Improving Reliability of Abstracted Prehospital Care Data: Use of Decision Rules

AbstractOur experience suggests that even with standard definitions, information on ambulance report forms may be abstracted inconsistently.Hypothesis:The use of written decision rules will improve agreement between paramedics abstracting data from records of prehospital cardiac arrest.Methods:Sixty-three ambulance reports were selected by a random sample of all out-of-hospital cardiac arrests. Four paramedic abstractors each were given a set of definitions for use in abstracting data and one pair, randomly assigned, also was given a set of decision rules. Abstractors recorded whether there was: (1) underlying cardiovascular disease; (2) a witnessed arrest; (3) bystander CPR; and (4) the presenting rhythm. Agreement between pairs of abstractors was determined by computing kappa values.Results:Kappa values for each variable, for abstractors without and with decision rules were: (1) 0.23, 0.33; (2) 0.39, 0.41; (3) 0.43, 0.66; and (4) 0.65, 0.80. Kappa values consistently were higher for the pair of abstractors using decision rules. The degree of improvement varied with the difficulty of the decision required.Conclusion:The addition of decision rules to variable definitions is worthwhile but does not ensure good or excellent levels of agreement in data abstracted from records by paramedics.

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Complication Rates for the Esophageal Obturator Airway and Endotracheal Tube in the Prehospital Setting

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00040176 ◽

1993 ◽

Vol 8 (2) ◽

pp. 117-121 ◽

Cited By ~ 10

Author(s):

Daniel G. Hankins ◽

Nancy Carruthers ◽

R. J. Frascone ◽

Linda Ann Long ◽

Brian C. Campion

Keyword(s):

Cardiac Arrest ◽

Endotracheal Tube ◽

Complication Rate ◽

Prehospital Care ◽

Survival Rates ◽

Complication Rates ◽

Quasi Experimental ◽

Continued Use ◽

Prehospital Cardiac Arrest ◽

Careful Thought

AbstractPurpose:The purpose of this study was to determine the complication rates associated with the use of the endotracheal tube (ET) a the use of the esophageal obturator airway/esophageal gastric tube airway (EOA/EGT during the treatment of patients with prehospital cardiac arrest.Methods:A descriptive, quasi-experimental study of 509 consecutive adults, cardiac arrest patients was conducted. Patients were examined prospectively for airway intervention type and complications. Some patients were examined at their final destinations (field, morgue, funeral home), while other patients were examined by EMS providers in the field when airway adjuncts were switched. Also, airways were evaluated for complications by emergency physicians at destination emergency departments.Results:The airway in use at the time of examination was the esophageal obturator airway (EOA) or esophageal gas lube airway (EGTA) in 208 patients (40.1%); the ET (endotracheal tube) in 232 patients (45.6%); and an oral or nasopha ryngeal airway in 47 patients (9.2%). Twenty-two patients (4.3%) had both an EOA/EGTA and an ET tube in place at the time of the examination. The survival rates were similar between the EOA/EGTA and the ET groups (28% and 32%, respectively). The complication rates overall also were similar, but the serious or potentially lethal complication rate was 3.3 times more common with the use of the EOA/EGTA than with the ET tube (8.7% versus 2.6%, respectively).Conclusions:The complication rate for the EOA/EGTA is unacceptably high, and careful thought must be given to its continued use. Serious questions also arise concerning the complication rates associated with the use of the ET: is the complication rate of 2.5% acceptable or should other airway alternative be considered for use in prehospital care?

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Diffusion of Cardiopulmonary Resuscitation Training to Chinese Immigrants with Limited English Proficiency

Emergency Medicine International ◽

10.1155/2011/685249 ◽

2011 ◽

Vol 2011 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Mei Po Yip ◽

Brandon Ong ◽

Shin Ping Tu ◽

Devora Chavez ◽

Brooke Ike ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Limited English Proficiency ◽

English Proficiency ◽

Chinese Immigrants ◽

Resuscitation Training ◽

Bystander Cpr ◽

Cpr Training ◽

Prehospital Cardiac Arrest ◽

Training Opportunities

Cardiopulmonary resuscitation (CPR) is an effective intervention for prehospital cardiac arrest. Despite all available training opportunities for CPR, disparities exist in participation in CPR training, CPR knowledge, and receipt of bystander CPR for certain ethnic groups. We conducted five focus groups with Chinese immigrants who self-reported limited English proficiency (LEP). A bilingual facilitator conducted all the sessions. All discussions were taped, recorded, translated, and transcribed. Transcripts were analyzed by content analysis guided by the theory of diffusion. The majority of participants did not know of CPR and did not know where to get trained. Complexity of CPR procedure, advantages of calling 9-1-1, lack of confidence, and possible liability discourage LEP individuals to learn CPR. LEP individuals welcome simplified Hands-Only CPR and are willing to perform CPR with instruction from 9-1-1 operators. Expanding the current training to include Hands-Only CPR and dispatcher-assisted CPR may motivate Chinese LEP individuals to get trained for CPR.

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Study of pre-hospital care of Out of Hospital Cardiac Arrest victims and their outcome in a tertiary care hospital in India

10.1101/2020.06.12.20129502 ◽

2020 ◽

Author(s):

Rachana Bhat ◽

Prithvishree Ravindra ◽

Ankit Kumar Sahu ◽

Roshan Mathew ◽

William Wilson

Keyword(s):

Cardiac Arrest ◽

Prehospital Care ◽

Tertiary Care ◽

Spontaneous Circulation ◽

Care Hospital ◽

Shockable Rhythm ◽

Common Location ◽

Bystander Cardiopulmonary Resuscitation ◽

Initial Rhythm ◽

Bystander Cpr

AbstractBACKGROUNDIndia does not have a formal cardiac arrest registry and a centralized emergency medical system. In this study, we aimed to assess the prehospital care received by the patients with OHCA and to predict the factors that could influence their outcome.METHODSWe performed a prospective observational study, including OHCA patients presenting to the emergency department (ED) between February 2019 and January 2020. A structured proforma was used to capture information like basic demography, prehospital details like bystander cardiopulmonary resuscitation (CPR), use of an automated external defibrillator (AED), clinical profile, and outcome.RESULTSAmong the included 205 patients, the majority were male (71.2%) and belonged to older age (49.3%). The nature of arrest was predominantly non-traumatic (82.4%). The initial rhythm at presentation was non-shockable (96.5%). Return of spontaneous circulation (ROSC) was achieved in 17 (8.3%) patients, of which only 3 (1.4%) patients survived till discharge. The home was the most common location of OHCA (116, 56.6%). Among the OHCA patients, witnessed arrests were seen only in 64 (31.2%), of which 15 (7.8%) received bystander CPR, and AED was used in 1% of the patients. The initial shockable rhythm was a significant predictor of ROSC (OR 18.97 95%CI 3.83-93.89; p<0.001) and survival to discharge (OR 42.67; 95%CI 7.69-234.32; p<0.001).CONCLUSIONIn a developing country like India, this study underlines the poor status of the prehospital system like lower bystander CPR, AED and ambulance usage. Moreover, ROSC was seen only in less than 10% of patients, and only 1.3% got discharged from the hospital.

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Clinical Characteristics and Prehospital care in Prehospital Cardiac Arrest Patients by Paramedic's Reports

Journal of the Korea Academia-Industrial cooperation Society ◽

10.5762/kais.2010.11.4.1540 ◽

2010 ◽

Vol 11 (4) ◽

pp. 1540-1546 ◽

Cited By ~ 4

Author(s):

Bong-Yeun Koh ◽

Young-Soon Park

Keyword(s):

Cardiac Arrest ◽

Clinical Characteristics ◽

Prehospital Care ◽

Prehospital Cardiac Arrest

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Assessment of the 2015 cardiopulmonary resuscitation guidelines for patients with out-of-hospital cardiac arrest: results from the All-Japan Utstein registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1823 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Yagi ◽

K Nagao ◽

E Tachibana ◽

N Yonemoto ◽

Y Tahara ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Prehospital Care ◽

Multivariable Logistic Regression Analysis ◽

Time Interval ◽

Shockable Rhythm ◽

Resuscitation Guidelines ◽

Bystander Cpr ◽

Favorable Neurological Outcome

Abstract Background The 2015 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from cardiac arrest (CA). In particular, the guidelines recommended that it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min in adult CA patients. However, it is unknown whether the 2015 guidelines contributed to favorable neurological outcome in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines in adult CA patients, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA). Methods From the data of this registry between 2011 and 2016, we included adult witnessed OHCA patients due to cardiac etiology, who had non-shockable rhythm as an initial rhythm. We excluded patients who received prehospital care in 2015 because it was difficult to distinguish prehospital care based on either 2010 CPR guidelines or 2015 CPR guidelines. We also excluded patients who received bystander CPR by citizens because we cannot assess the quality of bystander CPR in this registry. Study patients were divided into five groups based on different years (figure). The endpoint was the favorable neurological outcome at 30 days after OHCA. Potential confounding factors based on biological plausibility and previous studies were included in the multivariable logistic regression analysis. These variables included the age, sex (male, female), advanced airway or not, the administration of adrenaline or not, the administration of saline or not, instructed by dispatcher or not, and time interval from call EMS to scene. Results The figure showed favorable neurological outcomes at 30 days. In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in OHCA patients in 2016 as compared to in 2011 was 1.32 (95% CI: 1.04–1.68, p=0.022). On the other hands, there were no significant differences from 2011 to 2014. Conclusion In the OHCA patients with non-shockable rhythm, the 2015 guidelines were superior to the 2010 guidelines, in terms of neurological benefits. Figure 1 Funding Acknowledgement Type of funding source: None

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Prehospital cardiac arrest: The impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times

Annals of Emergency Medicine ◽

10.1016/s0196-0644(05)82285-1 ◽

1990 ◽

Vol 19 (11) ◽

pp. 1264-1269 ◽

Cited By ~ 93

Author(s):

Daniel W Spaite ◽

Teresa Hanlon ◽

Elizabeth A Criss ◽

Terence D Valenzuela ◽

A Larry Wright ◽

...

Keyword(s):

Cardiac Arrest ◽

Response Times ◽

Bystander Cpr ◽

Prehospital Cardiac Arrest ◽

The Impact

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Effect of chest-compression-only bystander cardiopulmonary resuscitation on the likelihood of initial shockable rhythm after out-of-hospital cardiac arrest: a propensity matching analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1829 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Funada ◽

Y Goto ◽

T Maeda ◽

H Okada ◽

M Takamura

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Shockable Rhythm ◽

Significant Difference ◽

Bystander Cardiopulmonary Resuscitation ◽

Bystander Cpr

Abstract Background/Introduction Shockable rhythm after cardiac arrest is highly expected after early initiation of bystander cardiopulmonary resuscitation (CPR) owing to increased coronary perfusion. However, the relationship between bystander CPR and initial shockable rhythm in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. We hypothesized that chest-compression-only CPR (CC-CPR) before emergency medical service (EMS) arrival has an equivalent effect on the likelihood of initial shockable rhythm to the standard CPR (chest compression plus rescue breathing [S-CPR]). Purpose We aimed to examine the rate of initial shockable rhythm and 1-month outcomes in patients who received bystander CPR after OHCA. Methods The study included 59,688 patients (age, ≥18 years) who received bystander CPR after an OHCA with a presumed cardiac origin witnessed by a layperson in a prospectively recorded Japanese nationwide Utstein-style database from 2013 to 2017. Patients who received public-access defibrillation before arrival of the EMS personnel were excluded. The patients were divided into CC-CPR (n=51,520) and S-CPR (n=8168) groups according to the type of bystander CPR received. The primary end point was initial shockable rhythm recorded by the EMS personnel just after arrival at the site. The secondary end point was the 1-month outcomes (survival and neurologically intact survival) after OHCA. In the statistical analyses, a Cox proportional hazards model was applied to reflect the different bystander CPR durations before/after propensity score (PS) matching. Results The crude rate of the initial shockable rhythm in the CC-CPR group (21.3%, 10,946/51,520) was significantly higher than that in the S-CPR group (17.6%, 1441/8168, p<0.0001) before PS matching. However, no significant difference in the rate of initial shockable rhythm was found between the 2 groups after PS matching (18.3% [1493/8168] vs 17.6% [1441/8168], p=0.30). In the Cox proportional hazards model, CC-CPR was more negatively associated with the initial shockable rhythm before PS matching (unadjusted hazards ratio [HR], 0.97; 95% confidence interval [CI], 0.94–0.99; p=0.012; adjusted HR, 0.92; 95% CI, 0.89–0.94; p<0.0001) than S-CPR. After PS matching, however, no significant difference was found between the 2 groups (adjusted HR of CC-CPR compared with S-CPR, 0.97; 95% CI, 0.94–1.00; p=0.09). No significant differences were found between C-CPR and S-CPR in the 1-month outcomes after PS matching as follows, respectively: survival, 8.5% and 10.1%; adjusted odds ratio, 0.89; 95% CI, 0.79–1.00; p=0.07; cerebral performance category 1 or 2, 5.5% and 6.9%; adjusted odds, 0.86; 95% CI, 0.74–1.00; p=0.052. Conclusions Compared with S-CPR, the CC-CPR before EMS arrival had an equivalent multivariable-adjusted association with the likelihood of initial shockable rhythm in the patients with OHCA due to presumed cardiac causes that was witnessed by a layperson. Funding Acknowledgement Type of funding source: None

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