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Gehlen M, Brokmann JC, Röhrig R, Hübel C, Unterkofler J, Plata C. Effect of different intervals of verbal motivation during dispatcher-assisted CPR: A randomized controlled simulation trial. Am J Emerg Med 2025; 89:12-18. [PMID: 39689627 DOI: 10.1016/j.ajem.2024.11.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 11/26/2024] [Accepted: 11/28/2024] [Indexed: 12/19/2024] Open
Abstract
AIM OF THE STUDY High quality chest compressions are essential for survival and good neurological outcome in out-of-hospital cardiac arrest (OHCA). Dispatcher- assisted CPR (DA-CPR) has led to increased survival in OHCA. Recently, additional verbal motivation has shown positive effects on CPR quality. The present randomized and controlled simulation trial investigates the effect of different intervals of verbal motivation during DA-CPR. METHODS 159 medical laypersons performed eight minutes of CPR on a simulator after randomization into one of three study groups: 1) "DA-CPR" 2) "DA-CPR + motivation every 30s" 3) "DA-CPR + motivation every 60s". Verbal motivation consisted of "push harder, do not relent. Additionally, a metronome beat was audible via telephone in the motivation groups. Primary endpoint was the difference in median chest compression depth during the eight-minute CPR compared between the study groups. RESULTS There were significant differences in median compression depth between the three study groups (p = 0.002). However, only the group "DA-CPR + motivation every 60s" showed a significant difference in compression depth compared to standard DA-CPR and was within the recommended range. Compressions with adequate depth (p = 0.009) and median compression rate (p < 0.001) were significantly elevated in both motivational groups compared to the "DA-CPR"-group. CONCLUSION Verbal encouragement every 30 or 60 s combined with a metronome beat led to a significant augmentation of chest compression depth compared to standard DA-CPR.
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Affiliation(s)
- Marcel Gehlen
- Department for Acute and Emergency Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Jörg Christian Brokmann
- Department for Acute and Emergency Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Rainer Röhrig
- Institute for Medical Informatics, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Christian Hübel
- Department for Acute and Emergency Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Jenny Unterkofler
- Department for Acute and Emergency Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Christopher Plata
- Department for Acute and Emergency Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Tanaka Y, Tanaka K, Ushimoto T, Inaba H. Impact of the COVID-19 Pandemic on Out-of-Hospital Cardiac Arrests Occurring in the Workplace. Cureus 2025; 17:e80168. [PMID: 40190993 PMCID: PMC11972104 DOI: 10.7759/cureus.80168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2025] [Indexed: 04/09/2025] Open
Abstract
Background The impact of the coronavirus disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) occurring in this setting remains unclear. Objective The objective of this study is to elucidate the impact of the COVID-19 pandemic on the prehospital characteristics and outcomes of OHCA occurring in the workplace. Methods This nationwide observational study in Japan was a retrospective analysis and included 16,364 non-emergency medical service witnessed and adult workplace OHCAs. The characteristics and outcomes of workplace OHCAs were compared between the pre-pandemic period (2016-2019) and the pandemic period (2020-2021). Furthermore, subgroup analyses were performed for workplace location (office vs. non-office) and infection burden region. Results During the pandemic period, no significant changes were observed in incidence, public access defibrillation (PAD) provision rates, one-month survival rates, or neurologically favorable survival rates. However, increases were observed for bystander cardiopulmonary resuscitation (CPR) (crude odds rate (cOR), 95% confidence interval (CI): 1.10, 1.02-1.16; P<0.001), particularly compression-only CPR. The multivariable analysis revealed that the impact of the pandemic was similarly seen in an increase in bystander CPR (adjusted OR, 95% CI: 1.14, 1.06-1.22; P<0.001). Furthermore, the monthly changes in only PAD were altered biennially (PAD: P=0.02, bystander CPR: P=0.52, one-month survival: P=0.26, and neurologically favorable one-month survival: P=0.48). Analysis restricted to high-infection burden regions revealed that only the PAD rate decreased (P=0.03). Conclusion The COVID-19 pandemic had no impact on OHCA survival in workplaces and had a limited positive impact on bystander responses. This may be attributed to previous positive CPR training experiences and routine preparation for health crises.
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Affiliation(s)
- Yoshio Tanaka
- Department of Emergency and Disaster Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, JPN
- Department of Emergency Medicine, Kanazawa Medical University, Uchinada, JPN
| | - Koichi Tanaka
- Department of Emergency Medical Science, Niigata University of Health and Welfare, Niigata, JPN
| | - Tomoyuki Ushimoto
- Department of Emergency Medicine, Kanazawa Medical University, Uchinada, JPN
| | - Hideo Inaba
- Department of Emergency Medicine, Kanazawa Medical University, Uchinada, JPN
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Spangler DN, Blomberg H. Continuous individual feedback to nurses at emergency medical dispatch centres: a stepped-wedge, interrupted time series analysis. BMJ Open Qual 2025; 14:e002993. [PMID: 39884723 PMCID: PMC11792563 DOI: 10.1136/bmjoq-2024-002993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 01/11/2025] [Indexed: 02/01/2025] Open
Abstract
BACKGROUND Clinical feedback is often lacking in prehospital care, and while performance data is increasingly available to clinical and operational leadership, it is seldom made available to care providers themselves. In this study, we investigate the impact of a simple intervention consisting of the provision of monthly feedback reports via email to emergency medical dispatch nurses in three Swedish regions. METHOD Individualised reports consisting of 14 measures divided into descriptive (eg, priority-setting and call times), process (eg, dispatch times and documentation completeness) and outcome (eg, over/under triage rate) categories were developed with staff and management input. Report delivery was implemented using a stepped-wedge design, and effects were evaluated using a hierarchical regression-based interrupted time series analysis. RESULTS 40 dispatchers were included in the study between March 2020 and October 2023, who handled a total of 246 353 incidents. Some impacts on documentation-related process measures were identified, with the odds of complete documentation increasing by 7.5% (95% CI 5.1 to 9.9) and the odds of having a documented contact reason increasing by 3.8% (1.5-5.9). These effects remained robust over the post-intervention period. Weaker impacts on outcome measures were identified which could be explained by a higher priority given to emergency medical dispatches overall. CONCLUSION Providing performance data can influence care providers to adjust their behaviour to improve process-related quality metrics under their direct control. The intervention may also have induced nurses to more often upgrade the priority of their patients. Improving outcome metrics may however require more intensive, multifaceted interventions.
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Affiliation(s)
- Douglas Nils Spangler
- Uppsala Center for Prehospital Research, Institute of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Blomberg
- Uppsala Center for Prehospital Research, Institute of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Aldridge ES, Perera N, Ball S, Whiteside A, Bray J, Finn J. Breaking down barriers: Call-taker strategies to address caller perception of inappropriateness of cardiopulmonary resuscitation during the emergency ambulance call. Resuscitation 2025; 206:110459. [PMID: 39662739 DOI: 10.1016/j.resuscitation.2024.110459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 11/22/2024] [Accepted: 12/01/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND Ambulance call-takers perform the critical role of prompting callers to initiate and continue cardiopulmonary resuscitation (CPR) for patients with suspected out-of-hospital cardiac arrest (OHCA). This study aimed to identify call-taker strategies to address callers' perceptions of CPR 'inappropriateness' (perceiving the patient as dead and beyond help, or as showing signs of life). METHODS Using a linguistic approach, we analysed 31 calls previously identified as having an inappropriateness barrier to CPR initiation or continuation. In Phase 1, we listened to call recordings and studied call transcripts to identify the strategies and linguistic features used by call-takers. Phase 2 was a discourse analysis of transcript extracts to describe how certain strategies, identified in Phase 1, were used in the caller-call-taker interactions. RESULTS Call-takers used various strategies when responding to callers who considered CPR inappropriate. Call-takers rarely used a single strategy or linguistic feature in isolation, tending to use combinations of minimal tokens of alignment (e.g. caller name or encouragements statements), with deontics (including directives/commands and statements of obligation e.g. "do this for me") and provision of either context (e.g. "the ambulance is on its way") or a rationale ("he's not breathing effectively so we need to perform CPR to help him"). Most call-taker attempts were successful, with callers overcoming 71% of initiation barriers and 88% of continuation barriers. CONCLUSIONS Call-takers used a combination of linguistic features (minimal/symbolic tokens, deontics) and strategies (providing unscripted statements about the context or a rationale for CPR) to overcome barriers of perceived inappropriateness to CPR.
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Affiliation(s)
- Emogene S Aldridge
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia.
| | - Nirukshi Perera
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia; St John Western Australia, Western Australia, Australia
| | - Austin Whiteside
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia; St John Western Australia, Western Australia, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia; St John Western Australia, Western Australia, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
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Park DH, Park GJ, Kim YM, Chai HS, Kim SC, Kim H, Lee SW. Barriers to successful dispatcher-assisted cardiopulmonary resuscitation in out-of-hospital cardiac arrest in Korea. Resusc Plus 2024; 19:100725. [PMID: 39091585 PMCID: PMC11293587 DOI: 10.1016/j.resplu.2024.100725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) improves bystander CPR rates and survival outcomes. This study aimed to identify barriers to successful DA-CPR in patients with out-of-hospital cardiac arrest (OHCA). Methods This retrospective observational study used data from a nationwide OHCA database from 2017 to 2021. Adult emergency medical services (EMS)-treated patients with OHCA with a presumed cardiac etiology were enrolled. The main exposure variable was compliance with DA-CPR. The primary outcome was good neurological recovery at hospital discharge. Multivariable logistic regression analysis was conducted to identify the major factors associated with unsuccessful DA-CPR with and without multiple imputations. Causal mediation analysis was conducted using witnessed status as a mediator. Results In the final analysis, 49,165 patients with OHCA were included. A total of 36,865 (75.0%) patients successfully underwent DA-CPR. A higher proportion of good neurological recovery was observed in the successful DA-CPR group than in the non-successful DA-CPR group (P < 0.001). The following factors were identified as risk factors for unsuccessful DA-CPR: age > 65 years, male sex, OHCA occurring in a non-metropolitan area or private place, unwitnessed status, whether the bystander was a non-family member or non-cohabitant, female sex or had not received CPR training, and primary call dispatchers not receiving any first-aid training. Additional analyses after multiple imputations showed similar results. Mediation effect was significant for most risk factors for unsuccessful DA-CPR. Conclusions Bystander characteristics (non-family member or non-cohabitant, female, and uneducated status for CPR) and primary call dispatchers not receiving first-aid training were identified as risk factors for unsuccessful DA-CPR.
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Affiliation(s)
- Dong Hyun Park
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Gwan Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Young Min Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyun Seok Chai
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sang Chul Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hoon Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Suk Woo Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
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Youngstrom DW, Sutton TS, Kabala FS, Rosenzweig IC, Johndro CW, Al-Araji R, Burke-Martindale C, Mather JF, McKay RG. Community-level bystander treatment and outcomes for witnessed out-of-hospital cardiac arrest in the state of Connecticut. Resusc Plus 2024; 19:100727. [PMID: 39171330 PMCID: PMC11338120 DOI: 10.1016/j.resplu.2024.100727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/23/2024] Open
Abstract
Background Prior reports have demonstrated underutilization of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use in patients with witnessed out-of-hospital cardiac arrest (OHCA) in Connecticut. This study aimed to identify community-level risk factors that contribute to low rates of bystander intervention to improve statewide OHCA outcomes. Methods We analyzed 2,789 adult patients with witnessed, non-traumatic OHCA submitted to the Connecticut Cardiac Arrest Registry to Enhance Survival (CARES) between 2013-2022. Patients were grouped by zip code, and associated municipal characteristics were acquired from 2022 United States Census Bureau data. Use of bystander CPR, attempted bystander AED defibrillation, and patient survival with favorable neurological function were determined for 19 of the 20 most populous cities and towns. Pearson correlation tests and linear regression were used to determine associations between OHCA treatment and outcomes with population size, racial/ethnic demographics, language use, income, and educational level. Results Bystander CPR was lower in municipalities with population size > 100,000 and in communities where > 40% of residents are non-English-speaking. AED use was also lower in these municipalities, as well as those with per capita incomes < $40,000 or > 1/3 Hispanic residents. Communities with populations > 100,000, > 40% non-English-speaking, per capita income < $40,000, and > 1/3 Hispanic residents were all associated with lower survival rates. Conclusions OHCA pre-hospital treatment and outcomes vary significantly by municipality in Connecticut. Community outcomes might be improved by specifically targeting urban population centers and Hispanic communities with culturally sensitive, low, or no-cost CPR and AED educational programs, using instructional languages other than English.
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Affiliation(s)
- Daniel W. Youngstrom
- Hartford HealthCare Emergency Medical Services Network, 450 West Main Street, Meriden, CT 06451, USA
| | - Trevor S. Sutton
- Department of Anesthesiology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
- Hartford HealthCare Heart & Vascular Institute, 85 Jefferson Street, Hartford, CT 06106, USA
- Integrated Anesthesia Associates, 100 Retreat Avenue, Hartford, CT 06106, USA
| | - Fleur S. Kabala
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Isabella C. Rosenzweig
- Quinnipiac University Frank H. Netter MD School of Medicine, 370 Bassett Road, North Haven, CT 06473, USA
| | - Charles W. Johndro
- Department of Emergency Medicine, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Rabab Al-Araji
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | | | - Jeff F. Mather
- Department of Research Administration, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Raymond G. McKay
- Department of Cardiology, Hartford Hospital, 85 Seymour Street, Hartford, CT 06106, USA
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Mok V, Haines M, Nowroozpoor A, Yap J, Brebner C, Asamoah-Boaheng M, Hutton J, Scheuermeyer F, Sekhon M, Christenson J, Grunau B. The association of non-prescription drug use preceding out-of-hospital cardiac arrest and clinical outcomes. Resuscitation 2024; 202:110313. [PMID: 38996908 DOI: 10.1016/j.resuscitation.2024.110313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/01/2024] [Accepted: 07/07/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Clinicians may make prognostication decisions for out-of-hospital cardiac arrest (OHCA) using historical details pertaining to non-prescription drug use. However, differences in outcomes between OHCAs with evidence of non-prescription drug use, compared to other OHCAs, have not been well described. METHODS We included emergency medical service-treated OHCA in the British Columbia Cardiac Arrest Registry (January/2019-June/2023). We classified cases as "non-prescription drug-associated cardiac arrests" (DA-OHCA) if there was evidence of non-prescription drug use preceding the OHCA, including witness accounts of use within 24 h or paraphernalia at the scene. We fit logistic regression models to investigate the association between DA-OHCA (vs. other cases) and favourable neurological outcome (Cerebral Performance Category [CPC] 1-2) and survival at hospital discharge, and return of spontaneous circulation (ROSC). RESULTS Of 18,426 OHCA, 2,171 (12%) were classified as DA-OHCA. DA-OHCA tended to be younger, unwitnessed, occur during the evening or night, and present with a non-shockable rhythm, compared to other OHCA. DA-OHCA (221 [10%]) had a greater proportion (difference 1.8%; 95% CI 0.49-3.2) with favourable neurological outcomes compared to other OHCA (1,365 [8.4%]). Adjusted models did not identify an association of DA-OHCA with favourable neurological outcome (OR 1.08, 95% CI 0.87-1.33) or survival to hospital discharge (OR 1.13, 95% CI 0.93-1.38), but did demonstrate an association with ROSC (OR 1.13, 95% CI 1.004-1.27). CONCLUSION In unadjusted models, DA-OHCA was associated with an improved odds of survival and favourable neurological outcomes at hospital discharge, compared to other OHCA. However, we did not detect an association in adjusted analyses.
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Affiliation(s)
- Valerie Mok
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Morgan Haines
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada
| | - Armin Nowroozpoor
- Department of Emergency Medicine, Duke University School of Medicine, NC, USA
| | - Justin Yap
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada
| | - Callahan Brebner
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Michael Asamoah-Boaheng
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jacob Hutton
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada
| | - Frank Scheuermeyer
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mypinder Sekhon
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Division of Critical Care Medicine, University of British Columbia, British Columbia, Canada
| | - Jim Christenson
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Brian Grunau
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.
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Skelton J, Templeton A, Dang Guay J, MacInnes L, Clegg G. Developing and evaluating a brief, socially primed video intervention to enable bystander cardiopulmonary resuscitation: A randomised control trial. PLoS One 2024; 19:e0297598. [PMID: 38968194 PMCID: PMC11226058 DOI: 10.1371/journal.pone.0297598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/10/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Over 30,000 people experience out-of-hospital cardiac arrest in the United Kingdom annually, with only 7-8% of patients surviving. One of the most effective methods of improving survival outcomes is bystander intervention in the form of calling the emergency services and initiating chest compressions. Additionally, the public must feel empowered to act and use this knowledge in an emergency. This study aimed to evaluate an ultra-brief CPR familiarisation video that uses empowering social priming language to frame CPR as a norm in Scotland. METHODS In a randomised control trial, participants (n = 86) were assigned to view an ultra-brief CPR video intervention or a traditional long-form CPR video intervention. Following completion of a pre-intervention questionnaire examining demographic variables and prior CPR knowledge, participants completed an emergency services-led resuscitation simulation in a portable simulation suite using a CPR manikin that measures resuscitation quality. Participants then completed questionnaires examining social identity and attitudes towards performing CPR. RESULTS During the simulated resuscitation, the ultra-brief intervention group's cumulative time spent performing chest compressions was significantly higher than that observed in the long-form intervention group. The long-form intervention group's average compressions per minute rate was significantly higher than the ultra-brief intervention group, however both scores fell within a clinically acceptable range. No other differences were observed in CPR quality. Regarding the social identity measures, participants in the ultra-brief condition had greater feelings of expected emergency support from other Scottish people when compared to long-form intervention participants. There were no significant group differences in attitudes towards performing CPR. CONCLUSIONS Socially primed, ultra-brief CPR interventions hold promise as a method of equipping the public with basic resuscitation skills and empowering the viewer to intervene in an emergency. These interventions may be an effective avenue for equipping at-risk groups with resuscitation skills and for supplementing traditional resuscitation training.
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Affiliation(s)
- Jean Skelton
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- School of Philosophy, Psychology, & Language Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Anne Templeton
- School of Philosophy, Psychology, & Language Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Jennifer Dang Guay
- School of Philosophy, Psychology, & Language Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Lisa MacInnes
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Gareth Clegg
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Scottish Ambulance Service, Edinburgh, Scotland, United Kingdom
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Bathe J, Daubmann A, Doehn C, Napp A, Raudies M, Beck S. Online training to improve BLS performance with dispatcher assistance? Results of a cluster-randomised controlled simulation trial. Scand J Trauma Resusc Emerg Med 2024; 32:50. [PMID: 38835039 PMCID: PMC11149242 DOI: 10.1186/s13049-024-01226-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The prognosis for patients improves significantly with effective cardiopulmonary resuscitation (CPR) performed by bystanders. Current research indicates that individuals who receive CPR from trained bystanders have a greater likelihood of survival compared to those who receive dispatcher-assisted CPR from untrained laypersons. This cluster-randomised controlled trial assessed the impact of a 30-min online training session prior to a simulated cardiac arrest situation with dispatcher-assisted CPR (DA-CPR) on enhancing Basic Life Support (BLS) performance. METHODS This study was performed in 2018 in Hamburg, Germany. The primary outcome was the practical BLS skills of high school students in simulated out-of-hospital cardiac arrest scenarios with dispatcher assistance. The intervention group participants underwent a 30-min online BLS training session, while the control group did not receive an intervention. It was hypothesized that the average practical BLS scores of the intervention group would be 1.5 points higher than those of the control group. RESULTS BLS assessments of 286 students of 16 different classes were analysed. The estimated mean BLS score in the intervention group was 7.60 points (95% CI: 6.76 to 8.44) compared to 6.81 (95% CI: 5.97 to 7.65) in the control group adjusted for BLS training and class. Therefore, the estimated mean difference between the groups was 0.79 (95% CI: -0.40 to 1.97) and not significantly different (p-value: 0.176). Based on a logistic regression analysis the intervention had only a significant effect on the chance to pass the item "vertically above the chest" (OR = 4.99; 95% CI: 1.46 to 17.12) adjusted for BLS training and class. CONCLUSION Prior online training exhibits beneficial impacts on the BLS performance of bystanders during DA-CPR. To maximise the effect size, online training should be incorporated into a set of interventions that are mutually complementary and specifically designed for the target participants. TRIAL REGISTRATION DRKS00033531 . "Kann online Training Laien darauf vorbereiten Reanimationsmaßnahmen unter Anleitung der Leitstelle adäquat durchzuführen? " Registered on January 29, 2024.
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Affiliation(s)
- Janina Bathe
- Centre of Anaesthesiology and Intensive Care Medicine, Hamburg-Eppendorf University Medical Centre, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, Hamburg-Eppendorf University Medical Centre, Hamburg, Germany
| | - Christoph Doehn
- Centre of Anaesthesiology and Intensive Care Medicine, Hamburg-Eppendorf University Medical Centre, Hamburg, Germany
| | - Antonia Napp
- Centre of Anaesthesiology and Intensive Care Medicine, Hamburg-Eppendorf University Medical Centre, Hamburg, Germany
| | | | - Stefanie Beck
- Centre of Anaesthesiology and Intensive Care Medicine, Hamburg-Eppendorf University Medical Centre, Hamburg, Germany.
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Chen YJ, Chen CY, Kang CW, Tzeng DW, Wang CC, Hsu CF, Huang TL, Liu CY, Tsai YT, Weng SJ. Dispatchers trained in persuasive communication techniques improved the effectiveness of dispatcher-assisted cardiopulmonary resuscitation. Resuscitation 2024; 196:110120. [PMID: 38266768 DOI: 10.1016/j.resuscitation.2024.110120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Early recognition of cardiac arrest and early initiation of bystander cardiopulmonary resuscitation can increase the survival of patients with out-of-hospital cardiac arrest (OHCA). We compared dispatcher-assisted cardiopulmonary resuscitation (DACPR) effectiveness before and after using different communication models in the dispatching center. METHOD We analyzed dispatch recordings of non-trauma origin OHCA cases received by the Taichung dispatch center between May 1 to September 30, 2021, and November 1, 2021, to March 31, 2022. The dispatchers underwent an 8-hour training intervention consisting of targeted education using a new communication model for DACPR. Several outcome measures were evaluated, including the sustained return of spontaneous circulation and the time to first chest compression. RESULTS We included 640 cases in the preintervention group and 580 cases in the postintervention group. The return of spontaneous circulation (ROSC) rate, the time to first chest compression, and good neurological outcome were significantly improved in the postintervention group (20.9% vs. 31.0%, p < 0.001;168 seconds vs. 151 seconds, p = 0.004; 2.8% vs. 5.3%, p = 0.024, respectively). In subgroup analyses, the intervention was related to a statistical improvement in ROSC rate among patients whose caller was a family member (18.7% vs. 31.4%, p < 0.001). Among patients whose caller was female, both ROSC and good neurological outcome significantly improved after the intervention (19.8% vs. 36.6%, p < 0.001; 2.7% vs. 7.5%, p = 0.006, respectively). There was a statistical difference between the pre-intervention and post-intervention group with respect to ROSC rate among patients whose caller was family (the adjusted odds ratio:1.78, 95% CI: 0.59-1.25], p < 0.001.) or female (the adjusted odds ratio:3.18,95% CI: 1.77-5.70], p = 0.008.) in the multivariable regression model. CONCLUSION The new communication model has enhanced the effectiveness of DACPR in terms of the ROSC rate, particularly when the caller was a family member or female, leading to improved rates of ROSC and favorable neurological outcomes.
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Affiliation(s)
- Yen-Ju Chen
- Department of Emergency Medicine, Asia University Hospital, Taichung 413, Taiwan.
| | - Chih-Yu Chen
- Department of Emergency Medicine, Everan Hospital, Taichung 411, Taiwan; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407, Taiwan.
| | - Chao-Wei Kang
- Department of Information Management, Chung Chou University of Science and Technology, Changhua 510, Taiwan; Fire Bureau of Taichung City Government, Taichung 408, Taiwan.
| | - Da-Wei Tzeng
- Fire Bureau of Taichung City Government, Taichung 408, Taiwan.
| | - Chia-Chin Wang
- Department of Leisure and Recreation Management, Asia University, Taichung 413, Taiwan; Fire Bureau of Taichung City Government, Taichung 408, Taiwan
| | - Chien-Feng Hsu
- Department of Business Administration, Asia University, Taichung 413, Taiwan; Fire Bureau of Taichung City Government, Taichung 408, Taiwan.
| | - Tai-Lin Huang
- Tungs' Taichung Metroharbor Hospital, Taichung 435, Taiwan.
| | - Chien-Yu Liu
- Department of Emergency Medicine, China Medical University Hospital, Taichung 404, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung 413, Taiwan.
| | - Yao-Te Tsai
- Department of Information Management, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.
| | - Shao-Jen Weng
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407, Taiwan.
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11
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Claesson A, Hult H, Riva G, Byrsell F, Hermansson T, Svensson L, Djärv T, Ringh M, Nordberg P, Jonsson M, Forsberg S, Hollenberg J, Nord A. Outline and validation of a new dispatcher-assisted cardiopulmonary resuscitation educational bundle using the Delphi method. Resusc Plus 2024; 17:100542. [PMID: 38268848 PMCID: PMC10805935 DOI: 10.1016/j.resplu.2023.100542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024] Open
Abstract
Aim Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is time-dependent. To date, evidence-based training programmes for dispatchers are lacking. This study aimed to reach expert consensus on an educational bundle content for dispatchers to provide DA-CPR using the Delphi method. Method An educational bundle was created by the Swedish Resuscitation Council consisting of three parts: e-learning on DA-CPR, basic life support training and audit of emergency out-of-hospital cardiac arrest calls. Thereafter, a two-round modified Delphi study was conducted between November 2022 and March 2023; 37 experts with broad clinical and/or scientific knowledge of DA-CPR were invited. In the first round, the experts participated in the e-learning module and answered a questionnaire with 13 closed and open questions, whereafter the e-learning part of the bundle was revised. In the second round, the revised e-learning part was evaluated using Likert scores (20 items). The predefined consensus level was set at 80%. Results Delphi rounds one and two were assessed by 20 and 18 of the invited experts, respectively. In round one, 18 experts (18 of 20, 90%) stated that they did not miss any content in the programme. In round two, the scale-level content validity index based on the average method (S-CVI/AVE, 0.99) and scale-level content validity index based on universal agreement (S-CVI/UA, 0.85) exceeded the threshold level of 80%. Conclusion Expert consensus on the educational bundle content was reached using the Delphi method. Further work is required to evaluate its effect in real-world out-of-hospital cardiac arrest calls.
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Affiliation(s)
- Andreas Claesson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Håkan Hult
- Department of Healthcare, Clinicum, Linköping University Hospital, Sweden
| | - Gabriel Riva
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Fredrik Byrsell
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Thomas Hermansson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Therese Djärv
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Ringh
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Per Nordberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Martin Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Sune Forsberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Jacob Hollenberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anette Nord
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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12
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Lee HJ, Choi MY, Choi YS. Analysis of Out-of-Hospital First Aid for Recovery of Spontaneous Circulation after Cardiac Arrest in Korea. Diagnostics (Basel) 2024; 14:224. [PMID: 38275471 PMCID: PMC10813884 DOI: 10.3390/diagnostics14020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
The characteristics of an individual patient experiencing out-of-hospital cardiac arrest who recovered spontaneous circulation with the assistance of witnesses and paramedics were examined. The analysis of bystander cardiopulmonary resuscitation (CPR) and the professional first aid efforts of paramedics in the pre-hospital environment is pivotal to enhancing the survival rate of out-of-hospital cardiac arrest patients. The data used in this study were extracted from the Korea Centers for Disease Control and Prevention (KCDC) nationally recognized statistics, Acute Heart Failure big data survey. Out-of-hospital cardiac arrest (OHCA) customer data were collected from the Gangwon Fire Headquarters public information database as social management data. The data were analyzed using SPSS 24. The study's results emphasized the significance of offering basic CPR training to the public. This is evident from the fact that 90.5% of the first witnesses in the study performed CPR on OHCA patients, resulting in the recovery of spontaneous circulation (ROSC). The majority of patients with ROSC were male, with the highest age group being 41-50 years. Heart disease, hypertension, and diabetes were common medical conditions. The rate of witnessing cardiac arrest was high. Among the first witnesses, about 78.4% were of cardiac arrest incidents involving family members, co-workers, or acquaintances; 12.2% were on-duty medical healthcare personnel; and 9.5% were off-duty healthcare personnel. Cardiac arrest was treated in 83.8% of cases, with 90% of witnesses performing CPR. The percentage of witnesses that used an automated external defibrillator (AED) was 13.5%. In this study, the rates of ECG monitoring, CPR performance, and defibrillation performed by paramedics were high, but intravascular access and drug administration had a lower rate of performance. The time elapsed depended on the patient's physical fitness. The study found that paramedics had the highest CPC restoration rate in patients with cardiac arrest, followed by EMTs and nurses. Significant differences were observed in cerebral performance scores after care by these paramedics and nurses. To increase the performance of AEDs, more AEDs should be installed in public spaces so that the public can access them conveniently in cases of emergency. In addition, it is necessary to improve the quality of professional first aid physical activity services performed by first-class paramedics.
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Affiliation(s)
- Hyeon-Ji Lee
- Department of Emergency Medical Technology, College of Health Science, Kangwon National University, 346 Hwangjo-Gil, Samcheck-si 25949, Republic of Korea
| | - Mi-Young Choi
- Department of Emergency Medical Technology, College of Health Science, Kangwon National University, 346 Hwangjo-Gil, Samcheck-si 25949, Republic of Korea
| | - Young-Soon Choi
- Department of Nursing, College of Health Science, Kangwon National University, 346 Hwangjo-Gil, Samcheck-si 25949, Republic of Korea
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13
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Wilson C, Janes G, Lawton R, Benn J. Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis. BMJ Qual Saf 2023; 32:573-588. [PMID: 37028937 PMCID: PMC10512001 DOI: 10.1136/bmjqs-2022-015634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/13/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Extensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback and follow-up to emergency medical service (EMS) staff might provide staff with closure and improve clinical performance. Our aim was to summarise the literature on the types of feedback received by EMS professionals and its effects on the quality and safety of patient care, staff well-being and professional development. METHODS A systematic review and meta-analysis, including primary research studies of any method published in peer-reviewed journals. Studies were included if they contained information on systematic feedback to emergency ambulance staff regarding their performance. Databases searched from inception were MEDLINE, Embase, AMED, PsycINFO, HMIC, CINAHL and Web of Science, with searches last updated on 2 August 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Data analysis followed a convergent integrated design involving simultaneous narrative synthesis and random effects multilevel meta-analyses. RESULTS The search strategy yielded 3183 articles, with 48 studies meeting inclusion criteria after title/abstract screening and full-text review. Interventions were categorised as audit and feedback (n=31), peer-to-peer feedback (n=3), postevent debriefing (n=2), incident-prompted feedback (n=1), patient outcome feedback (n=1) or a combination thereof (n=4). Feedback was found to have a moderate positive effect on quality of care and professional development with a pooled effect of d=0.50 (95% CI 0.34, 0.67). Feedback to EMS professionals had large effects in improving documentation (d=0.73 (0.00, 1.45)) and protocol adherence (d=0.68 (0.12, 1.24)), as well as small effects in enhancing cardiac arrest performance (d=0.46 (0.06, 0.86)), clinical decision-making (d=0.47 (0.23, 0.72)), ambulance times (d=0.43 (0.12, 0.74)) and survival rates (d=0.22 (0.11, 0.33)). The between-study heterogeneity variance was estimated at σ2=0.32 (95% CI 0.22, 0.50), with an I2 value of 99% (95% CI 98%, 99%), indicating substantial statistical heterogeneity. CONCLUSION This review demonstrated that the evidence base currently does not support a clear single point estimate of the pooled effect of feedback to EMS staff as a single intervention type due to study heterogeneity. Further research is needed to provide guidance and frameworks supporting better design and evaluation of feedback interventions within EMS. PROSPERO REGISTRATION NUMBER CRD42020162600.
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Affiliation(s)
- Caitlin Wilson
- School of Psychology, University of Leeds, Leeds, UK
- Research and Development Department, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Gillian Janes
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Jonathan Benn
- School of Psychology, University of Leeds, Leeds, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
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14
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Nishimura T, Suga M, Hongo T, Yumoto T, Nakao A, Ishihara S, Naito H. Comparison of outcomes of out-of-hospital cardiac arrest patients: Emergency calls placed from mobile phones vs. landline phones. Resusc Plus 2023; 15:100434. [PMID: 37583510 PMCID: PMC10423887 DOI: 10.1016/j.resplu.2023.100434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/17/2023] Open
Abstract
Background Until recently, calls to the emergency medical service (EMS) from landline phones, which display the caller's exact location at the dispatch center, had been common. Since the use of mobile phones has become widespread, many emergency calls are now made from mobile phones. Differences in outcomes of out-of-hospital cardiac arrest (OHCA) patients for whom EMS was called from mobile versus landline phones has not yet been fully elucidated. Methods We performed a retrospective, population-based analysis in Kobe, Japan to examine whether EMS calls from mobiles improved the prognosis of OHCA patients over EMS calls placed from landlines. The primary outcome was favorable neurological outcome, defined as Cerebral Performance Category (CPC) scores of 1 or 2 at discharge. Secondary outcomes were survival at one-month, survival at discharge, and time durations between call and EMS activities. Results Of 4,231 OHCA cases, 2,194 cases (706 landline cases vs. 1,488 mobile cases) were included in this study. The percentages of favorable neurological outcomes were 0.7% (5/706) in the landline group and 3.8% (56/1,488) in the mobile group. Adjusted multivariable logistic regression revealed that favorable neurological outcomes (odds ratio [OR] 3.03, 95% confidence interval [CI] 1.12-8.17, p = 0.03) were better in the mobile group, while one-month survival (OR 1.30, 95% CI 0.80-2.14, p = 0.29) was not significantly different. Bystander CPR was more frequently administered in the mobile group (landlines 61.3% vs. mobiles 68.4%, p < 0.01). Time durations between call to EMS dispatch (184.5 [IQR 157-220 s] vs. 205 [IQR 174-248 s], p < 0.01) and EMS arrival (476.5 [IQR 377-599 s] vs. 491 [IQR 407.5-611.5 s], p < 0.01) were shorter in the landline group. Conclusions Although the landline caller location display system seems effective for shorter times between EMS call and EMS arrival, mobile phone use was associated with better neurological outcomes.
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Affiliation(s)
- Takeshi Nishimura
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Japan
| | - Masafumi Suga
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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15
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Ushimoto T, Yao S, Nunokawa C, Murasaka K, Inaba H. Association between the COVID-19 pandemic in 2020 and out-of-hospital cardiac arrest outcomes and bystander resuscitation efforts for working-age individuals in Japan: a nationwide observational and epidemiological analysis. Emerg Med J 2023; 40:556-563. [PMID: 37280044 PMCID: PMC10423471 DOI: 10.1136/emermed-2022-213001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/20/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Improving out-of-hospital cardiac arrest (OHCA) prognosis within the working-age population is important, but no studies have investigated the effects of COVID-19 pandemic specifically on the working-age population with OHCAs. We aimed to determine the association between the 2020 COVID-19 pandemic and OHCA outcomes and bystander resuscitation efforts among the working-age population. METHODS Prospectively collected nationwide, population-based records concerning 166 538 working-age individuals (men, 20-68 years; women, 20-62 years) with OHCA between 2017 and 2020 were assessed. We compared characteristics and outcome differences of the arrests between three prepandemic years (2017-2019) and the pandemic year 2020. The primary outcome was neurologically favourable 1-month survival (cerebral performance category 1 or 2). Secondary outcomes were bystander cardiopulmonary resuscitation (BCPR), dispatcher-assisted instruction for cardiopulmonary resuscitation (DAI-CPR), bystander-provided defibrillation (public access defibrillation (PAD)) and 1-month survival. We examined variations in bystander resuscitation efforts and outcomes among pandemic phase and regional classifications. RESULTS Among 149 300 OHCA cases, 1-month survival (2020, 11.2%; 2017-2019, 11.1% (crude OR (cOR) 1.00, 95% CI 0.97 to 1.05)) and 1-month neurologically favourable survival (7.3%-7.3% (cOR 1.00, 95% CI 0.96 to 1.05)) were unchanged; however, the neurologically favourable 1-month survival rate decreased in 12 of the most COVID-19-affected prefectures (7.2%-7.8% (cOR 0.90, 95% CI 0.85 to 0.96)), whereas it increased in 35 other prefectures (7.5%-6.6% (cOR 1.15, 95% CI 1.07 to 1.23)). Favourable outcomes decreased for OHCAs of presumed cardiac aetiology (10.3%-10.9% (cOR 0.94, 95% CI 0.90 to 0.99)) but increased for OHCAs of non-cardiac aetiology (2.5%-2.0% (cOR 1.27, 95% CI 1.12 to 1.44)). BCPR provision increased from 50.7% of arrests prepandemic to 52.3% (crude OR 1.07, 95% CI 1.04 to 1.09). Compared with 2017-2019, home-based OHCAs in 2020 increased (64.8% vs 62.3% (crude OR 1.12, 95% CI 1.09 to 1.14)), along with DAI-CPR attempts (59.5% vs 56.6% (cOR 1.13, 95% CI 1.10 to 1.15)) and multiple calls to determine a destination hospital (16.4% vs 14.5% (cOR 1.16, 95% CI 1.12 to 1.20)). PAD use decreased from 4.0% to 3.7% but only during the state of emergency period (7 April-24 May 2020) and in prefectures significantly affected by COVID-19. CONCLUSIONS Reviewing automated external defibrillator (AED) locations and increasing BCPR through DAI-CPR may help prevent pandemic-associated decreases in survival rates for patients with cardiac OHCAs.
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Affiliation(s)
- Tomoyuki Ushimoto
- Emergency Medicine, Kanazawa Medical University, Uchinada-machi, Japan
| | - Shintaro Yao
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Chika Nunokawa
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kenshi Murasaka
- Emergency Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Hideo Inaba
- Emergency Medicine, Kanazawa Medical University, Uchinada-machi, Japan
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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16
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Tanaka Y, Okumura K, Yao S, Okajima M, Inaba H. Impact of the COVID-19 pandemic on prehospital characteristics and outcomes of out-of-hospital cardiac arrest among the elderly in Japan: A nationwide study. Resusc Plus 2023; 14:100377. [PMID: 36945239 PMCID: PMC10011040 DOI: 10.1016/j.resplu.2023.100377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Aim To assess the impact of the 2020 coronavirus disease (COVID-19) pandemic on the prehospital characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in the elderly. Methods In this population-based nationwide observational study in Japan, 563,100 emergency medical service-unwitnessed OHCAs in elderly (≥65 years) patients involving any prehospital resuscitation efforts were analysed (144,756, 140,741, 140,610, and 136,993 cases in 2020, 2019, 2018, and 2017, respectively). The epidemiology, characteristics, and outcomes associated with OHCAs in elderly patients were compared between 3 years pre-pandemic (2017-2019) and the pandemic year (2020). The primary outcome was neurologically favourable one-month survival. The secondary outcomes were the rate of bystander cardiopulmonary resuscitation (CPR), defibrillation by a bystander, dispatcher-assisted (DA)-CPR attempts, and one-month survival. Results During the pandemic year, the rates of neurologically favourable 1-month survival (crude odds ratio, 95% confidence interval: 1.19, 1.14-1.25), bystander CPR (1.04, 1.03-1.06), and DA-CPR attempts (1.10, 1.08-1.11) increased, whereas the incidence of public access defibrillation (0.88, 0.83-0.93) decreased. Subgroup analyses based on interaction tests showed that the increased rate of neurologically favourable survival during the pandemic year was enhanced in OHCA at care facilities (1.51, 1.36-1.68) and diminished or abolished on state-of-emergency days (0.90, 0.74-1.09), in the mainly affected prefectures (1.08, 1.01-1.15), and in cases with shockable initial rhythms (1.03, 0.96-1.12). Conclusions The COVID-19 pandemic increased the bystander CPR rate in association with enhanced DA-CPR attempts and improved the outcomes of elderly patients with OHCAs.
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Key Words
- Bystander actions
- CI, Confidence intervals
- CPR, Cardiopulmonary resuscitation
- Covid-19 pandemic
- DA-CPR, Dispatcher-assisted cardiopulmonary resuscitation
- ECG, Electrocardiogram
- EMS, Emergency medical services
- EMT, Emergency medical technicians
- Elderly patient
- FDMA, Fire and Disaster Management Agency
- OHCA, Out-of-hospital cardiac arrest
- OR, Odds ratio
- Out-of-hospital cardiac arrest
- Outcome
- PAD, Public-access automated external defibrillator
- PPE, Personal protective equipment
- Prehospital characteristics
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Affiliation(s)
- Yoshio Tanaka
- Department of Emergency and Disaster Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan
- Department of Surgery, Shin Kyoto-Minami Hospital, 94 Goshonouchikita-machi, Shimogyo-ku, Kyoto 600-8861, Japan
| | - Kazuki Okumura
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Shintaro Yao
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Masaki Okajima
- Department of Emergency and Disaster Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | - Hideo Inaba
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
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Beger SB, Mejia E, Bobrow BJ. Challenges of remotely witnessed emergencies - A case of international out-of-hospital cardiac arrest recognition via video call. Am J Emerg Med 2023; 63:182.e1-182.e3. [PMID: 36544292 DOI: 10.1016/j.ajem.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
We present the first report, to our knowledge, of an Out-of-hospital cardiac arrest (OHCA) witnessed during a remote international video meeting. We report an emergency system activation and OHCA resuscitation initiated after an OHCA in a 41-year-old otherwise healthy female in Houston, Texas witnessed by a co-worker in Australia during a 1-on-1 Zoom video call. Remotely witnessed emergencies such as OHCA present unique challenges to successful cardiac resuscitation and will likely become significantly more common in the future as remote video calls increase.
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Affiliation(s)
- Samuel B Beger
- McGovern Medical School at The University of Texas Health Science Center at Houston, Department of Emergency Medicine, United States.
| | - Eduardo Mejia
- McGovern Medical School at The University of Texas Health Science Center at Houston, Department of Emergency Medicine, United States
| | - Bentley J Bobrow
- McGovern Medical School at The University of Texas Health Science Center at Houston, Department of Emergency Medicine, United States; Texas-Cardiac Arrest Registry to Enhance Survival (CARES), United States
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18
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Compression-Only Cardiopulmonary Resuscitation and Automated External Defibrillator Course for Primary School Students: A Malaysian Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010058. [PMID: 36670609 PMCID: PMC9856577 DOI: 10.3390/children10010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/01/2022] [Accepted: 11/24/2022] [Indexed: 12/29/2022]
Abstract
The Malaysian national school curriculum currently lacks resources and tools to enforce CPR education. The aim of this study was to investigate the efficacy of a compression-only cardiopulmonary resuscitation and automated external defibrillator course among primary school students to increase their knowledge and technical skills and improve their attitudes. A quasi-experimental study was conducted using a pre−post non-equivalent design involving 38 students aged 10−12. Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, technical skills, and attitude towards CPR were assessed in a post test with three-month follow-up. Results of the MANOVA analysis showed significant differences in the level of knowledge (F = 10.29, p < 0.001) and attitude (F = 13.87, p < 0.001) based on the students’ age group at the time of the post test. The proportion of students who passed the technical skills component differed significantly by age (χ2 = 12.12; p = 0.002) and BMI (χ2 = 6.34; p = 0.041). No significant decay was reported in the total mean scores for knowledge, technical skills, and attitude (F = 0.727, p = 0.54) at 3-month follow-up. The course helped students perform CPR and utilize AED effectively while promoting a positive attitude with up to 3 months of retention, demonstrating the feasibility of extending the course within the Malaysian primary school curriculum.
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Pan DF, Li ZJ, Ji XZ, Yang LT, Liang PF. Video-assisted bystander cardiopulmonary resuscitation improves the quality of chest compressions during simulated cardiac arrests: A systemic review and meta-analysis. World J Clin Cases 2022; 10:11442-11453. [PMID: 36387811 PMCID: PMC9649565 DOI: 10.12998/wjcc.v10.i31.11442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/10/2022] [Accepted: 09/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It remains unclear whether video aids can improve the quality of bystander cardiopulmonary resuscitation (CPR).
AIM To summarize simulation-based studies aiming at improving bystander CPR associated with the quality of chest compression and time-related quality parameters.
METHODS The systematic review was conducted according to the PRISMA guidelines. All relevant studies were searched through PubMed, EMBASE, Medline and Cochrane Library databases. The risk of bias was evaluated using the Cochrane collaboration tool.
RESULTS A total of 259 studies were eligible for inclusion, and 6 randomised controlled trial studies were ultimately included. The results of meta-analysis indicated that video-assisted CPR (V-CPR) was significantly associated with the improved mean chest compression rate [OR = 0.66 (0.49-0.82), P < 0.001], and the proportion of chest compression with correct hand positioning [OR = 1.63 (0.71-2.55), P < 0.001]. However, the difference in mean chest compression depth was not statistically significant [OR = 0.18 (-0.07-0.42), P = 0.15], and V-CPR was not associated with the time to first chest compression compared to telecommunicator CPR [OR = -0.12 (-0.88-0.63), P = 0.75].
CONCLUSION Video real-time guidance by the dispatcher can improve the quality of bystander CPR to a certain extent. However, the quality is still not ideal, and there is a lack of guidance caused by poor video signal or inadequate interaction.
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Affiliation(s)
- Dong-Feng Pan
- Department of Emergency Medicine, The First Affiliated Hospital of Northwest Minzu University, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
- Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Zheng-Jun Li
- Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Xin-Zhong Ji
- Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Li-Ting Yang
- Department of Emergency Medicine, The Third Clinical Medical College of Ningxia Medical University, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Pei-Feng Liang
- Department of Medicine Statistics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
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Tellier É, Lacaze M, Naud J, Sanchez O, Vally R, Bérard C, Revel P, Galinski M, Gil-Jardiné C. Comparison of two infant cardiopulmonary resuscitation techniques explained by phone in a non-health professionals' population: Two-thumbs encircling hand technique vs. two-fingers technique, a randomised crossover study in a simulation environment. Am J Emerg Med 2022; 61:163-168. [PMID: 36148735 DOI: 10.1016/j.ajem.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/14/2022] [Accepted: 09/11/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Paediatric out-of-hospital cardiac arrest (OHCA) is the reason for an emergency call in approximately 8/100,000 person-years. Improvement of OHCA resuscitation needs a quality chain of survival and a rapid start of resuscitation. The aim of this study was to compare the efficacy of two resuscitation techniques provided on a mannequin, the two-fingers technique (TFT) and the two-thumbs encircling hand technique (TTHT), explained by a trained emergency call responder on the phone in a population of non-health professionals. METHODS We conducted a randomised crossover study in the simulation lab of a University Hospital. The participants included in the study were non-health professional volunteers of legal age. The participants were assigned (1:1 ratio) to two groups: group A: TFT then TTHT, group B: TTHT then TFT. Scenario and techniques were discovered during the evaluation. RESULTS Thirty-five volunteers were randomised before the sessions and 33 ultimately came to the simulation lab. We found a better median QCPR global score during TTHT sessions than during TFT sessions (74 vs. 59, P = 0.046). Linear mixed models showed that the TTHT method was the only variable associated with a better QCPR global score [model 1: β = 14.3; 95% confidence interval (CI), 2.4-26.2; model 2: β = 14.5; 95% CI, 2.5-26.6]. CONCLUSION Our study showed the superiority of TTHT for infant CPR performed by non-health professionals when an emergency call responder advised them over the phone. It seemed to be the best technique for a solo rescuer regardless of previous training.
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Affiliation(s)
- Éric Tellier
- University Hospital of Bordeaux, Pellegrin Hospital, Pole of Emergency, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France; INSERM, ISPED, Bordeaux Population Health Research Center INSERM U1219-"Injury Epidemiology Transport Occupation" Team, F-33076 Bordeaux Cedex, France
| | - Mélanie Lacaze
- University Hospital of Bordeaux, Pellegrin Hospital, Pole of Emergency, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France; Pole Santé Arcachon, Emergency Department, Avenue Jean Hameau, 33164 La Teste de Buch Cedex, France
| | - Julien Naud
- University Hospital of Bordeaux, Pellegrin Hospital, Pole of Pediatry, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France; University Hospital of Bordeaux, Pediatric Transport Team, SMUR Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
| | - Oriana Sanchez
- University Hospital of Bordeaux, Pellegrin Hospital, Pole of Emergency, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
| | - Rishad Vally
- University Hospital of Bordeaux, Pellegrin Hospital, Pole of Emergency, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
| | - Cécile Bérard
- University Hospital of Bordeaux, Pellegrin Hospital, Pole of Emergency, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
| | - Philippe Revel
- University Hospital of Bordeaux, Pellegrin Hospital, Pole of Emergency, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France; INSERM, ISPED, Bordeaux Population Health Research Center INSERM U1219-"Injury Epidemiology Transport Occupation" Team, F-33076 Bordeaux Cedex, France
| | - Michel Galinski
- University Hospital of Bordeaux, Pellegrin Hospital, Pole of Emergency, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France; INSERM, ISPED, Bordeaux Population Health Research Center INSERM U1219-"Injury Epidemiology Transport Occupation" Team, F-33076 Bordeaux Cedex, France
| | - Cédric Gil-Jardiné
- University Hospital of Bordeaux, Pellegrin Hospital, Pole of Emergency, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France; INSERM, ISPED, Bordeaux Population Health Research Center INSERM U1219-"Injury Epidemiology Transport Occupation" Team, F-33076 Bordeaux Cedex, France.
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21
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Ahmed F, Khan UR, Soomar SM, Raheem A, Naeem R, Naveed A, Razzak JA, Khan NU. Acceptability of telephone-cardiopulmonary resuscitation (T-CPR) practice in a resource-limited country- a cross-sectional study. BMC Emerg Med 2022; 22:139. [PMID: 35918647 PMCID: PMC9347158 DOI: 10.1186/s12873-022-00690-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND T-CPR has been shown to increase bystander CPR rates dramatically and is associated with improved patient survival. OBJECTIVE To evaluate the acceptability of T-CPR by the bystanders and identify baseline quality measures of T-CPR in Karachi, Pakistan. METHODS A cross-sectional study was conducted from January to December 2018 at the Aman foundation command and control center. Data was collected from audiotaped phone calls of patients who required assistance from the Aman ambulance and on whom the EMS telecommunicator recognized the need for CPR and provided instructions. Information was recorded using a structured questionnaire on demographics, the status of the patient, and different time variables involved in CPR performance. A One-way ANOVA was used to compare different time variables with recommended AHA guidelines. P-value ≤ 0.05 was considered significant. RESULTS There were 481 audiotaped calls in which CPR instruction was given, listened to, and recorded data. Out of which in 459(95.4%) of cases CPR was attempted Majority of the patients were males (n = 278; 57.8%) and most had witnessed cardiac arrest (n = 470; 97.7%) at home (n = 430; 89.3%). The mean time to recognize the need for CPR by an EMS telecommunicator was 4:59 ± 1:59(min), while the mean time to start CPR instruction by a bystander was 5:28 ± 2:24(min). The mean time to start chest compression was 6:04 ± 1:52(min.). CONCLUSION Our results show the high acceptability of T-CPR by bystanders. We also found considerable delays in recognizing cardiac arrest and initiation of CPR by telecommunicators. Further training of telecommunicators could reduce these delays.
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Affiliation(s)
- Fareed Ahmed
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Abid Naveed
- Sindh Rescue & Medical Services, Karachi, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.,Emergency Medicine, Weill Cornell Medicine, New York City, USA
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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22
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Park GJ, Song KJ, Shin SD, Hong KJ, Kim TH, Park YM, Kong J. Clinical effects of a new dispatcher-assisted basic life support training program in a metropolitan city. Medicine (Baltimore) 2022; 101:e29298. [PMID: 35839001 PMCID: PMC11132370 DOI: 10.1097/md.0000000000029298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study estimates the effect of a new dispatcher-assisted basic life support training program on the survival outcomes of out-of-hospital cardiac arrest (OHCA). Before-and-after intervention trials were conducted in Seoul. Patients who suffered OHCA in a private place from January 2014 to December 2017 were included. The intervention group was 3 districts; the other 22 districts were regarded as the control group. The primary outcome was survival up to hospital discharge. The difference-in-difference (DID) was calculated to evaluate changes in the survival outcomes of the 2 groups over the period. A total of 10,127 OHCA patients were included in the final analysis. OHCA patients in the intervention group were less likely to receive bystander cardiopulmonary resuscitation (57.8% vs 61.1%; P = .02) and showed lower survival outcomes (5.7% vs 6.4% for survival up to hospital discharge; P = .34 and 2.8% vs 3.7% for good neurological recovery; P = .11), but this was not statistically significant. Compared to 2014, good neurological recovery in 2017 was significantly improved in the intervention group (DID for good neurological recovery = 3.2%; 0.6-5.8). There were no statistically significant differences in return of spontaneous circulation and survival up to hospital discharge between the 2 groups (DID for survival to discharge was 1.8% [-1.7 to 5.3] and DID for return of spontaneous circulation was -2.5% [-9.8 to 4.8]). Improvement in neurological recovery was observed in the 3 districts after implementing the new dispatcher-assisted basic life support training program.
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Affiliation(s)
- Gwan Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute
| | - Tae Han Kim
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Yu Mi Park
- Citizens' Health Bureau, Seoul Metropolitan Government
| | - Joyce Kong
- Laerdal Medical, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute
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23
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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: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [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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24
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Igarashi Y, Norii T, Sung‐Ho K, Nagata S, Yoshino Y, Hamaguchi T, Nagaosa R, Nakao S, Tagami T, Yokobori S. Airway obstruction time and outcomes in patients with foreign body airway obstruction: multicenter observational choking investigation. Acute Med Surg 2022; 9:e741. [PMID: 35309267 PMCID: PMC8918414 DOI: 10.1002/ams2.741] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/03/2022] [Accepted: 02/18/2022] [Indexed: 11/26/2022] Open
Abstract
Aim Foreign body airway obstruction (FBAO) is a major public health concern worldwide for infants and older adults. This study determines the association between airway obstruction time and neurological outcomes to plan an effective response for patients with FBAO. Methods This multicenter retrospective observational study was carried out among patients with life‐threatening FBAO in Japan over a period of 4 years. The duration of airway obstruction was calculated from the time of the accident to the time of foreign body removal. The study examined the relationship between airway obstruction time and outcome. The primary outcome was vegetative state or death at hospital discharge. Results Among 119 patients, 68 were in the category of vegetative state or death. Logistic regression analysis showed that longer airway obstruction time (adjusted odds ratio 1.04; 95% confidence interval 1.01–1.07) was associated with vegetative state or death. When the cut‐off value was set at 10, the sensitivity was 0.88, the specificity 0.47, with the area under the curve 0.69. Using the other cut‐off value of 4 min, the negative predictive value was 1.00. Conclusion Longer airway obstruction time was associated with vegetative state or death for patients with FBAO. The incidence of vegetative state or death increased when the airway obstruction time exceeded 10 min. Meanwhile, 4 min or less may be set as a target time for foreign body removal in order to prevent vegetative state or death and plan an effective response.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Tatsuya Norii
- Department of Emergency Medicine University of New Mexico Albuquerque New Mexico USA
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Kim Sung‐Ho
- Senshu Trauma and Critical Care Center Rinku General Medical Center Osaka Japan
| | - Shimpei Nagata
- Department of Clinical Epidemiology and Health Economics The University of Tokyo Tokyo Japan
| | - Yudai Yoshino
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
- Department of Emergency and Critical Care Medicine Nippon Medical School Musashi Kosugi Hospital Kanagawa Japan
| | - Takuro Hamaguchi
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Riko Nagaosa
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
- Department of Emergency and Critical Care Medicine Nippon Medical School Musashi Kosugi Hospital Kanagawa Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
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Ong MEH, Shin SD, Ko PCI, Lin X, Ma MHM, Ryoo HW, Wong KD, Supasaowapak J, Lin CH, Kuo CW, Rao R, Cai W, Gaerlan FJ, Khursheed M, Son DN, Sarah K, El Sayed M, Al Qahtani S, Tanaka H. International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2). Resuscitation 2021; 171:80-89. [PMID: 34974143 DOI: 10.1016/j.resuscitation.2021.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/18/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dispatcher-assisted CPR (DA-CPR) has the potential to deliver early bystander CPR (BCPR) and improve out-of-hospital cardiac arrest (OHCA) survival. This study in the Asia-Pacific evaluated the impact of a DA-CPR program on BCPR rates and survival. METHODS This was a three-arm, prospective, multi-national, population-based, community-level, implementation trial. Cases between January 2009 and June 2018 from the Pan-Asian Resuscitation Outcomes Study were included. Sites either implemented a comprehensive (with quality improvement tool) or a basic DA-CPR package, or served as controls. Primary outcome was survival-to-discharge/30th day post-arrest. Secondary outcomes were BCPR and favorable neurological outcome. A before-after comparison was made within each country; this before-after change was then compared across the three groups using logistic regression. RESULTS 170,687 cases were analyzed. Before-after comparison showed that survival to discharge was higher in the 'implementation' period in all three groups: comprehensive odds ratio (OR) 1.09, 95% confidence interval (CI; [1.0-1.19]); basic OR 1.14, 95% CI (1.08-1.2); and control OR 1.25, 95% CI (1.02-1.53). Comparing between groups, the comprehensive group had significantly higher change in BCPR (comprehensive vs control ratio of OR 1.86, 95% CI [1.66-2.09]; basic vs control ratio of OR 0.94, 95% CI [0.85-1.05]; and comprehensive vs basic ratio of OR 1.97, 95% CI [1.87-2.08]) and survival with favorable neurological outcome (comprehensive vs basic ratio of OR 1.2, 95% CI [1.04-1.39]). CONCLUSION We evaluated the impact of a DA-CPR program across heterogeneous EMS systems and demonstrated that a comprehensive DA-CPR program had the most impact on BCPR and favorable neurological outcome.
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Affiliation(s)
- Marcus Eng Hock Ong
- Prehospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Xinyi Lin
- Singapore Clinical Research Institute, Singapore, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | | | | | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Chang-Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ramana Rao
- GVK Emergency Management and Research Institute (GVK EMRI), Secunderabad, Telangana, India
| | - Wenwei Cai
- Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | | | - Munawar Khursheed
- Emergency Department, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Do Ngoc Son
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam
| | - Karim Sarah
- Department of Emergency Medicine, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saad Al Qahtani
- National Ambulance, Abu Dhabi, United Arab Emirates; Department of Health Science, Saudi Electronic University, Saudi Arabia
| | - Hideharu Tanaka
- Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan
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Poth JM, Buschmann CM, Kappler J, Heister U, Ehrentraut SF, Muenster S, Diepenseifen CJ, Ellerkmann R, Schewe JC. Neurologisches Ergebnis und allgemeiner Gesundheitszustand bei Langzeitüberleben nach außerklinischer kardiopulmonaler Reanimation. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00929-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Fragestellung
Für Deutschland liegen nur wenige Daten zum Gesundheitszustand und Langzeitüberleben nach außerklinischer Reanimation vor. Die vorliegende Studie untersucht den allgemeinen Gesundheitszustand und das neurologische Langzeitergebnis 2,5 bis 5 Jahre nach dem Reanimationsereignis sowie den Zusammenhang zwischen Behandlungsergebnis und präklinischen Patienten- und Behandlungsfaktoren.
Methodik
Alle über einen Zeitraum von 30 Monaten (2011–2013) durch den Rettungsdienst der Stadt Bonn durchgeführten Reanimationen wurden auf Grundlage der Notarzteinsatzprotokolle und des Deutschen Reanimationsregisters retrospektiv analysiert. Der allgemeine Gesundheitszustand wurde in Anlehnung an den SF-12 erfasst und das neurologische Langzeitergebnis kategorisiert (Cerebral Performance Category [CPC]). Die vorliegenden Daten wurden einer uni- und multivariaten logistischen Regressionsanalyse unterzogen.
Ergebnis
Von insgesamt 458 Patienten überlebten 17,9 % bis zur Krankenhausentlassung, 13,8 % mehr als 2,5 Jahre und 7,7 % bis zum Stichtag der Befragung. Von den noch lebenden Patienten hatten 85,3 % ein gutes neurologisches Ergebnis (CPC ≤ 2), welches durch ein geringeres Alter, einen beobachteten Kollaps, die Durchführung einer Defibrillation und das Ausbleiben einer Vasopressorgabe begünstigt wurde (multivariate Analyse). 74,2 % der Überlebenden beschrieben ihren Gesundheitszustand als gut.
Interpretation
Insgesamt überleben langfristig nur wenige Patienten einen außerklinischen Herz-Kreislauf-Stillstand. Die überlebenden Patienten beurteilen ihren Gesundheitszustand als gut und zeigen ein gutes neurologisches Ergebnis. Dabei hängt dieses Behandlungsergebnis von denselben Parametern wie der primäre Reanimationserfolg (Überleben bis Krankenhausaufnahme) ab. Die Etablierung klinischer Instrumente zur frühen Prognoseerstellung ist wünschenswert. Hierzu sind weitere Langzeituntersuchungen größerer Patientenkollektive mit Zugriff auf Routinedaten notwendig.
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Plata C, Nellessen M, Roth R, Ecker H, Böttiger BW, Löser J, Wetsch WA. Impact of video quality when evaluating video-assisted cardiopulmonary resuscitation: a randomized, controlled simulation trial. BMC Emerg Med 2021; 21:96. [PMID: 34418968 PMCID: PMC8380108 DOI: 10.1186/s12873-021-00486-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although not routinely established during cardiopulmonary resuscitation (CPR), video-assisted CPR has been described as beneficial in the communication with emergency medical service (EMS) authorities in out-of-hospital cardiac arrest scenarios. Since the influence of video quality has not been investigated systematically and due to variation of quality of a live-stream video during video-assisted CPR, we investigated the influence of different video quality levels during the evaluation of CPR performance in video sequences. METHODS Seven video sequences of CPR performance were recorded in high quality and artificially reduced to medium and low quality afterwards. Video sequences showed either correct CPR performance or one of six typical errors: too low and too high compression rate, superficial and increased compression depth, wrong hand position and incomplete release. Video sequences were randomly assigned to the different quality levels. During the randomised and double-blinded evaluation process, 46 paramedics and 47 emergency physicians evaluated seven video sequences of CPR performance in different quality levels (high, medium and low resolution). RESULTS Of 650 video sequences, CPR performance was evaluable in 98.2%. CPR performance was correctly evaluated in 71.5% at low quality, in 76.8% at medium quality, and in 77.3% at high quality level, showing no significant differences depending on video quality (p = 0.306). In the subgroup analysis, correct classification of increased compression depth showed significant differences depending on video quality (p = 0.006). Further, there were significant differences in correct CPR classification depending on the presented error (p < 0.001). Allegedly errors, that were not shown in the video sequence, were classified in 28.3%, insignificantly depending on video quality. Correct evaluation did not show significant interprofessional differences (p = 0.468). CONCLUSION Video quality has no significant impact on the evaluation of CPR in a video sequence. Even low video quality leads to an acceptable rate of correct evaluation of CPR performance. There is a significant difference in evaluation of CPR performance depending on the presented error in a video sequence. TRIAL REGISTRATION German Clinical Trial Register (Registration number DRKS00015297 ) Registered on 2018-08-21.
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Affiliation(s)
- Christopher Plata
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany
- Emergency Department, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Martin Nellessen
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Rebecca Roth
- University of Cologne, Faculty of Medicine, and University Hospital of Cologne, Institute of Medical Statistics and Computational Biology, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Hannes Ecker
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Bernd W Böttiger
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Johannes Löser
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Centre of Palliative Medicine, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Wolfgang A Wetsch
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany.
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28
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Development of a Performance Assessment Scale for Simulated Dispatcher-Assisted Cardiopulmonary Resuscitation (Telephone-CPR): A Multi-Center Randomized Simulation-Based Clinical Trial. Prehosp Disaster Med 2021; 36:561-569. [PMID: 34296667 DOI: 10.1017/s1049023x21000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Dispatchers should be trained to interrogate bystanders with strict protocols to elicit information focused on recognizing cardiac arrest and should provide telephone cardiopulmonary resuscitation (CPR) instructions in all cases of suspected cardiac arrest. While an objective assessment of training outcomes is needed, there is no performance assessment scale for simulated dispatcher-assisted CPR. STUDY OBJECTIVE The aim of the study was to create a valid and reliable performance assessment scale for simulated dispatcher-assisted CPR. METHODS In this prospective, randomized, controlled, multi-centric simulation-based trial (registration number TCTR20210130002), the scale was developed according to the European Resuscitation Council (ERC) and American Heart Association (AHA) Guidelines 2015 and revised by experts. The performance of 48 dispatchers' telephone-CPR and of 48 bystanders carrying out CPR on a manikin was assessed by two independent evaluators using the scale and using a SkillReporter (PC) software to provide CPR objective performance. Continuous variables were described as mean (SD) and categorical variables as numbers and percentage (%). Comparative analysis between two groups used a Student t-test or a non-parametric test of Mann-Whitney. The internal structure of the scale was evaluated, including internal consistency using α Cronbach coefficient, and reproducibility using intraclass correlation coefficient (ICC) and linear correlation coefficient (R2) calculation. RESULTS The scale included three different parts: two sections for dispatchers' (32 items) and bystanders' CPR performance (15 items) assessment, and a third part recording times. There was excellent internal consistency (α Cronbach coefficient = 0.77) and reproducibility (ICC = 0.93; R² = 0.86). For dispatchers' performance assessment, α Cronbach coefficient = 0.76; ICC = 0.91; R2 = 0.84. For bystanders' performance assessment, α Cronbach coefficient = 0.75; ICC = 0.93; R2 = 0.87. Reproducibility was excellent for nine items, good for 19 items, and moderate for 19 items. No item had poor reproducibility. There was no significant difference between dispatch doctors' and medical dispatch assistants' performances (33.0 [SD = 4.7] versus 32.3 [SD = 3.2] out of 52, respectively; P = .70) or between trained and untrained bystanders to follow the instructions (14.3 [SD = 2.0] versus 13.9 [SD = 1.8], respectively; P = .64). Objective performance (%) was significantly higher for trained bystanders than for untrained bystanders (67.4 [SD = 14.5] versus 50.6 [SD = 19.3], respectively; P = .03). CONCLUSION The scale was valid and reliable to assess performance for simulated dispatcher-assisted CPR. To the authors' knowledge, no other valid performance tool currently exists. It could be used in simulated telephone-CPR training programs to improve performance.
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29
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Goodloe JM, Topjian A, Hsu A, Dunne R, Panchal AR, Levy M, McEvoy M, Vaillancourt C, Cabanas JG, Eisenberg MS, Rea TD, Kudenchuk PJ, Gienapp A, Flores GE, Fuchs S, Adelgais KM, Owusu-Ansah S, Terry M, Sawyer KN, Fromm P, Panczyk M, Kurz M, Lindbeck G, Tan DK, Edelson DP, Sayre MR. Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic. Circ Cardiovasc Qual Outcomes 2021; 14:e007666. [PMID: 34157848 PMCID: PMC8288195 DOI: 10.1161/circoutcomes.120.007666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jeffrey M Goodloe
- Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa (J.M.G.)
| | - Alexis Topjian
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania (A.T.)
| | - Antony Hsu
- St Joseph Mercy Hospital, Ann Arbor, MI (A.H.)
| | - Robert Dunne
- Department of Emergency Medicine, St John Hospital, Detroit, MI (R.D.)
| | - Ashish R Panchal
- The Ohio State University Wexner Medical Center, Columbus (A.R.P.)
| | - Michael Levy
- University of Alaska Anchorage, Anchorage Areawide EMS (M.L.)
| | - Mike McEvoy
- EMS Coordinator - Saratoga County, NY (M.M.)
| | - Christian Vaillancourt
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (C.V.)
| | - Jose G Cabanas
- Wake County Department of Emergency Medical Services, University of North Carolina at Chapel Hill (J.G.C.)
| | - Mickey S Eisenberg
- Department of Emergency Medicine (M.S.E., M.R.S.).,University of Washington, Seattle. King County Emergency Medical Services, Seattle, WA (M.S.E., T.D.R., P.J.K.)
| | - Thomas D Rea
- Department of Medicine (T.D.R.).,University of Washington, Seattle. King County Emergency Medical Services, Seattle, WA (M.S.E., T.D.R., P.J.K.)
| | - Peter J Kudenchuk
- Division of Cardiology (P.J.K.).,University of Washington, Seattle. King County Emergency Medical Services, Seattle, WA (M.S.E., T.D.R., P.J.K.)
| | - Andy Gienapp
- Office of Emergency Medical Services, Wyoming Department of Health, Cheyenne (A.G.)
| | - Gustavo E Flores
- Emergency and Critical Care Trainings, San Juan, Puerto Rico (G.E.F.)
| | - Susan Fuchs
- Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital, Chicago, IL (S.F.)
| | - Kathleen M Adelgais
- Department of Pediatrics, Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora (K.M.A.)
| | - Sylvia Owusu-Ansah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh (S.O.-A.), University of Pittsburgh School of Medicine, PA
| | - Mark Terry
- National Registry of Emergency Medical Technicians, Columbus, OH (M.T.)
| | - Kelly N Sawyer
- Department of Emergency Medicine (K.N.S.), University of Pittsburgh School of Medicine, PA
| | - Peter Fromm
- Mount Sinai South Nassau Hospital, Oceanside, NY (P.F.)
| | - Micah Panczyk
- University of Texas Health Science Center, Houston (M.P.)
| | | | - George Lindbeck
- Office of Emergency Medical Services, Virginia Department of Health, Richmond (G.L.)
| | - David K Tan
- Washington University School of Medicine, St Louis, MO (D.K.T.)
| | | | - Michael R Sayre
- Department of Emergency Medicine (M.S.E., M.R.S.).,Seattle Fire Department, WA (M.R.S.)
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30
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Greif R, Lockey A, Breckwoldt J, Carmona F, Conaghan P, Kuzovlev A, Pflanzl-Knizacek L, Sari F, Shammet S, Scapigliati A, Turner N, Yeung J, Monsieurs KG. [Education for resuscitation]. Notf Rett Med 2021; 24:750-772. [PMID: 34093075 PMCID: PMC8170459 DOI: 10.1007/s10049-021-00890-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/22/2022]
Abstract
Diese Leitlinien des European Resuscitation Council basieren auf dem internationalen wissenschaftlichen Konsens 2020 zur kardiopulmonalen Reanimation mit Behandlungsempfehlungen (International Liaison Committee on Resuscitation 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations [ILCOR] 2020 CoSTR). Dieser Abschnitt bietet Bürgern und Angehörigen der Gesundheitsberufe Anleitungen zum Lehren und Lernen der Kenntnisse, der Fertigkeiten und der Einstellungen zur Reanimation mit dem Ziel, das Überleben von Patienten nach Kreislaufstillstand zu verbessern.
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Affiliation(s)
- Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Schweiz.,School of Medicine, Sigmund Freud University Vienna, Wien, Österreich
| | - Andrew Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, Großbritannien
| | - Jan Breckwoldt
- Institute of Anesthesiology, University Hospital Zurich, Zürich, Schweiz
| | | | - Patricia Conaghan
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, Großbritannien
| | - Artem Kuzovlev
- Negovsky Research Institute of General Reanimatology of the Federal research and clinical center of intensive care medicine and Rehabilitology, Moskau, Russland
| | - Lucas Pflanzl-Knizacek
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Ferenc Sari
- Emergency Department, Skellefteå Hospital, Skellefteå, Schweden
| | | | - Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rom, Italien
| | - Nigel Turner
- Department of Pediatric Anesthesia, Division of Vital Functions, Wilhelmina Children's Hospital at the University Medical Center, Utrecht, Niederlande
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
| | - Koenraad G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Edegem, Belgien
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31
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Lee MJ, Shin TY, Lee CH, Moon JD, Roh SG, Kim CW, Park HE, Woo SH, Lee SJ, Shin SL, Oh YT, Lim YS, Choe JY, Na SH, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 9. Education and system implementation for enhanced chain of survival. Clin Exp Emerg Med 2021; 8:S116-S124. [PMID: 34034453 PMCID: PMC8171173 DOI: 10.15441/ceem.21.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/28/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Mi Jin Lee
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae-Yong Shin
- Department of Emergency Medicine, Asan Chungmu General Hospital, Asan, Korea
| | - Chang Hee Lee
- Department of Emergency Medical Technician, Namseoul University, Cheonan, Korea
| | - Jun Dong Moon
- Department of Emergency Medical Service, College of Health & Nursing, Kongju National University, Gongju, Korea
| | - Sang Gyun Roh
- Department of Emergency Medical Services, Sun Moon University, Asan, Korea
| | - Chan Woong Kim
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyo Eun Park
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Seon Hee Woo
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seung Joon Lee
- National Medical Emergency Center, National Medical Center, Seoul, Korea
| | - Seung Lyul Shin
- Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea
| | - Young Taeck Oh
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Su Lim
- Department of Emergency Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Jae Young Choe
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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32
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Song KJ, Lee SY, Cho GC, Kim G, Kim JY, Oh J, Oh JH, Ryu S, Ryoo SM, Lee EH, Hwang SO, Hong JY, Chung SP. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 3. Adult basic life support. Clin Exp Emerg Med 2021; 8:S15-S25. [PMID: 34034447 PMCID: PMC8171172 DOI: 10.15441/ceem.21.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kyoung-Jun Song
- Department of Emergency Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Giwoon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jung-Youn Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Je Hyeok Oh
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Ho Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ju Young Hong
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
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33
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Greif R, Lockey A, Breckwoldt J, Carmona F, Conaghan P, Kuzovlev A, Pflanzl-Knizacek L, Sari F, Shammet S, Scapigliati A, Turner N, Yeung J, Monsieurs KG. European Resuscitation Council Guidelines 2021: Education for resuscitation. Resuscitation 2021; 161:388-407. [PMID: 33773831 DOI: 10.1016/j.resuscitation.2021.02.016] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
These European Resuscitation Council education guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidance to citizens and healthcare professionals with regard to teaching and learning the knowledge, skills and attitudes of resuscitation with the ultimate aim of improving patient survival after cardiac arrest.
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Affiliation(s)
- Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria.
| | - Andrew Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, UK
| | - Jan Breckwoldt
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Patricia Conaghan
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Artem Kuzovlev
- Negovsky Research Institute of General Reanimatology of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Lucas Pflanzl-Knizacek
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ferenc Sari
- Emergency Department, Skellefteå Hospital, Sweden
| | | | - Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Nigel Turner
- Department of Pediatric Anesthesia, Division of Vital Functions, Wilhelmina Children's Hospital at the University Medical Center, Utrecht, The Netherlands
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Koenraad G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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34
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Gram KH, Præst M, Laulund O, Mikkelsen S. Assessment of a quality improvement programme to improve telephone dispatchers' accuracy in identifying out-of-hospital cardiac arrest. Resusc Plus 2021; 6:100096. [PMID: 34223361 PMCID: PMC8244530 DOI: 10.1016/j.resplu.2021.100096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction Early recognition of out-of-hospital cardiac arrest (OHCA) by the medical dispatcher is a prerequisite for an effective chain of survival, leading to rapid dispatch of emergency medical services. Aim To analyse and compare the accuracy of the Emergency Medical Dispatch Centre in identifying OHCA before and after an educational intervention. Methods A quality-assessment study collecting data from prehospital medical voice logs in Southern Denmark during two periods. Baseline data and post-interventional data were obtained during December, January, and February 2017/2018 and 2019/2020, respectively. We imposed an intervention consisting of a specifically targeted education in quick assessment of OHCA and instructions regarding telephone-assisted-CPR. The primary outcome measure was the dispatcher's ability to recognise OHCA. Secondary outcome measures were time from contact with the caller to the dispatcher formulated essential questions related to the NO-NO-GO algorithm. These questions included an assessment of the patients’ consciousness and respiratory efforts and if both negative, would ideally lead to the dispatcher initiating telephone-assisted-CPR. All data was analysed in accordance with the recommendations and performance goals made by Resuscitation Academy. Results Baseline data included 209 calls. Post-interventional data was based on 208 calls. The sensitivity for recognition of OHCA was 82.3% (95% CI: 76.4–87.2%) before and 92.7% (95% CI: 88.2–95.8%) after the intervention (p = 0.0014). The median duration of calls before recognition of OHCA was 68 and 56 s before and after the intervention (p = 0.097). Conclusion After the period of intervention, the accuracy of OHCA recognition by dispatchers improved. The median time to identify OHCA or recognise the first compression did not differ significantly. This indicates that continuing education and quality assessment may be beneficial and necessary.
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Affiliation(s)
- Kristel Hadberg Gram
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Præst
- The Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Denmark.,Emergency Medical Dispatch Centre, Region of Southern Denmark, Denmark
| | - Ole Laulund
- Emergency Medical Dispatch Centre, Region of Southern Denmark, Denmark
| | - Søren Mikkelsen
- The Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Denmark.,The Prehospital Research Unit, Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
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35
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Sturny L, Regard S, Larribau R, Niquille M, Savoldelli GL, Sarasin F, Schiffer E, Suppan L. Differences in Basic Life Support Knowledge Between Junior Medical Students and Lay People: Web-Based Questionnaire Study. J Med Internet Res 2021; 23:e25125. [PMID: 33620322 PMCID: PMC7943337 DOI: 10.2196/25125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/06/2021] [Accepted: 01/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early cardiopulmonary resuscitation and prompt defibrillation markedly increase the survival rate in the event of out-of-hospital cardiac arrest (OHCA). As future health care professionals, medical students should be trained to efficiently manage an unexpectedly encountered OHCA. OBJECTIVE Our aim was to assess basic life support (BLS) knowledge in junior medical students at the University of Geneva Faculty of Medicine (UGFM) and to compare it with that of the general population. METHODS Junior UGFM students and lay people who had registered for BLS classes given by a Red Cross-affiliated center were sent invitation links to complete a web-based questionnaire. The primary outcome was the between-group difference in a 10-question score regarding cardiopulmonary resuscitation knowledge. Secondary outcomes were the differences in the rate of correct answers for each individual question, the level of self-assessed confidence in the ability to perform resuscitation, and a 6-question score, "essential BLS knowledge," which only contains key elements of the chain of survival. Continuous variables were first analyzed using the Student t test, then by multivariable linear regression. Fisher exact test was used for between-groups comparison of binary variables. RESULTS The mean score was higher in medical students than in lay people for both the 10-question score (mean 5.8, SD 1.7 vs mean 4.2, SD 1.7; P<.001) and 6-question score (mean 3.0, SD 1.1 vs mean 2.0, SD 1.0; P<.001). Participants who were younger or already trained scored consistently better. Although the phone number of the emergency medical dispatch center was well known in both groups (medical students, 75/80, 94% vs lay people, 51/62, 82%; P=.06), most participants were unable to identify the criteria used to recognize OHCA, and almost none were able to correctly reorganize the BLS sequence. Medical students felt more confident than lay people in their ability to perform resuscitation (mean 4.7, SD 2.2 vs mean 3.1, SD 2.1; P<.001). Female gender and older age were associated with lower confidence, while participants who had already attended a BLS course prior to taking the questionnaire felt more confident. CONCLUSIONS Although junior medical students were more knowledgeable than lay people regarding BLS procedures, the proportion of correct answers was low in both groups, and changes in BLS education policy should be considered.
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Affiliation(s)
- Ludovic Sturny
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Simon Regard
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Georges Louis Savoldelli
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - François Sarasin
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Eduardo Schiffer
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Pek PP, Lim JYY, Leong BSH, Mao DRH, Chia MYC, Cheah SO, Gan HN, Ng YY, Tham LP, Arulanandam S, Shahidah N, Lin X, Ho AFW, Ong MEH. Improved Out-of-Hospital Cardiac Arrest Survival with a Comprehensive Dispatcher-Assisted CPR Program in a Developing Emergency Care System. PREHOSP EMERG CARE 2020; 25:802-811. [DOI: 10.1080/10903127.2020.1846824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, Bigham BL, Hirsch KG, Hoover AV, Kurz MC, Levy A, Lin Y, Magid DJ, Mahgoub M, Peberdy MA, Rodriguez AJ, Sasson C, Lavonas EJ. Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S580-S604. [PMID: 33081524 DOI: 10.1161/cir.0000000000000899] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Survival after cardiac arrest requires an integrated system of people, training, equipment, and organizations working together to achieve a common goal. Part 7 of the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, with an emphasis on elements that are relevant to a broad range of resuscitation situations. Previous systems of care guidelines have identified a Chain of Survival, beginning with prevention and early identification of cardiac arrest and proceeding through resuscitation to post-cardiac arrest care. This concept is reinforced by the addition of recovery as an important stage in cardiac arrest survival. Debriefing and other quality improvement strategies were previously mentioned and are now emphasized. Specific to out-of-hospital cardiac arrest, this Part contains recommendations about community initiatives to promote cardiac arrest recognition, cardiopulmonary resuscitation, public access defibrillation, mobile phone technologies to summon first responders, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about the recognition and stabilization of hospital patients at risk for developing cardiac arrest. This Part also includes recommendations about clinical debriefing, transport to specialized cardiac arrest centers, organ donation, and performance measurement across the continuum of resuscitation situations.
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Venkatesan J, Janumpally R, Gimkala A, Megavaran V, Myklebust H, Ramana Rao GV. Importance of "Telephone Cardiopulmonary Resuscitation" in out-of-Hospital Cardiac Arrest in India. Indian J Community Med 2020; 45:194-198. [PMID: 32905051 PMCID: PMC7467192 DOI: 10.4103/ijcm.ijcm_223_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality in developing countries such as India. Most cardiac arrests happen outside the hospital and are associated with poor survival rates due to delay in recognition and in performing early cardiopulmonary resuscitation (CPR). Community CPR training and telephone CPR (T-CPR) in the dispatch centers have been shown to increase bystander CPR rates and survival. Objectives: The aim of this study is to identify the significance of T-CPR in OHCA and to discuss its implementation in the health system to improve OHCA outcomes in India. Materials and Methods: A descriptive research study methodology was adopted following a literature search. Results: The search criterion “Cardiovascular diseases” resulted in 162, “Out-side hospital cardiac arrest” in 50; For a comprehensive overview, these publications were evaluated looking for data on T-CPR incidence, criteria for detecting OHCA by emergency medical dispatchers, sensitivity and specificity, and BCPR. Conclusion: This current research stresses the scale and seriousness of the implementation of T-CPR in OHCA in India.
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Affiliation(s)
- Jyothi Venkatesan
- Department of Emergency Medicine Learning Centre, GVK Emergency Management and Research Institute, Hyderabad, Telangana, India
| | - Rani Janumpally
- Department of Emergency Medicine Learning Centre and Research, GVK Emergency Management and Research Institute, Hyderabad, Telangana, India
| | - Aruna Gimkala
- Department of Research, GVK Emergency Management and Research Institute, Hyderabad, Telangana, India
| | - Vimal Megavaran
- Department of Emergency Medicine Learning Centre, GVK Emergency Management and Research Institute, Hyderabad, Telangana, India
| | | | - G V Ramana Rao
- Department of Emergency Medicine Learning Centre and Research, GVK Emergency Management and Research Institute, Hyderabad, Telangana, India
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Fukushima H, Bolstad F. Telephone CPR: Current Status, Challenges, and Future Perspectives. Open Access Emerg Med 2020; 12:193-200. [PMID: 32982493 PMCID: PMC7490094 DOI: 10.2147/oaem.s259700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/12/2020] [Indexed: 12/16/2022] Open
Abstract
With each successive update of the cardiopulmonary resuscitation (CPR) guidelines, the role of dispatchers in sudden cardiac arrest (CA) has grown. Dispatchers instruct callers in how to perform CPR until the arrival of emergency medical service (EMS) professionals. This is widely known as telephone CPR (TCPR) or dispatch-assisted CPR (DACPR). Studies have shown the efficacy of TCPR in increasing the survival rate of sudden CA. The TCPR process, however, is challenging and needs to be constantly evaluated and refined in order to improve the survival rate of sudden CA victims throughout the world. In this review article, the current status, challenges, and future perspectives of TCPR are discussed with a view to providing a research foundation from which to launch further studies into the effective role of dispatchers in sudden CA.
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Affiliation(s)
- Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan
| | - Francesco Bolstad
- Department of Clinical English, Nara Medical University, Kashihara City, Nara, Japan
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The Effectiveness of a New Dispatcher-Assisted Basic Life Support Training Program on Quality in Cardiopulmonary Resuscitation Performance During Training and Willingness to Perform Bystander Cardiopulmonary Resuscitation: A Cluster Randomized Controlled Study. Simul Healthc 2020; 15:318-325. [PMID: 32604135 DOI: 10.1097/sih.0000000000000435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A new dispatcher-assisted basic life support training program, called "Home Education and Resuscitation Outcome Study (HEROS)" was developed with a goal to provide high-quality dispatcher-assisted cardiopulmonary resuscitation (CPR) training, with a focus on untrained home bystanders. This study aimed to determine whether the HEROS program is associated with improved quality in CPR performance during training and willingness to provide bystander CPR compared with other basic life support programs without dispatcher-assisted CPR (non-HEROS). METHODS This clustered randomized trial was conducted in 3 district health centers in Seoul. Intervention group was trained with the HEROS program and control group was trained with non-HEROS program. The primary outcome was overall CPR quality, measured as total CPR score. Secondary outcomes were other CPR quality parameters including average compression depth and rate, percentages of adequate depth, and acceptable release. Tertiary outcomes were posttraining survey results. Difference in difference analysis was performed to analyze the outcomes. RESULTS Among total 1929 trainees, 907 (47.0%) were trained with HEROS program. Compared with the non-HEROS group, the HEROS group showed higher-quality CPR performances and better maintenance of their CPR quality throughout the course (total scores of 84% vs. 80% for first session and 72% vs. 67% for last session; difference in difference of 12.2 vs. 13.2). Other individual CPR parameters also showed significantly higher quality in the HEROS group. The posttraining survey showed that both groups were highly willing to perform bystander CPR (91.4% in the HEROS vs. 92.3% in the non-HEROS) with only 3.4% of respondents in the HEROS group were not willing to volunteer compared with 6.2% in the non-HEROS group (P < 0.01). CONCLUSIONS The HEROS training program helped trainees perform high-quality CPR throughout the course and enhanced their willingness to provide bystander CPR.
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Dispatcher-Assisted Cardiopulmonary Resuscitation: Disparity between Urban and Rural Areas. Emerg Med Int 2020; 2020:9060472. [PMID: 32566308 PMCID: PMC7285275 DOI: 10.1155/2020/9060472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/16/2020] [Indexed: 01/14/2023] Open
Abstract
Methods Patients with out-of-hospital cardiac arrest (OHCA) were prospectively registered in Taichung. The 29 districts of Taichung city were divided into urban and rural areas based on whether the population density is more than 1,000 people per square kilometer. Prehospital data were collected according to the Utstein-style template, and telephone auditory records were collected by a dispatch center. Results 2,716 patients were enrolled during the study period. 88.4% OHCA occurred in urban areas and 11.6% in rural areas. 74.9% after dispatcher assistance, laypersons performed CPR in urban areas and 67.7% in rural areas (p=0.023). The proportion of laypersons continued CPR until an emergency medical technician's (EMT) arrival was higher in the urban areas (59.57% vs 52.27%, p=0.039). Laypersons continued CPR until an EMT' arrival would increase the chance of return of spontaneous circulation in urban and rural areas, with adjusted odds ratio (aOR) of 1.02, 95% confidence interval (CI) of 0.82–1.27, and aOR of 1.49, 95% CI of 0.80–2.80, respectively. Continued laypersons CPR until the EMT' arrival also improved survival with favorable neurological function, with aOR of 1.16, 95% CI of 0.61–2.20 in urban areas and aOR of 2.90 95% CI of 0.18–46.81 in rural areas. Conclusion Bystanders in urban areas exhibited higher ratio of acceptance of DACPR. However, after DACPR intervention, prognosis improvement was considerably higher in rural areas than in urban areas.
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Impact of Dispatcher-Assisted Bystander Cardiopulmonary Resuscitation with Out-of-Hospital Cardiac Arrest: A Systemic Review and Meta-Analysis. Prehosp Disaster Med 2020; 35:372-381. [PMID: 32466824 DOI: 10.1017/s1049023x20000588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This systemic review and meta-analysis was conducted to explore the impact of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) on bystander cardiopulmonary resuscitation (BCPR) probability, survival, and neurological outcomes with out-of-hospital cardiac arrest (OHCA). METHODS Electronically searching of PubMed, Embase, and Cochrane Library, along with manual retrieval, were done for clinical trials about the impact of DA-BCPR which were published from the date of inception to December 2018. The literature was screened according to inclusion and exclusion criteria, the baseline information, and interested outcomes were extracted. Two reviewers assessed the methodological quality of the included studies. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated by STATA version 13.1. RESULTS In 13 studies, 235,550 patients were enrolled. Compared with no dispatcher instruction, DA-BCPR tended to be effective in improving BCPR rate (I2 = 98.2%; OR = 5.84; 95% CI, 4.58-7.46; P <.01), return of spontaneous circulation (ROSC) before admission (I2 = 36.0%; OR = 1.17; 95% CI, 1.06-1.29; P <.01), discharge or 30-day survival rate (I2 = 47.7%; OR = 1.25; 95% CI, 1.06-1.46; P <.01), and good neurological outcome (I2 = 30.9%; OR = 1.24; 95% CI, 1.04-1.48; P = .01). However, no significant difference in hospital admission was found (I2 = 29.0%; OR = 1.09; 95% CI, 0.91-1.30; P = .36). CONCLUSION This review shows DA-BPCR plays a positive role for OHCA as a critical section in the life chain. It is effective in improving the probability of BCPR, survival, ROSC before admission, and neurological outcome.
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Using a Mobile Phone Application Versus Telephone Assistance During Cardiopulmonary Resuscitation: A Randomized Comparative Study. J Emerg Nurs 2020; 46:460-467.e2. [PMID: 32444161 DOI: 10.1016/j.jen.2020.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/22/2020] [Accepted: 03/16/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In recent years, the way CPR instructions are given has changed because of the development of new technology that allows bystanders who witness a cardiac arrest to be guided in performing CPR. This study aimed to compare the effectiveness of using a mobile phone application (app) versus telephone operator assistance in performing cardiopulmonary resuscitation (CPR) techniques in simulated settings. METHODS A comparative study was performed with 2 intervention groups: (1) mobile phone app and (2) telephone assistance. A total of 128 students participated and were distributed randomly into each intervention group. A CPR observation checklist and standard CPR quality parameter measurements were used for data collection. RESULTS The group that used the app obtained better results than the group that had telephone assistance on 5 items during CPR observation: checking if the area is secure (X2(1) = 26.81; P < 0.05), asking for help (X2(1) = 66.07; P < 0.05), opening of airways (X2(1) = 12.03; P < 0.05), checking for breathing (X2(1) = 6.10; P < 0.05), and contacting emergency services (X2(1) = 12.41; P < 0.05). Regarding the skill level of CPR, no statistically significant differences were found when comparing the 2 intervention groups (X2(1) = 0.91; P = 0.33). As for the parameters measured, there were only statistically significant differences found in the item compression fraction (U = 1,593.00; Z = -2.16; P < 0.05), with the group that used the app obtaining better results. DISCUSSION Better outcomes were observed in recognizing if the area was safe, asking for help, opening up the airways, checking for breathing, and calling emergency services in the mobile phone app group. However, the results indicated that there were no differences in the CPR parameters, except compression fraction, when the app was used as opposed to being guided by telephone.
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Plata C, Nowack M, Loeser J, Drinhaus H, Steinhauser S, Hinkelbein J, Wetsch WA, Böttiger BW, Spelten O. Verbal Motivation vs. Digital Real-Time Feedback during Cardiopulmonary Resuscitation: Comparing Bystander CPR Quality in a Randomized and Controlled Manikin Study of Simulated Cardiac Arrest. PREHOSP EMERG CARE 2020; 25:377-387. [PMID: 32301644 DOI: 10.1080/10903127.2020.1757181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The use of smartphone applications increases bystander CPR quality as well as the use of telephone CPR protocols. The present prospective, randomized, controlled manikin trial analyses the effects of a smartphone application (PocketCPR©) on CPR quality in a bystander CPR scenario compared to a dispatcher-assisted telephone CPR with the additional use of a metronome and verbal motivation. Methods: 150 laypersons were included to perform 8-minute CPR on a manikin. Volunteers were randomly assigned to one of three groups: (1) dispatcher-assisted telephone CPR (telephone-group), (2) dispatcher-assisted telephone CPR combined with the smartphone-application (telephone + app-group) and (3) dispatcher-assisted telephone CPR with additional verbal motivation ("push harder, release completely," every 20 seconds, starting after 60 seconds) and a metronome with 100 min-1 (telephone + motivation-group). Results: Median compression depth did not differ significantly between the study groups (p = 0.051). However, in the post hoc analysis median compression depth in the telephone + motivation-group was significantly elevated compared to the telephone + app-group (59 mm [IQR 47-67 mm] vs. 51 mm [IQR 46-57 mm]; p = 0.025). The median number of superficial compressions was significantly reduced in the telephone + motivation-group compared to the telephone + app-group (70 [IQR 3-362] vs. 349 [IQR 88-538]; p = 0.004), but not compared to the telephone-group (91 [IQR 4-449]; p = 0.707). In contrast to the other study groups, median compression depth of the telephone + motivation-group increased over time. Chest compressions with correct depth were found significantly more often in the telephone + app-group compared to the other study groups (p = 0.011). Median compression rate in the telephone + app-group was significantly elevated (108 min-1 [IQR 96-119 min-1]) compared to the telephone-group (78 min-1 [IQR 56-106 min-1]; p < 0.001) and the telephone + motivation-group (99 min-1 [IQR 91-101 min-1]; p < 0.001). Conclusions: The use of a smartphone application as well as verbal motivation by a dispatcher during telephone CPR leads to higher CPR quality levels compared to standard telephone CPR. Thereby, the use of the smartphone application mainly shows an increase in compression rate, while increased compression rate with simultaneously increased compression depth was only apparent in the telephone + motivation-group.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Oliver Spelten
- Faculty of Medicine and University Hospital of Cologne, Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany (CP, MN, HD, JH, WAW, BWB).,Faculty of Medicine and University Hospital of Cologne, Centre of Palliative Medicine, University of Cologne, Cologne, Germany (JL).,Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany (SS).,Department of Anesthesiology and Intensive Care Medicine, Schön Klinik Düsseldorf, Düsseldorf, Germany (OS)
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Siman-Tov M, Strugo R, Podolsky T, Rosenblat I, Blushtein O. Impact of dispatcher assisted CPR on ROSC rates: A National Cohort Study. Am J Emerg Med 2020; 44:333-338. [PMID: 32336582 DOI: 10.1016/j.ajem.2020.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Out of hospital cardiac arrest (OHCA) is a leading cause of mortality. Bystander CPR is associated with increased OHCA survival rates. Dispatcher assisted CPR (DA-CPR) increases rates of bystander CPR, shockable rhythm prevalence, and improves ROSC rates. The aim of this article was to quantify and qualify DA-CPR (acceptance/rejection), ROSC, shockable rhythms, and associations between factors as seen in MDA, Israel, during 2018. METHODS All 2018 OHCA incidents in Israel's national EMS database were studied retrospectively. We identified rates and reasons for DA-CPR acceptance or rejection. Reasons DA-CPR was rejected/non-feasible by caller were categorized into 5 groups. ROSC was the primary outcome. We created two study groups: 1) No DA-CPR (n = 542). 2) DA-CPR & team CPR (n = 1768). RESULTS DA-CPR was accepted by caller 76.5% of incidents. In group 1, ROSC rates were significantly lower compared to patients in group 2 (12.4% vs. 21.3% p < .001). Group 1 had 12.4% shockable rhythms vs. 17.1% in group 2 (DA-CPR and team CPR). Of the total 369 shockable cases, 42.3% (156) achieved ROSC, in the non-shockable rhythms only 14.8% achieved ROSC. CONCLUSIONS OHCA victims receiving dispatcher assisted bystander CPR have higher rates of ROSC and more prevalence of shockable rhythms. MDA dispatchers offer DA-CPR and it is accepted 76.5% of the time. MDA patients receiving DA-CPR had higher ROSC rates and more shockable rhythms. MDA's age demographic is high, possibly affecting ROSC and shockable rhythm rates.
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Affiliation(s)
- Maya Siman-Tov
- Magen David Adom, Tel Aviv, Israel; Sackler Faculty, Public Health School, Tel-Aviv University, Tel-Aviv, Israel.
| | | | | | | | - Oren Blushtein
- Magen David Adom, Tel Aviv, Israel; Sackler Faculty, Public Health School, Tel-Aviv University, Tel-Aviv, Israel
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Kurz MC, Bobrow BJ, Buckingham J, Cabanas JG, Eisenberg M, Fromm P, Panczyk MJ, Rea T, Seaman K, Vaillancourt C. Telecommunicator Cardiopulmonary Resuscitation: A Policy Statement From the American Heart Association. Circulation 2020; 141:e686-e700. [PMID: 32088981 DOI: 10.1161/cir.0000000000000744] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Every year in the United States, >350 000 people have sudden cardiac arrest outside of a hospital environment. Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness and is commonly the result of an electric disturbance in the heart. Unfortunately, only ≈1 in 10 victims survives this dramatic event. Early access to 9-1-1 and early cardiopulmonary resuscitation (CPR) are the first 2 links in the chain of survival for out-of-hospital cardiac arrest. Although 9-1-1 is frequently accessed, in the majority of cases, individuals with out-of-hospital cardiac arrest do not receive lay rescuer CPR and wait for the arrival of professional emergency rescuers. Telecommunicators are the true first responders and a critical link in the cardiac arrest chain of survival. In partnership with the 9-1-1 caller, telecommunicators have the first opportunity to identify a patient in cardiac arrest and provide initial care by delivering CPR instructions while quickly dispatching emergency medical services. The telecommunicator and the caller form a unique team in which the expertise of the telecommunicator is provided just in time to a willing caller, transforming the caller into a lay rescuer delivering CPR. The telecommunicator CPR (T-CPR) process, also previously described as dispatch CPR, dispatch-assisted CPR, or telephone CPR, represents an important opportunity to improve survival from sudden cardiac arrest. Conversely, failure to provide T-CPR in this manner results in preventable harm. This statement describes the public health impact of out-of-hospital cardiac arrest, provides guidance and resources to construct and maintain a T-CPR program, outlines the minimal acceptable standards for timely and high-quality delivery of T-CPR instructions, and identifies strategies to overcome common implementation barriers to T-CPR.
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Yamashita A, Kurosaki H, Takada K, Tanaka Y, Nishi T, Wato Y, Inaba H. Prehospital Epinephrine as a Potential Factor Associated with Prehospital Rearrest. PREHOSP EMERG CARE 2020; 24:741-750. [PMID: 32023141 DOI: 10.1080/10903127.2020.1725197] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To investigate the impact of epinephrine on prehospital rearrest and re-attainment of prehospital return of spontaneous circulation (ROSC). Methods: Data for 9,292 (≥ 8 years) out-of-hospital cardiac arrest (OHCA) patients transported to hospitals by emergency medical services were collected in Ishikawa Prefecture, Japan during 2010-2018. Univariate and multivariable analyses were retrospectively performed for 1,163 patients with prehospital ROSC. Results: Of 1,163 patients, rearrest occurred in 272 (23.4%) but not in 891 (76.6%). Both single and multiple doses of epinephrine administered before prehospital ROSC (adjusted odds ratio (OR): 3.62, 95% confidence interval (CI): 2.42-5.46 for 1 mg, and 4.27, 2.58-6.79 for ≥ 2 mg) were main factors associated with rearrest. The association between initial and rearrest rhythms was significantly associated with epinephrine administration (p = 0.02). However, the rearrest rhythm was primarily associated with the initial rhythm (p < 0.01). The majority of patients with the non-shockable initial rhythm had pulseless electrical activity (PEA) as the rearrest rhythm, regardless of epinephrine administration (80.4% for administration, 81.6% for no administration). When the initial rhythm was shockable, the primary rearrest rhythms in patients with and without epinephrine administration before prehospital ROSC were PEA (52.2%) and ventricular fibrillation/pulseless ventricular tachycardia (56.8%), respectively. Only epinephrine administration after rearrest was associated with prehospital re-attainment of ROSC (adjusted OR: 2.49, 95% CI: 1.20-5.19). Stepwise multivariable logistic regression analyses revealed that neurologically favorable outcome was poorer in patients with rearrest than those without rearrest (9.9% vs. 25.0%, adjusted OR: 0.42, 95% CI: 0.23-0.73). The total prehospital doses of epinephrine were associated with poorer neurological outcome in a dose-dependent manner (adjusted OR: 0.22, 95% CI: 0.13-0.36 for 1 mg; 0.09, 0.04-0.19 for 2 mg; 0.03, 0.01-0.09 for ≥ 3 mg, no epinephrine as a reference). Transportation to hospitals with a unit for post-resuscitation care was associated with better neurological outcome (adjusted OR: 1.53, 95% CI: 1.02-2.32). Conclusions: The requirement for epinephrine administration before prehospital ROSC was associated with subsequent rearrest. Routine epinephrine administrations and rearrest were associated with poorer neurological outcome of OHCA patients with prehospital ROSC.
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Berg DD, Bobrow BJ, Berg RA. Key components of a community response to out-of-hospital cardiac arrest. Nat Rev Cardiol 2020; 16:407-416. [PMID: 30858511 DOI: 10.1038/s41569-019-0175-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death worldwide, with substantial geographical, ethnic and socioeconomic disparities in outcome. Successful resuscitation efforts depend on the 'chain of survival', which includes immediate recognition of cardiac arrest and activation of the emergency response system, early bystander cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions, rapid defibrillation, basic and advanced emergency medical services and integrated post-cardiac arrest care. Well-orchestrated telecommunicator CPR programmes can improve rates of bystander CPR - a critical link in the chain of survival. High-performance CPR by emergency medical service providers includes minimizing interruptions in chest compressions and ensuring adequate depth of compressions. Developing local, regional and statewide systems with dedicated high-performing cardiac resuscitation centres for post-resuscitation care can substantially improve survival after OHCA. Innovative digital tools for recognizing cardiac arrest where and when it occurs, notifying potential citizen rescuers and providing automated external defibrillators at the scene hold the promise of improving survival after OHCA. Improved implementation of the chain of survival can save thousands of lives each year.
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Affiliation(s)
- David D Berg
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bentley J Bobrow
- Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Sin R, Vodehnalova I, Ralbovska DC, Struncova D, Cechurova L. Out-of-hospital cardiac arrest in the Pilsen Region in 2018. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:43-50. [PMID: 31974532 DOI: 10.5507/bp.2019.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
AIMS To acquire epidemiological data on pre-hospital cardiac arrest incidents occurring in the Pilsen Region of the Czech Republic in 2018, and the results of subsequent cardiopulmonary resuscitation Methods. A prospective observational study of the survival rate of out-of-hospital cardiac arrest (OHCA) in patients undergoing CPR carried out by emergency medical service personnel. The observed time period was from January 1st, 2018 until December 31st, 2018. The data were acquired from patients' records in paper and electronic forms. RESULTS In the monitored period 707 patients with signs of cardiac arrest were recorded in the Pilsen Region with an incidence rate of 128.9 per 100,000 inhabitants. Emergency medical units performed CPR in 484 cases. The incidence rate of pre-hospital CPR was 88.2 cases per 100,000 inhabitants. Spontaneous blood circulation was temporarily or permanently restored in 276 patients (57.0%), 203 (41.9%) patients were transferred to a hospital, and there were 61 (12.6%) cases of survival with Cerebral Performance Category (CPC) score of 1 or 2. The first monitored rhythm was a shockable in 134 (27.7%) cases. In this sub-group ROSC was achieved in 94 (70.1%) cases and 58 (43.3%) of those were subsequently transferred to a hospital. A good CPC result was achieved in 41 (30.6%) patients of this sub group. CONCLUSION The study has provided valuable epidemiological data on OHCA and prehospital CPR in the area of the Pilsen Region in 2018. The collected data, compared to international results, show a higher survival rate with good neurological score in 12.6% of cases.
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Affiliation(s)
- Robin Sin
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic.,Department of Infectious Diseases and Travel Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Czech Republic
| | - Ivana Vodehnalova
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic
| | - Denisa Charlotte Ralbovska
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic.,Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Denisa Struncova
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic
| | - Lenka Cechurova
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic
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Hasan DA, Drennan J, Monger E, Mahmid SA, Ahmad H, Ameen M, Sayed ME. Dispatcher assisted cardiopulmonary resuscitation implementation in Kuwait: A before and after study examining the impact on outcomes of out of hospital cardiac arrest victims. Medicine (Baltimore) 2019; 98:e17752. [PMID: 31689831 PMCID: PMC6946391 DOI: 10.1097/md.0000000000017752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Dispatcher assisted cardiopulmonary resuscitation (DACPR) by Emergency medical services has been shown to improve rates of early out of hospital cardiac arrest (OHCA) recognition and early cardiopulmonary resuscitation (CPR) for OHCA. This study measures the impact of introducing DACPR on OHCA recognition, CPR rates and on patient outcomes in a pilot region in Kuwait.EMS treated OHCA data over 10 months period (February 21-December 31, 2017) before and after the intervention was prospectively collected and analyzed.Comprehensive DACPR in the form of: a standardized dispatch protocol, 1-day training package and quality assurance and improvement measures were applied to Kuwait EMS central Dispatch unit only for pilot region. Primary outcomes: OHCA recognition rate, CPR instruction rate, and Bystander CPR rate. Secondary outcome: survival to hospital discharge.A total of 332 OHCA cases from the EMS archived data were extracted and after exclusion 176 total OHCA cases remain. After DACPR implementation OHCA recognition rate increased from 2% to 12.9% (P = .037), CPR instruction rate increased from 0% to 10.4% (P = .022); however, no significant change was noted for bystander CPR rates or prehospital return of spontaneous circulation. Also, survival to hospital discharge rate did not change significantly (0% before, and 0.8% after, P = .53)In summary, DACPR implementation had positive impacts on Kuwait EMS system operational outcomes; early OHCA recognition and CPR instruction rates in a pilot region of Kuwait. Expanding this initiative to other regions in Kuwait and coupling it with other OHCA system of care interventions are needed to improve OHCA survival rates.
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Affiliation(s)
- Dalal Al Hasan
- Department of Applied Medical Sciences, Health Sciences College, Public Authority of Applied Education and Training, State of Kuwait
| | - Jonathan Drennan
- Department of Nursing and Health Services Research, University College Cork, Cork, Ireland
| | - Eloise Monger
- Department of Critical Care Nursing, University of Southampton, Southampton, United Kingdom
| | | | - Haitham Ahmad
- Audit Department, Emergency Medicals Services, State of Kuwait
| | - Mohmmad Ameen
- Audit Department, Emergency Medicals Services, State of Kuwait
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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