Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system

ABSTRACT Objectives: Previous studies have shown a low but meaningful survival rate in cases of prehospital cardiac arrest with an initial rhythm of asystole. There may be, however, an identifiable subgroup in which resuscitation efforts are futile. This study identified potential field criteria for predicting 100% nonsurvival when the presenting rhythm is asystole in a Basic Life Support-Defibrillation (BLS-D) system. Methods: This prospective cohort study, a component of Phases I and II of the Ontario Prehospital Advanced Life Support (OPALS) Study, was conducted in 21 Ontario communities with BLS-D level of care, and included all adult arrests of presumed cardiac etiology according to the Utstein Style Guidelines. Analyses included descriptive and appropriate univariate tests, as well as multivariate stepwise logistic regression to determine predictors of survival. Results: From 1991 to 1997, 9899 consecutive cardiac arrest cases with the following characteristics: male (67.2%), bystander-witnessed (44.7%), bystander CPR (14.2%), call–response interval (CRI) ≤ 8 minutes (82%) and overall survival (4.3%) were enrolled. Of 9529 cases with available rhythm strip recordings, initial arrest rhythms were asystole in 40.8%, pulseless electrical activity in 21.2% and ventricular fibrillation or ventricular tachycardia in 38%. Of 3888 asystolic patients, 9 (0.2%) survived to discharge; 3 of these cases were unwitnessed arrests with no bystander CPR. There were no survivors if the CRI exceeded 8 minutes. Logistic regression analysis demonstrated that independent predictors of survival to admission were “CRI in minutes” (odds ratio [OR] = 0.87; 95% confidence interval [CI], 0.77–0.98) and “bystander-witnessed” (OR = 2.6; 95% CI, 1.5–4.4). Conclusions: In a BLS-D system, there is a very low but measurable survival rate for prehospital asystolic cardiac arrest. CRIs of over 8 minutes were associated with 100% nonsurvival, whereas unwitnessed arrests with no bystander CPR were not. These data add to the growing literature that will help guide ethical decision-making for protocol development in emergency medical services systems.

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Resuscitation on the field: basic and advanced life support and automatic external defibrillators

The ESC Textbook of Sports Cardiology ◽

10.1093/med/9780198779742.003.0044 ◽

2019 ◽

pp. 403-410

Author(s):

Mark S. Link ◽

Mark Estes III

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Basic Life Support ◽

Life Support ◽

Action Plan ◽

Advanced Life Support ◽

Advanced Cardiac Life Support ◽

Screening Strategy ◽

Automated External Defibrillators ◽

Playing Field

Resuscitation on the playing field is at least as important as screening in the prevention of death. Even if a screening strategy is largely effective, individuals will suffer sudden cardiac arrests. Timely recognition of a cardiac arrest with rapid implementation of cardiopulmonary resuscitation (CPR) and deployment and use of automated external defibrillators (AEDs) will save lives. Basic life support, including CPR and AED use, should be a requirement for all those involved in sports, including athletes. An emergency action plan is important in order to render advanced cardiac life support and arrange for transport to medical centres.

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Life-threatening emergencies

Oxford Handbook of Emergency Medicine ◽

10.1093/med/9780199589562.003.0002 ◽

2012 ◽

pp. 40-61

Author(s):

Jonathan P. Wyatt ◽

Robin N. Illingworth ◽

Colin A. Graham ◽

Kerstin Hogg ◽

Michael J. Clancy ◽

...

Keyword(s):

Cardiac Arrest ◽

Basic Life Support ◽

Life Support ◽

Central Venous Access ◽

Treatment Algorithm ◽

Advanced Life Support ◽

Venous Access ◽

Central Venous ◽

Life Threatening

Anaphylaxis 42 Treatment algorithm for adults with anaphylaxis 44 Choking 45 Cardiac arrest 46 In-hospital resuscitation algorithm 47 Adult basic life support 48 Cardiac arrest management 50 Advanced life support algorithm 52 Notes on using the advanced life support algorithm 53 Post-resuscitation care 54 Central venous access ...

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2019 American Heart Association Focused Update on Pediatric Basic Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Circulation ◽

10.1161/cir.0000000000000736 ◽

2019 ◽

Vol 140 (24) ◽

Author(s):

Jonathan P. Duff ◽

Alexis A. Topjian ◽

Marc D. Berg ◽

Melissa Chan ◽

Sarah E. Haskell ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

American Heart Association ◽

Basic Life Support ◽

Life Support ◽

American Heart ◽

Heart Association ◽

Liaison Committee ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation’s continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress.

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Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest

Emergency Medicine Journal ◽

10.1136/emermed-2018-207833 ◽

2019 ◽

Vol 36 (8) ◽

pp. 479-484 ◽

Cited By ~ 5

Author(s):

Mark H Ebell ◽

Akke Vellinga ◽

Siobhan Masterson ◽

Phillip Yun

Keyword(s):

Cardiac Arrest ◽

Basic Life Support ◽

Life Support ◽

Meta Analysis ◽

Advanced Life Support ◽

Study Quality ◽

European Resuscitation Council ◽

Comprehensive Search ◽

Hospital Cardiac Arrest ◽

Low Rate

BackgroundOur objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA).MethodsWe performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R.ResultsWe identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%).ConclusionsThe BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.

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Сardiopulmonary and cerebral resuscitation: new European Resuscitation Council Guidelines for resuscitation 2021

EMERGENCY MEDICINE ◽

10.22141/2224-0586.17.8.2021.245567 ◽

2021 ◽

Vol 17 (8) ◽

pp. 6-19

Author(s):

L.V. Usenko ◽

А.V. Tsarev ◽

Yu.Yu. Kobelatsky

Keyword(s):

Cardiac Arrest ◽

Healthcare Workers ◽

Basic Life Support ◽

Life Support ◽

Extracorporeal Life Support ◽

Advanced Life Support ◽

European Resuscitation Council ◽

Improved Outcomes ◽

Electrical Defibrillation

The article presents the current changes in the algorithm of cardiopulmonary and cerebral resuscitation (CPCR), adopted by the European Council for Resuscitation in 2021. The article presents the principles of basic life support and advanced life support, inclu-ding taking into account the European recommendations published in 2020, dedicated to the specifics of CPCR in the context of the COVID-19 pandemic. The main focus of CPCR in the COVID-19 pandemic is that the safety of healthcare workers should never be compromised, based on the premise that the time it takes to ensure that care is delivered safely to rescuers is acceptable part of the CPCR process. The principles of electrical defibrillation, including in patients with coronavirus disease who are in the prone position, pharmacological support of CPCR, modern monitoring capabilities for assessing the quality of resuscitation measures and identifying potentially reversible causes of cardiac arrest, the use of extracorporeal life support techno-logies during CPR are highlighted. The modern principles of intensive care of the post-resuscitation syndrome are presented, which makes it possible to provide improved outcomes in patients after cardiac arrest.

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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.

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Abstract 19542: A North American Survey of Public Opinion on the Acceptability of Crowdsourcing Basic Life Support for Out-of-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.132.suppl_3.19542 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Katie N Dainty ◽

Steven Brooks

Keyword(s):

Cardiac Arrest ◽

North American ◽

Basic Life Support ◽

Life Support ◽

Public Access ◽

The North ◽

The Usa ◽

Bystander Cpr ◽

Use Of Social Media ◽

Hospital Cardiac Arrest

Introduction: Performance of bystander CPR and early defibrillation following out-of-hospital cardiac arrest (OHCA) have been shown to increase the odds of survival to hospital discharge more than 3-fold. The PulsePoint Respond™ Application (App) is a novel system that can be implemented by EMS to crowdsource basic life support for victims of OHCA. The system sends cardiac arrest notifications to a user’s mobile device which includes the location of the emergency and nearby public access defibrillators to facilitate bystander CPR and AED use while EMS personnel are en route. We conducted a North American survey to evaluate public perceptions of such an application, including acceptability and willingness to respond to alerts. Methods: The web-based survey was conducted in Canada and the USA by an established external polling vendor, Ipsos Reid. Sampling was designed to ensure broad representation of gender, age, geography, and spoken language following recent census statistics. Respondents were presented with a short concept description of cardiac arrest and the Pulsepoint app in text format followed by 6 closed-ended and 4 open-ended questions. Results: A random sample of 2,415 total surveys were collected (1106 from Canada and 1309 from the US). 70% of Canadian respondents but only 47% of US respondents had been trained in CPR at some point. On average, 79.5% of respondents agreed that Pulsepoint is something they would like to see in their community and 59.5% said they would download the App. 80% of Canadians and 77% of Americans were comfortable with receiving help in a public setting (street, office, etc) and 72 and 68% respectively, indicated they would be comfortable with receiving help in a private setting (home). Less than 40% of respondents identified concerns; as expected those identified included training concerns and trust issues. An average of 89% of the sample from both countries felt it was important that responders have up-to-date CPR certification. Conclusions: Overall, the North American public find the concept of the Pulsepoint application and crowdsourcing basic life support for OHCA acceptable and would be willing to respond. This is encouraging insight to support the use of social media to increasing bystander CPR rates in North America.

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The Role of Bystander-initiated Basic Life Support in Sports-related Sudden Cardiac Arrest: A Systematic Review

Inquiry@Queen's Undergraduate Research Conference Proceedings ◽

10.24908/iqurcp.14582 ◽

2021 ◽

Author(s):

Braeden Hill ◽

Nicholas Grubic ◽

Dermot M. Phelan ◽

Aaron L. Baggish ◽

Paul Dorian ◽

...

Keyword(s):

Cardiac Arrest ◽

Full Text ◽

Basic Life Support ◽

Life Support ◽

Sudden Cardiac Arrest ◽

Survival Outcomes ◽

Full Text Review ◽

Bystander Cpr ◽

Median Rate

Background: Sudden cardiac arrest is the leading medical cause of death amongst athletes and a common cause of death during exercise. The provision of cardiopulmonary resuscitation (CPR) and automatic external defibrillator (AED) use by bystanders can greatly improve survival outcomes in sudden cardiac arrest. However, the effectiveness of these interventions within exertional settings requires further investigation. Objective: To evaluate the role of bystander-initiated CPR and AED use on survival outcomes amongst sports-related sudden cardiac arrest (SrSCA). Methods: Several databases and grey literature sources were queried from inception until November 2020 using a comprehensive search strategy. Abstract screening, full-text review, and data extraction of eligible studies were conducted independently by two reviewers. SrSCA was defined as a cardiac arrest which occurred during (or within 1-hour of) physical activity, sport, or exercise. Bystander CPR and AED rates, as well as appropriate survival outcomes, were extracted from each study, and overall summary measures were calculated. Results: A total of 2,850 unique records were identified, with 176 articles selected for full-text review, of which 32 studies were included in this review. The median rate of bystander CPR and AED use was 75% and 24%, respectively. Survival to hospital discharge ranged from 11%-93%, with a median rate of 33%. Conclusions: Majority of SrSCAs received bystander CPR and achieved a high rate of survival to hospital discharge, yet AED use was low. These findings encourage layperson education in basic life support, the availability of AEDs in athletic facilities, and emergency action plans to ensure timely resuscitation.

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Association of school hours with outcomes of out-of-hospital cardiac arrest in schoolchildren

Heart Asia ◽

10.1136/heartasia-2019-011236 ◽

2019 ◽

Vol 11 (2) ◽

pp. e011236

Author(s):

Akira Yamashita ◽

Hisanori Kurosaki ◽

Kohei Takada ◽

Yoshio Tanaka ◽

Yoshitaka Hamada ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Survival Rate ◽

Public Access ◽

Stepwise Logistic Regression ◽

Stepwise Logistic Regression Analysis ◽

Bystander Cardiopulmonary Resuscitation ◽

Initial Rhythm ◽

Major Factors ◽

Hospital Cardiac Arrest

ObjectiveTo investigate the association of school hours with outcomes of schoolchildren with out-of-hospital cardiac arrest (OHCA).MethodsFrom the 2005–2014 nationwide databases, we extracted the data for 1660 schoolchildren (6–17 years) with bystander-witnessed OHCA. Univariate analyses followed by propensity-matching procedures and stepwise logistic regression analyses were applied. School hours were defined as 08:00 to 18:00.ResultsThe neurologically favourable 1-month survival rate during school hours was better than that during non-school hours only on school days: 18.4% and 10.5%, respectively. During school hours on school days, patients with OHCA more frequently received bystander cardiopulmonary resuscitation (CPR) and public access defibrillation (PAD), and had a shockable initial rhythm and presumed cardiac aetiology. The neurologically favourable 1-month survival rate did not significantly differ between school hours on school days and all other times of day after propensity score matching: 16.4% vs 16.1% (unadjusted OR 1.02; 95% CI 0.69 to 1.51). Stepwise logistic regression analysis during school hours on school days revealed that shockable initial rhythm (adjusted OR 2.44; 95% CI 1.12 to 5.42), PAD (adjusted OR 3.32; 95% CI 1.23 to 9.10), non-exogenous causes (adjusted OR 5.88; 95% CI 1.85 to 20.0) and a shorter emergency medical service (EMS) response time (adjusted OR 1.15; 95% CI 1.02 to 1.32) and witness-to-first CPR interval (adjusted OR 1.08; 95% CI 1.01 to 1.15) were major factors associated with an improved neurologically favourable 1-month survival rate.ConclusionsSchool hours are not an independent factor associated with improved outcomes of OHCA in schoolchildren. The time delays in CPR and EMS arrival were independently associated with poor outcomes during school hours on school days.

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Factors Associated with High-Quality Cardiopulmonary Resuscitation Performed by Bystander

Emergency Medicine International ◽

10.1155/2020/8356201 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Hye Ji Park ◽

Won Jung Jeong ◽

Hyung Jun Moon ◽

Gi Woon Kim ◽

Jin Seong Cho ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Age Groups ◽

Sudden Cardiac Arrest ◽

Advanced Life Support ◽

Fold Increase ◽

High Quality ◽

Neurological Outcomes ◽

Bystander Cpr ◽

Cpr Quality

Bystander cardiopulmonary dresuscitation (CPR) improves the survival and neurological outcomes of sudden cardiac arrest patients. The rate of bystander CPR is increasing; however, its performance quality has not been evaluated in detail. In this study, emergency medical technicians (EMTs) in the field evaluated bystander CPR quality, and we aimed to investigate the association between bystander information and CPR quality. This retrospective cohort study was based on data included in the Smart Advanced Life Support (SALS) registry between January 2016 and December 2017. We included patients older than 18 years who experienced an out-of-hospital cardiac arrest (OHCA) due to medical causes. Bystander CPR quality was judged to be “high” when the hand positions were appropriate and when compression rates of at least 100/min and compression depths of at least 5 cm were achieved. Among 6,769 eligible patients, 3,799 (58.7%) received bystander CPR, and 6% of bystanders performed high-quality CPR. After adjustment, the occurrence of cardiac arrest at home (adjusted odds ratio (aOR), 95% confidence interval (CI); 0.42, 0.27–0.64), witnessed cardiac arrest (1.45, 1.03–2.06), and younger bystander age all showed associations with one another. High-quality CPR led to a 4.29-fold increase in the chance of neurological recovery. In particular, high-quality CPR in patients aged 60 years showed a significant association compared with other age groups (7.61, 1.41–41.04). The main factor affecting CPR quality in this study was the age of the bystander, and older bystanders found it more difficult to maintain CPR quality. To improve the quality of bystander CPR, training among older bystanders should be the focus.

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