High survival rate of 43% in out-of-hospital cardiac arrest patients in an optimised chain of survival

Introduction: EMS system factors key to improved survival for out-of-hospital cardiac arrest (OHCA) have not been well elucidated. This study explores factors associated with sustained return of spontaneous circulation (ROSC) in the field with pulse upon arrival to the ED-a measure of high quality of prehospital care-across the chain of survival. Methods: This sequential mixed methods study used data from the Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) to evaluate variation in OHCA outcomes across EMS agencies. Sites were sampled based on geography, rurality, population density, and survival rate. We visited 1 low-, 1 middle-, and 3 high-survival EMS systems. At each site, we conducted key informant interviews with field staff, mid-level managers, and leadership from EMS, police, fire, and dispatch, as well as multidisciplinary focus groups. Transcripts were coded using a structured codebook and analyzed using thematic analysis. Results: An integrated multidisciplinary approach was critical for timely OHCA care coordination across the chain of survival. Themes that emerged across all stakeholders included: 1) OHCA education and multidisciplinary training; 2) shared awareness of roles in the chain of survival and system-wide response; 4) multidisciplinary QI; and 5) leadership and initiative (Table 1). Conclusions: Recognizing the critical role of each level in the chain of survival, this study identified specific practices from EMS system stakeholders that were associated with improved survival. The next phase of this work will include validating the factors associated with increased survival identified through a statewide survey of EMS agencies in Michigan. The final product of this work will include a toolkit of best practices and an implementation guide.

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Better outcome of exercise-related out-of-hospital cardiac arrest in men and in the young

European Heart Journal ◽

10.1093/ehjci/ehaa946.3120 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Frisk Torell ◽

A Stromsoe ◽

J Herlitz ◽

A Claesson ◽

A Rawshani ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Group Analysis ◽

Age Groups ◽

Underlying Disease ◽

Funding Source ◽

Lower Grade ◽

High Survival ◽

Disease Pattern ◽

Hospital Cardiac Arrest

Abstract Background Survival from out-of-hospital cardiac arrest (OHCA) is higher if the arrest occurs in relation to physical activity,however there is contradicting data on prognosis with regards to gender and age. The purpose of the study was to compare prognosis and circumstances of exercise-related OHCA in different age-groups as well as between genders in a large unselected population. Methods Observational data from exercise-related OHCA occurring outside of home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 and from 2016 to 2018 was analyzed. Comparing analyses were made for three different age-groups (0–35, 36–65 and >65 years) and for males versus females. Results A total number of 9607 cases of OHCA outside of home where resuscitation was attempted occurred during the study period, 635 (6.6%) were exercise-related. Mean age was similar between males and females (59.1 years in both groups). The 30-day survival rate was significantly higher among exercise-related OHCAs compared to non-exercise-related OHCAs (44.5% vs 18.8%, p<0.0001). The highest survival rate was observed in the age-group 0–35 years, compared to 36–65 years and >65 years respectively (59.6% vs 46.0% and 40.4% respectively, p=0.01). A sub-group analysis of victims aged 0–25 years (n=32) showed a survival rate of 68.8%. Exercise-related OHCA in women (9.1% of total) were bystander witnessed to a lower extent than in men (66.7% vs 79.6%, p=0.03). Both men and women received bystander CPR at the same extent but median time to CPR was 1min longer for women (2.0 vs 1.0 min, p=0.001). Women had lower rates of ventricular fibrillation as initial rhythm (43.4% vs 64.7%, p=0.003) and 30-day survival was lower among women (29.3% vs 46.0%, p=0.02). Conclusion Women seem to be protected from exercise-related OHCA but in case of occurrence the prognosis is actually worse compared to men. This may partly be explained by lower grade of bystander witnesses and longer time to CPR, but the results indicate the need for further studies on additional factors, such as variances in underlying disease pattern and exercise habits of women. In addition, this study presents an exceptionally high survival rate for exercise-related OHCA in the youngest age-groups, especially in victims 0–25 years of age which is a novel finding. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Swedish Heart-Lung Foundation, Laerdal Foundation

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Abstract 367: Factors That Influence Emergency Responder Treatment Versus Transport Decisions for Out-of-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.142.suppl_4.367 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Valencia Waller ◽

Sydney Fouche ◽

Kaitlyn Entel ◽

Nasma Berri ◽

Wilson Nham ◽

...

Keyword(s):

Cardiac Arrest ◽

Critical Role ◽

Spontaneous Circulation ◽

System Of Care ◽

High Survival ◽

Key Factors ◽

Emergency Responder ◽

Emergency Medical ◽

Chain Of Survival ◽

Hospital Cardiac Arrest

Introduction: Emergency medical system factors that improve out-of-hospital cardiac arrest (OHCA) survival have not been well elucidated. This study explores factors important to decisions to transport patients before obtaining sustained return of spontaneous circulation (ROSC) in the field throughout the OHCA system of care. Choosing to treat versus transport is a complex decision and reflects various aspects of EMS care that may differ across agencies at different levels of performance. Methods: This sequential mixed-methods study used data from the Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) for the years 2014—2017 to identify variation in OHCA outcomes across emergency medical services (EMS) agencies. We then sampled emergency medical stakeholders—dispatch, fire, police, EMS, and receiving emergency departments (EDs)—across nine EMS system sites of varied urbanicity: four high-survival, two intermediate-survival, and three low-survival based on a primary outcome of sustained ROSC with pulse upon ED arrival. To qualitatively explore variations in OHCA survival, we conducted key informant and focus group interviews at each site. Qualitative data were analyzed through combined rapid and rigorous analysis, with a focus on treat versus transport decisions in the Advanced Care link of the “chain of survival” within a broader system of care framework. Results: Key factors that weighed into OHCA treatment versus transport decisions pre-ROSC across all sites included: clearly defined roles and protocols, on-scene decision-making authority, distance to the hospital, level of training and expertise, resource availability with regard to personnel and equipment, and payment and reimbursement models. Conclusions: Recognizing the critical role of each link in the “chain of survival,” this study identified key factors that impact treat versus transport decisions from the perspective of EMS stakeholders. The next phase of this work will include validating the importance of the identified factors to OHCA survival through a statewide survey of EMS agencies in Michigan. The final product will be a toolkit of best practices to improve survival across U.S. communities.

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Faculty Opinions recommendation of Implementation of the fifth link of the chain of survival concept for out-of-hospital cardiac arrest.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717954693.793461207 ◽

2012 ◽

Author(s):

Florian Falter

Keyword(s):

Cardiac Arrest ◽

Chain Of Survival ◽

Hospital Cardiac Arrest

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Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Critical Care ◽

10.1186/s13054-021-03606-5 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Sivagowry Rasalingam Mørk ◽

Carsten Stengaard ◽

Louise Linde ◽

Jacob Eifer Møller ◽

Lisette Okkels Jensen ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Survival Rate ◽

Neurological Outcome ◽

Mechanical Circulatory Support ◽

Circulatory Support ◽

Good Neurological Outcome ◽

Factors Associated ◽

National Consensus ◽

Hospital Cardiac Arrest

Abstract Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

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High survival rate in advanced-stage B-cell lymphomas and leukemias without CNS involvement with a short intensive polychemotherapy: results from the French Pediatric Oncology Society of a randomized trial of 216 children.

Journal of Clinical Oncology ◽

10.1200/jco.1991.9.1.123 ◽

1991 ◽

Vol 9 (1) ◽

pp. 123-132 ◽

Cited By ~ 203

Author(s):

C Patte ◽

T Philip ◽

C Rodary ◽

J M Zucker ◽

H Behrendt ◽

...

Keyword(s):

Survival Rate ◽

B Cell ◽

Pediatric Oncology ◽

Stage Iv ◽

High Dose ◽

High Survival ◽

Advanced Stage ◽

High Survival Rate ◽

Cns Involvement

From April 1984 to December 1987, the French Pediatric Oncology Society (SFOP) organized a randomized trial for advanced-stage B-cell lymphoma without CNS involvement to study the possibility of reducing the length of treatment to 4 months. After receiving the same three intensive six-drug induction courses based on high-dose fractionated cyclophosphamide, high-dose methotrexate (HD MTX), and cytarabine in continuous infusion, patients were evaluated for remission. Those who achieved complete remission (CR) were randomized between a long arm (five additional courses with two additional drugs; 16 weeks of treatment) and a short arm (two additional courses; 5 weeks). For patients in partial remission (PR), intensification of treatment was indicated. Two hundred sixteen patients were registered: 15 stage II nasopharyngeal and extensive facial tumors, 167 stage III, and 34 stage IV, 20 of the latter having more than 25% blast cells in bone marrow. The primary sites of involvement were abdomen in 172, head and neck in 30, thorax in two, and other sites in 12. One hundred sixty-seven patients are alive in first CR with a minimum follow-up of 18 months; four are lost to follow-up. Eight patients died from initial treatment failure, 14 died from toxicity or deaths unrelated to tumor or treatment, and 27 relapsed. The event-free survival (EFS), with a median follow-up of 38 months, is 78% (SE 3) for all the patients, 73% (SE 11) for the stage II patients, 80% (SE 3) for the stage III patients, and 68% (SE 8) for the stage IV and acute lymphoblastic leukemia (ALL) patients. One hundred sixty-six patients were randomized: 82 in the short arm and 84 in the long arm. EFS is, respectively, 89% and 87%. Statistical analysis confirms equivalence of both treatment arms with regard to EFS. Moreover, morbidity was lower in the short arm. This study confirms the high survival rate obtained in the previous LMB 0281 study without radiotherapy or debulking surgery and demonstrates the effectiveness of short treatment.

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High survival rate of a critically endangered species, the Azores Bullfinch Pyrrhula murina, as a contribution to population recovery

Journal of Ornithology ◽

10.1007/s10336-010-0501-4 ◽

2010 ◽

Vol 151 (3) ◽

pp. 627-636 ◽

Cited By ~ 9

Author(s):

David Monticelli ◽

Ricardo Ceia ◽

Ruben Heleno ◽

Hugo Laborda ◽

Sergio Timóteo ◽

...

Keyword(s):

Survival Rate ◽

Endangered Species ◽

Critically Endangered ◽

High Survival ◽

Population Recovery ◽

High Survival Rate ◽

Critically Endangered Species

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Repeat hepatectomy for recurrent colorectal liver metastases is associated with a high survival rate

HPB ◽

10.1111/j.1477-2574.2011.00370.x ◽

2011 ◽

Vol 13 (11) ◽

pp. 774-782 ◽

Cited By ~ 48

Author(s):

Andreas Andreou ◽

Antoine Brouquet ◽

Eddie K. Abdalla ◽

Thomas A. Aloia ◽

Steven A. Curley ◽

...

Keyword(s):

Survival Rate ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Repeat Hepatectomy ◽

High Survival ◽

High Survival Rate

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Abstract P85: Out-of-hospital Cardiac Arrests With Extracorporeal Cardiopulmonary Resuscitation In Japan: Systematic Literature Review

Circulation ◽

10.1161/circ.118.suppl_18.s_1463-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Tetsuya Sakamoto ◽

Yasufumi Asai ◽

Ken Nagao ◽

Yoshio Tahara ◽

Takahiro Atsumi ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Cardiopulmonary Resuscitation ◽

Literature Review ◽

Case Series ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Funnel Plot ◽

Case Series Study ◽

Series Study ◽

Hospital Cardiac Arrest

Background: In Japan, extracorporeal cardiopulmonary resuscitation (ECPR) became popular for cardiac arrest patients who resist conventional advanced life supports. Regardless of many clinical experiences, there has been no previous systematic literature review. Methods: Case series, reports and proceedings of scientific meeting about ECPR for out-of-hospital cardiac arrest written in Japanese between January 1, 1983 and July 31, 2007 were collected with Japana Centra Revuo Medicina (medical publication database in Japan) and review by experts. The outcome and characteristics of the patients were investigated, and the influence of publication bias of the case series study was also examined by the Funnel Plot method. Results: There were 951 out-of-hospital cardiac arrest patients who received ECPR in 92 reports (including 59 case series and 33 case reports) during the period. The average of age was 38.1 (4 – 88) years old and 76.1% was male. Three hundreds and eighty-one cases (40.1%) were arrests of cardiac etiology, and 212 were non-cardiac (22.3%). The cause of arrest was not described in other 37.6%. Excluding reports for only one case, weighted survival rate at discharge of 792 cases those were clearly described the outcome was 39.5±10.0%. When the relationship between the number of cases and the survival rate at discharge in each 59 case series study was shown in figure by the Funnel Plot method, the plotted data presented the reverse-funnel type that centered on the average of survival rate of all. Conclusions: The influence of publication bias of previous reports in Japan was relatively low. ECPR can greatly contribute to improve the outcome of out-of hospital cardiac arrests.

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Revegetation of Rock Slopes with Different Substrates in an Abandoned Quarry in Jinju, Korea

Journal of Geography and Geology ◽

10.5539/jgg.v8n3p26 ◽

2016 ◽

Vol 8 (3) ◽

pp. 26

Author(s):

Ma Hoseop ◽

Ettagbor Hans Enukwa ◽

Kang Wonseok ◽

Kim Choonsig

Keyword(s):

Growth Rate ◽

Survival Rate ◽

Festuca Arundinacea ◽

High Survival ◽

Rock Slopes ◽

High Survival Rate ◽

Feasible Method ◽

Leaf Mold ◽

Dianthus Barbatus ◽

Target Plant

The purpose of this research was to investigate the use of drilled slanted holes filled with different substrates in the revegetation of rock slopes. Slanted holes were drilled on rock slopes using pneumatic drillers in an abandoned limestone quarry area. These holes were filled with twelve different substrates, treated with Trichoderma harzianum. One climbing plant of Ivy (Hedera rhombea), a native woody plant (Lespedeza cyrtobotrya), three native herbaceous plants (Dianthus barbatus, Siberian chrysanthemum and Aster koraiensis) and one exotic grass plant (Festuca arundinacea) were planted in each of the soils. Six months after planting, only Ivy, Festuca arundinacea, Lespedeza cyrtobotrya and Dianthus barbatus were still observed growing on the soils, while the other plant species had already died in all the 12 soil treatments. Leaf mold soil + 50% Trichoderma harzianum provide the best conditions for revegetation of Festuca arundinacea, as this plant had its highest mean height, high survival rate, with impressive growth rate on this soil. Lespedeza cyrtobotrya also had its most favorable growth on Leaf mold soil + 50% T. harzianum. Mixed soil + 100% T. harzianum provide the best conditions for revegetation of Ivy. Leaf mold soil + 100% T. harzianum provide the best condition for revegetation of Dianthus barbatus as it had its highest mean height, highest growth rate and high survival rate on this soil. Siberian chrysanthemum and Aster koraiensis had the worse results as all of the plants died within a short period of time after planting. Ivy had the highest mean height, followed by Festuca arundinacea. The planted Ivy and Festuca arundinacea now form the vegetation of the research site which together with the substrate is now providing habitat to some wildlife like some species of centipedes, earthworms, insects and wild plants. Less than one year after planting, F. arundinacea already produced flowers and seeds which would further increase the plant population after dispersal and germination. Drilling slanted holes on rock slopes is therefore a feasible method to be used for revegetation and restoration of degraded quarries.The revegetation of steep rock slopes of quarries is a very challenging activity. However, the method of drilling slanted holes on rock slopes is a feasible method to be used for restoration of degraded quarries. These holes could serve in soil deposition and water retention that will further enhance plant growth.Methods of improving seed germination as well as enhancing growth of plants are also imperative in revegetation success of such degraded landscapes. Different percentage mixtures of T. harzianum in different soils could enhance plant growth depending on the target plant species. Different substrates could thus be used in such revegetation process depending on the target plant species.Revegetation would provide habitat and improve landscape beauty and stability, thus it is important for successful restoration of rock slopes

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