed before the arrival of emergency medical services (EMS) is associated with increased survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to determine whether patients who receive bystander CPR have a different comorbidity compared with patients who do not, and to determine the association between bystander CPR and 30-day survival when adjusting for such a possible difference. Methods Patients with witnessed OHCA in the Swedish Registry for Cardiopulmonary Resuscitation between 2011 and 2015 were included, and merged with the National Patient Registry. The Charlson Comorbidity Index (CCI) was used to measure comorbidity. Multiple logistic regression was used to examine the effect of CCI on the association between bystander CPR and outcome. Results In total, 11 955 patients with OHCA were included, 71% of whom received bystander CPR. Patients who received bystander CPR had somewhat lower comorbidity (CCI) than those who did not (mean±SD: 2.2±2.3 vs 2.5±2.4; p<0.0001). However, this difference in comorbidity had no influence on the association between bystander CPR and 30-day survival in a multivariable model including other possible confounders (OR 2.34 (95% CI 2.01 to 2.74) without adjustment for CCI and OR 2.32 (95% CI 1.98 to 2.71) with adjustment for CCI). Conclusion Patients who undergo CPR before the arrival of EMS have a somewhat lower degree of comorbidity than those who do not. Taking this difference into account, bystander CPR is still associated with a marked increase in 30-day survival after OHCA.
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Affiliation(s)
- Geir Hirlekar
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg, Sweden .,Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Martin Jonsson
- Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Karlsson
- Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Maria Bäck
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg, Sweden
| | - Jacob Hollenberg
- Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Per Albertsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Johan Herlitz
- Center for Pre-Hospital Research, University of Borås, Borås, Sweden
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14
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Nishiyama C, Kitamura T, Sakai T, Murakami Y, Shimamoto T, Kawamura T, Yonezawa T, Nakai S, Marukawa S, Sakamoto T, Iwami T. Community-Wide Dissemination of Bystander Cardiopulmonary Resuscitation and Automated External Defibrillator Use Using a 45-Minute Chest Compression-Only Cardiopulmonary Resuscitation Training. J Am Heart Assoc 2020; 8:e009436. [PMID: 30612478 PMCID: PMC6405716 DOI: 10.1161/jaha.118.009436] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Little is known about whether cardiopulmonary resuscitation (CPR) training can increase bystander CPR in the community or the appropriate target number of CPR trainings. Herein, we aimed to demonstrate community‐wide aggressive dissemination of CPR training and evaluate temporal trends in bystander CPR. Methods and Results We provided CPR training (45‐minute chest compression–only CPR plus automated external defibrillator use training or the conventional CPR training), targeting 16% of residents. All emergency medical service–treated out‐of‐hospital cardiac arrests of medical origin were included. Data on patients experiencing out‐of‐hospital cardiac arrest and bystander CPR quality were prospectively collected from September 2010 to December 2015. The primary outcome was the proportion of high‐quality bystander CPR. During the study period, 57 173 residents (14.7%) completed the chest compression–only CPR training and 32 423 (8.3%) completed conventional CPR training. The proportion of bystander CPR performed did not change (from 43.3% in 2010 to 42.0% in 2015; P for trend=0.915), but the proportion of high‐quality bystander CPR delivery increased from 11.7% in 2010 to 20.7% in 2015 (P for trend=0.015). The 1‐year increment was associated with high‐quality bystander CPR (adjusted odds ratio, 1.461; 95% CI, 1.055–2.024). Bystanders who previously experienced CPR training were 3.432 times (95% CI, 1.170–10.071) more likely to perform high‐quality CPR than those who did not. Conclusions We trained 23.0% of the residents in the medium‐sized city of Osaka, Japan, and demonstrated that the proportion of high‐quality CPR performed on the scene increased gradually, whereas that of bystander CPR delivered overall remained stable.
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Affiliation(s)
- Chika Nishiyama
- 1 Department of Critical Care Nursing Kyoto University Graduate School of Human Health Science Kyoto Japan
| | - Tetsuhisa Kitamura
- 2 Division of Environmental Medicine and Population Sciences Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Tomohiko Sakai
- 3 Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Yukiko Murakami
- 4 Department of Preventive Services Kyoto University Graduate School of Medicine Kyoto Japan
| | - Tomonari Shimamoto
- 4 Department of Preventive Services Kyoto University Graduate School of Medicine Kyoto Japan
| | | | | | | | | | - Tetsuya Sakamoto
- 8 Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan
| | - Taku Iwami
- 5 Kyoto University Health Service Kyoto Japan
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15
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Malta Hansen C, Kragholm K, Dupre ME, Pearson DA, Tyson C, Monk L, Rea TD, Starks MA, Nelson D, Jollis JG, McNally B, Corbett CM, Granger CB. Association of Bystander and First-Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative. J Am Heart Assoc 2019; 7:e009873. [PMID: 30371210 PMCID: PMC6222952 DOI: 10.1161/jaha.118.009873] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The Institute of Medicine has called for actions to understand and target sex‐related differences in care and outcomes for out‐of‐hospital cardiac arrest patients. We assessed changes in bystander and first‐responder interventions and outcomes for males versus females after statewide efforts to improve cardiac arrest care. Methods and Results We identified out‐of‐hospital cardiac arrests from North Carolina (2010–2014) through the CARES (Cardiac Arrest Registry to Enhance Survival) registry. Outcomes for men versus women were examined through multivariable logistic regression analyses adjusted for (1) nonmodifiable factors (age, witnessed status, and initial heart rhythm) and (2) nonmodifiable plus modifiable factors (bystander cardiopulmonary resuscitation and defibrillation before emergency medical services), including interactions between sex and time (ie, year and year2). Of 8100 patients, 38.1% were women. From 2010 to 2014, there was an increase in bystander cardiopulmonary resuscitation (men, 40.5%–50.6%; women, 35.3%–51.8%; P for each <0.0001) and in the combination of bystander cardiopulmonary resuscitation and first‐responder defibrillation (men, 15.8%–23.0%, P=0.007; women, 8.5%–23.7%, P=0.004). From 2010 to 2014, the unadjusted predicted probability of favorable neurologic outcome was higher and increased more for men (men, from 6.5% [95% confidence interval (CI), 5.1–8.0] to 9.7% [95% CI, 8.1–11.3]; women, from 6.3% [95% CI, 4.4–8.3] to 7.4% [95% CI, 5.5–9.3%]); while adjusted for nonmodifiable factors, it was slightly higher but with a nonsignificant increase for women (from 9.2% [95% CI, 6.8–11.8] to 10.2% [95% CI, 8.0–12.5]; men, from 5.8% [95% CI, 4.6–7.0] to 8.4% [95% CI, 7.1–9.7]). Adding bystander cardiopulmonary resuscitation and defibrillation before EMS (modifiable factors) did not substantially change the results. Conclusions Bystander and first‐responder interventions increased for men and women, but outcomes improved significantly only for men. Additional strategies may be necessary to improve survival among female cardiac arrest patients.
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Affiliation(s)
- Carolina Malta Hansen
- 1 Duke Clinical Research Institute Duke University Durham NC.,2 Division of Endocrinology and Nephrology North Zealand Hospital Copenhagen University Copenhagen Denmark.,3 Emergency Medical Services Capital Region of Denmark Copenhagen University Copenhagen Denmark
| | | | - Matthew E Dupre
- 1 Duke Clinical Research Institute Duke University Durham NC.,4 Department of Population Health Sciences Duke University Durham NC
| | | | - Clark Tyson
- 1 Duke Clinical Research Institute Duke University Durham NC.,6 Ctr for Educational Excellence Duke University Durham NC
| | - Lisa Monk
- 1 Duke Clinical Research Institute Duke University Durham NC
| | - Thomas D Rea
- 7 Department of Medicine University of Washington Seattle WA
| | | | | | - James G Jollis
- 1 Duke Clinical Research Institute Duke University Durham NC
| | - Bryan McNally
- 9 Emory University School of Medicine Atlanta GA.,10 Rollins School of Public Health Atlanta GA
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16
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Yamashita A, Kurosaki H, Takada K, Tanaka Y, Hamada Y, Ishita T, Kubo M, Inaba H. Association of school hours with outcomes of out-of-hospital cardiac arrest in schoolchildren. Heart Asia 2019; 11:e011236. [PMID: 31565076 DOI: 10.1136/heartasia-2019-011236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/03/2022]
Abstract
Objective To investigate the association of school hours with outcomes of schoolchildren with out-of-hospital cardiac arrest (OHCA). Methods From the 2005-2014 nationwide databases, we extracted the data for 1660 schoolchildren (6-17 years) with bystander-witnessed OHCA. Univariate analyses followed by propensity-matching procedures and stepwise logistic regression analyses were applied. School hours were defined as 08:00 to 18:00. Results The neurologically favourable 1-month survival rate during school hours was better than that during non-school hours only on school days: 18.4% and 10.5%, respectively. During school hours on school days, patients with OHCA more frequently received bystander cardiopulmonary resuscitation (CPR) and public access defibrillation (PAD), and had a shockable initial rhythm and presumed cardiac aetiology. The neurologically favourable 1-month survival rate did not significantly differ between school hours on school days and all other times of day after propensity score matching: 16.4% vs 16.1% (unadjusted OR 1.02; 95% CI 0.69 to 1.51). Stepwise logistic regression analysis during school hours on school days revealed that shockable initial rhythm (adjusted OR 2.44; 95% CI 1.12 to 5.42), PAD (adjusted OR 3.32; 95% CI 1.23 to 9.10), non-exogenous causes (adjusted OR 5.88; 95% CI 1.85 to 20.0) and a shorter emergency medical service (EMS) response time (adjusted OR 1.15; 95% CI 1.02 to 1.32) and witness-to-first CPR interval (adjusted OR 1.08; 95% CI 1.01 to 1.15) were major factors associated with an improved neurologically favourable 1-month survival rate. Conclusions School hours are not an independent factor associated with improved outcomes of OHCA in schoolchildren. The time delays in CPR and EMS arrival were independently associated with poor outcomes during school hours on school days.
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Affiliation(s)
- Akira Yamashita
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.,Department of Cardiology, Noto General Hospital, Nanao, Japan
| | - Hisanori Kurosaki
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kohei Takada
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Yoshio Tanaka
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.,Emergency Medical Centre, Ishikawa Prefecture Central Hospital, Kanazawa, Japan
| | | | | | - Minoru Kubo
- Ishikawa Prefectural Nursing School, Kanazawa, Japan
| | - Hideo Inaba
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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17
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Suematsu Y, Zhang B, Kuwano T, Sako H, Ogawa M, Yonemoto N, Nonogi H, Kimura T, Nagao K, Yasunaga S, Saku K, Miura SI. Citizen bystander-patient relationship and 1-month outcomes after out-of-hospital cardiac arrest of cardiac origin from the All-Japan Utstein Registry: a prospective, nationwide, population-based, observational study. BMJ Open 2019; 9:e024715. [PMID: 31350237 PMCID: PMC6661562 DOI: 10.1136/bmjopen-2018-024715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The presence of a bystander witness is a crucial predictor of patient survival after out-of-hospital cardiac arrest (OHCA). However, the differences in survival and neurological outcomes among different types of citizen bystanders are not well understood. DESIGN We analysed data from the All-Japan Utstein Registry, a prospective, nationwide, population-based, observational study that was started in January 2005. SETTING The registry includes all patients with OHCA who were transported to the hospital by emergency medical service (EMS) in Japan. The type of citizen bystander was classified as family member, friend, colleague, passerby or other. PARTICIPANTS We analysed 210 642 patients in the registry who were 18 years or older and experienced OHCA of cardiac origin witnessed by a citizen bystander between 2005 and 2014. PRIMARY AND SECONDARY OUTCOME MEASURES The main outcomes were 1 month survival and 1 month survival with minimal neurological impairment. RESULTS Of the citizen bystander-witnessed cases, 65.1% (137 147/210 642) were witnessed by a family member. However, among patients who survived to 1 month and who had a favourable 1 month neurological outcome, much lower proportions (53.9% (10 907/20 239) and 48.9% (5722/11 696)) were witnessed by a family member. Witness by a friend, colleague or passerby was associated with good 1 month neurological function, after controlling for the patient's age, first recorded rhythm, gender, bystander cardiopulmonary resuscitation (CPR), use of a public-access automated external defibrillator, dispatcher instructions, collapse-call time and response time compared with witness by a family member (friend: OR 1.35, 95% CI 1.24 to 1.46, colleague: OR 1.63, 95% CI 1.33 to 1.98, passerby: OR 1.60, 95% CI 1.39 to 1.84). CONCLUSIONS One-month survival and favourable1 month neurological outcome of patients with OHCA of cardiac origin witnessed by a family member were worse than those in cases witnessed by a friend, colleague or passerby, independent of the patient characteristics and the response of EMS.
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Grants
- Boston Scientific Japan Co. LTD
- Grant-in-aid from the JCS-ReSS group of the Japanese Circulation Society, Japan
- Central Institute of Cardiovascular Medicine, Fukuoka University, Fukuoka, Japan
- AIG Collaborative Research Institute of Cardiovascular Medicine, Fukuoka University, Fukuoka, Japan
- Central Research Institute of Fukuoka University, Fukuoka, Japan
- FU-Global program, Fukuoka, Japan
- Nihon Kohden Corp. LTD
- Public Interest Incorporated Foundation of “Clinical Research Promotion Foundation” in Fukuoka, Japan
- MSD Co., Ltd
- NPO Clinical and Applied Science, Fukuoka, Japan
- St Jude Medical Japan Co. LTD
- Biotronik Japan, Co. Ltd
- Japan Lifeline Co. LTD
- Japan Medtronic Co. LTD
- Izumi City, Kagoshima, Japan
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Affiliation(s)
| | - Bo Zhang
- Biochemistry, Fukuoka University, Fukuoka, Japan
| | | | - Hideto Sako
- Cardiology, Fukuoka University, Fukuoka, Japan
| | | | - Naohiro Yonemoto
- Department of Epidemiology and Biostatistics, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Nagao
- Cardiovascular Center, Surugadai Nihon University Hospital, Chiyoda-ku, Japan
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18
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Naim MY, Griffis HM, Burke RV, McNally BF, Song L, Berg RA, Nadkarni VM, Vellano K, Markenson D, Bradley RN, Rossano JW. Race/Ethnicity and Neighborhood Characteristics Are Associated With Bystander Cardiopulmonary Resuscitation in Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Study From CARES. J Am Heart Assoc 2019; 8:e012637. [PMID: 31288613 PMCID: PMC6662125 DOI: 10.1161/jaha.119.012637] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Whether racial and neighborhood characteristics are associated with bystander cardiopulmonary resuscitation (BCPR) in pediatric out‐of‐hospital cardiac arrest (OHCA) is unknown. Methods and Results An analysis was conducted of CARES (Cardiac Arrest Registry to Enhance Survival) for pediatric nontraumatic OHCAs from 2013 to 2017. An index (range, 0–4) was created for each arrest based on neighborhood characteristics associated with low BCPR (>80% black; >10% unemployment; <80% high school; median income, <$50 000). The primary outcome was BCPR. BCPR occurred in 3399 of 7086 OHCAs (48%). Compared with white children, BCPR was less likely in other races/ethnicities (black: adjusted odds ratio [aOR], 0.59; 95% CI, 0.52–0.68; Hispanic: aOR, 0.78; 95% CI, 0.66–0.94; and other: aOR, 0.54; 95% CI, 0.40–0.72). Compared with arrests in neighborhoods with an index score of 0, BCPR occurred less commonly for arrests with an index score of 1 (aOR, 0.80; 95% CI, 0.70–0.91), 2 (aOR, 0.75; 95% CI, 0.65–0.86), 3 (aOR, 0.52; 95% CI, 0.45–0.61), and 4 (aOR, 0.46; 95% CI, 0.36–0.59). Black children had an incrementally lower likelihood of BCPR with increasing index score while white children had an overall similar likelihood at most scores. Black children with an index of 4 were approximately half as likely to receive BCPR compared with white children with a score of 0. Conclusions Racial and neighborhood characteristics are associated with BCPR in pediatric OHCA. Targeted CPR training for nonwhite, low‐education, and low‐income neighborhoods may increase BCPR and improve pediatric OHCA outcomes.
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Affiliation(s)
- Maryam Y Naim
- 1 The Cardiac Center Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine Philadelphia PA.,5 Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Heather M Griffis
- 2 Healthcare Analytics Unit of Center for Pediatric Clinical Effectiveness and PolicyLab Children's Hospital of Philadelphia PA
| | - Rita V Burke
- 3 Children's Hospital of Los Angeles Keck School of Medicine University of Southern California Los Angeles CA
| | - Bryan F McNally
- 4 Department of Emergency Medicine Emory University Atlanta GA
| | - Lihai Song
- 2 Healthcare Analytics Unit of Center for Pediatric Clinical Effectiveness and PolicyLab Children's Hospital of Philadelphia PA
| | - Robert A Berg
- 5 Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Vinay M Nadkarni
- 5 Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | | | | | - Richard N Bradley
- 7 Division of Emergency Medicine University of Texas Health Science Center Houston TX
| | - Joseph W Rossano
- 1 The Cardiac Center Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine Philadelphia PA.,8 Leonard Davis Institute The University of Pennsylvania Philadelphia PA
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19
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Ho AFW, Hao Y, Pek PP, Shahidah N, Yap S, Ng YY, Wong KD, Lee EJ, Khruekarnchana P, Wah W, Liu N, Tanaka H, Shin SD, Ma MHM, Ong MEH. Outcomes and modifiable resuscitative characteristics amongst pan-Asian out-of-hospital cardiac arrest occurring at night. Medicine (Baltimore) 2019; 98:e14611. [PMID: 30855446 PMCID: PMC6417559 DOI: 10.1097/md.0000000000014611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Studies are divided on the effect of day-night temporal differences on clinical outcomes in out-of-hospital cardiac arrest (OHCA). This study aimed to elucidate any differences in OHCA survival between day and night occurrence, and the factors associated with differences in survival.This was a prospective, observational study of OHCA cases across multinational Pan-Asian sites. Cases were divided according to time call received by dispatch centers into day (0700H-1900H) and night (1900H-0659H). Primary outcome was 30-day survival. Secondary outcomes were prehospital and hospital modifiable resuscitative characteristics.About 22,501 out of 55,881 cases occurred at night. Night cases were less likely to be witnessed (40.2% vs. 43.1%, P < .001), more likely to occur at home (32.5% vs. 29%, P < .001), had non-shockable initial rhythms (90.8% vs. 89.4%, P < .001), lower bystander CPR rates (36.2 vs. 37.6%, P = .001), lower bystander AED application rate (0.3% vs. 0.7%, P < .001), lower rates of prehospital defibrillation (13% vs. 14.4%, P < .001), and were less likely to receive prehospital adrenaline (9.8% vs. 11%, P < .001). 30-day survival at night was lower with an adjusted odds ratio of 0.79 (95% CI 0.73-0.86, P < .001). On multivariate logistic regression, occurrence at night was associated with decreased provision of bystander CPR, bystander AED application, and prehospital adrenaline.30-day survival was worse in OHCA occurring at night. There were circadian patterns in incidence. Bystander CPR and bystander AED application were significantly lower at night in multivariate analysis. This would at least partially explain the decreased survival at night.
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Affiliation(s)
- Andrew Fu Wah Ho
- SingHealth Emergency Medicine Residency Programme, Singapore Health Services, Singapore
| | - Ying Hao
- Division of Medicine, Singapore General Hospital
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Susan Yap
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore
| | | | - Eui Jung Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | | | - Win Wah
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Nan Liu
- Health Services Research Centre, Singapore Health Services, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Hideharu Tanaka
- Department of Emergency System, Graduate School of Sport System, Kokushikan University, Tokyo, Japan
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
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Mohr GH, Søndergaard KB, Pallisgaard JL, Møller SG, Wissenberg M, Karlsson L, Hansen SM, Kragholm K, Køber L, Lippert F, Folke F, Vilsbøll T, Torp-Pedersen C, Gislason G, Rajan S. Survival of patients with and without diabetes following out-of-hospital cardiac arrest: A nationwide Danish study. Eur Heart J Acute Cardiovasc Care 2019; 9:599-607. [PMID: 30632777 DOI: 10.1177/2048872618823349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research regarding out-of-hospital cardiac arrest (OHCA) survival of diabetes patients is sparse and it remains unknown whether initiatives to increase OHCA survival benefit diabetes and non-diabetes patients equally. We therefore examined overall and temporal survival in diabetes and non-diabetes patients following OHCA. METHODS Adult presumed cardiac-caused OHCAs were identified from the Danish Cardiac Arrest Registry (2001-2014). Associations between diabetes and return of spontaneous circulation upon hospital arrival and 30-day survival were estimated with logistic regression adjusted for patient- and OHCA-related characteristics. RESULTS In total, 28,955 OHCAs were included of which 4276 (14.8%) had diabetes. Compared with non-diabetes patients, diabetes patients had more comorbidities, same prevalence of bystander-witnessed arrests (51.7% vs. 52.7%) and bystander cardiopulmonary resuscitation (43.2% vs. 42.0%), more arrests in residential locations (77.3% vs. 73.0%) and were less likely to have shockable heart rhythm (23.5% vs. 27.9%). Temporal increases in return of spontaneous circulation and 30-day survival were seen for both groups (return of spontaneous circulation: 8.8% in 2001 to 22.3% in 2014 (diabetes patients) vs. 7.8% in 2001 to 25.7% in 2014 (non-diabetes patients); and 30-day survival: 2.8% in 2001 to 9.7% in 2014 vs. 3.5% to 14.8% in 2014, respectively). In adjusted models, diabetes was associated with decreased odds of return of spontaneous circulation (odds ratio 0.74 (95% confidence interval 0.66-0.82)) and 30-day survival (odds ratio 0.56 (95% confidence interval 0.48-0.65)) (interaction with calendar year p=0.434 and p=0.243, respectively). CONCLUSION No significant difference in temporal survival was found between the two groups. However, diabetes was associated with lower odds of return of spontaneous circulation and 30-day survival.
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Affiliation(s)
- Grímur Høgnason Mohr
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Kathrine B Søndergaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Jannik L Pallisgaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Sidsel Gamborg Møller
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Mads Wissenberg
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Lena Karlsson
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Steen Møller Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark
| | - Kristian Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark.,Department of Cardiology, Hjørring Regional Hospital, Denmark.,Department of Cardiology, Aalborg University Hospital, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Tina Vilsbøll
- Clinical Metabolic Physiology, Steno Diabetes Centre Copenhagen, University of Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark.,Department of Cardiology, Aalborg University Hospital, Denmark.,Department of Health Science and Technology, Aalborg University, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Shahzleen Rajan
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
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Affiliation(s)
- Bentley J Bobrow
- Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Tucson, AZ
| | - Micah Panczyk
- Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Tucson, AZ
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22
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Böttiger BW, Semeraro F, Wingen S. "Kids Save Lives": Educating Schoolchildren in Cardiopulmonary Resuscitation Is a Civic Duty That Needs Support for Implementation. J Am Heart Assoc 2017; 6:JAHA.117.005738. [PMID: 28292747 PMCID: PMC5524048 DOI: 10.1161/jaha.117.005738] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Federico Semeraro
- Department of Anesthesia and Intensive Care Medicine, Maggiore Hospital, Bologna, Italy
| | - Sabine Wingen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
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