Association of chain of survival factors with out of hospital cardiac arrest survival in a region with low average population-density: a retrospective population-based cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Connolly ◽  
J Goldstein ◽  
K Giddens ◽  
M Nallbani ◽  
P Kennedy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Nova Scotia ◽  
Population Density ◽  
Funding Source ◽  
Survival Factors ◽  
Average Population Density ◽  
Average Population ◽  
Chain Of Survival ◽  
Hospital Cardiac Arrest

Abstract Background Out of hospital cardiac arrest (OHCA) has an average global survival rate to discharge of 8%. Chain of survival factors are heavily time-dependant and optimization can increase survival. Regions with low population density encounter challeges in providing optimal OHCA care. Nova Scotia's average population density is 17.4 persons per square kilometer in compasiron to Toronto with 4334.4 person per square kilometer. OHCAs have been described well in large urban centers globally, however the characterization of OHCA chain of survival in low density populations is sparse. Purpose To describe chain of survival factors and identify characteristics of survivors and non-survivors among those treated by paramedics in a low average density provincial population. Methods This was a retrospective cohort study of OHCAs responded to by paramedics. All OHCA responses with a cardiac etiology in Nova Scotia, Canada were included. Exclusion criteria were non-cardiac cause arrests, those with “do not resuscitate” (DNR) directives and expected deaths. The paramedic electronic patient care record was reviewed for demographic, bystander, out of hospital treatment and operational characteristics. Primary outcome was survival to hospital discharge. Descriptive statistics were calculated to describe differences between survivorship using Prism 8.0 (San Diego, CA) with alpha=0.05 applying unpaired, Mann-Whitney tests. Results Of 1517 OHCA, 463 were excluded leaving 1054 OHCA. Of these, 478 (45.3%) were treated by paramedics and included in this analysis. Most were men (67.2%; n=274) with a mean age 66.8 (±16.4). A total of 7.1% (n=75) survived to discharge with 76% of survivors (n=58) discharged home. Survivors were more likely to present with ventricular fibrillation than non-survivors (42.7% vs. 19.6%). Survivors compared to non-survivors had significantly shorter paramedic response time (8.1 vs. 10.7 min, P<0.001), paramedic time on scene (35.7 vs. 45.4 min, P=0.002), estimated time to paramedic defibrillation (13.2 vs 19.4 min, P<0.001), and estimated time to return of spontaneous circulation (ROSC) (22.9 vs 31.9min, P<0.001). Conclusion Links in the chain of survival are associated with survival from OHCA. OHCA survival is lower in the less densely populated province of Nova Scotia compared to studies in urban Canadian centers and worldwide. Our study is limited by the retrospective nature of data collection and lack of access to neurological outcomes. Even among survivors, EMS response is delayed compared to more densely populated centers. In Nova Scotia, longer paramedic response times are associated with decreased survival. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Maritime Heart Center

scholarly journals A retrospective multi-centre cohort study: Pre-hospital survival factors of out-of-hospital cardiac arrest (OHCA) patients in Thailand

2022 ◽  
Vol 9 ◽  
pp. 100196
Author(s):  
Wachiranun Sirikul ◽  
Chanodom Piankusol ◽  
Borwon Wittayachamnankul ◽  
Sattha Riyapan ◽  
Jirapong Supasaovapak ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Survival Factors ◽  
Hospital Survival ◽  
Hospital Cardiac Arrest

Rapid recognition of out-of-hospital cardiac arrest by emergency medical dispatchers is associated with improved survival

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Gnesin ◽  
A.L Moeller ◽  
E.H.A Mills ◽  
N Zylyftari ◽  
B Jensen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Linked Data ◽  
Funding Source ◽  
Multivariate Logistic Regression ◽  
Priority Level ◽  
Emergency Medical ◽  
Chain Of Survival ◽  
Emergency Medical Dispatchers ◽  
Hospital Cardiac Arrest

Abstract Background Emergency medical dispatchers' (EMD) recognition of out-of-hospital cardiac arrest (OHCA) is an essential part of the first link in the Chain of Survival. However, it is unknown whether the time-to-recognition of OHCA by EMD during an emergency call is associated with survival. Purpose To investigate the effect of time-to-recognition on 30-day survival among patients with recognised OHCA. Methods We linked data on OHCAs occurring in the Capital Region of Denmark from 2016 through 2017 to records of corresponding emergency calls. We defined recognition as dispatching an ambulance with an appropriate priority level and subsequently defined time-to-recognition as the time from start of the call to the time of dispatching the ambulance. Among patients with recognised OHCA, we performed uni- and multivariate logistic regression to investigate the association of time-to-recognition and 30-day survival and reported odds ratios (OR) with 95% confidence intervals (CI). Results Among 2,382 patients with OHCA, 94.2% were recognised, in which median age was 73.6 years, 61.6% were males and median time-to-recognition was 0.8 minutes (interquartile range 0.7 minutes). Patients for whom time-to-recognition was up to (but not including) one minute had more than three-fold higher probability of surviving 30 days (15.5%) compared to patients for whom time-to-recognition was three or more minutes (4.5%) (Figure 1). Time-to-recognition was significantly associated with 30-day survival: OR 0.75 per minute (95% CI 0.62–0.91, P<0.005), and results were similar in the adjusted analysis: OR 0.72 per minute (95% CI 0.58–0.90, P<0.005). Conclusion Rapid recognition of OHCA by EMD resulted in improved survival rate of patients. This was particularly evident when time-to-recognition was three or more minutes. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Hjerteforeningen

scholarly journals Contacts to the healthcare system prior to out-of-hospital cardiac arrests

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Zylyftari ◽  
S.G Moller ◽  
M Wissenberg ◽  
F Folke ◽  
C.A Barcella ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
General Population ◽  
Healthcare System ◽  
Early Identification ◽  
Sudden Cardiac Arrest ◽  
Funding Source ◽  
Horizon 2020 ◽  
One Year ◽  
Public Grant ◽  
Hospital Cardiac Arrest

Abstract Background Patients who suffer a sudden out-of-hospital cardiac arrest (OHCA) may be preceded by warning symptoms and healthcare system contact. Though, is currently difficult early identification of sudden cardiac arrest patients. Purpose We aimed to examine contacts with the healthcare system up to two weeks and one year before OHCA. Methods OHCA patients were identified from the Danish Cardiac Arrest Registry (2001–2014). The pattern of healthcare contacts (with either general practitioner (GP) or hospital) within the year prior to OHCA of OHCA patients was compared with that of 9 sex- and age-matched controls from the background general population. Additionally, we evaluated characteristics of OHCA patients according to the type of healthcare contact (GP/hospital/both/no-contact) and the including characteristics of contacts, within two weeks prior their OHCA event. Results Out of 28,955 OHCA patients (median age of 72 (62–81) years and with 67% male) of presumed cardiac cause, 16,735 (57.8%) contacted the healthcare system (GP and hospital) within two weeks prior to OHCA. From one year before OHCA, the weekly percentages of contacts to GP were relatively constant (26%) until within 2 weeks prior to OHCA where they markedly increased (54%). In comparison, 14% of the general population contacted the GP during the same period (Figure). The weekly percentages of contacts with hospitals gradually increased in OHCA patients from 3.5% to 6.5% within 6 months, peaking at the second week (6.8%), prior to OHCA. In comparison, only 2% of the general population had a hospital contact in that period (Figure). Within 2 weeks of OHCA, patients contacted GP mainly by telephone (71.6%). Hospital diagnoses were heterogenous, where ischemic heart disease (8%) and heart failure (4.5%) were the most frequent. Conclusions There is an increase in healthcare contacts prior to “sudden” OHCA and overall, 54% of OHCA-patients had contacted GP within 2 weeks before the event. This could have implications for developing future strategies for early identification of patients prior to their cardiac arrest. Figure 1. The weekly percentages of contacts to GP (red) and hospital (blue) within one year before OHCA comparing the OHCA cases to the age- and sex-matched control population (N cases = 28,955; N controls = 260,595). Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020

Impact of rapid response car system on ECMO in out-of-hospital cardiac arrest: A retrospective cohort study

2018 ◽  
Vol 36 (3) ◽  
pp. 442-445 ◽  
Author(s):  
Ryota Sato ◽  
Akira Kuriyama ◽  
Michitaka Nasu ◽  
Shinnji Gima ◽  
Wataru Iwanaga ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Rapid Response ◽  
Hospital Cardiac Arrest
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