Impact of Ambulance Crew Configuration on Simulated Cardiac Arrest Resuscitation

Introduction The concept of the chain of survival is widely accepted. The four links viz. early access, early cardiopulmonary resuscitation (CPR), early defibrillation and early Advanced Cardiac Life Support (ACLS) are related to survival after pre-hospital cardiac arrest. Owing to the dismal survival-to-discharge figures locally, we conducted this study to identify any weaknesses in the chain, looking in particular at bystander CPR rates and times to Basic Cardiac Life Support (BCLS) and ACLS. Methods and materials A retrospective cohort study was conducted in the Emergency Department of an urban tertiary 1500-bed hospital. Over a 12-month period, all cases of non-trauma out-of-hospital cardiac arrest were evaluated. Results A total of 142 cases of non-trauma out-of-hospital cardiac arrest were identified; the majority being Chinese (103/142, 72.5%) and male (71.8%) with a mean age of 64.3±7.8 years (range 23–89 yrs). Most patients (111/142, 78.2%) did not receive any form of life support until arrival of the ambulance crew. Mean time from collapse to arrival of the ambulance crew and initiation of BCLS and defibrillation was 9.2±3.5 minutes. Mean time from collapse to arrival in the Emergency Department (and thus ACLS) was 16.8±7.1 minutes. Three patients (2.11%) survived to discharge. Conclusion There is a need to (i) facilitate layperson training in bystander CPR, and (ii) enhance paramedic training to include ACLS, in order to improve the current dismal survival outcomes from out-of-hospital cardiac arrest in Singapore.

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Do patients suffering an out-of-hospital cardiac arrest present to the ambulance service with symptoms in the preceding 48 h?

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcz054 ◽

2019 ◽

Vol 6 (4) ◽

pp. 308-314

Author(s):

Charles D Deakin ◽

Albert Quartermain ◽

Jacob Ellery

Keyword(s):

Cardiac Arrest ◽

End Of Life Care ◽

Initial Assessment ◽

Physiological Status ◽

Life Care ◽

Deteriorating Patient ◽

Hospital Cardiac Arrest ◽

Ambulance Crew ◽

Missed Opportunity ◽

At Home

Abstract Aims In-hospital cardiac arrests are often preceded by a period of physiological deterioration that has often gone unnoticed. We proposed that the same might be true for out-of-hospital cardiac arrests (OHCAs) where ambulance crews leave patients at home who then subsequently go on to suffer a cardiac arrest. Methods and results We identified all OHCA over a 12-month period that had been seen and assessed by an ambulance crew within the 48 h preceding their cardiac arrest. We retrospectively calculated the patient’s NEWS2 score at the time of their initial assessment as a marker of their physiological status and need for hospital admission. Of 1960 OHCA patients, 184 (9.4%) had been assessed by ambulance crews within the preceding 48 h. Excluding those who had been taken to hospital (and then discharged), declined hospital conveyance or were on end-of-life care pathways, 79 (56% of total) were left at home through crew discretion. Thirty-four out of 79 (43%) patients not conveyed had either a NEWS score of 3 in a single parameter or a score of ≥5, which in hospital would mandate an urgent medical review. The most overlooked observation was respiratory rate. Conclusions In total, 1.7% of all OHCA had been assessed in the previous 48 h and inappropriately left at home by ambulance crews. This represents a missed opportunity to avert cardiac arrest. NEWS scoring has the potential to improve pre-hospital triage of these patients and avoid missing the deteriorating patient.

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Abstract 2232: Survival Is Decreased If Ambulance Dispatchers Do Not Recognize Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.116.suppl_16.ii_486 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Jocelyn Berdowski ◽

Fred Beekhuis ◽

Rudolph W Koster

Keyword(s):

Cardiac Arrest ◽

Prospective Observational Study ◽

Early Recognition ◽

Survival Rates ◽

Exclusion Criteria ◽

Recognition Time ◽

Emergency Calls ◽

Emergency Medical Dispatchers ◽

Hospital Cardiac Arrest ◽

Ambulance Crew

Introduction Exact content of 112 emergency calls for suspected cardiac arrest (CA) are rarely analyzed. The purpose of this study was to investigate if not recognizing a CA by emergency medical dispatchers influences survival rates. Methods This was a prospective, observational study. During 8 months, all digitalized voice recordings of consecutive 112 high priority emergency calls were collected from the Amsterdam dispatch center and audited for CA recognition, time to recognition of CA and telephone CPR. Also, description of breathing and consciousness that the caller uses to describe a CA were scored. Actual presence of CA during call was assessed from the ambulance crew report. Calls were placed by laypersons on site, not involving trauma. Exclusion criteria were calls by a professional, by the victim or when victim was known to be conscious. Time recordings of call, dispatching and arrival were generated automatically. Survival after 3 months was taken as the primary endpoint. Results Results are shown in table 1 . In 8 months, out of 11.329 calls, 285 involved patients in CA. Of these, 203 were recognized during the call; the remaining 82 cases (29%) were only diagnosed on site. Recognizing CA resulted in faster dispatch and earlier arrival on scene. When not recognizing CA, the dispatchers did not ask the caller about respiration in over 50% of the calls. Not recognizing the CA was associated with no telephone CPR, and significantly lower three-month survival. Conclusion If the dispatcher did not recognize the CA, no CPR instruction is given. The ambulance is dispatched less rapidly and arrives a median of 2 minutes later at the scene. Both factors may contribute to the lower survival rates. Consequent interrogating the caller about the patientâ™s consciousness and respiration could improve CA recognition. In conclusion, not only early call, but also early recognition of a CA by dispatcher contributes to the survival after CA. Table 1: A comparison between calls where the dispatcher did and did not recognize CA

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