O-46 Outcome for patients with out-of hospital cardiac arrest for whom cardio-pulmonary resuscitation was ongoing on admission to emergency room

Introduction: The interactions of various variables on out-of-hospital cardiac arrest (OHCA) in the young (1-35 years old) outcomes are complex. Network models have emerged as a way to abstract complex systems and gain insights into relational patterns among observed variables. Hypothesis: Network analysis helps provide qualitative and quantitative insights into how various variables interact with each other and affect outcomes in OHCA in the young. Methods: A mixed graphical network analysis was performed using variables collected by CARES. The network allows the visualization and quantification of each unique interaction between two variables that cannot be explained away by other variables in the data set. The strength of the underlying interaction is proportional to the thickness of the connections (edges) between the variables (nodes). We used the mgm package in R. Results: Figure 1 shows the network of the OHCA in the young cases in Chicago from 2013 to 2017. There are apparent clusters. Sustained return of spontaneous circulation and hypothermia are strongly correlated with survival and neurological outcomes. This cluster is in turn connected to the rest of the network by survival to emergency room. The interaction between any two variables can also be quantified. For example, American Indians cases occur more often in disadvantaged locations when compared to Whites (OR 4.5). The network also predicts how much one node can be explained by adjacent nodes. Only 20% of survival to emergency room is explained by its adjacent nodes. The remaining 80% is attributed to variables not represented in this network. This suggests that interventions to improve this node is difficult unless further data is available. Conclusion: Network analysis provides both a qualitative and quantitative evaluation of the complex system governing OHCA in the young. The networks predictive capability could help in identifying the most effective interventions to improve outcomes.

Download Full-text

READINESS OF THE CRIMEAN POPULATION TO PERFORM CARDIO PULMONARY RESUSCITATION IN OUT-OF-HOSPITAL CARDIAC ARREST

Social Aspects of Population Health ◽

10.21045/2071-5021-2019-65-1-5 ◽

2019 ◽

Vol 65 (1) ◽

pp. 5-5

Author(s):

A.A. Birkun ◽

◽

Y.A. Kosova ◽

Keyword(s):

Cardiac Arrest ◽

Cardio Pulmonary Resuscitation ◽

Hospital Cardiac Arrest

Download Full-text

The effectiveness of dispatcher-assisted cardio-pulmonary resuscitation on survival of out-of-hospital cardiac arrest : a literature review

10.5353/th_b4842650 ◽

2012 ◽

Author(s):

Chun, Andy Wu

Keyword(s):

Cardiac Arrest ◽

Literature Review ◽

Cardio Pulmonary Resuscitation ◽

Hospital Cardiac Arrest

Download Full-text

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

10.20944/preprints202107.0447.v1 ◽

2021 ◽

Author(s):

Charles Payot ◽

Christophe A Fehlmann ◽

Laurent Suppan ◽

Marc Niquille ◽

Christelle Lardi ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Life Support ◽

Multivariable Logistic Regression Model ◽

Physician Decision Making ◽

Factors Influencing ◽

Cardio Pulmonary Resuscitation ◽

Prehospital Emergency ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

Download Full-text

Survival rate of incoming patients with cardiac arrest at the cardiology infirmary of the emergency department of a public hospital in Greece

Health & Research Journal ◽

10.12681/healthresj.20871 ◽

2019 ◽

Vol 5 (2) ◽

pp. 53

Author(s):

Styliani Papadopoulou ◽

Olympia Konstantakopoulou ◽

Antonia Kalogianni ◽

Martha Kelesi-Stavropoulou ◽

Theodore Kapadohos

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Survival Rate ◽

Emergency Room ◽

Survival Rates ◽

Public Health Problem ◽

Spontaneous Circulation ◽

Shockable Rhythm ◽

Discharged Patients ◽

Hospital Cardiac Arrest

Introduction: Cardiac arrest is an urgent situation that, despite the improved resuscitation capabilities, the survival rate of out-of-hospital cardiac arrest victims remains low.Aim: Τo investigate the survival rate of the incoming patients with cardiac arrest in the cardiology infirmary of the emergency department of a public hospital.Material-Method: The study included 210 patients who were transferred pulseless and breathless at the cardiology infirmary of the emergency department of “Tzaneio” Hospital, Piraeus, during the period April 2017 - November 2018. Data was collected from the National Center of Emergency Dispatch's printed forms, as well as from the patients’ admission book of the emergency department.Results: More than 10% (11.9%) of patients with cardiac arrest returned to spontaneous circulation in the emergency department, of which 16% was discharged. Patients with known cardiac history, (p=0.002), with a shockable rhythm (p<0.001), and especially ventricular fibrillation (p<0.001) upon arrival at the emergency room, and patients who were defibrillated at the ambulance during admission and at the emergency room, were more likely to survive (p<0.001). No statistically significant correlation was found between the factors studied and survival after cardiac arrest, in the group of patients that were discharged.Conclusions: The survival rate of the incoming patients with cardiac arrest at the emergency department of “Tzaneio” Hospital, Piraeus, was low. As for most health systems, this issue constitutes a fairly complex public health problem. Cardiopulmonary resuscitation and corresponding guidelines require further improvement in order for the survival rates of out-of-hospital cardiac arrest patients to increase.

Download Full-text

Abstract 483: Out of Hospital Cardiac Arrest Outcomes After Transitioning to Pit Crew Model

Circulation ◽

10.1161/circ.140.suppl_2.483 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Mohinder Reddy Vindhyal ◽

Paul M Ndunda ◽

Shravani Vindhyal ◽

Brent Duran

Keyword(s):

Cardiac Arrest ◽

Vegetative State ◽

Fire Department ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Cardio Pulmonary Resuscitation ◽

Improved Outcomes ◽

Before And After ◽

Hospital Cardiac Arrest ◽

Model Approach

Introduction: One of the leading causes of untimely death as per the Resuscitation Outcomes Consortium Epistry for cardiac arrest is out of hospital cardiac arrest (OHCA). Adoption of the choreographed approach of the pit crew model resuscitation improved outcomes after OHCA in some previous studies. Hypothesis: Compare outcomes post OHCA before and after adopting a pit crew model approach in one of the largest counties in Kansas. Methods: The data was collected before (2010 – 2012) and after the pit crew (2013-2016) approach from 2010 to 2016. The patient demographics and resuscitation variables were similar and comparable including the emergency and fire department personnel. The primary outcome was the proportion of patients having sustained return of spontaneous circulation (ROSC). Secondary outcomes were average number of pauses >10 seconds, cerebral performance post return of spontaneous circulation, and average cardio-pulmonary resuscitation (CPR) cycles to ROSC. Results: The patients who had sustained ROSC post pit crew approach was 67.9% vs 32.1% (p=< 0.001). Average number of CPR pause time > 10 seconds post pit crew model was 1 vs 5 (p=0.01). Cerebral performance post return of spontaneous circulation using pit crew approach with good cerebral performance was 47% vs 56% (p=0.2), moderate cerebral disability was 17% vs 23% (p=0.19), severe cerebral disability was 8% vs 11% (p=0.44) and in coma/vegetative state was 8% vs 16% (p=0.001). Average CPR cycles to ROSC was 6.63. Conclusion: This focused model of high-quality CPR performance with individualized assigned tasks with minimal interruptions has shown increased numbers of sustained ROSC. The pit crew model approach also has showed decline in the rates of cerebral performance especially with moderate and severe cerebral performance including the patients in coma or vegetative state which is mainly through continuous cerebral perfusion pressures. More studies with better follow-up care in coordination with hospital outcomes will be key for the pit crew approach to be adopted.

Download Full-text

Abstract 11964: Citizen Responders Provide Emotional Support for Relatives to Out-of-Hospital Cardiac Arrest Patients

Circulation ◽

10.1161/circ.144.suppl_2.11964 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Astrid Rolin Kragh ◽

Linn Andelius ◽

Mads Christian Tofte Gregers ◽

Julie Kjoelbye ◽

Line Zinckernagel ◽

...

Keyword(s):

Cardiac Arrest ◽

Emotional Support ◽

Health Care Professionals ◽

Smartphone Application ◽

Cardio Pulmonary Resuscitation ◽

Cr System ◽

Hospital Cardiac Arrest ◽

External Defibrillator ◽

Resuscitation Attempt

Introduction: A citizen responder (CR) system to activate volunteer citizens by a smartphone application (HeartRunner) to nearby cardiac arrests was implemented in 2017 in the Capital Region of Denmark. Participating in resuscitation may not only involve provision of cardio-pulmonary resuscitation (CPR) but also include provision of emotional support for relatives to the cardiac arrest patient. We examined the proportion of CR who reported provision of support to relatives to out-of-hospital cardiac arrest (OHCA) patients during resuscitation attempt. Hypothesis: We hypothesized that CR not only deliver CPR but also provide emotional support to relatives of OHCA patients. Methods: All CR activated by the HeartRunner app received a follow-up questionnaire 90 minutes after the alarm including questions about how CRs participated in resuscitation and whether they provided emotional support to relatives present during the resuscitation attempt. All surveys from March 12, 2020 to June 1, 2021, from CR who accepted an alarm and arrived at the cardiac arrest location were included. Results: A total of 1,868 CR responded to the survey (median age 37 years (IQR 28-37). Half (54.4%) were male and 23.9% health care professionals. CRs arrived before the emergency medical services (EMS) in almost 1/3 (28.9%) of OHCA cases with CR activation, with 227 CRs (41.9%) performing CPR and 139 (25.7%) attaching an automated external defibrillator. In total, more than 433 CRs (23.2%) reported provision of support for relatives at the OHCA location. Even though a higher proportion of support was observed among CR who arrived before the EMS, almost 12% reported provision of support to relatives even when arriving after EMS (Figure). Conclusions: Citizen responders provide not only resuscitative efforts but offer emotional support to relatives to OHCA patients. Citizen responders may be an important resource for both EMS personnel and relatives who are present at the cardiac arrest scene.

Download Full-text