scholarly journals The effect of video-instructed versus audio-instructed dispatcher-assisted cardiopulmonary resuscitation on patient outcomes following out of hospital cardiac arrest in Seoul

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hee Soon Lee ◽  
Kicheol You ◽  
Jin Pyeong Jeon ◽  
Chulho Kim ◽  
Sungeun Kim
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Elderly Patients ◽  
Discharge Rate ◽  
Neurologic Outcome ◽  
Binary Logistic Regression Analysis ◽  
Video Instruction ◽  
Neurologic Recovery ◽  
Metropolitan City ◽  
Hospital Cardiac Arrest

AbstractWe aimed to investigate whether video-instructed dispatcher-assisted (DA)-cardiopulmonary resuscitation (CPR) improved neurologic recovery and survival to discharge compared to audio-instructed DA-CPR in adult out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city with sufficient experience and facilities. A retrospective cohort study was conducted for adult bystander-witnessed OHCA patients administered DA-CPR due to presumed cardiac etiology between January 1, 2018 and October 31, 2019 in Seoul, Korea. The primary and secondary outcomes were the differences in favorable neurologic outcome and survival to discharge rates in adult OHCA patients in the two instruction groups. Binary logistic regression analysis was performed to identify the outcome predictors after DA-CPR. A total of 2109 adult OHCA patients with DA-CPR were enrolled. Numbers of elderly patients in audio instruction and video instruction were 1260 (73.2%) and 214 (55.3%), respectively. Elderly patients and those outside the home or medical facility were more likely to receive video instruction. Favorable neurologic outcome was observed more in patients who received video-instructed DA-CPR (n = 75, 19.4%) than in patients who received audio-instructed DA-CPR (n = 117, 6.8%). The survival to discharge rate was also higher in video-instructed DA-CPR (n = 105, 27.1%) than in audio-instructed DA-CPR (n = 211, 12.3%). Video-instructed DA-CPR was significantly associated with neurologic recovery (aOR = 2.11, 95% CI 1.48–3.01) and survival to discharge (aOR = 1.81, 95% CI 1.33–2.46) compared to audio-instructed DA-CPR in adult OHCA patients after adjusting for age, gender, underlying diseases and CPR location. Video-instructed DA-CPR was associated with favorable outcomes in adult patients with OHCA in a metropolitan city equipped with sufficient experience and facilities.

scholarly journals Retrospective analysis of video-instructed dispatcher-assisted cardiopulmonary resuscitation in Seoul, a metropolitan city

2021 ◽  
Author(s):  
Hee Soon Lee ◽  
Kicheol You ◽  
Jin Pyeong Jeon ◽  
Chulho Kim ◽  
Sungeun Kim
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Discharge Rate ◽  
Binary Logistic Regression ◽  
Neurologic Outcome ◽  
Binary Logistic Regression Analysis ◽  
Neurologic Recovery ◽  
Metropolitan City ◽  
Discharge Rates ◽  
Video And Audio ◽  
To Receive

Abstract We aimed to investigate whether video-instructed dispatcher-assisted (DA)-cardiopulmonary resuscitation (CPR) improved neurologic recovery and survival to discharge compared to audio-instructed DA-CPR in adult out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city with sufficient experience and facilities. A retrospective cohort study was conducted for adult bystander-witnessed OHCA patients administered DA-CPR due to presumed cardiac etiology between January 2018 and October 2019 in Seoul, Korea. The primary and secondary outcomes were the differences in favorable neurologic outcome and survival to discharge rates in adult OHCA patients in the two instruction groups. Binary logistic regression analysis was performed to identify the outcome predictors after DA-CPR. A total of 2109 adult OHCA patients with DA-CPR were enrolled. The number of video and audio instructed DA-CPR procedures was 387 (18.3%) and 1722 (81.7%), respectively. Elderly patients and those outside the home or medical facility were more likely to receive video instruction. Favorable neurologic outcome was observed more in patients who received video-instructed DA-CPR (n = 75, 19.4%) than in patients who received audio-instructed DA-CPR (n = 117, 6.8%). The survival to discharge rate was also higher in video-instructed DA-CPR (n = 105, 27.1%) than in audio-instructed DA-CPR (n = 211, 12.3%). Video-instructed DA-CPR was significantly associated with neurologic recovery (aOR = 2.11, 95% CI: 1.48–3.01) and survival to discharge (aOR = 1.81, 95% CI: 1.33–2.46) compared to audio-instructed DA-CPR in adult OHCA patients. Video-instructed DA-CPR was associated with favorable outcomes in adult patients with OHCA in a metropolitan city equipped with sufficient experience and facilities.

scholarly journals Promising candidates for extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yo Sep Shin ◽  
Youn-Jung Kim ◽  
Seung Mok Ryoo ◽  
Chang Hwan Sohn ◽  
Shin Ahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurologic Status ◽  
Good Neurologic Outcome ◽  
Hospital Stays ◽  
Hospital Cardiac Arrest

AbstractPrecise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether adopting our hypothesized criteria for ECPR to patients with refractory OHCA could benefit. This before-after study compared 4.5 years after implementation of ECPR for refractory OHCA patients who met our criteria (Jan, 2015 to May, 2019) and 4 years of undergoing conventional CPR (CCPR) prior to ECPR with patients who met the criteria (Jan, 2011 to Jan, 2014) in the emergency department. The primary and secondary outcomes were good neurologic outcome at 6-months and 1-month respectively, defined as 1 or 2 on the Cerebral Performance Category score. A total of 70 patients (40 with CCPR and 30 with ECPR) were included. For a good neurologic status at 6-months and 1-month, patients with ECPR (33.3%, 26.7%) were superior to those with CCPR (5.0%, 5.0%) (all Ps < 0.05). Among patients with ECPR, a group with a good neurologic status showed shorter low-flow time, longer extracorporeal membrane oxygenation duration and hospital stays, and lower epinephrine doses used (all Ps < 0.05). The application of the detailed indication before initiating ECPR appears to increase a good neurologic outcome rate.

scholarly journals Association between prehospital airway management methods and neurologic outcome in out-of-hospital cardiac arrest with respiratory cause: a nationwide retrospective observational study

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Interaction Analysis ◽  
Neurologic Outcome ◽  
Supraglottic Airway ◽  
Neurologic Recovery ◽  
Logistic Regression Models ◽  
Advanced Airway ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

Cardiac arrests are resulted by various aetiology including respiratory cause. Advanced airway placement is an important prehospital intervention for oxygenation and ventilation in respiratory cardiac arrest. We evaluated the association between of advanced airway method and neurologic outcome in arrest with respiratory cause. Adult witnessed non-traumatic OHCA (out-of-hospital cardiac arrest) treated by emergency medical service (EMS) providers in 2013–2017 were enrolled in a nationwide OHCA database. The association between airway management methods (endotracheal intubation (ETI), supraglottic airway (SGA) and bag valve mask (BVM)) and outcome were evaluated according to the presumed cause of cardiac arrest (cardiac, respiratory or others). The primary outcome was good neurological recovery at discharge. Multivariable logistic regression models with interaction analysis was conducted. Of 40,443 eligible OHCA patients, the cause of arrest of 90.0%, 7.5%, and 2.4% of patients were categorized as cardiac, respiratory and others, respectively. There were no statistically significant differences in the effect of the advanced airway type on good neurologic recovery in the total population (adjusted odds ratio (aOR) 0.96 (0.81–1.14) for ETI; 1.01 (95% confidence intervals (CI) 0.93–1.11) for BVM). However, ETI was associated with better neurologic recovery than SGA or BVM in OHCA in cardiac arrest with suspected respiratory cause (aOR 3.12 (95% CI 1.24–7.80) for ETI; 0.99 (95% CI 0.51–1.91) for BVM). Prehospital ETI was associated with good neurologic outcome when the cause of arrest was respiratory. ETI may be considered initially when a respiratory cause is suspected on the scene.

Abstract 146: Neurological Prognostication by Gender in Patients with Out-of-Hospital Cardiac Arrest Receiving Hypothermia Treatment

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Min Jung Kim ◽  
Sang Do Shin ◽  
William McClellan ◽  
Bryan McNally
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Rhythm ◽  
Age Groups ◽  
Patient Characteristics ◽  
Neurologic Outcome ◽  
Neurologic Recovery ◽  
Hypothermia Treatment ◽  
Shockable Rhythm ◽  
Gender And Age ◽  
Hospital Cardiac Arrest

Objectives: This study aimed to to examine whether neurologic recovery of out-of-hospital cardiac arrest patients receiving hypothermia treatment is enhanced for women of childbearing age. Methods: A cross-sectional analysis was conducted using a nationwide surveillance database in Korea of out-of-hospital cardiac arrest (OHCA) that occurred between 2008 and 2012. The exposure and outcomes studied were hypothermia treatment and neurologic outcome at discharge. Patient characteristics between hypothermia-treated and non-treated groups were compared. Multivariate logistic regression was used to account for the patient characteristics. The association was examined for each stratum of gender, age (<45, 45-65, and >65 years old), and initial cardiac rhythm. Cardiac rhythms were considered in two different categorizations: 1) shockable/non-shockable rhythm, and 2) VF.VT/PEA/asystole. Results: Crude analysis showed that women of childbearing ages treated with hypothermia had enhanced neurologic recovery than older aged women and all men. After adjusted, men had stronger association between hypothermia and good neurologic recovery than women. The highest association was found in men who are under 45 years of age and have shockable cardiac rhythm (OR=2.00 (1.26, 3.19)). The association between hypothermia and neurologic recovery was not statistically significant in all women. The magnitude of association decreased with age. Shockable rhythm was associated with better neurologic recovery than non-shockable rhythms in all gender and age groups. Using VF.VT/PEA/asystole categorization of cardiac rhythms, men consistently showed higher ORs than women. In all gender and age groups, having PEA rhythm was associated with better neurologic outcome than shockable rhythms (VF/VT) or asystole. Conclusion: The unadjusted association between hypothermia and neurologic recovery was the strongest in women of childbearing ages. After adjustment, men had a better neurologic outcome than women across all ages. Shockable rhythms were associated with enhanced neurologic recovery. Our results suggest that among OHCA patients, the effect of hypothermia treatment on neurologic recovery is greater for men, young ages, and having shockable cardiac rhythm.

scholarly journals Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Out-of-Hospital Cardiac Arrest due to Pulseless Ventricular Tachycardia/Fibrillation

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Konstantinos Dean Boudoulas ◽  
Bryan A. Whitson ◽  
David P. Keseg ◽  
Scott Lilly ◽  
Cindy Baker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Tachycardia ◽  
Cardiopulmonary Resuscitation ◽  
Medical Center ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurologic Recovery ◽  
Cardiac Catheterization Laboratory ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Background. Survival rates for out-of-hospital cardiac arrest are very low and neurologic recovery is poor. Innovative strategies have been developed to improve outcomes. A collaborative extracorporeal cardiopulmonary resuscitation (ECPR) program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire. Methods. From August 15, 2017, to June 1, 2019, there were 86 patients that were evaluated in the field for cardiac arrest in which 42 (49%) had refractory pulseless VT and/or VF resulting from different underlying pathologies and were placed on an automated cardiopulmonary resuscitation device; from these 42 patients, 16 (38%) met final inclusion criteria for ECPR and were placed on extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL). Results. From the 16 patients who underwent ECPR, 4 (25%) survived to hospital discharge with cerebral perfusion category 1 or 2. Survivors tended to be younger (48.0 ± 16.7 vs. 59.3 ± 12.7 years); however, this difference was not statistically significant (p=0.28) likely due to a small number of patients. Overall, 38% of patients underwent percutaneous coronary intervention (PCI). No significant difference was found between survivors and nonsurvivors in emergency medical services dispatch to CCL arrival time, lactate in CCL, coronary artery disease severity, undergoing PCI, and pre-ECMO PaO2, pH, and hemoglobin. Recovery was seen in different underlying pathologies. Conclusion. ECPR for out-of-hospital refractory VT/VF cardiac arrest demonstrated encouraging outcomes. Younger patients may have a greater chance of survival, perhaps the need to be more aggressive in this subgroup of patients.

scholarly journals How effective is hypothermia for neuroprotection in adults after cardiopulmonary resuscitation?

2010 ◽  
Vol 8 (1) ◽  
Author(s):  
Stephen Burgess
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Therapeutic Hypothermia ◽  
Neurologic Outcome ◽  
Independent Life ◽  
Resuscitated Patients ◽  
Conventional Cooling ◽  
Hospital Cardiac Arrest ◽  
Cooling Methods

After cardiopulmonary resuscitation, about one tenth to a third of successfully resuscitated patients leave hospital to live an independent life again. This review shows that therapeutic hypothermia with conventional cooling methods improves neurologic outcome and survival of patients successfully resuscitated after in-hospital and out-of-hospital cardiac arrest.

scholarly journals Prehospital Advanced Cardiac Life Support with a Smartphone-Based Direct Medical Oversight in a Metropolitan City, Korea

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Neurological Outcome ◽  
Life Support ◽  
Advanced Life Support ◽  
Neurologic Outcome ◽  
Good Neurological Outcome ◽  
Metropolitan City ◽  
Hospital Cardiac Arrest

Out-of-hospital cardiac arrest is considered an important health care problem because it causes family breakdown and enormous social loss due to sudden death. Despite the efforts of many medical policymakers, paramedics, and doctors, the survival rate after cardiac arrest is only marginally increasing. Objective: This study aimed to determine whether advanced life support (ALS) under physician’s direct medical oversight during an emergency through video call on smartphones was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes on the "Smart Advanced Life Support (SALS)" pilot project. Methods: This study was conducted using a "Before-After" controlled trial. The OHCA patients were divided into two periods in a metropolitan city. The basic life support (BLS group) and ALS using video calls on smartphones (SALS group) were performed in the 'Before' and 'After' phases in 2014 and 2015, respectively. The OHCA patients over 18 years of age were included in this study. On the other hand, the patients with trauma, poisoning, and family’s unwillingness, as well as those who received no resuscitation were excluded from the study. The primary and secondary outcomes were survival to discharge and a good neurological outcome (cerebral performance category [CPC] 1-2), respectively. A propensity score matching was conducted to equalize potential prognostic factors in both groups. The adjusted odds ratio (OR) and 95% confidence interval (95% CI) were calculated for survival to discharge and good neurological outcome. Results: In total, 235 and 198 OHCA patients were enrolled in the BLS and the SALS groups, respectively. The outcomes were better in the SALS group, compared to the BLS group regarding the survival to discharge (9.8% vs. 6.8%, P<0.001) and good neurological outcome (6.6% vs. 4.0%, P<0.001), respectively. Regarding propensity score matching, 304 cases were randomly assigned to the SALS and BLS groups. The survivals to discharge rates after matching were 9.2% and 7.2% in the SALS and the BLS groups, respectively (P=0.06). Furthermore, the good neurological outcome rate was 5.9% in the SALS group versus 3.9% in the BLS group (p=0.008). The adjusted ORs of the SALS group were estimated at 1.33 (95% CI: 1.00-1.77) for survival to discharge and 1.73 (95% CI: 1.19-2.53) for the good neurologic outcome, compared to those in the BLS group. Conclusion: An emergency medical system intervention using the SALS protocol was associated with a significant increase in prehospital ROSC and improved survival and neurologic outcome after OHCA.

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