60. The Impact of AEDs on Cardiac Survival in an Urban Out-of-Hospital Setting

Introduction: Prior studies have documented less than 3% survival for out-of-hospital cardiac arrest (CA) in D.C. EMS intubation has failed to improve extremely poor survival rates for out of hospital CA. This study will investigate whether the addition of automatic external defibrillator (AED) use will improve the negligible survival rate experienced in a system that transports 80,000 pts/yr; Thus replicating success with AED for CA in other centers.Methods: Retrospective review of all CA data from D.C. EMS system from 1-12/91 (no AED) vs. 1-12/93 (AED in use). Supporting data from run sheets and hospital records was compared for years with and without the AED using student's t test, chi-square with p <0.05.Results: In 1991 there were 414 out of hospital CAs arrests with an overall survival rate of 2.3% with a mean EMS arrival time of 10 minutes. There were no significant differences with respect to CA patients’ age, bystander CPR or BLS/ALS response times between two years (1991 and 1993) p = NS. In VF patients who comprised 26% and 24% of presenting rhythms for ’91 and ’93 respectively, the use of AEDs improved survival 3.8% vs. 29% with AEDs in ’93 (p <0.05). There was no difference in percentage of non-VF presenting rhythms or patient outcomes between the two groups.

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LO72: Implementation of an educational program to improve the cardiac arrest diagnostic accuracy of ambulance communication officers: a concurrent control before-after study

CJEM ◽

10.1017/cem.2017.134 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S52-S53

Author(s):

C. Vaillancourt ◽

A. Kasaboski ◽

M. Charette ◽

L. Calder ◽

L. Boyle ◽

...

Keyword(s):

Cardiac Arrest ◽

Educational Program ◽

Survival Rates ◽

Control Site ◽

Chi Square ◽

Concurrent Control ◽

Initial Rhythm ◽

Bystander Cpr ◽

The Impact ◽

Hospital Cardiac Arrest

Introduction: Most ambulance communication officers receive minimal education on agonal breathing, often leading to unrecognized out-of-hospital cardiac arrest (OHCA). We sought to evaluate the impact of an educational program on cardiac arrest recognition, and on bystander CPR and survival rates. Methods: Ambulance communication officers in Ottawa, Canada received additional training on agonal breathing, while the control site (Windsor, Canada) did not. Sites were compared to their pre-study performance (before-after design), and to each other (concurrent control). Trained investigators used a piloted-standardized data collection tool when reviewing the recordings for all potential OHCA cases submitted. OHCA was confirmed using our local OHCA registry, and we requested 9-1-1 recordings for OHCA cases not initially suspected. Two independent investigators reviewed medical records for non-OHCA cases receiving telephone-assisted CPR in Ottawa. We present descriptive and chi-square statistics. Results: There were 988 confirmed and suspected OHCA in the “before” (540 Ottawa; 448 Windsor), and 1,076 in the “after” group (689 Ottawa; 387 Windsor). Characteristics of “after” group OHCA patients were: mean age (68.1 Ottawa, 68.2 Windsor); Male (68.5% Ottawa, 64.8% Windsor); witnessed (45.0% Ottawa, 41.9% Windsor); and initial rhythm VF/VT (Ottawa 28.9, Windsor 22.5%). Before-after comparisons were: for cardiac arrest recognition (from 65.4% to 71.9% in Ottawa p=0.03; from 70.9% to 74.1% in Windsor p=0.37); for bystander CPR rates (from 23.0% to 35.9% in Ottawa p=0.0001; from 28.2% to 39.4% in Windsor p=0.001); and for survival to hospital discharge (from 4.1% to 12.5% in Ottawa p=0.001; from 3.9% to 6.9% in Windsor p=0.03). “After” group comparisons between Ottawa and Windsor (control) were not statistically different, except survival (p=0.02). Agonal breathing was common (25.6% Ottawa, 22.4% Windsor) and present in 18.5% of missed cases (15.8% Ottawa, 22.2% Windsor p=0.27). In Ottawa, 31 patients not in OHCA received chest compressions resulting from telephone-assisted CPR instructions. None suffered injury or adverse effects. Conclusion: While all OHCA outcomes improved over time, the educational intervention significantly improved OHCA recognition in Ottawa, and appeared to mitigate the impact of agonal breathing.

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P4169The crucial role of the bystander in out-of-hospital cardiac arrest resuscitation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0740 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Campos ◽

V Baert ◽

H Hubert ◽

E Wiel ◽

N Benameur

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Survival Data ◽

Health Concern ◽

Propensity Analysis ◽

Bystander Cardiopulmonary Resuscitation ◽

Bystander Cpr ◽

The Impact ◽

Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a major public health concern in France, given that there are 61.5 cases per 100,000 inhabitants a year. The impact of bystander action, performed before the arrival of emergency medical services (EMS), on survival has never been studied in France. Purpose Determine whether bystander cardiopulmonary resuscitation (CPR), performed before the arrival of EMS, was correlated with an increased 30-day survival rate after an OHCA. Methods 24,885 out-of-hospital cardiac arrests witnessed in France from 1 January 2012 to 1 May 2018 were analysed to determine whether CPR, performed before the arrival of EMS, was correlated with survival. Data from the Electronic Registry of Cardiac Arrests was used. The association between the effect of CPR performed before the arrival of EMS and 30-day survival rate was studied, using propensity analysis (which included variables such as age and sex of the patient, location, cause, and year of cardiac arrest, initial cardiac rhythm, EMS response time and no-flow time). Results CPR was performed before the arrival of EMS in 14,904 cases (59.9%) and was not performed in 9,981 cases (40.1%). The 30-day survival rate was 10.2% when CRP was performed by bystanders versus 3.9% when CRP was not performed before the EMS arrival (p<0.001). CPR performed by bystanders was associated with an increased 30-day survival rate (odds ratio 1.269; 1.207 to 1.334). The effect of bystander CPR on survival Conclusion Bystander CPR performed before the arrival of EMS was associated with an increased 30-day survival rate after an out-of-hospital cardiac arrest in France.

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Association Between Modifiable Prehospital Prognostic Factors on Out-Of-Hospital Cardiac Arrest in Different Age Groups

10.21203/rs.3.rs-102316/v1 ◽

2020 ◽

Author(s):

Jyun-Bin Huang ◽

Kuo-Hsin Lee ◽

Yu-Ni Ho ◽

Ming-Ta Tsai ◽

Wei-Ting Wu ◽

...

Keyword(s):

Cardiac Arrest ◽

Prognostic Factors ◽

Response Time ◽

Age Groups ◽

Kaplan Meier ◽

Bystander Cpr ◽

Underlying Diseases ◽

The Impact ◽

Hospital Cardiac Arrest ◽

External Defibrillator

Abstract Background The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor. While several prehospital factors are known to be associated with improved survival, the impact of prehospital factors on different age groups is unclear. The objective of the study was to access the impact of prehospital factors and pre-existing comorbidities on OHCA outcomes in different age groupsMethods A retrospective observational analysis was conducted using the emergency medical service (EMS) database from January 2015 to December 2019. We collected information on prehospital factors, underlying diseases, and outcome of OHCAs in different age groups. Kaplan-Meier type survival curves and multivariable logistic regression were used to analyze the association between modifiable pre-hospital factors and outcomes. Results A total of 4188 witnessed adult OHCAs were analyzed. For the younger group (age ≦75 years old), after adjustment for confounding factors, EMS response time (odds ratio [OR]=0.860, 95% confidence interval [CI]: 0.811-0.909, p<0.001), public location (OR=1.843, 95% CI: 1.179-1.761, p<0.001), bystander CPR (OR=1.329, 95% CI: 1.007-1.750, p=0.045), attendance by an EMT-Paramedic (OR=1.666, 95% CI: 1.277-2.168, p<0.001), and prehospital defibrillation by automated external defibrillator (AED)(OR=1.666, 95% CI: 1.277-2.168, p<0.001) were prognostic factors for OHCA. For the older group (age >75 years old), age (OR=0.924, CI: 0.880-0.966, p=0.001), EMS response time (OR=0.833, 95% CI: 0.742-0.928, p=0.001), public location (OR=4.290, 95% CI: 2.450-7.343, p<0.001), and attendance by an EMT-Paramedic (OR=2.702, 95% CI: 1.704-4.279, p<0.001) were independent prognostic factors for OHCA.Conclusions There were variations between younger and older OHCA patients. We found that bystander CPR and prehospital defibrillation by AED were independent prognostic factors for younger OHCA patients but not for the older group.

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Outcomes of arrest patients resuscitated in an emergency department: a prospective, observational study

10.22514/sv.2021.219 ◽

2021 ◽

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Life Support ◽

Survival Rates ◽

Secondary Outcome ◽

Time Interval ◽

Trauma Patients ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

In developing countries, a lack of knowledge about basic life support and overcrowded emergency departments (EDs) may cause problems related to the quality of cardiopul-monary resuscitation and postresuscitation care. We aimed to investigate which factors affect the return of spontaneous circulation (ROSC) and survival rates among out-of-hospital and in-hospital arrest patients in an upper-middle income country. The study was prospectively conducted from January 2018 to April 2019. All patients resuscitated in the ED, except trauma patients, were included. The out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) groups were followed up for 30 days. The primary outcome was the 30-day-survival rate, while the secondary outcome was the ROSC rate. A total of 177 patients were included in the study (80 OHCA and 97 IHCA patients). Among the OHCA patients, ROSC was achieved at a rate of 58.8%, and a 30-day survival rate of 12.5% was observed. None of the OHCA patients underwent bystander CPR. One of the main factors affecting survival in this group was the time interval until the patient reached the ED. ROSC was achieved in 54.4% of IHCA patients, while 17.5% of them were alive at 30 days. Patients who survived 30 days were significantly younger than those who died within 30 days (56 (46–74) vs. 73 (64.2–83.7) years, respectively). In the IHCA group, patients with creatinine and potassium levels closer to normal survived for 30 days. Effective and rapid fluid-electrolyte treatments of patients with high lactate and potassium levels may improve the mortality rates of these patients. We think that a focus on improving the quality of the prehospital CPR practice in OHCA patients and increasing the rates of bystander CPR by educating the public can positively contribute to outcomes.

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Abstract 25: Effect of Thrombolytics on the Immediate Prognosis for Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.116.suppl_16.ii_928-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Aurelien Renard ◽

Daniel Jost ◽

Catherine Verret ◽

Frederique Briche ◽

David Fontaine ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Arrest ◽

Response Time ◽

Hospital Admission ◽

Hospital Admissions ◽

Response Times ◽

Randomized Study ◽

Bystander Cpr ◽

The Impact ◽

Hospital Cardiac Arrest

Immediate care of out-of-hospital cardiac arrest (CA) is standardized by the established ILCOR ACLS Guidelines. Studies concerning the impact of thrombolysis, generally for CA of cardiac etiology have not shown a benefit. We sought to evaluate the rate of hospital admission for all CA patients treated with pre-hospital thrombolytics. Methods: Non-randomized retrospective study was conducted from 09/1/2005 to 02/15/2007 of non-traumatic CA patients treated with (T+) or without (T-) thrombolysis. The protocol for administration of thrombolytics was at the discretion of the field physician, aiming for within 20 minutes of collapse in almost all cases, and prior to return of spontaneous circulation. The primary endpoint was admission alive to the hospital. We performed multivariate analysis by logistic regression to identify risk factors independently associated with outcome: age, gender, response time, defibrillation, witnessed arrest, bystander CPR. Results: We reviewed 1331 consecutive patient records, of which 116 (8.7%) received thrombolytics. Both T+ and T- groups had comparable response times, witnessed arrest, and bystander CPR. Patients in T+ were significantly younger (59±14 vs 67±19 years old), predominantly males (81% vs 61%), and received more defibrillation shocks (61% vs 26 %). Significantly more patients T+ arrived alive to hospital for admission (45% vs 24%). Risk factors independently associated with hospital admissions were thrombolysis, age, response time, witnessed arrest, and bystander CPR. The impact of thrombolysis was different whether or not the patient was defibrillated (odds ratio with shocks 1.1 [95%CI: 0.2–5.0] vs without shocks 3.6 [95%CI: 1.9 – 6.9]), despite a greater overall rate of hospital admission for shocked patients. Conclusion: Thrombolysis appears to improve the rate of admission alive to the hospital in patients that were not defibrillated with adjustment for age, gender, response time, witnessed arrest, and bystander CPR. These preliminary results should be confirmed by a prospective randomized study. This analysis can help determine appropriate inclusion criteria for a future study.

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Abstract 252: The Association of Award Recognition From Get With the Guidelines-Resuscitation with Improved Survival Rates in In-Hospital Cardiac Arrest Events

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.252 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Kathie Thomas ◽

Art Miller ◽

Greg Poe

Keyword(s):

Cardiac Arrest ◽

Quality Improvement ◽

Survival Rate ◽

Discharge Rate ◽

Survival Rates ◽

Improvement Program ◽

Award Winning ◽

National Survival ◽

Get With The Guidelines ◽

Hospital Cardiac Arrest

Background and Objectives: It is estimated that over 200,000 adults experience in-hospital cardiac arrest each year. Overall survival to discharge has remained relatively unchanged for decades and survival rates remain at about 20% (Elenbach et al., 2009). Get With The Guidelines-Resuscitation (GWTG-R) is an in-hospital quality improvement program designed to improve adherence to evidence-based care of patients who experience an in-hospital resuscitation event. GWTG-R focuses on four achievement measures. The measures for adult patients include time to first chest compression of less than or equal to one minute, device confirmation of correct endotracheal tube placement, patients with pulseless VF/VT as the initial documented rhythm with a time to first shock of less than or equal to two minutes, and events in which patients were monitored or witnessed at the time of cardiac arrest. The objective of this abstract is to examine the association between hospital adherence to GWTG-R and in-hospital cardiac arrest survival rates. Methods: A retrospective review of adult in-hospital cardiopulmonary arrest (CPA) patients (n=1849) from 21 Michigan, Illinois, and Indiana hospitals using the GWTG-R database was conducted from January 2014 through December 2014. This study included adult CPA patients that did and did not survive to discharge. Results: The review found that hospitals that had attained 84.6% or higher thresholds in all four achievement measures for at least one year, which is award recognition status, had a significantly improved in-hospital CPA survival to discharge rate of 29.6%. Hospitals that did not obtain award status had a CPA survival to discharge rate of 24.3%. The national survival rate for in-hospital adult CPA survival to discharge is 20%. Hospitals that did not achieve award recognition status still demonstrated improvement in survival rate when compared to the national survival rate, indicating the importance of a quality improvement program such as GWTG-R. No significant difference was found between in-hospital adult CPA survival rate and race between GWTG-R award winning and non-award winning hospitals. Hospitals that earned award recognition from GWTG-R had a survival to discharge rate of 30.2% for African Americans and 29.6% for whites. Hospitals that were did not earn award recognition from GWTG-R had a survival to discharge rate of 20.0% for African Americans and 20.1% for whites. Conclusions: Survival of in-hospital adult CPA patients improved significantly when GWTG-R measures are adhered to. Survival of in-hospital adult CPA patients also improves with implementation of GWTG-R. It is crucial that hospitals collect and analyze data regarding resuscitation processes and outcomes. Quality improvement measures can then be implemented in order to assist with improving in-hospital CPA survival rates.

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What Do Adolescents Learn from a 50 Minute Cardiopulmonary Resuscitation/Automated External Defibrillator Education in a Rural Area: A Pre-Post Design

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16061053 ◽

2019 ◽

Vol 16 (6) ◽

pp. 1053

Author(s):

Ming-Fen Tsai ◽

Li-Hsiang Wang ◽

Ming-Shyan Lin ◽

Mei-Yen Chen

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Education Program ◽

Individual Performance ◽

Automated External Defibrillator ◽

Quasi Experimental ◽

Rescue Time ◽

The Impact ◽

Hospital Cardiac Arrest ◽

External Defibrillator

Background: Literature indicates that patients who receive cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) from bystanders have a greater chance of surviving out-of-hospital cardiac arrest (OHCA). A few evaluative studies involving CPR/AED education programs for rural adolescents have been initiated. This study aimed to examine the impact of a 50 min education program that combined CPR with AED training in two rural campuses. Methods: A quasi-experimental pre-post design was used. The 50 min CPR/AED training and individual performance using a Resusci Anne manikin was implemented with seventh grade students between August and December 2018. Results: A total of 336 participants were included in this study. The findings indicated that the 50 min CPR/AED education program significantly improved participant knowledge of emergency responses (p < 0.001), correct actions at home (p < 0.01) and outside (p < 0.001) during an emergency, and willingness to perform CPR if necessary (p < 0.001). Many participants described that “I felt more confident to perform CPR/AED,” and that “It reduces my anxiety and saves the valuable rescue time.” Conclusions: The brief education program significantly improved the immediate knowledge of cardiac emergency in participants and empowered them to act as first responders when they witnessed someone experiencing a cardiac arrest. Further studies should consider the study design and explore the effectiveness of such brief programs.

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THE EFFECT OF NORADRENALINE ON THE SURVIVAL OF RATS SUBJECTED TO HEMORRHAGIC SHOCK

Canadian Journal of Biochemistry and Physiology ◽

10.1139/o57-012 ◽

1957 ◽

Vol 35 (1) ◽

pp. 93-101 ◽

Cited By ~ 5

Author(s):

A. M. Lansing ◽

J. A. F. Stevenson ◽

C. W. Gowdey

Keyword(s):

Survival Rate ◽

Hemorrhagic Shock ◽

Survival Time ◽

Intravenous Infusion ◽

Survival Rates ◽

Distilled Water ◽

Sprague Dawley ◽

Chi Square ◽

Sprague Dawley Rats ◽

Chi Square Test

Reports of the efficacy of l-noradrenaline in the treatment of clinical shock stimulated an investigation of its effect in controlled hemorrhagic hypotension. Seventy-three 350-g. male Sprague–Dawley rats were subjected to a standardized hemorrhagic shock procedure. Of 15 control animals that received no treatment, only one survived for 48 hours; none survived of the five controls that received a constant intravenous infusion, after the shock procedure, of 5% glucose in distilled water until death or for 36 hours. The treated animals received, after the shock procedure, an infusion of l-noradrenaline (0.5–2.0 μg./min.) in 5% glucose in distilled water. The survival rates for the treated animals were: treatment for 1 hour, 1/8; treatment for 4 hours, 4/15; treatment until death or for 36 hours, 8/15. Fifteen animals received, in addition to noradrenaline for 36 hours, hydrocortisone administered intravenously (0.7 μg./min.) or intramuscularly (2.5 mg. every 6 hours); seven of these animals survived.Analysis of variance showed that there was no difference in the shock procedure undergone by the controls and by the treated survivors. The Chi square test on the survival rates revealed that the infusion of noradrenaline for 1 hour or 4 hours did not improve survival, but infusion for 36 hours produced a very significant increase in survival time and in total survival rate. The addition of hydrocortisone neither enhanced nor impaired this improvement.

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Impact of obesity upon the survival of cholangiocarcinoma patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.288 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 288-288

Author(s):

Phani Keerthi Surapaneni ◽

Zhuo Li ◽

Lalitha Padmanabha Vemireddy ◽

Pashtoon Murtaza Kasi ◽

Jason Scott Starr ◽

...

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Survival Rates ◽

Tumor Location ◽

Normal Weight ◽

Categorical Variables ◽

Overall Survival Rate ◽

Exact Test ◽

Significant Difference ◽

The Impact

288 Background: Obesity is a risk factor for developing cholangiocarcinoma (CCA). However, the effect of obesity on survival of CCA is unclear. The primary aim of this study was to analyze the impact of obesity upon overall survival of CCA patients. Secondary aims were to analyze impact of obesity upon other disease characteristics such as tumor site, stage, age, sex, BMI and Ca 19-9. Methods: A total of 411 unique pts diagnosed with CCA at Mayo Clinic Florida between 2000 and 2018 were retrieved from our collective SDMS database. Variables evaluated included:demographics, Body Mass Index (BMI), AJCC stage, tumor location and Ca 19-9.A total of 185 pts had all data available pertaining to these variables. We further restricted the analysis to pts with intrahepatic CCA classified BMI as per CDC criteria normal (18.5-25kg/m2), overweight (25-29.9kg/m2) and obese (≥30 kg/m2), thus leaving a total of 152 pts. Continuous and categorical variables were compared across BMI groups using Chi-squared or Fisher’s exact test. Overall survival rates after diagnosis at 1, 2 and 3 years were estimated using Kaplan-Meier method. Results: Among 152 pts included in the study, 28% were normal weight, 40% were overweight and 32% were obese. The overall survival rate at 1, 2 and 3 years for normal weight pts with all stages combined was 54.1%, 35%, and 30.7%, respectively. The overall survival rate at 1, 2 and 3 years for overweight pts with all stages combined was 59.7 %, 32.6%, and 25.4%, respectively. The overall survival rate at 1, 2 and 3 years for obese pts with all stages combined was 63.9%, 37.6%, and 26.7%, respectively(p = 0.8766). Multivariate analysis demonstrated is no significant difference in overall survival for obese pts compared to normal or overweight pts.(Table to be shown) However it showed, gender and Ca19-9 were statistically significant predictors of overall survival, with males and pts with Ca19-9≥100 doing worse (HR1.65 (CI = 1.05, 2.61, p = 0.031) and HR 2.31 (CI = 1.49, 3.59, p = < 0.01), respectively). Conclusions: BMI did not make a significant impact on the overall survival, though there may be a trend toward worse OS for ptswith higher BMI. A larger, stage focused evaluation is warranted for further exploration of this trend.

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Sentinel lymph node in colorectal cancer — 5 years follow up

Open Medicine ◽

10.2478/s11536-011-0020-6 ◽

2011 ◽

Vol 6 (3) ◽

pp. 271-278

Author(s):

Jacek Zielinski ◽

Radoslaw Jaworski ◽

Pawel Kabata ◽

Robert Rzepko ◽

Wiesław Kruszewski ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Histopathological Examination ◽

Survival Rates ◽

Surgical Oncology ◽

Blue Dye ◽

Chi Square ◽

Regional Lymph Nodes ◽

Term Survival ◽

The Impact

AbstractTo assess the impact of micrometastases in sentinel and non-sentinel lymph nodes on long-term survival rates of patients treated for colorectal cancer (CRC). Data of 57 patients diagnosed with CRC and treated in the Department of Surgical Oncology in Gdansk in the years 2002–2006 were retrospectively analyzed. Clinico-histopathological data were analyzed using chi-square tests. The effect on long-time survival rates was analyzed using Kaplan-Meier survival probability estimates. Identification of the SLN was performed using the blue dye staining method. All regional lymph nodes were subject to standard histopathological examination. Additionally in 32(56.14%) patients whose nodes were found negative for metastases on standard staining further immunohistochemical analyses were performed. In the analyzed group SLNB was performed in 42(73.7%) patients with colon cancer and in 15(26.3%) with rectal cancer. Identification of the SLN was possible in 45(78.9%) patients. The sensitivity of SLNB was 33%. False negatives were found in 66%. SLNB is a feasible method in CRC patients. We presume that lack of micrometastases in the SLN and non-SLN cannot be regarded as a prognostic factor.

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