Testing the strength of the last link in the Chain of Survival

Resuscitation ◽  
2021 ◽  
Author(s):  
Filip Gnesin
Keyword(s):  
Chain Of Survival

Abstract 264: Out-of-Hospital Cardiac Arrest: The Cumulative Effect of Bystander Cardiopulmonary Resuscitation, Automated External Defibrillator and Automated Load Distributing Band Device Use on Return of Spontaneous Circulation

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Nabil El Sanadi ◽  
Todd Leduc ◽  
Gabriel Thornton ◽  
David Erdman ◽  
Jason Mansour ◽  
...  
Keyword(s):  
Cumulative Effect ◽  
Spontaneous Circulation ◽  
Essential Elements ◽  
High Rate ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Chain Of Survival ◽  
Device Use ◽  
Data Elements ◽  
Hospital Cardiac Arrest

Introduction : Early bystander C.P.R., A.E.D. use and continuous chest compressions are essential elements of the a.h.a. “chain of survival”. Bystander C.P.R. and A.E.D. use in urban settings are becoming more prevalent. The use of an automated load distributing band (l.d.b.) device for O.H.C.A. management in a large metropolitan area by paramedics was implemented in the winter of 2007; in 9 municipalities, 582 paramedics were trained to use the l.d.b. device as part of a.l.s. measures. A retrospective paramedic “run-sheet” review was performed from 4/2008 - 8/2009 for all nontraumatic adult cardiac arrests. R.O.S.C. on arrival to the emergency departments (e.d.) was the endpoint. Methods: 86 adult nontraumatic O.H.C.A. rehorts were found. each of the prehospital reports were reviewed. Utstein data elements were collected. bystander C.P.R. with “caller-aided” dispatch, A.E.D. use, paramedic use of standard a.h.a. resuscitation alogarthythms in addition to use of an automated l.d.b. device use (auto pulse® zoll) was recorded. Minitab 15 statistical software was used to evaluate the data. The cumulative effect of sequential “chain-of-survival” components was calculated. Results: the mean age was 63 Y.O.; there were 58 males and 28 females. The initial rhythm was: v.fib, pulseless v.tach, P.E.A., or asystole. Chain of survival cumulative synergistic effect on R.O.S.C. Conclusion: When bystander C.P.R., in addition to A.E.D. and autopulse were utilized synegistically, R.O.S.C. on e.d. arrival was 71%. When bystander C.P.R. and autopulse were used (without A.E.D. use) only 49% of patients had R.O.S.C. on e.d. arrival. Which is higher than previously reported: Hallstrom et al. (2006): 26% and Ong et al. (2006): 35%. When the l.d.b. device was used with a.l.s., R.O.S.C. was only 20%; which may be due to delayed care; since no efforts were made to resuscitate patients until the paramedics arrived. Our data reaffirms that early bystander C.P.R. and A.E.D. use are essential for achieving a high rate of R.O.S.C.

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.

Chain of survival: differences in early access and early CPR between policemen and high-school students

Resuscitation ◽  
2001 ◽  
Vol 49 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Tiziano Rosafio ◽  
Carmela Cichella ◽  
Luigi Vetrugno ◽  
Enzo Ballone ◽  
Pierluigi Orlandi ◽  
...  
Keyword(s):  
High School ◽  
High School Students ◽  
School Students ◽  
Early Access ◽  
Chain Of Survival ◽  
Survival Differences

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

Abstract T P276: Calling Stroke Alert: Does It Make a Difference in the Chain of Survival?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Cristine W Small ◽  
Donald L Price ◽  
Jeffrey D Ferguson ◽  
Lawrence I Madubeze ◽  
Susan D Freeman
Keyword(s):  
Clinical Outcomes ◽  
Stroke Severity ◽  
Golden Hour ◽  
Discharge Disposition ◽  
Improved Outcomes ◽  
Stroke Team ◽  
Severity Scores ◽  
Response Team ◽  
Chain Of Survival ◽  
The Impact

Purpose: To determine whether the stroke alert process results in improved outcomes, as reflected in door to lytic times and other outcome measures. Introduction: The diagnosis and treatment of stroke is time-sensitive and should be inclusive of all seven D’s in the “chain of survival” - Detection, Dispatch, Delivery, Door, Data, Decision and Drug (Adams, Stroke, 2007). Early stroke activation is part of the “Delivery” which incorporates transport and management by Emergency Medical Services (EMS). Clinical suspicion of stroke by EMS resulted in a process of early activation which was labeled “Stroke Alert.” This expedited the code stroke process upon arrival, preparing the hospital based stroke team to provide immediate triage and evaluation. The goal was to improve clinical efficiency and possibly clinical outcomes. Methods: • Implementation of a notification process from EMS to ED - Stroke Alert • Incorporated Stroke Alert to include Stroke Response Team (SRT) nurses January 22, 2011 • Retrospective review of internal stroke database (January 22, 2011 to July 2013) for comparative analysis of Stroke Alerts called versus those where no stroke alert was called • Evaluate clinical outcomes directly related to Stroke Alert process Results: From January 22, 2011 to July 2013: Stroke Alert Called: • 37 t-PA patients and 14 of those, 37.8%, met the 60 minute benchmark • Average Door to Lytic time - 65 minutes Stroke Alert NOT Called: • 35 t-PA patients and 10 of those, 28.6% met the 60 minute benchmark • Average Door to Lytic time - 79 minutes Conclusions: The ability for a SRT to meet the golden hour of stroke benchmark occurs more frequently when a Stroke Alert is called to the SRT nurse. Future plans include review of stroke severity scores, length of stay (LOS), and discharge disposition, to determine the impact a Stroke Alert may have on clinical outcomes.

Abstract 181: An Analysis of Worldwide Public Access Defibrillator Usage Since October 2012. Does CPR Prior to Defibrillation Improve Survival Outcomes?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Hannah Torney ◽  
Adam Harvey ◽  
Olibhear McAlister ◽  
Amy Kernaghan ◽  
Laura Davis ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Sudden Cardiac Arrest ◽  
Public Spaces ◽  
Public Access ◽  
Survival Outcomes ◽  
Summary Statistics ◽  
Demographic Information ◽  
Chain Of Survival ◽  
Bystander Cpr ◽  
Cpr Quality

Introduction: As outlined by the Chain of Survival, effective cardiopulmonary resuscitation (CPR) and rapid defibrillation are vital to improve survival from sudden cardiac arrest (SCA). Placement of public access defibrillators (PADs) is becoming more common in public spaces, and they are more frequently used by untrained lay-users. The objective of this analysis was to assess the effect of CPR prior to defibrillation, and the success of PAD usage in terms of first shock success and survival to hospital admission. Methods: This dataset was composed of voluntarily submitted demographic information and electronic PAD files collected from October 2012 - June 2018. Summary statistics were calculated, and proportions were determined with 95% confidence intervals (CI) where appropriate. The association between CPR prior to defibrillation and survival was investigated by fitting a logistical model with survival as the dependent variable and CPR as covariate. Results: A total of 2812 PAD events were analyzed. Mean (SD) patient age was 61 (19) years and males comprised 72.5% (1922 of 2650 events where gender was known) of the events reported. The most common locations of SCA were the home (1039, 36.9%), public (719, 25.6%) and medical facility (328, 11.7%). Median (IQR) time to PAD delivery was 5 (3, 11) minutes. Ventricular fibrillation or tachycardia was present in 1010 (35.9%) patients, and 979 received a shock, with 87.2% (95%CI [85.0%, 89.3%]) achieving first shock success. Of the 849 shockable patients for whom survival was known, 565 (66.5%, (95%CI [63.3%, 69.7%]) survived to hospital admission. Survival outcome was known for 2150 patients, and 681 (31.7%, 95%CI [29.7%, 33.69%]) survived to hospital admission. A total of 1649 (58.6%) SCAs were witnessed and 1293 (78.4%) patients received bystander CPR prior to defibrillation. Bystander CPR prior to defibrillation was significantly associated with survival to hospital admission (OR = 2.17, 95%CI [1.69, 2.81], p<0.001). Conclusion: These results suggest that CPR application prior to application of a PAD significantly increases a patient’s chances of surviving to hospital admission. This study did not assess CPR quality, but it is intuitive that good quality CPR would align with higher survival outcomes.

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.

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