scholarly journals A MULTI-DISCIPLINARY APPROACH TO THE DEVELOPMENT AND IMPLEMENTATION OF BEST PRACTICES FOR THE MANAGEMENT OF CARDIAC ARREST PATIENTS: INCREASING THE ‘CHAIN OF SURVIVAL’

2015 ◽  
Vol 31 (10) ◽  
pp. S323-S324
Author(s):  
B. Quinlan ◽  
C. Cooper ◽  
K. Murfitt ◽  
A. Charlebois
Keyword(s):  
Cardiac Arrest ◽  
Best Practices ◽  
Chain Of Survival

Abstract 138: Defining System of Care Best Practices for Out-Of-Hospital Cardiac Arrest Survival

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mahshid Abir ◽  
Timothy C Guetterman ◽  
Sydney Fouche ◽  
Samantha Iovan ◽  
Jessica L Lehrich ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Best Practices ◽  
Prehospital Care ◽  
Critical Role ◽  
Spontaneous Circulation ◽  
High Survival ◽  
Factors Associated ◽  
Defining System ◽  
Chain Of Survival ◽  
Hospital Cardiac Arrest

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.

scholarly journals Neuroprognostication of Cardiac Arrest Patients: Outcomes of Importance

2017 ◽  
Vol 38 (06) ◽  
pp. 775-784
Author(s):  
Tobias Cronberg
Keyword(s):  
Cardiac Arrest ◽  
Vegetative State ◽  
Survival Rates ◽  
High Quality ◽  
Cognitive Difficulties ◽  
Cardiac Arrest Survivor ◽  
Chain Of Survival ◽  
Quality Decision ◽  
Improved Methods

AbstractDuring the last two decades, survival rates after cardiac arrest have increased while the fraction of patients surviving with a severe neurological disability or vegetative state has decreased in many countries. While improved survival is due to improvements in the whole “chain of survival,” improved methods for prognostication of neurological outcome may be of major importance for the lower disability rates. Patients who are resuscitated and treated in intensive care will die mainly from the withdrawal of life-sustaining (WLST) therapy due to presumed poor chances of meaningful neurological recovery. To ensure high-quality decision-making and to reduce the risk of premature withdrawal of care, implementation of local protocols is crucial and should be guided by international recommendations. Despite rigorous neurological prognostication, cognitive impairment and related psychological distress and reduced participation in society will still be relevant concerns for cardiac arrest survivors. The commonly used outcome measures are not designed to provide information on these domains. Follow-up of the cardiac arrest survivor needs to consider the cardiovascular burden as an important factor to prevent cognitive difficulties and future decline.

P172 How could we improve the efficacy of the “chain of survival” in patients with out-of-hospital cardiac arrest?

Resuscitation ◽  
1994 ◽  
Vol 28 (2) ◽  
pp. S30
Author(s):  
P. Mols ◽  
E. Beaucarne ◽  
P.H. Robert ◽  
C. Langen ◽  
M. Muller
Keyword(s):  
Cardiac Arrest ◽  
Chain Of Survival ◽  
Hospital Cardiac Arrest

Out-of-hospital cardiac arrest: role of percutaneous coronary intervention

2018 ◽  
pp. 351-360
Author(s):  
Peter Radsel ◽  
Marko Noc
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Arrest ◽  
Life Support ◽  
Significant Coronary Artery Disease ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Chain Of Survival ◽  
Artery Disease ◽  
A Chain ◽  
Hospital Cardiac Arrest

Out-of-hospital cardiac arrest (OHCA) remains the leading cause of death in developed countries, with an annual incidence from 36 to 81 events per 100,000. Prehospital treatment includes immediate recognition, bystander cardiopulmonary resuscitation, defibrillation, and advanced cardiac life support known as a ‘chain of survival’. Owing to improvements in the ‘chain of survival’, the proportion of patients with re-establishment of spontaneous circulation on the field may nowadays exceed 50%. This leads to increased hospital admission observed in communities with mature prehospital emergency services. According to autopsy and immediate coronary angiography (CAG), significant coronary artery disease may be documented in more than 70% of patients. Moreover, in the presence of ST-elevation myocardial infarction (STEMI) in post-resuscitation electrocardiogram, acute thrombotic lesions may be found in up to 90%. However, the absence of STEMI does not exclude obstructive or thrombotic coronary stenosis, which may be present in 25–58% of patients. Because of these findings, interventional cardiologists are increasingly alerted for immediate CAG and percutaneous coronary intervention in OHCA patients.

Cardiac arrest, chain of survival and Utstein style

2002 ◽  
Vol 19 (9) ◽  
pp. 624-633 ◽  
Author(s):  
A. Gullo
Keyword(s):  
Cardiac Arrest ◽  
Chain Of Survival ◽  
Utstein Style

scholarly journals Strengthening Links in the “Chain of Survival”: A Singapore Perspective

2002 ◽  
Vol 9 (3) ◽  
pp. 121-125 ◽  
Author(s):  
Ra Charles ◽  
F Lateef ◽  
V Anantharaman
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Basic Cardiac Life Support ◽  
Chain Of Survival ◽  
Bystander Cpr ◽  
Mean Time ◽  
Hospital Cardiac Arrest ◽  
Ambulance Crew

Introduction The concept of the chain of survival is widely accepted. The four links viz. early access, early cardiopulmonary resuscitation (CPR), early defibrillation and early Advanced Cardiac Life Support (ACLS) are related to survival after pre-hospital cardiac arrest. Owing to the dismal survival-to-discharge figures locally, we conducted this study to identify any weaknesses in the chain, looking in particular at bystander CPR rates and times to Basic Cardiac Life Support (BCLS) and ACLS. Methods and materials A retrospective cohort study was conducted in the Emergency Department of an urban tertiary 1500-bed hospital. Over a 12-month period, all cases of non-trauma out-of-hospital cardiac arrest were evaluated. Results A total of 142 cases of non-trauma out-of-hospital cardiac arrest were identified; the majority being Chinese (103/142, 72.5%) and male (71.8%) with a mean age of 64.3±7.8 years (range 23–89 yrs). Most patients (111/142, 78.2%) did not receive any form of life support until arrival of the ambulance crew. Mean time from collapse to arrival of the ambulance crew and initiation of BCLS and defibrillation was 9.2±3.5 minutes. Mean time from collapse to arrival in the Emergency Department (and thus ACLS) was 16.8±7.1 minutes. Three patients (2.11%) survived to discharge. Conclusion There is a need to (i) facilitate layperson training in bystander CPR, and (ii) enhance paramedic training to include ACLS, in order to improve the current dismal survival outcomes from out-of-hospital cardiac arrest in Singapore.

Stress and distress: the art and science of dispatcher’s assisted cardiopulmonary resuscitation.

2016 ◽  
Vol 2 (8) ◽  
Author(s):  
Régine Zandona ◽  
Aline Gillet ◽  
Céline Stassart ◽  
Laura Nothelier ◽  
Anne-Sophie Delfosse ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Coping Strategies ◽  
Negative Impact ◽  
Post Traumatic Stress ◽  
Psychological Burden ◽  
Key Factor ◽  
Chain Of Survival ◽  
Bystander Cpr ◽  
The Cost

<p>Chances of survival following a cardiac arrest are very low and inversely proportional to the duration of cardiovascular arrest. It is of critical importance to perform cardiopulmonary resuscitation (CPR) as soon as possible, even before the arrival of emergency medical team (EMT) on the scene. Therefore, early bystander CPR is a key factor in improving survival from out-of-hospital cardiac arrest (OOH-CA). In Belgium, the ALERT algorithm (Algorithme Liégeois d’Encadrement à la Réanimation par Téléphone<a title="" href="#_ftn1">[1]</a> offers the opportunity to help bystanders perform CPR. Dispatchers’ assisted telephone CPR has introduced a new link in the chain of survival, that contributes to a reduced OOH-CA mortality rate but at the cost of increased responsibilities and stress. ALERT also gives a new role to bystanders; they are no longer just spectators but become actors when they witness a cardiac arrest. Our team was interested in the psychological burden of ALERT. Therefore, we evaluated the effects of CPR performed by untrained persons. We studied the potential influence of different coping strategies on this impact, as well as the possible correlation with the degree of attachment to the victim and the risk of developing PTSD (Post Traumatic Stress Disorder). We noticed that some psychological negative impact on the bystanders could be recognized. We also identified beneficial and detrimental coping strategies.  In the future, we wonder if Video-CPR (V-CPR) might improve the quality of resuscitation.</p><div><br clear="all" /><hr align="left" size="1" width="33%" /><div><p><a title="" href="#_ftnref1">[1]</a> Algorithm for CPR guidance over the phone originating from Liege, Belgium</p></div></div>

scholarly journals Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival

2014 ◽  
Vol 36 (14) ◽  
pp. 863-871 ◽  
Author(s):  
A. Stromsoe ◽  
L. Svensson ◽  
A. B. Axelsson ◽  
A. Claesson ◽  
K. E. Goransson ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chain Of Survival ◽  
Hospital Cardiac Arrest ◽  
Improved Outcome
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