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Leung L, Lo C, Tong H. Prehospital Resuscitation of Out-of-Hospital Cardiac Arrest in Queen Mary Hospital. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790000700401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Management of out-of-hospital cardiac arrest is a major task of the accident and emergency department. The aim of this study is to evaluate the efficacy of prehospital resuscitation of out-of-hospital cardiac arrest in Hong Kong and identify areas for improvement. It was a prospective descriptive study of adults with non-traumatic out-of-hospital cardiac arrest who were admitted to the Accident and Emergency Department of Queen Mary Hospital by the ambulance service from March 15, 1999 to October 15, 1999. Patient characteristics and the response times of the ambulance service were recorded according to the Utstein style. One hundred and thirty patients were included. The overall immediate survival rate was 14.6% and the overall survival to discharge rate was 1.54%. The outcome of out-of-hospital cardiac arrest is poor. Every link in the chain of survival has to be improved.
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Affiliation(s)
- Lp Leung
- Queen Mary Hospital, Accident and Emergency Department, Pokfulam, Hong Kong
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Sathianathan K, Tiruvoipati R, Vij S. Prognostic factors associated with hospital survival in comatose survivors of cardiac arrest. World J Crit Care Med 2016; 5:103-110. [PMID: 26855900 PMCID: PMC4733450 DOI: 10.5492/wjccm.v5.i1.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/08/2015] [Accepted: 01/11/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify patient, cardiac arrest and management factors associated with hospital survival in comatose survivors of cardiac arrest.
METHODS: A retrospective, single centre study of comatose patients admitted to our intensive care unit (ICU) following cardiac arrest during the twenty year period between 1993 and 2012. This study was deemed by the Human Research Ethics Committee (HREC) of Monash Health to be a quality assurance exercise, and thus did not require submission to the Monash Health HREC (Research Project Application, No. 13290Q). The study population included all patients admitted to our ICU between 1993 and 2012, with a discharge diagnosis including “cardiac arrest”. Patients were excluded if they did not have a cardiac arrest prior to ICU admission (i.e., if their primary arrest was during their admission to ICU), or were not comatose on arrival to ICU. Our primary outcome measure was survival to hospital discharge. Secondary outcome measures were ICU and hospital length of stay (LOS), and factors associated with survival to hospital discharge.
RESULTS: Five hundred and eighty-two comatose patients were admitted to our ICU following cardiac arrest, with 35% surviving to hospital discharge. The median ICU and hospital LOS was 3 and 5 d respectively. There was no survival difference between in-hospital and out-of-hospital cardiac arrests. Males made up 62% of our cardiac arrest population, were more likely to have a shockable rhythm (56% vs 37%, P < 0.001), and were more likely to survive to hospital discharge (40% vs 28%, P = 0.006). On univariate analysis, therapeutic hypothermia, regardless of method used (e.g., rapid infusion of ice cold fluids, topical ice, “Arctic Sun”, passive rewarming, “Bair Hugger”) and location initiated (e.g., pre-hospital, emergency department, intensive care) was associated with increased survival. There was however no difference in survival associated with target temperature, time at target temperature, location of initial cooling, method of initiating cooling, method of maintaining cooling or method of rewarming. Patients that survived were more likely to have a shockable rhythm (P < 0.001), shorter time to return of spontaneous circulation (P < 0.001), receive therapeutic hypothermia (P = 0.03), be of male gender (P = 0.006) and have a lower APACHE II score (P < 0.001). After multivariate analysis, only a shockable initial rhythm (OR = 6.4, 95%CI: 3.95-10.4; P < 0.01) and a shorter time to return of spontaneous circulation (OR = 0.95, 95%CI: 0.93-0.97; P < 0.01) was found to be independently associated with survival to hospital discharge.
CONCLUSION: In comatose survivors of cardiac arrest, shockable rhythm and shorter time to return of spontaneous circulation were independently associated with increased survival to hospital discharge.
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Abstract
AbstractBackground:At a large public event, or mass gathering, various factors influence patient presentations that brings challenges to patient care. The chain of survival has been investigated in the prehospital setting. However, this has not explicitly included the mass-gathering environment.Objective:This study sought to determine the facilitators and barriers to the chain of survival at mass gatherings.Methods:This case-series research was exploratory and descriptive, using the analysis of personal experiences of resuscitation. Participants were members of St John Ambulance Australia who had participated actively in a resuscitation event in 2007. Telephone interviews were used as a means of data collection. Participant narrative was recorded electronically, transcribed verbatim, and analyzed thematically using a well established human science approach.Results:The thematic analysis revealed five main themes and a number of sub-themes. Four of the main themes were aligned easily with the four chain of survival links. The remaining main theme outlined a new link in the chain of survival of specific importance to mass gatherings, ‘early planning’. Additionally, a number of sub-themes were identified, which exemplified various facilitators and barriers to the chain of survival in this environment.Conclusions:This research highlights various barriers and facilitators to the chain of survival in the mass-gathering environment. Additionally, the unique “early planning” link in the chain of survival as described in this research highlights the importance of a preparatory phase for responders at mass gatherings.
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Successful therapeutic hypothermia in a cardiac arrest patient with profound thrombocytopenia: a case report and literature review. Am J Emerg Med 2011; 29:961.e5-7. [DOI: 10.1016/j.ajem.2010.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 08/11/2010] [Indexed: 11/17/2022] Open
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Yeeheng U. Factors Associated With Successful Resuscitation of Out-of-Hospital Cardiac Arrest at Rajavithi Hospital’s Narenthorn Emergency Medical Service Center, Thailand. Asia Pac J Public Health 2011; 23:601-7. [DOI: 10.1177/1010539511411902] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study is to determine factors associated with successful resuscitation of out-of-hospital cardiac arrest (OHCA) patients by Narenthorn Emergency Medical Service Center (EMS), Thailand. A retrospective observational study was conducted with 73 OHCA patients who were resuscitated from December 2004 to January 2007. Inferential statistics, univariate (χ2) and multivariate analyses (logistic regression) were applied for data analysis. A total of 73 OHCA patients were included. The mean age was 58.3 years; 86.3% were ≥40 years, 72.6% were male. The causes of arrest were cardiac problem 53.4%. In all, 46.6% were witnessed arrest; 53.4% had response time (RT) ≥10 minutes, and 27.4% had bystander cardiopulmonary resuscitation (CPR). Overall, 79.5% were found in the residence. Initial electrocardiogram showed that 74% were nonshockable rhythm. A total of 34.2% were resuscitated by an EMS team with <4 members, and 53.4% had return of spontaneous circulation, survival to admission was 61.5% and survival to discharge was 7.7%. Witnessed arrest (odds ratio [OR] = 7.403; 95% confidence interval [CI] = 2.169-24.683) and bystander CPR (OR = 5.619; 95% CI = 1.014-36.170) had correlation with successful resuscitation of OHCA patients. RT showed a trend toward statistical significance (OR = 1.051; 95% CI = 0.765-16.083). This study found that witnessed arrest and bystander CPR were major factors associated with successful resuscitation of OHCA patients. Our findings will be useful for the development of community programs to decrease the mortality from OHCA.
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Affiliation(s)
- Ubon Yeeheng
- Rajavithi Hospital’s Narenthorn Emergency Medical Service Center, Bangkok, Thailand
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Shukla VK. Application of Induced Hypothermia for Neuroprotection after Cardiac Arrest: A Systematic Review. J Intensive Care Soc 2009. [DOI: 10.1177/175114370901000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The dismal outcome after cardiac arrest calls for novel therapeutic approaches. Therapeutic hypothermia is a promising therapeutic modality. In this article we review the evidence for therapeutic hypothermia, for the best methods for cooling available and for the safety of therapeutic hypothermia.
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Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest. Am J Emerg Med 2009; 27:570-3. [DOI: 10.1016/j.ajem.2008.04.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 04/16/2008] [Accepted: 04/20/2008] [Indexed: 11/21/2022] Open
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Hammer L, Adrie C, Timsit JF. Early Cooling in Cardiac Arrest: What is the Evidence? Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21st ESICM Annual Congress. Intensive Care Med 2008. [PMCID: PMC2799007 DOI: 10.1007/s00134-008-1240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due to acute ST-segment elevation myocardial infarction undergoing immediate percutaneous coronary intervention. Crit Care Med 2008; 36:1780-6. [PMID: 18496378 DOI: 10.1097/ccm.0b013e31817437ca] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Mild therapeutic hypothermia (MTH) has been integrated into international resuscitation guidelines. In the majority of patients, sudden cardiac arrest is caused by myocardial infarction. This study investigated whether a combination of MTH with primary percutaneous coronary intervention (PCI) is feasible, safe, and potentially beneficial in patients after cardiac arrest due to acute myocardial infarction. DESIGN Single-center observational study with a historical control group. SETTING University clinic. PATIENTS Thirty-three patients after cardiac arrest with ventricular fibrillation as initial rhythm and restoration of spontaneous circulation who remained unconscious at admission and presented with acute ST elevation myocardial infarction (STEMI). INTERVENTIONS In 16 consecutive patients (2005-2006), MTH was initiated immediately after admission and continued during primary PCI. Seventeen consecutive patients who were treated in a similar 2-yr observation interval before implementation of MTH (2003-2004) served as a control group. Feasibility, safety, mortality, and neurologic outcome were documented. MEASUREMENTS AND MAIN RESULTS Initiation of MTH did not result in longer door-to-balloon times compared with the control group (82 vs. 85 mins), indicating that implementation of MTH did not delay the onset of primary PCI. Target temperature (32-34 degrees C) in the MTH group was reached within 4 hrs, consistent with previous trials and suggesting that primary PCI did not affect the velocity of cooling. Despite a tendency to increased bleeding complications and infections, patients treated with MTH tended to have a lower mortality after 6 months (25% vs. 35%, p = .71) and an improved neurologic outcome as determined by a Glasgow-Pittsburgh Cerebral Performance Scale score of 1 or 2 (69% vs. 47% in the control group, p = .30). CONCLUSIONS MTH in combination with primary PCI is feasible and safe in patients resuscitated after cardiac arrest due to acute myocardial infarction. A combination of these therapeutic procedures should be strongly considered as standard therapy in patients after out-of-hospital cardiac arrest due to STEMI.
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Abstract
Increasing evidence suggests that induction of mild hypothermia (32-35 degrees C) in the first hours after an ischaemic event can prevent or mitigate permanent injuries. This effect has been shown most clearly for postanoxic brain injury, but could also apply to other organs such as the heart and kidneys. Hypothermia has also been used as a treatment for traumatic brain injury, stroke, hepatic encephalopathy, myocardial infarction, and other indications. Hypothermia is a highly promising treatment in neurocritical care; thus, physicians caring for patients with neurological injuries, both in and outside the intensive care unit, are likely to be confronted with questions about temperature management more frequently. This Review discusses the available evidence for use of controlled hypothermia, and also deals with fever control. Besides discussing the evidence, the aim is to provide information to help guide treatments more effectively with regard to timing, depth, duration, and effective management of side-effects. In particular, the rate of rewarming seems to be an important factor in establishing successful use of hypothermia in the treatment of neurological injuries.
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Affiliation(s)
- Kees H Polderman
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, Netherlands.
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Wartenberg KE, Mayer SA. Use of induced hypothermia for neuroprotection: indications and application. FUTURE NEUROLOGY 2008. [DOI: 10.2217/14796708.3.3.325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Therapeutic temperature regulation has become an exciting field of interest. Mild-to-moderate hypothermia is a safe and feasible management strategy for neuroprotection and control of intracranial pressure in neurological catastrophies such as traumatic brain injury, subarachnoid and intracerebral hemorrhage, and large hemispheric stroke. Fever is associated with worse neurological outcome in patients with brain injury, normothermia may be of benefit in this patient population. The efficacy of mild-to-moderate hypothermia has been proven for neuroprotection after cardiac arrest with ventricular fibrillation as initial rhythm, and after neonatal asphyxia. Application of hypothermia and fever control in neurocritical care, available cooling technologies and systemic effects and complications of hypothermia will be discussed.
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Affiliation(s)
- Katja E Wartenberg
- University Hospital Carl Gustav Carus Dresden, Neurointensive Care Unit, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Stephan A Mayer
- Columbia University, Dept of Neurosurgery, 710 W 168th Street, New York, NY 10032, USA
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Early Cooling in Cardiac Arrest: What is the Evidence? YEARBOOK OF INTENSIVE CARE AND EMERGENCY MEDICINE 2008. [DOI: 10.1007/978-3-540-77290-3_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Chan T, Braitberg G, Elbaum D, Taylor DM. Hatzolah emergency medical responder service: to save a life. Med J Aust 2007; 186:639-42. [PMID: 17576181 DOI: 10.5694/j.1326-5377.2007.tb01083.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 04/29/2007] [Indexed: 11/17/2022]
Abstract
"First responders" are people trained in advanced first aid who can respond at the same time as, and often more quickly than, ambulance services to suspected medical emergencies. Hatzolah is a volunteer First Responder group, based on halakhic (Jewish legal) principles, in a localised area of metropolitan Melbourne with the highest density of Holocaust survivors outside Israel. Low numbers of "call-outs" to Victoria's Metropolitan Ambulance Service (MAS) from this community suggested that many were reluctant to make contact with a "uniformed" external agency. Hatzolah is an autonomous organisation operating under adapted MAS clinical practice guidelines and clinical governance processes. Hatzolah responders undergo an 18-month MAS training course comprising first aid, cardiopulmonary resuscitation, the use of semiautomated defibrillators, and oxygen therapy. We describe the first 11 years (1995-2005) of the Hatzolah service. The number of patients attended to annually has risen steadily, peaking at 867 in 2005. The most frequent reasons for call-outs were falls (19.4%), chest pain (9.7%), or respiratory distress (7.6%). Hatzolah's median response times were 2 or 3 min for all cases. They attended 35 patients with cardiac arrest (median response time, 2 min), and arrived before the MAS to 29 call-outs (83%). Nineteen patients (54%) with cardiac arrest were resuscitated and transported from the scene alive. Among those transported, significantly more had a shockable cardiac rhythm (50% v 13%, P = 0.03). Five (14%) survived to hospital discharge. Hatzolah has evolved into an organisation providing a complementary service to the MAS. It serves as a model for the establishment of other metropolitan community First Responder groups.
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Affiliation(s)
- Tony Chan
- Austin Health, Melbourne, Victoria, Australia.
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Gratrix AP, Pittard AJ, Bodenham AR. Outcome after admission to ITU following out-of-hospital cardiac arrest: are non-survivors suitable for non-heart-beating organ donation? Anaesthesia 2007; 62:434-7. [PMID: 17448052 DOI: 10.1111/j.1365-2044.2007.04981.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We have reviewed retrospective data from two large UK teaching hospitals regarding outcome following out-of-hospital cardiac arrest and the suitability of non-survivors for non-heart-beating organ donation. Patients were selected retrospectively from consecutive admissions from two intensive care units who had presented following out-of-hospital cardiac arrest, to a total of 50 patients in each centre. They had all been resuscitated to achieve a spontaneous cardiac output at the scene, in transit or after arrival in hospital, and required further intensive care support due to cardiovascular, respiratory, or neurological impairment. Eighty-six patients (86%) died in the Intensive Care Unit and only 14 (14%) survived to discharge from the Unit. A further nine (9%) patients died in hospital before discharge home. Four patients (4%) were alive after 6 months and three (3%) were alive after 1 year. Fifty-seven (57%) of patients had active withdrawal of treatment with only four (4%) being potentially suitable for organ procurement having not been excluded because of age, medical history or the length of time to die following withdrawal of treatment. Our results show that only a small increase in donor organs could be potentially achieved from this population. Further work is required to determine whether such patients should be considered as non-heart-beating donors.
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Jennings PA, Cameron P, Walker T, Bernard S, Smith K. Out‐of‐hospital cardiac arrest in Victoria: rural and urban outcomes. Med J Aust 2006; 185:135-9. [PMID: 16893352 DOI: 10.5694/j.1326-5377.2006.tb00498.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 05/01/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the survival rate from out-of-hospital cardiac arrest in rural and urban areas of Victoria, and to investigate the factors associated with these differences. DESIGN Retrospective case series using data from the Victorian Ambulance Cardiac Arrest Registry. SETTING All out-of-hospital cardiac arrests occurring in Victoria that were attended by Rural Ambulance Victoria or the Metropolitan Ambulance Service. PARTICIPANTS 1790 people who suffered a bystander-witnessed cardiac arrest between January 2002 and December 2003. RESULTS Bystander cardiopulmonary resuscitation was more likely in rural (65.7%) than urban areas (48.4%) (P = 0.001). Urban patients with bystander-witnessed cardiac arrest were more likely to arrive at an emergency department with a cardiac output (odds ratio [OR], 2.92; 95% CI, 1.65-5.17; P < 0.001), and to be discharged from hospital alive than rural patients (urban, 125/1685 [7.4%]; rural, 2/105 [1.9%]; OR, 4.13; 95% CI, 1.09-34.91). Major factors associated with survival to hospital admission were distance of cardiac arrest from the closest ambulance branch (OR, 0.87; 95% CI, 0.82-0.92), endotracheal intubation (OR, 3.46; 95% CI, 2.49-4.80), and the presence of asystole (OR, 0.50; 95% CI, 0.38-0.67) or pulseless electrical activity (OR, 0.73; 95% CI, 0.56-0.95) on arrival of the first ambulance crew. CONCLUSIONS Survival rates differ between urban and rural cardiac arrest patients. This is largely due to a difference in ambulance response time. As it is impractical to substantially decrease response times in rural areas, other strategies that may improve outcome after cardiac arrest require investigation.
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Flynn J, Archer F, Morgans A. Sensitivity and specificity of the medical priority dispatch system in detecting cardiac arrest emergency calls in Melbourne. Prehosp Disaster Med 2006; 21:72-6. [PMID: 16770995 DOI: 10.1017/s1049023x00003381] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In Australia, cardiac arrest kills 142 out of every 100,000 people each year; with only 3-4% of out-of-hospital patients with cardiac arrest in Melbourne surviving to hospital discharge. Prompt initiation of cardiopulmonary resuscitation (CPR), defibrillation, and advanced cardiac care greatly improves the chances of survival from cardiac arrest. A critical step in survival is identifying by the emergency ambulance dispatcher potential of the probability that the person is in cardiac arrest. The Melbourne Metropolitan Ambulance Service (MAS) uses the computerized call-taking system, Medical Priority Dispatch System (MPDS), to triage incoming, emergency, requests for ambulance responses. The MPDS is used in many emergency medical systems around the world, however, there is little published evidence of the system's efficacy. OBJECTIVE This study attempts to undertake a sensitivity/specificity analysis to determine the ability of MPDS to detect cardiac arrest. METHODS Emergency ambulance dispatch records of all cases identified as suspected cardiac arrest by MPDS were matched with ambulance, patient-care records and records from the Victorian Ambulance Cardiac Arrest Registry to determine the number of correctly identified cardiac arrests. Additionally, cases that had cardiac arrests, but were not identified correctly at the point of call-taking, were examined. All data were collected retrospectively for a three-month period (01 January through 31 March 2003). RESULTS The sensitivity of MPDS in detecting cardiac arrest was 76.7% (95% confidence interval (CI): 73.6%-79.8%) and specificity was 99.2% (95% CI: 99.1-99.3%). These results indicate that cardiac arrests are correctly identified in 76.7% of cases. CONCLUSION Although the system correctly identified 76.7% of cardiac arrest cases, the number of false negatives suggests that there is room for improvement in recognition by MPDS to maximize chances for survival in out-of-hospital cardiac arrest. This study provides an objective and comprehensive measurement of the accuracy of MPDS cardiac-arrest detection in Melbourne, as well as providing a baseline for comparison with subsequent changes to the MPDS.
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Affiliation(s)
- Julie Flynn
- Centre for Ambulance and Paramedic Studies, Monash University, Frankston, Australia
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Willis CD, Cameron PA, Bernard SA, Fitzgerald M. Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile. Injury 2006; 37:448-54. [PMID: 16427640 DOI: 10.1016/j.injury.2005.11.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 10/17/2005] [Accepted: 11/16/2005] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The use of guidelines regarding the termination or withholding of cardiopulmonary resuscitation (CPR) in traumatic cardiac arrest patients remains controversial. This study aimed to describe the outcomes for victims of penetrating and blunt trauma who received prehospital CPR. METHODS We conducted a retrospective review of a statewide major trauma registry using data from 2001 to 2004. Subjects suffered penetrating or blunt trauma, received CPR in the field by paramedics and were transported to hospital. Demographics, vital signs, injury severity, prehospital time, length of stay and mortality data were collected and analysed. RESULTS Eighty-nine patients met inclusion criteria. Eighty percent of these were blunt trauma victims, with a mortality rate of 97%, while penetrating trauma patients had a mortality rate of 89%. The overall mortality rate was 95%. Sixty-six percent of patients had a length of stay of less than 1 day. Four patients survived to discharge, of which two were penetrating and two were blunt injuries. Hypoxia and electrical injury were probable associated causes of two cardiac arrests seen in survivors of blunt injury. CONCLUSIONS While only a small number of penetrating and blunt trauma patients receiving CPR survived to discharge, this therapy is not always futile. Prehospital emergency personnel need to be aware of possible hypoxic and electrical causes for cardiac arrest appearing in combination with traumatic injuries.
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Affiliation(s)
- Cameron D Willis
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
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Abstract
The use of IH for 24 hours in patients who remain comatose following resuscitation from out-of-hospital cardiac arrest improves outcomes. How-ever, the induction of hypothermia has several physiologic effects that need to be considered. A protocol for the rapid induction of hypothermia is described. At present, the rapid infusion of a large volume (40 mL/kg) of ice-cold crystalloid (ie, lactated Ringer's solution) would appear to be an inexpensive, safe strategy for the induction of hypothermia after cardiac arrest. Hypothermia (33 degrees C) should be maintained for 24 hours, followed by rewarming over 12 hours. Particular attention must be paid to potassium and glucose levels during hypothermia.
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Affiliation(s)
- Stephen Bernard
- Intensive Care Unit, Dandenong Hospital, David Street, Dandenong, Victoria 3175, Australia.
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Hajbaghery MA, Mousavi G, Akbari H. Factors influencing survival after in-hospital cardiopulmonary resuscitation. Resuscitation 2005; 66:317-21. [PMID: 16081201 DOI: 10.1016/j.resuscitation.2005.04.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Revised: 04/04/2005] [Accepted: 04/19/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION During recent years, in-hospital cardiopulmonary resuscitation (CPR) management has received much attention. However, the rate of survival after in-hospital resuscitation in Iran hospitals is not known. Therefore, a study was designed to evaluate the outcome of in-hospital cardiopulmonary resuscitation (CPR) in the city of Kashan, Iran, during a 6-month period during 2002. MATERIAL AND METHODS A prospective descriptive study was conducted on all cases of in-hospital cardiopulmonary resuscitation. Necessary data including the age and sex of patients, shift, time from cardiac arrest until initiating of CPR, time from cardiac arrest until defibrillation, duration and result of CPR, were recorded in a checklist. Descriptive statistics presented. RESULTS A total of 206 cases of CPR were attempted during the research period. The study population consisted of 59.2% males and 40.8% females. The survival rate was similar for both sexes. Short-term survival was observed in 19.9% of cases and only 5.3% survived to discharge. The key predictors of survival to hospital discharge were CPR duration, time of cardiac arrest, time from cardiac arrest to initiation of CPR, and defibrillation within the first few minutes of cardiac arrest. CONCLUSIONS Our study showed that it needs more attention to be paid to cardiopulmonary resuscitation management in Iran's hospitals. The results of this study could be an important first step toward a national study on the survival after cardiopulmonary resuscitation to provide accurate data on our performance with regards to the chain of survival.
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Torbey MT, Geocadin R, Bhardwaj A. Predicting outcome after cardiac arrest: Time for innovation. Resuscitation 2005. [DOI: 10.1016/j.resuscitation.2005.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brüx A, Girbes ARJ, Polderman KH. [Controlled mild-to-moderate hypothermia in the intensive care unit]. Anaesthesist 2005; 54:225-44. [PMID: 15742173 DOI: 10.1007/s00101-005-0808-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Controlled hypothermia is used as a therapeutic intervention to provide neuroprotection and (more recently) cardioprotection. The growing insight into the underlying pathophysiology of apoptosis and destructive processes at the cellular level, and the mechanisms underlying the protective effects of hypothermia, have led to improved application and to a widening of the range of potential indications. In many centres hypothermia has now become part of the standard therapy for post-anoxic coma in certain patients, but for other indications its use still remains controversial. The negative findings of some studies may be partly explained by inadequate protocols for the application of hypothermia and insufficient attention to the prevention of potential side effects. This review deals with some of the concepts underlying hypothermia-associated neuroprotection and cardioprotection, and discusses some potential clinical indications as well as reasons why some clinical trials may have produced conflicting results. Practical aspects such as methods to induce hypothermia, as well as the side effects of cooling are also discussed.
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Affiliation(s)
- A Brüx
- Abteilung Intensivmedizin, Freie Universität Medisch Centrum Amsterdam, Niederlande
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Destruction of Conventional and Chemical Weapons from World War I (1914–1918), Ieper, Belgium—Example of Long-term Problems after War Situations. Prehosp Disaster Med 2005. [DOI: 10.1017/s1049023x00014096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Hypothermia is now standard care for some types of cardiac arrest.
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Kelly AM, Kerr D. A high proportion of patients with ST elevation myocardial infarction do not come to hospital by ambulance. Intern Med J 2003; 33:546-7. [PMID: 14656267 DOI: 10.1046/j.1445-5994.2003.00470.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gwinnutt CL, Nolan JP. Resuscitative hypothermia after cardiac arrest in adults. Eur J Anaesthesiol 2003; 20:511-4. [PMID: 12884983 DOI: 10.1017/s0265021503000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
The objectives of this study are to (1). quantify prior cardiopulmonary resuscitation (CPR) training in households of patients presenting to the Emergency Department (ED) with or without chest pain or ischaemic heart disease (IHD); (2). evaluate the willingness of household members to undertake CPR training; and (3). identify potential barriers to the learning and provision of bystander CPR. A cross-sectional study was conducted by surveying patients presenting to the ED of a metropolitan teaching hospital over a 6-month period. Two in five households of patients presenting with chest pain or IHD had prior training in CPR. This was no higher than for households of patients presenting without chest pain or IHD. Just under two in three households of patients presenting with chest pain or IHD were willing to participate in future CPR classes. Potential barriers to learning CPR included lack of information on CPR classes, perceived lack of intellectual and/or physical capability to learn CPR and concern about causing anxiety in the person at risk of cardiac arrest. Potential barriers to CPR provision included an unknown cardiac arrest victim and fear of infection. The ED provides an opportunity for increasing family and community capacity for bystander intervention through referral to appropriate training.
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Affiliation(s)
- Kevin H Chu
- Department of Emergency Medicine, Royal Brisbane Hospital, Brisbane, Herston, Qld 4029 Australia.
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Bernard S, Buist M, Monteiro O, Smith K. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation 2003; 56:9-13. [PMID: 12505732 DOI: 10.1016/s0300-9572(02)00276-9] [Citation(s) in RCA: 335] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
STUDY HYPOTHESIS Recent studies have shown that induced hypothermia for twelve to twenty four hours improves outcome in patients who are resuscitated from out-of-hospital cardiac arrest. These studies used surface cooling, but this technique provided for relatively slow decreases in core temperature. Results from animal models suggest that further improvements in outcome may be possible if hypothermia is induced earlier after resuscitation from cardiac arrest. We hypothesized that a rapid infusion of large volume (30 ml/kg), ice-cold (4 degrees C) intravenous fluid would be a safe, rapid and inexpensive technique to induce mild hypothermia in comatose survivors of out-of-hospital cardiac arrest. METHODS We enrolled 22 patients who were comatose following resuscitation from out-of-hospital cardiac arrest. After initial evaluation in the Emergency Department (ED), a large volume (30 ml/kg) of ice-cold (4 degrees C) lactated Ringers solution was infused intravenously over 30 min. Data on vital signs, arterial blood gas, electrolyte and hematological was collected immediately before and after the infusion. RESULTS The rapid infusion of large volume, ice-cold crystalloid fluid resulted in a significant decrease in median core temperature from 35.5 to 33.8 degrees C. There were also significant improvements in mean arterial blood pressure, renal function and acid-base analysis. No patient developed pulmonary odema. CONCLUSION A rapid infusion of large volume, ice-cold crystalloid fluid is an inexpensive and effective method of inducing mild hypothermia in comatose survivors of out-of-hospital cardiac arrest, and is associated with beneficial haemodynamic, renal and acid-base effects. Further studies of this technique are warranted.
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Affiliation(s)
- Stephen Bernard
- The Intensive Care Unit, Dandenong Hospital, David St, Victoria 3175, Dandenong, Australia.
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Smith KL, McNeil JJ. Cardiac arrests treated by ambulance paramedics and fire fighters. Med J Aust 2002; 177:305-9. [PMID: 12225277 DOI: 10.5694/j.1326-5377.2002.tb04788.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2001] [Accepted: 06/27/2002] [Indexed: 11/17/2022]
Abstract
The Emergency Medical Response (EMR) program is a Victorian Government initiative in which fire fighters trained in cardiopulmonary resuscitation and equipped with automatic external defibrillators are dispatched to suspected cardiac arrests simultaneously with ambulance paramedics across metropolitan Melbourne. During the first 12 months (February 2000 to February 2001) of the expanded EMR program, 2942 events involved simultaneous dispatch of ambulance paramedics and fire fighters. In 430 events, patients had suffered a cardiac arrest of presumed cardiac cause, and resuscitation was attempted by the emergency medical services. Fire fighters provided the initial defibrillation to 41 (26.5%) patients presenting in ventricular fibrillation. Survival to hospital discharge for bystander-witnessed ventricular fibrillation cardiac arrests was 21.8%. The mean emergency services (fire and ambulance) response time to cardiac arrest patients was 6.03 (SD, 1.65) minutes. The mean time to defibrillation for ventricular fibrillation patients was 8.75 (SD, 2.07) minutes.
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Affiliation(s)
- Karen L Smith
- Department of Epidemiology and Preventive Medicine, Monash Medical School, Monash University, Melbourne, Australia.
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Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346:557-63. [PMID: 11856794 DOI: 10.1056/nejmoa003289] [Citation(s) in RCA: 3799] [Impact Index Per Article: 165.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest. METHODS The study subjects were 77 patients who were randomly assigned to treatment with hypothermia (with the core body temperature reduced to 33 degrees C within 2 hours after the return of spontaneous circulation and maintained at that temperature for 12 hours) or normothermia. The primary outcome measure was survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility. RESULTS The demographic characteristics of the patients were similar in the hypothermia and normothermia groups. Twenty-one of the 43 patients treated with hypothermia (49 percent) survived and had a good outcome--that is, they were discharged home or to a rehabilitation facility--as compared with 9 of the 34 treated with normothermia (26 percent, P=0.046). After adjustment for base-line differences in age and time from collapse to the return of spontaneous circulation, the odds ratio for a good outcome with hypothermia as compared with normothermia was 5.25 (95 percent confidence interval, 1.47 to 18.76; P=0.011). Hypothermia was associated with a lower cardiac index, higher systemic vascular resistance, and hyperglycemia. There was no difference in the frequency of adverse events. CONCLUSIONS Our preliminary observations suggest that treatment with moderate hypothermia appears to improve outcomes in patients with coma after resuscitation from out-of-hospital cardiac arrest.
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Finn JC, Jacobs IG, Holman CD, Oxer HF. Outcomes of out-of-hospital cardiac arrest patients in Perth, Western Australia, 1996-1999. Resuscitation 2001; 51:247-55. [PMID: 11738774 DOI: 10.1016/s0300-9572(01)00408-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To describe the epidemiology and survival from out-of-hospital cardiac arrest. DESIGN Longitudinal follow-up study from the time of paramedic attendance to 12 months later. SETTING Perth, Western Australia (WA), a metropolitan capital city with an adult population of approximately one million people. METHOD The St John Ambulance Australia (WA Ambulance Service Incorporated) cardiac arrest database was linked to the WA hospital morbidity and mortality data using probabilistic matching. INCIDENCE Of 3730 cardiorespiratory arrests in 1996-1999, the age standardised rate of arrests of presumed cardiac origin, where resuscitation was attempted (n=1293) was 32.9 per 100000 person-years and 7.1 per 100000 person-years for bystander-witnessed VF/VT arrests. SURVIVAL Survival to 28 days was 6.8% following all bystander-witnessed cardiac arrests; 10.6% following bystander-witnessed VF/VT arrests and 33% for paramedic-witnessed cardiac arrests. Logistic regression analysis showed an inverse association between ambulance response time interval and survival following all bystander-witnessed cardiac arrests (and VF/VT arrests). ONE YEAR SURVIVAL: 89% of bystander-witnessed cardiac arrest survivors and 92% of paramedic-witnessed cardiac arrests were still alive at 1 year post-arrest. CONCLUSION The trends in occurrence and survival following out-of-hospital cardiac arrest in Perth, WA, are similar to those found elsewhere. There is an opportunity to strengthen the chain of survival by reducing the response time interval and increasing the use of bystander cardiopulmonary resuscitation (CPR). First-responder programs and public access defibrillation will need to be considered in the light of local demographics, location and the epidemiologic features of out-of-hospital cardiac arrest.
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Affiliation(s)
- J C Finn
- Department of Public Health, The University of Western Australia, Royal Perth Hospital, GPO Box X2213, Western Australia 6847, Perth, Australia.
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Smith K, Rich D, Pinol JP, Hankin J, McNeil J. Acceptance of a medical first-responder role by fire fighters. Resuscitation 2001; 51:33-8. [PMID: 11719171 DOI: 10.1016/s0300-9572(01)00385-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE In July 1998, a pilot trial which used fire fighters as medical first-responders for the first time in Australia, was implemented in Melbourne. We aimed to assess the impact of the introduction of a medical first-responder role to the fire service, on the fire fighters both professionally and personally. METHODS Focus groups were conducted at the fire stations located in the study area. Data from the focus groups was collated and examined for themes. The issues identified as important through the focus groups were then incorporated into a questionnaire. RESULTS The fire fighters located at the pilot stations involved in the first-responder programme appear to view their new role as first-responders as a positive addition to their emergency profession. Some areas of the programme were identified by this study as in need of improvement. Some aspects of the communication strategies utilised by the Fire Brigade were highly criticised. Some aspects of the support system offered by the Fire Brigade also appear to be regarded as unfavourable. CONCLUSION Results from this study provide useful information on professional fire fighter first-responder programmes and their impact on participating personnel. These results can be used to improve training modules, communication strategies and support services.
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Affiliation(s)
- K Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Monash Medical School, Alfred Hospital, Commercial Road, Vic. 3181, Prahran, Australia.
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Jennings P, Pasco J. Survival from out-of-hospital cardiac arrest in the Geelong region of Victoria, Australia. EMERGENCY MEDICINE (FREMANTLE, W.A.) 2001; 13:319-25. [PMID: 11554863 DOI: 10.1046/j.1035-6851.2001.00235.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the outcome from prehospital cardiac arrest managed by ambulance personnel, and to examine overall survival rates from successful resuscitation. METHODS A retrospective analysis was made of 115 patient care records of prehospital cardiac arrests with attempted resuscitation between July 1996 and September 1999. All cases had a presumed primary cardiac cause for their cardiac arrest. RESULTS Overall survival, defined as admitted to hospital alive, was 22 subjects (19.1%), with five subjects (4.3%) being discharged from hospital neurologically intact. Of the patients who survived to the emergency department, six (5%) had initially presented in pulseless electrical activity and 16 (14%) presented with ventricular fibrillation. No patients presented with ventricular tachycardia and no survivors presented in asystole. Median response interval from time of call to arrival of initial crew at patient's side was 9 min. No patients survived when response interval was greater than 14 min. Bystander cardiopulmonary resuscitation was being performed on 55 patients (48%) on arrival of initial ambulance crew; 68.2% of patients surviving to hospital having had bystander cardiopulmonary resuscitation. CONCLUSION Decreasing time delays in accessing the patient is crucial to improving outcome in out-of-hospital cardiac arrest.
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Affiliation(s)
- P Jennings
- Rural Ambulance Victoria, The Geelong Hospital, Geelong, Victoria, Australia.
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Abstract
OBJECTIVES To evaluate the effectiveness of the local emergency medical services system in resuscitation of out-of-hospital cardiac arrest and identify areas for improvement. METHODS This was a prospective descriptive study of adults with nontraumatic out-of-hospital cardiac arrest treated in the three accident & emergency departments that serve the whole of Hong Kong Island from March 15, 1999, to October 15, 1999. Patient characteristics, circumstances of cardiac arrest, final outcomes, and response times of the ambulance service were recorded according to the Utstein style. RESULTS Three hundred twenty patients were included. There was male predominance, and the mean age was 71.5 years. The majority of cardiac arrests occurred at patients' homes. In 57.5% of cases the arrest was not witnessed. The bystander cardiopulmonary resuscitation (CPR) rate was 15.6%. The most common electrocardiographic (ECG) rhythm at scene was asystole. Ventricular fibrillation or pulseless ventricular tachycardia constituted 14.1%. The average call to dispatch interval was 1.04 minutes. The average call to CPR interval was 9.82 minutes. The average total prehospital interval was 27.55 minutes. The overall immediate survival rate was 14.1% and the rate of survival to hospital discharge was 1.25%. CONCLUSION The prognosis of out-of-hospital cardiac arrest in Hong Kong was dismal. Every link in the chain of survival has to be improved.
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Affiliation(s)
- L P Leung
- Accident & Emergency Department, Queen Mary Hospital, Pokfulam, Hong Kong.
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Meyer AD, Bernard S, Smith KL, McNeil JJ, Cameron PA. Asystolic cardiac arrest in Melbourne, Australia. EMERGENCY MEDICINE (FREMANTLE, W.A.) 2001; 13:186-9. [PMID: 11482856 DOI: 10.1046/j.1442-2026.2001.00208.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the outcome of victims of out-of-hospital cardiac arrest presenting to the Metropolitan Ambulance Service in asystole, in Melbourne, Australia. METHODS A retrospective case-note review of all patients presenting to the Metropolitan Ambulance Service in asystole for 1997 was performed. Metropolitan Ambulance Service case notes and hospital records were examined to determine the presenting rhythm and the patients' outcome. RESULTS In a 12-month period, 778 patients met the entry criteria. Age mean was 67 years, 36% female, 64% male. Metropolitan Ambulance Service response time to scene time was a mean of 9.76 min. Resuscitation was commenced on 37% of patients. There was one survivor (0.12%). CONCLUSION Adult victims of out-of-hospital cardiac arrest presenting as asystole should not receive treatment.
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Affiliation(s)
- A D Meyer
- Emergency Department, The Royal Melbourne Hospital, Monash University, Australia.
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Smith KL, Peeters A, McNeil JJ. Results from the first 12 months of a fire first-responder program in Australia. Resuscitation 2001; 49:143-50. [PMID: 11382519 DOI: 10.1016/s0300-9572(00)00355-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE We aimed to reduce response times and time to defibrillation for out-of-hospital cardiac arrest patients through fire first-responders equipped with automatic external defibrillators (AEDs). The fire first-responders were added as an extra tier to the existing two-tired ambulance response. METHODS This prospective controlled trial set in Melbourne, Australia, consisted of a control area (277 km2, population density 2343/km2-ambulance only dispatch) and a pilot area (171 km2, population density 2290/km2-ambulance and fire first-responder dispatch). The main outcome measures were time to emergency medical service (EMS) arrival at scene for all cardiac arrest patients and time to defibrillation for cardiac arrest patients presenting in ventricular fibrillation (VF). The study participants were patients who suffered a cardiac arrest of presumed cardiac aetiology for which a priority 0 emergency response was activated. A total of 268 patients were located in the control area and 161 in the pilot (intervention) area. RESULTS The mean response time to arrival at scene was reduced by 1.60 (95% CI 1.21, 1.99) min, P < 0.001. A large reduction in prolonged responses (> or = 10 min) to cardiac arrests was also observed in the pilot area (2%) compared with the control area (18%), chi = 23.19, P < 0.001. Mean time to defibrillation was reduced by 1.43 (95% CI 0.11, 2.98) min, P = 0.068. CONCLUSION The results from this study suggest that fire officers can be successfully trained in the use of AEDs and can integrate well into a medical response role. The combined response of ambulance and fire personnel significantly reduced the response interval and reduced time to defibrillation. This suggests that in appropriate situations other agencies could be considered for involvement in co-ordinated first-responder programs.
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Affiliation(s)
- K L Smith
- Monash Medical School, Monash University, Alfred Hospital, Commercial Rd., Vic. 3181, Prahran, Australia.
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Smith KL, Cameron PA, Peeters A, Meyer AD, McNeil JJ. Automatic external defibrillators: changing the way we manage ventricular fibrillation. Med J Aust 2000; 172:384-8. [PMID: 10840491 DOI: 10.5694/j.1326-5377.2000.tb124014.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To discuss recent developments in automatic defibrillation and to review the evidence that first-responders equipped with automatic external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrest. DATA SOURCES MEDLINE search from 1966 to 1999 (articles in English only) and examination of bibliographies. STUDY SELECTION Published studies of out-of-hospital cardiac arrest and first-responders equipped with AEDs. Studies had to have a control group and to report survival to hospital discharge from ventricular fibrillation (VF). DATA EXTRACTION Six studies met the selection criteria (two prospective randomised trials, two prospective controlled trials, and one cohort study and one retrospective study, both with historical controls). DATA SYNTHESIS A random effects meta-analysis of odds ratios for survival from VF. CONCLUSIONS Meta-analysis suggests that equipping first-responders with AEDs increases the probability of survival to hospital discharge after out-of-hospital cardiac arrest (odds ratio, 1.74; 95% CI, 1.27-2.38; P < 0.001). However, most of the studies lacked sufficient power to draw definitive conclusions. Until the impact of wide deployment of AEDs is fully understood, first-responder defibrillation in Australia should only occur as part of coordinated multicentre research studies.
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Affiliation(s)
- K L Smith
- Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Melbourne, VIC.
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Wassertheil J, Keane G, Fisher N, Leditschke JF. Cardiac arrest outcomes at the Melbourne Cricket Ground and shrine of remembrance using a tiered response strategy-a forerunner to public access defibrillation. Resuscitation 2000; 44:97-104. [PMID: 10767496 DOI: 10.1016/s0300-9572(99)00168-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The provision of medical, paramedical and first aid services at major public events is an important concern for pre-hospital emergency medical care providers. Patient outcomes of a cardiac arrest response strategy employed at the Melbourne Cricket Ground (MCG) and the Shrine of Remembrance by St John Ambulance Australia volunteers are reported. Twenty-eight consecutive events occurring between December 1989 and December 1997 have been analysed. Included are three cardiac arrests managed at ANZAC day parades utilising the same response strategy by the same unit. The incidence of cardiac arrest at the MCG was 1:500000 attendances. Of the 28 patients, 24 (86%) left the venue alive and 20 (71%) were discharged home from hospital. In all cases the initial rhythm was ventricular fibrillation (VF). All 26 patients (93%) who were defibrillated by St John teams had this intervention within 5 min from the documented time of collapse. One patient in VF spontaneously reverted during CPR. Of the eight fatalities, four died at the scene. At major public venues and events, a co-ordinated emergency life support provision strategy, tailor made for the venue, is necessary for the delivery of prompt CPR, timely defibrillation and advanced life support.
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Buist M, Gould T, Hagley S, Webb R. An analysis of excess mortality not predicted to occur by APACHE III in an Australian level III intensive care unit. Anaesth Intensive Care 2000; 28:171-7. [PMID: 10788969 DOI: 10.1177/0310057x0002800208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The APACHE III derived standardized mortality ratio has been suggested as a statistic to measure intensive care unit (ICU) effectiveness. From 1991 data collected on 519 consecutive admissions to the Royal Adelaide Hospital ICU a standardized mortality ratio of 1.25 was calculated. Of the 174 deaths only 95 had a prediction of death greater than 0.5. As part of a quality assurance study we undertook a retrospective case note audit to try to identify factors that were associated with the low mortality prediction (< 0.5) in hospital deaths. Firstly we analysed the patient population that died to determine the factors that were different between patients who had a mortality prediction of greater than 0.5 versus those who had a mortality prediction of less than 0.5. Next we analysed the patient population with a mortality prediction of less than 0.5 and compared actual survivors with patients who died in hospital. Amongst low mortality prediction patients admitted to the Royal Adelaide Hospital ICU we identified age, a history of acute myocardial infarction, presentation to ICU after a cardiac arrest or with an elevated creatinine and the development of acute renal failure and septicaemia during the ICU admission as being associated with in-hospital mortality. We also documented that late hospital deaths on the ward after ICU discharge occurred more frequently with low predicted hospital mortality ICU patients. Factors other than the APACHE III score may be associated with hospital deaths of ICU patients.
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Affiliation(s)
- M Buist
- Department of Anaesthetics and Intensive Care, Royal Adelaide Hospital, South Australia
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Abstract
Out-of-hospital cardiac arrest (OHCA), with its high fatality rate, is a significant public health issue. The aetiology of OHCA is reviewed, and management strategies are discussed, including the "chain of survival", the Utstein method of data collection, and recent developments in advanced cardiac life support emphasising defibrillation.
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Mackay MJ. Decision making in CPR. Med J Aust 1999; 171:276. [PMID: 10495764 DOI: 10.5694/j.1326-5377.1999.tb123644.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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