scholarly journals Out-of-hospital cardiac arrest in dialysis patients

2020 ◽  
Author(s):  
Marta Obremska ◽  
Katarzyna Madziarska ◽  
Dorota Zyśko ◽  
Jerzy R. Ładny ◽  
Robert Gałązkowski ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Stepwise Logistic Regression ◽  
Place Of Residence ◽  
Dialysis Patients ◽  
Stepwise Logistic Regression Analysis ◽  
Term Outcome ◽  
Emergency Medical ◽  
History Of ◽  
Hospital Cardiac Arrest

Abstract Purpose The aim of the study was to assess whether a history of dialysis is related to cardiopulmonary resuscitation (CPR) attempts and survival to hospital admission in patients with out-of-hospital cardiac arrest (OHCA). Methods The databases of the POL-OHCA registry and of emergency medical calls in the Command Support System of the State of Emergency Medicine (CSS) were searched to identify patients with OHCA and a history of dialysis. A total of 264 dialysis patient with OHCA were found: 126 were dead on arrival of emergency medical services (EMS), and 138 had OHCA with CPR attempts. Data from the POL-OHCA registry for patients with CPR attempts, including age, sex, place of residence, first recorded rhythm, defibrillation during CPR, and priority dispatch codes, were collected and compared between patients with and without dialysis. Results CPR attempts by EMS were undertaken in 138 dialyzed patients (52.3%). The analysis of POL-OHCA data revealed no differences in age, sex, place of residence, first recorded rhythm, and priority dispatch codes between patients with and without dialysis. Defibrillation was less frequent in dialysis patients (P = 0.04). A stepwise logistic regression analysis revealed no association between survival to hospital admission and a history of hemodialysis (odds ratio = 1.12; 95% CI 0.74–1.70, P = 0.60). Conclusions A history of dialysis in patients with OHCA does not affect the rate of CPR attempts by EMS or a short-term outcome in comparison with patients without dialysis. Defibrillation during CPR is less common in patients on dialysis than in those without.

scholarly journals Association of school hours with outcomes of out-of-hospital cardiac arrest in schoolchildren

Heart Asia ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. e011236
Author(s):  
Akira Yamashita ◽  
Hisanori Kurosaki ◽  
Kohei Takada ◽  
Yoshio Tanaka ◽  
Yoshitaka Hamada ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Public Access ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Major Factors ◽  
Hospital Cardiac Arrest

ObjectiveTo investigate the association of school hours with outcomes of schoolchildren with out-of-hospital cardiac arrest (OHCA).MethodsFrom the 2005–2014 nationwide databases, we extracted the data for 1660 schoolchildren (6–17 years) with bystander-witnessed OHCA. Univariate analyses followed by propensity-matching procedures and stepwise logistic regression analyses were applied. School hours were defined as 08:00 to 18:00.ResultsThe neurologically favourable 1-month survival rate during school hours was better than that during non-school hours only on school days: 18.4% and 10.5%, respectively. During school hours on school days, patients with OHCA more frequently received bystander cardiopulmonary resuscitation (CPR) and public access defibrillation (PAD), and had a shockable initial rhythm and presumed cardiac aetiology. The neurologically favourable 1-month survival rate did not significantly differ between school hours on school days and all other times of day after propensity score matching: 16.4% vs 16.1% (unadjusted OR 1.02; 95% CI 0.69 to 1.51). Stepwise logistic regression analysis during school hours on school days revealed that shockable initial rhythm (adjusted OR 2.44; 95% CI 1.12 to 5.42), PAD (adjusted OR 3.32; 95% CI 1.23 to 9.10), non-exogenous causes (adjusted OR 5.88; 95% CI 1.85 to 20.0) and a shorter emergency medical service (EMS) response time (adjusted OR 1.15; 95% CI 1.02 to 1.32) and witness-to-first CPR interval (adjusted OR 1.08; 95% CI 1.01 to 1.15) were major factors associated with an improved neurologically favourable 1-month survival rate.ConclusionsSchool hours are not an independent factor associated with improved outcomes of OHCA in schoolchildren. The time delays in CPR and EMS arrival were independently associated with poor outcomes during school hours on school days.

scholarly journals Dispatcher-assisted cardiopulmonary resuscitation for traumatic patients with out-of-hospital cardiac arrest

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Chien-Hsin Lu ◽  
Pin-Hui Fang ◽  
Chih-Hao Lin
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Statistical Significance ◽  
Spontaneous Circulation ◽  
Stepwise Logistic Regression ◽  
Population Database ◽  
Stepwise Logistic Regression Analysis ◽  
Emergency Calls ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Abstract Background Resuscitation efforts for traumatic patients with out-of-hospital cardiac arrest (OHCA) are not always futile. Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) during emergency calls could increase the rate of bystander cardiopulmonary resuscitation (CPR) and thus may enhance survival and neurologic outcomes of non-traumatic OHCA. This study aimed to examine the effectiveness of DA-CPR for traumatic OHCA. Methods A retrospective cohort study was conducted using an Utstein-style population database with data from January 1, 2014, to December 31, 2016, in Tainan City, Taiwan. Voice recordings of emergency calls were retrospectively retrieved and reviewed. The primary outcome was an achievement of sustained (≥2 h) return of spontaneous circulation (ROSC); the secondary outcomes were prehospital ROSC, ever ROSC, survival at discharge and favourable neurologic status at discharge. Statistical significance was set at a p-value of less than 0.05. Results A total of 4526 OHCA cases were enrolled. Traumatic OHCA cases (n = 560, 12.4%), compared to medical OHCA cases (n = 3966, 87.6%), were less likely to have bystander CPR (10.7% vs. 31.7%, p < 0.001) and initially shockable rhythms (7.1% vs. 12.5%, p < 0.001). Regarding DA-CPR performance, traumatic OHCA cases were less likely to have dispatcher recognition of cardiac arrest (6.3% vs. 42.0%, p < 0.001), dispatcher initiation of bystander CPR (5.4% vs. 37.6%, p < 0.001), or any dispatcher delivery of CPR instructions (2.7% vs. 20.3%, p < 0.001). Stepwise logistic regression analysis showed that witnessed cardiac arrests (aOR 1.70, 95% CI 1.10–2.62; p = 0.017) and transportation to level 1 centers (aOR 1.99, 95% CI 1.27–3.13; p = 0.003) were significantly associated with achievement of sustained ROSC in traumatic OHCA cases, while DA-CPR-related variables were not (All p > 0.05). Conclusions DA-CPR was not associated with better outcomes for traumatic OHCA in achieving a sustained ROSC. The DA-CPR program for traumatic OHCAs needs further studies to validate its effectiveness and practicability, especially in the communities where rules for the termination of resuscitation in prehospital settings do not exist.

Outcome after out-of-hospital cardiac arrest in a physician-staffed emergency medical system according to the Utstein style

2007 ◽  
Vol 153 (5) ◽  
pp. 792-799 ◽  
Author(s):  
Heidi L. Estner ◽  
Christian Günzel ◽  
Gjin Ndrepepa ◽  
Frederic William ◽  
Dirk Blaumeiser ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Medical System ◽  
Emergency Medical System ◽  
Emergency Medical ◽  
Utstein Style ◽  
Hospital Cardiac Arrest

scholarly journals 156 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

2020 ◽  
Vol 37 (12) ◽  
pp. 825.1-825
Author(s):  
Ed Barnard ◽  
Daniel Sandbach ◽  
Tracy Nicholls ◽  
Alastair Wilson ◽  
Ari Ercole
Keyword(s):  
Overall Survival ◽  
Cardiac Arrest ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Multivariable Analysis ◽  
Discharge Data ◽  
Successful Resuscitation ◽  
Bystander Cpr ◽  
Number Percentage ◽  
Hospital Cardiac Arrest

Aims/Objectives/BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Aim: to compare differential determinants of survival to hospital admission and survival to hospital discharge for traumatic (TCA) and non-traumatic cardiac arrest (NCTA).Methods/DesignAn analysis of 9109 OHCA in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for NTCA and TCA. Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. Data reported as number (percentage), number (percentage (95% CI)) and median (IQR) as appropriate. Continuous data have been analysed with a Mann-Whitney U test, and categorical data have been analysed with a χ2 test. Analyses were performed using the R statistical programming language.Results/ConclusionsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95%CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander-CPR was dependent on geographical socioeconomic status.NTCA and TCA are clinically distinct entities with different predictors for outcome and should be reported separately. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

Abstract 354: A Prediction Model for Patients With Emergency Medical Technicians Witnessed Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ming-Ju Hsieh ◽  
Wen-Chu Chiang ◽  
Wei-Tien Chang ◽  
Chih-Wei Yang ◽  
Yu-Chun Chien ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Prediction Model ◽  
Situation Awareness ◽  
Blood Pressure Level ◽  
Emergency Medical Technicians ◽  
Validation Dataset ◽  
Systolic Blood Pressure Level ◽  
Value System ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Introduction: In-hospital early warning system scores for prediction of clinical deterioration have been well-developed. However, such prediction tools in prehospital setting remain unavailable. Hypothesis: To develop a model for predicting patients with emergency medical technicians witnessed out-of-hospital cardiac arrest (EMT-witnessed OHCA) . Methods: We used the fire-based emergency medical service (EMS) data from Taipei city to develop the prediction model. Patients included in this study were those initially alive, non-traumatic, and aged ≧20 years. Data were extracted from records of ambulance run sheets and OHCA registry in Taipei. The primary outcome (i.e. EMT-witnessed OHCA) was defined as cardiac arrest occurring during EMT services before arrival at the receiving hospital. The prediction model was developed through the standard cross-validation method (i.e. divided dataset for training group and validation group). Area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow (HL) test were used to test discrimination and calibration. The point value system with Youden’s J Index was used to find the best cut-off value for practical application. Results: From 2011 to 2015, a total of 252,771 patients were included. Of them, 660 (0.26%) were EMT-witnessed OHCA. The prediction model, including gender, respiratory rate, heart rate, systolic blood pressure, level of consciousness and oxygen saturation, showed excellent discrimination (AUC 0.94) and calibration ( p =0.42 for HL test). When applied to the validation dataset, it maintained good discriminatory ability (AUC 0.94) and calibration ( p =0.11). The optimal cut-off value (≧13) of the point value system of the tool showed high sensitivity (87.84%) and specificity (86.20%). Conclusions: The newly developed prediction model will help identify high-risk patients with EMT-witnessed OHCA and indicate potential prevention by situation awareness in EMS.

Abstract 01: Dispatching Lay Rescuers Through a Smartphone Application is Associated With Increased Bystander Defibrillation in Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Linn Andelius ◽  
Carolina Malta Hansen ◽  
Freddy Lippert ◽  
Lena Karlsson ◽  
Christian Torp-Pedersen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Smartphone Application ◽  
Automated External Defibrillator ◽  
Early Defibrillation ◽  
Emergency Medical Dispatch ◽  
Capital Region ◽  
Electronic Survey ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest ◽  
External Defibrillator

Introduction: Survival after out-of-hospital cardiac arrest (OHCA) is dependent on early defibrillation. To increase bystander defibrillation in OHCAs, a first-responder program dispatching lay rescuers (Heart Runners) through a smartphone application (Heart Runner-app) was implemented in the Capital Region of Denmark. We investigated the proportion of Heart Runners arriving prior to the Emergency Medical Services (EMS) and rates of bystander defibrillation. Methods: The Capital Region of Denmark comprises 1.8 mil. inhabitants and 19,048 Heart Runners were registered. In cases of suspected OHCA, the Heart Runner-app was activated by the Emergency Medical Dispatch Center. Up to 20 Heart Runners < 1.8 km from the OHCA were dispatched to either start cardiopulmonary resuscitation (CPR) or to retrieve and use a publicly accessible automated external defibrillator (AED). Through an electronic survey, Heart Runners reported if they arrived before EMS and if they applied an AED. OHCAs where at least one Heart Runner arrived before EMS were compared with OHCAs where EMS arrived first. All OHCAs from September 2017 to May 2018, where Heart Runners had been dispatched, were included. Results: Of 399 EMS treated OHCAs, 78% (n=313/399) had a matching survey. A Heart Runner arrived before EMS in 47% (n=147/313) of the cases, and applied an AED in 41% (n=61/147) of these cases. Rate of bystander defibrillation was 2.5-fold higher compared to cases where the EMS arrived first (Table 1). Conclusions: By activation of the Heart Runner-app, Heart Runners arrived prior to EMS in nearly half of all the OHCA cases. Bystander defibrillation rate was significantly higher when Heart Runners arrived prior to EMS.

Abstract 12769: Amplitude-Spectral Area of the Ventricular Fibrillation Waveform and Chest Compression Quality in Witnessed and Unwitnessed Out-Of-Hospital Cardiac Arrest: Can We Predict Who is Unlikely to Survive?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Julia Indik ◽  
Zacherie Conover ◽  
Meghan McGovern ◽  
Annemarie Silver ◽  
Daniel Spaite ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Chest Compression ◽  
Stepwise Logistic Regression ◽  
Individual Subject ◽  
Spectral Area ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Background: Previous investigations in human out of hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) have shown that the frequency-based waveform characteristic, amplitude spectral area (AMSA) predicts defibrillation success and is associated with survival to hospital discharge. We evaluated the relative strength of factors associated with hospital discharge including witnessed/unwitnessed status, chest compression (CC) quality and AMSA. We then investigated if there is a threshold value for AMSA that can identify patients who are unlikely to survive. Methods: Adult OHCA patients (age ≥18), with initial rhythm of VF from an Utstein-Style database (collected from 2 EMS systems) were analyzed. AMSA was measured from the waveform immediately prior to each shock, and averaged for each individual subject (AMSA-ave). Univariate and stepwise multivariable logistic regression, and receiver-operator-characteristic (ROC) analyses were performed. Factors analyzed: age, sex, witnessed status, time from dispatch to monitor/defibrillator application, number of shocks, mean CC rate, depth, and release velocity (RV). Results: 140 subjects were analyzed, [104 M (74%), age 62 ± 14 yrs, witnessed 65%]. Survival was 38% in witnessed and 16% in unwitnessed arrest. In univariate analyses, age (P=0.001), witnessed status (P=0.009), AMSA-ave (P<0.001), mean CC depth (P=0.025), and RV (P< 0.001) were associated with survival. Stepwise logistic regression identified AMSA-ave (P<0.001), RV (P=0.001) and age (P=0.018) as independently associated with survival. The area under the curve (ROC analysis) was 0.849. The probability of survival was < 5% in witnessed arrest for AMSA-ave < 5 mV-Hz, and in unwitnessed arrest for AMSA-ave < 15 mV-Hz. Conclusion: In OHCA with an initial rhythm of VF, AMSA-ave and CC RV are highly associated with survival. Further study is needed to evaluate whether AMSA-ave may be useful to identify patients highly unlikely to survive.

scholarly journals Bystander Cardiopulmonary Resuscitation Quality: Potential for Improvements in Cardiac Arrest Resuscitation

2021 ◽  
Author(s):  
Richard Chocron ◽  
Julia Jobe ◽  
Sally Guan ◽  
Madeleine Kim ◽  
Mia Shigemura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Performance Metrics ◽  
Medical System ◽  
Emergency Medical System ◽  
Compression Rate ◽  
Emergency Medical ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out‐of‐hospital cardiac arrest. We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator CPR (TCPR). Methods and Results We investigated non‐traumatic out‐of‐hospital cardiac arrest occurring in a large metropolitan emergency medical system during a 6‐month period. Information about bystander care was ascertained through review of the 9‐1‐1 recordings in addition to emergency medical system and hospital records to determine bystander CPR status (none versus TCPR versus unassisted), the number of bystanders on‐scene, and CPR performance metrics of compression fraction and compression rate. Of the 428 eligible out‐of‐hospital cardiac arrest, 76.4% received bystander CPR including 43.7% unassisted CPR and 56.3% TCPR; 35.2% had one bystander, 33.3% had 2 bystanders, and 31.5% had ≥3 bystanders. Overall compression fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (fraction=52%, rate=87 per minute for TCPR versus fraction=69%, rate=102 for unassisted CPR, P <0.05 for each comparison) and the number of bystanders (fraction=55%, rate=87 per minute for 1 bystander, fraction=59%, rate=89 for 2 bystanders, fraction=65%, rate=97 for ≥3 bystanders, test for trend P <0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an automated external defibrillator (8.0%). Conclusions Bystander CPR quality as gauged by compression fraction and rate approached guideline goals though performance depended upon the type of CPR and number of bystanders.

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