scholarly journals When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China

2020 ◽  
pp. emermed-2019-209291 ◽  
Author(s):  
Lin Zhang ◽  
Menyue Luo ◽  
Helge Myklebust ◽  
Chun Pan ◽  
Liang Wang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Services ◽  
Public Awareness ◽  
Survival Rates ◽  
Process Compliance ◽  
Barriers To Implementation ◽  
Prolonged Delay ◽  
Hospital Cardiac Arrest

BackgroundSeveral Chinese cities have implemented dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), although out-of-hospital cardiac arrest (OHCA) survival rates remain low. We aimed to assess the process compliance, barriers and outcomes of OHCA in one of the earliest implemented (DA-CPR) programmes in China.MethodsWe retrospectively reviewed OHCA emergency dispatch records of Suzhou emergency medical service from 2014 to 2015 and included adult OHCA victims (>18 years) with a bystander-witnessed atraumatic OHCA that was subsequently confirmed by on-site emergency physician. The circumstances and DA-CPR process related to the OHCA event were analysed. Dispatch audio records were reviewed to identify potential barriers to implementation during the DA-CPR process.ResultsOf the 151 OHCA victims, none survived. The median time from patient collapse to call for emergency services and that from call to provision of cardiopulmonary resuscitation instructions was 30 (IQR 20–60) min and 115 (IQR 90–153) s, respectively. Only 110 (80.3%) bystanders/rescuers followed the dispatcher instructions; of these, 51 (46.3%) undertook persistent chest compressions. Major barriers to following the DA-CPR instructions were present in 104 (68.9%) cases, including caller disconnection of the call, distraught mood or refusal to carry out either compressions or ventilations.ConclusionsThe OHCA survival rate and the DA-CPR process were far from optimal. The zero survival rate is disproportionally low compared with survival statistics in high-income countries. The prolonged delay in calling the emergency services negated and rendered futile any DA-CPR efforts. Thus, efforts targeted at developing public awareness of OHCA, calling for help and competency in DA-CPR should be increased.

scholarly journals P065: Out-of-hospital cardiac arrest patients eligible for extracorporeal cardiopulmonary resuscitation in Regina emergency departments

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S87-S88
Author(s):  
B. Lee ◽  
E. Sy ◽  
A. Clay
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Departments ◽  
Survival Rates ◽  
Annual Number ◽  
Unexpected Death ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is a rapidly evolving technology for clinical use in patients with refractory cardiogenic arrest. Out-of-hospital cardiac arrest (OHCA) is a common cause of unexpected death and has a low survival rate. There is increasing evidence that suggests better outcomes for (OHCA) patients, including improved neurological outcomes and survival rates, who are started on extracorporeal corporeal membrane oxygenation (ECMO) versus traditional resuscitation methods. Methods: We conducted a retrospective chart review of 200 out-of-hospital cardiac arrest patients presenting to Regina emergency departments from January 1, 2017 to March 31, 2019. Eligibility for ECPR was assessed using different clinical criteria from different ECPR programs (University of British Columbia, University of Michigan, and a hypothetical “Regina” criteria created for this study). Outcomes of the eligible patients were compared using descriptive statistics with SPSS version 22. Results: Between four different criteria, 15%, 9.5%, 7.5%, and 3.5% of patients were respectively eligible to receive ECPR. Of patients who met eligibility for all four criteria, 80% were male, the average age was 61 years old, the average Cerebral Performance score was 4.46, and 83% died in hospital. There was a low survival rate of eligible patients, with rates of 16%, 17%, 20%, and 28% in each group. The survival rate for all patients was 21% and the average CPC score was 4.35. Conclusion: The significant percentage of patients were eligible for ECPR upon presentation to Regina Emergency Departments. Patients who were eligible had low survival rates and poor neurological outcomes, suggesting that ECPR could prove to be a valuable clinical tool that could improve patient outcomes in Saskatchewan. There were considerable differences in patient eligibility percentages based on different criterion. Differences in inclusion/exclusion criteria, modifying the expected annual number of ECPR eligible OHCA patients, could provide valuable information on required resources and planning for implementation of an ECPR program in a smaller centre, such as Regina.

Abstract P85: Out-of-hospital Cardiac Arrests With Extracorporeal Cardiopulmonary Resuscitation In Japan: Systematic Literature Review

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tetsuya Sakamoto ◽  
Yasufumi Asai ◽  
Ken Nagao ◽  
Yoshio Tahara ◽  
Takahiro Atsumi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Literature Review ◽  
Case Series ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Funnel Plot ◽  
Case Series Study ◽  
Series Study ◽  
Hospital Cardiac Arrest

Background: In Japan, extracorporeal cardiopulmonary resuscitation (ECPR) became popular for cardiac arrest patients who resist conventional advanced life supports. Regardless of many clinical experiences, there has been no previous systematic literature review. Methods: Case series, reports and proceedings of scientific meeting about ECPR for out-of-hospital cardiac arrest written in Japanese between January 1, 1983 and July 31, 2007 were collected with Japana Centra Revuo Medicina (medical publication database in Japan) and review by experts. The outcome and characteristics of the patients were investigated, and the influence of publication bias of the case series study was also examined by the Funnel Plot method. Results: There were 951 out-of-hospital cardiac arrest patients who received ECPR in 92 reports (including 59 case series and 33 case reports) during the period. The average of age was 38.1 (4 – 88) years old and 76.1% was male. Three hundreds and eighty-one cases (40.1%) were arrests of cardiac etiology, and 212 were non-cardiac (22.3%). The cause of arrest was not described in other 37.6%. Excluding reports for only one case, weighted survival rate at discharge of 792 cases those were clearly described the outcome was 39.5±10.0%. When the relationship between the number of cases and the survival rate at discharge in each 59 case series study was shown in figure by the Funnel Plot method, the plotted data presented the reverse-funnel type that centered on the average of survival rate of all. Conclusions: The influence of publication bias of previous reports in Japan was relatively low. ECPR can greatly contribute to improve the outcome of out-of hospital cardiac arrests.

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

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.

scholarly journals Perfusion parameters and target values during extracorporeal cardiopulmonary resuscitation: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030562
Author(s):  
Lars Saemann ◽  
Christine Schmucker ◽  
Lisa Rösner ◽  
Friedhelm Beyersdorf ◽  
Christoph Benk
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Scoping Review ◽  
Citation Index ◽  
Data Extraction ◽  
Survival Rates ◽  
Social Science Citation Index ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Target Values ◽  
Hospital Cardiac Arrest

IntroductionExtracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients. Treatment results are promising, but the efficacy and safety of the procedure are still unclear. Currently, there are no recommended target perfusion parameters during eCPR, the lack of which could result in inadequate (re)perfusion. We aim to perform a scoping review to explore the current literature addressing target perfusion parameters, target values, corresponding survival rates and neurologic outcomes in OHCA and IHCA patients treated with eCPR.Methods and analysisTo identify relevant research, we will conduct searches in the electronic databases MEDLINE, EMBASE, Social Science Citation Index, Social Science Citation Index Expanded and the Cochrane library. We will also check references of relevant articles and perform a cited reference research (forward citation tracking).Two independent reviewers will screen titles and abstracts, check full texts for eligibility and perform data extraction. We will resolve dissent by consensus, moderated by a third reviewer. We will include observational and controlled studies addressing target perfusion parameters and outcomes such as survival rates and neurologic findings in OHCA and IHCA patients treated with eCPR. Data extraction tables will be set up, including study and patients’ characteristics, aim of study, details on eCPR including target perfusion parameters and reported outcomes. We will summarise the data using tables and figures (ie, bubble plot) to present the research landscape and to describe potential clusters and/or gaps.Ethics and disseminationAn ethical approval is not needed. We intend to publish the scoping review in a peer-reviewed journal and present results on a scientific meeting.

scholarly journals Implementation of a National 5‐Year Plan for Prehospital Emergency Care in Singapore and Impact on Out‐of‐Hospital Cardiac Arrest Outcomes From 2011 to 2016

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Andrew Fu Wah Ho ◽  
Nurun Nisa Amatullah De Souza ◽  
Audrey L. Blewer ◽  
Win Wah ◽  
Nur Shahidah ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Care ◽  
Survival Rates ◽  
Prehospital Emergency Care ◽  
Shockable Rhythm ◽  
Automated External Defibrillation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Prehospital Emergency ◽  
Hospital Cardiac Arrest

Background Outcomes of patients from out‐of‐hospital cardiac arrest (OHCA) vary widely globally because of differences in prehospital systems of emergency care. National efforts had gone into improving OHCA outcomes in Singapore in recent years including community and prehospital initiatives. We aimed to document the impact of implementation of a national 5‐year Plan for prehospital emergency care in Singapore on OHCA outcomes from 2011 to 2016. Methods and Results Prospective, population‐based data of OHCA brought to Emergency Departments were obtained from the Pan‐Asian Resuscitation Outcomes Study cohort. The primary outcome was Utstein (bystander witnessed, shockable rhythm) survival‐to‐discharge or 30‐day postarrest. Mid‐year population estimates were used to calculate age‐standardized incidence. Multivariable logistic regression was performed to identify prehospital characteristics associated with survival‐to‐discharge across time. A total of 11 465 cases qualified for analysis. Age‐standardized incidence increased from 26.1 per 100 000 in 2011 to 39.2 per 100 000 in 2016. From 2011 to 2016, Utstein survival rates nearly doubled from 11.6% to 23.1% ( P =0.006). Overall survival rates improved from 3.6% to 6.5% ( P <0.001). Bystander cardiopulmonary resuscitation rates more than doubled from 21.9% to 56.3% and bystander automated external defibrillation rates also increased from 1.8% to 4.6%. Age ≤65 years, nonresidential location, witnessed arrest, shockable rhythm, bystander automated external defibrillation, and year 2016 were independently associated with improved survival. Conclusions Implementation of a national prehospital strategy doubled OHCA survival in Singapore from 2011 to 2016, along with corresponding increases in bystander cardiopulmonary resuscitation and bystander automated external defibrillation. This can be an implementation model for other systems trying to improve OHCA outcomes.

scholarly journals Persepsi Perlindungan Hukum dan Aspek Etik terhadap Keinginan Perawat IGD Melakukan CPR pada Out-of-Hospital Cardiac Arrest (OHCA)

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Wiwin Winarti ◽  
Rosiana Rosiana
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Ethical Issues ◽  
Legal Protection ◽  
The Elderly ◽  
Legal Aspects ◽  
Cross Sectional ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

ABSTRAKKejadian henti jantung dapat terjadi dimana saja baik di rumah sakit maupun di luar rumah sakit atau Out-of-Hospital Cardiac Arrest (OHCA). Usaha untuk meningkatkan survival rate kejadian henti jantung adalah pemberian Cardiopulmonary resuscitation (CPR)/ resusitasi jantung paru (RJP) yang berkualitas. Faktor yang mempengaruhi seseorang untuk mau menjadi bystander CPR bukan hanya terkait pengetahuan dan teknik melakukan CPR namun juga dipengaruhi oleh faktor sosial, kerelaan melakukan, kesiapan psikologis dan faktor lainnya seperti aspek etik dan hukum. Tujuan penelitian ini untuk mengetahui pengaruh persepsi perlindungan hukum dan aspek etik terhadap keinginan perawat dalam memberikan tindakan CPR pada kejadian Out-of-Hospital Cardiac Arrest. Penelitian menggunakan desain cross-sectional dengan metode kuisioner yang dikembangkan oleh peneliti dan menggunakan total sampling yang melibatkan seluruh perawat IGD RSUD Budhi Asih sebanyak 30 orang. Analisis menggunakan uji Fisher’s Exact dan Cochran-Mantel Haenszel. Hasil penelitian menunjukkan mayoritas responden (56,7%) memiliki persepsi yang negatif terhadap perlindungan hukum terhadap bystander CPR pada OHCA. Meskipun demikian, perawat cenderung memiliki persepsi yang positif ketika menjawab pertanyaan terkait isu etik CPR pada korban anak-anak, wanita maupun lansia. Sebanyak 43,33% (13 perawat) memiliki keinginan positif untuk melakukan CPR pada OHCA sementara 56,67% (17 perawat) lainnya memiliki keinginan negatif sebagai bystander CPR. Hasil uji Cochran-Mantel Haenszel menunjukkan persepsi terhadap perlindungan hukum mempengaruhi keinginan perawat dalam memberikan CPR pada OHCA dan akan diperbesar kemungkinan memberikan CPR apabila perawat tersebut berusia ≥ 30 tahun (p 0,014; OR 14,133; 95% CI 2,081-95,947) dan memiliki masa kerja ≥ 5 tahun (p 0,008; OR 25,667; 95% CI 2,253-292,462). Promosi mengenai aspek legal dan etik, serta landasan hukum perlindungan terhadap bystander CPR menjadi penting untuk dapat meningkatkan keinginan perawat dan jumlah bystander CPR. ABSTRACTCardiac arrest can occur anywhere in the hospital or outside the hospital, which is called Out-of-Hospital Cardiac Arrest (OHCA). An effort to increase the survival rate of cardiac arrest is the provision of quality Cardiopulmonary resuscitation (CPR). Factors that influence a person's willingness to become a bystander CPR are not only related to the knowledge and techniques of conducting CPR but are also influenced by social factors, willingness, psychological readiness, and other factors such as ethical and legal aspects. The purpose of this study is to determine the effect of perceptions of legal protection and ethical issues on the nurses' willingness to provide CPR in the OHCA incident. This study used a cross-sectional design using a questionnaire developed by researchers, conducted at Emergency Department Budhi Asih Regional Hospital in East Jakarta, and used a total sampling method involving 30 ED nurses. Fisher's Exact and Cochran-Mantel Haenszel tests were used to analyze the data. The study findings show that the majority of respondents (56.7%) have a negative perception of the legal protection of bystander CPR in OHCA. However, nurses have a positive perception when answering questions related to the ethical issue of CPR in victims of children, women, and the elderly. 43.33% (13 nurses) have a positive willingness to perform CPR on OHCA, while 56.67% (17 nurses) have a negative willingness as a bystander CPR. The results of the Cochran-Mantel Haenszel test show that perceptions of legal protection may influence nurses' willingness to provide CPPR to OHCA patient, and it will increase the likelihood of giving CPR if the nurse age is ≥ 30 years old (p 0.014; OR 14,133; 95% CI 2,081-95,947) and has been working for ≥ 5 years (p 0.008; OR 25,667; 95% CI 2,253-292,462). Promotion of the legal aspects, ethical issues, and protection to bystander CPR are essential to increase the willingness of nurses and the number of bystander CPR. 

scholarly journals Mechanical Versus Manual Chest Compression: A Retrospective-Cohort in Out-of-Hospital Cardiac Arrest

Acta Medica ◽  
2021 ◽  
pp. 1-7
Author(s):  
Alp Şener ◽  
Gül Pamukçu Günaydın ◽  
Fatih Tanrıverdi
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Retrospective Case ◽  
Return Of Spontaneous Circulation ◽  
Mechanical Chest Compression ◽  
Manual Chest Compression ◽  
Hospital Cardiac Arrest

Objective: In cardiac arrest cases, high quality cardiopulmonary resuscitation and effective chest compression are vital issues in improving survival with good neurological outcomes. In this study, we investigated the effect of mechanical chest compression devices on 30- day survival in out-of-hospital cardiac arrest. Materials and Methods: This retrospective case-control study was performed on patients who were over 18 years of age and admitted to the emergency department for cardiac arrest between January 1, 2016 and January 15, 2018. Manual chest compression was performed to the patients before January 15, 2017, and mechanical chest compression was performed after this date. Return of spontaneous circulation, hospital discharge, and 30-day survival rates were compared between the groups of patients in terms of chest compression type. In this study, the LUCAS-2 model piston-based mechanical chest compression device was used for mechanical chest compressions. Results: The rate of return of spontaneous circulation was significantly lower in the mechanical chest compression group (11.1% vs 33.1%; p < 0.001). The 30-day survival rate was higher in the manual chest compression group (6.8% vs 3.7%); however, this difference was not statistically significant (p = 0.542). Furthermore, 30-day survival was 0% in the trauma group and 0.6% in the patient group who underwent cardiopulmonary resuscitation for over 20 minutes. Conclusion: It can be seen that the effect of mechanical chest compression on survival is controversial; studies on this issue should continue and, furthermore, studies on the contribution of mechanical chest compression on labor loss should be conducted.

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