Outcomes after sudden cardiac arrest in sports centres with and without on-site external defibrillators

Heart ◽  
2018 ◽  
Vol 104 (16) ◽  
pp. 1344-1349 ◽  
Author(s):  
Daniela Aschieri ◽  
Diego Penela ◽  
Valentina Pelizzoni ◽  
Federico Guerra ◽  
Anna Chiara Vermi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Sudden Cardiac Arrest ◽  
Automated External Defibrillators ◽  
Shockable Rhythm ◽  
Tragic Event ◽  
Period Data ◽  
Neurologically Intact ◽  
Sports Activities

ObjectiveSudden cardiac arrest (SCA) is a rare but tragic event during amateur sports activities. Our aim is to analyse whether availability of automated external defibrillators (AEDs) in amateur sports centres could impact on SCA survival.MethodsThis is an observational study. During an 18-year period, data regarding exercise-related SCA in sports centres were prospectively collected. Survival rates and time to response were compared between centres with an AED already available and centres where an AED was not already present.ResultsOut of 252 sports facilities, 207 (82%) acquired an AED during follow-up while 45 (18%) did not. From 1999 to 2014, there were 26 SCAs (24 (92%) men, 54±17 years old) with 15 (58%) of them in centres with on-site AED. Neurologically intact survival rates were 93% in centres with on-site AED and 9% in centres without (P<0.001). Presence of on-site AED, presence of shockable rhythm, first assistance by a lay bystander and time to defibrillation were all related to neurological intact survival, but the presence of on-site AED was the only independent predictor in the multivariate analysis. The use of on-site AED resulted in a lower time to first shock when compared with emergency medical system-delivered AED (3.3±1.4min vs 7.3±3.2 min; P=0.001).ConclusionsThe presence of on-site AEDs is associated with neurologically intact survival after an exercise-related SCA. Continuous efforts are recommended in order to introduce AEDs in sports and fitness centres, implement educational programmes and increase common awareness about SCA.

Abstract 123: Field Accuracy of Paramedic Shock Delivery Using a Filtered ECG Rhythm

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Hill Stoecklein ◽  
Andrew Pugh ◽  
Michael Stroud ◽  
Scott Youngquist
Keyword(s):  
Cardiac Arrest ◽  
Salt Lake ◽  
Survival Rates ◽  
Salt Lake City ◽  
Fire Department ◽  
Shock Delivery ◽  
Shockable Rhythm ◽  
Lake City ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Introduction: Recognition and rapid defibrillation of shockable rhythms is strongly associated with increased survival from out-of-hospital cardiac arrest (OHCA). The Salt Lake City Fire Department (SLCFD) adopted ECG rhythm filtering technology in 2011, along with a protocol to rapidly defibrillate shockable rhythms without awaiting the end of the 2-minute CPR epoch. Paramedics were also trained to empirically shock asystole, as studies have shown poor agreement in cases of fine and moderate amplitude Ventricular Fibrillation (VF). Hypothesis: We hypothesized that the mandate to shock perceived asystole plus the use of filtering technology would result in high case sensitivity for shockable rhythms at the expense of an unknown frequency of shock delivery to organized rhythms. Methods: Prospectively collected defibrillator data from cardiac arrest cases treated by SLCFD between Dec 2011 and June 2019 were analyzed. Timing of rhythm changes and defibrillation events was manually abstracted using the manufacturer’s review software. The gold standard for rhythm interpretation was post-incident physician interpretation. Results: Paramedics attempted resuscitation in 942 OHCAs. We excluded 41 pediatric cases, 140 cases of BLS or bystander-only AED resuscitation, and 65 cases in which the defibrillator file was unavailable. Overall, 696 adult cardiac arrests with 1,389 shocks delivered were available for analysis. Shocks were delivered to 958 (69%) shockable, 261 (19%) asystole, 158 (11%) PEA, 4 (0.3%) SVT, and 8 (0.6%) unknown underlying rhythms. In 280 cases no shock was delivered despite an initial shockable rhythm in 3 of these cases. Shock delivery case sensitivity was 180/183 (0.98, 95% confidence interval [CI]:0.97-1.0) with false positive proportion of delivered shocks of 158/1,389 (0.11, 95% CI:0.10-0.13) for PEA only and 419/1,389 (0.30, 95% CI:0.28-0.33) for combined PEA and asystole. Neurologically intact (CPC 1-2) overall and Utstein survival rates were 15% and 46% respectively. Conclusions: Using ECG rhythm-filtering technology and an aggressive protocol to defibrillate VF and empirically shock asystole, we demonstrated high case sensitivity for VF at the expense of an 11% rate of shock delivery to underlying PEA.

scholarly journals Sudden Cardiac Arrest and Automated External Defibrillators

2003 ◽  
Vol 67 (12) ◽  
pp. 975-982 ◽  
Author(s):  
Mithilesh K. Das ◽  
Douglas P. Zipes
Keyword(s):  
Cardiac Arrest ◽  
Sudden Cardiac Arrest ◽  
Automated External Defibrillators

scholarly journals Neuroprognostication of Cardiac Arrest Patients: Outcomes of Importance

2017 ◽  
Vol 38 (06) ◽  
pp. 775-784
Author(s):  
Tobias Cronberg
Keyword(s):  
Cardiac Arrest ◽  
Vegetative State ◽  
Survival Rates ◽  
High Quality ◽  
Cognitive Difficulties ◽  
Cardiac Arrest Survivor ◽  
Chain Of Survival ◽  
Quality Decision ◽  
Improved Methods

AbstractDuring the last two decades, survival rates after cardiac arrest have increased while the fraction of patients surviving with a severe neurological disability or vegetative state has decreased in many countries. While improved survival is due to improvements in the whole “chain of survival,” improved methods for prognostication of neurological outcome may be of major importance for the lower disability rates. Patients who are resuscitated and treated in intensive care will die mainly from the withdrawal of life-sustaining (WLST) therapy due to presumed poor chances of meaningful neurological recovery. To ensure high-quality decision-making and to reduce the risk of premature withdrawal of care, implementation of local protocols is crucial and should be guided by international recommendations. Despite rigorous neurological prognostication, cognitive impairment and related psychological distress and reduced participation in society will still be relevant concerns for cardiac arrest survivors. The commonly used outcome measures are not designed to provide information on these domains. Follow-up of the cardiac arrest survivor needs to consider the cardiovascular burden as an important factor to prevent cognitive difficulties and future decline.

scholarly journals Sudden Cardiac Arrest as the First Manifestation of Takayasu Arteritis

2020 ◽  
pp. 1-2
Author(s):  
Stephane Manzo-Silberman ◽  
Stephane Manzo-Silberman ◽  
Alix de Gonneville ◽  
Martin Nicol ◽  
Sylvie Meireles ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Takayasu Arteritis ◽  
Immunosuppressive Treatment ◽  
Sudden Cardiac Arrest ◽  
Young Patients ◽  
Optimal Care ◽  
Total Occlusion ◽  
Coronary Syndrome ◽  
Shockable Rhythm ◽  
First Case

Management of out-of-hospital cardiac arrest (OHCA) remains challenging, particularly in young patients. Takayasu arteritis is a rare large-vessel vasculitis relatively. Coronary involvement has been previously described; we provided the first intracoronary images by OCT. We report the first case of OHCA with shockable rhythm revealing chronic total occlusion of the left main in a 41-year-old lady. The coronary anomaly made it possible to diagnose the vasculitis and to treat it by corticosteroid and immunosuppressive treatment. Vasculitis should be evoked in atypical coronary syndrome in young patients. A collaborative multidisciplinary approach permits optimal care for this complex patient.

Abstract 219: Out-of-Hospital Cardiac Arrest in Vienna 2014

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Markus Keferböck ◽  
Philip Datler ◽  
Mario Krammel ◽  
Elisabeth Lobmeyer ◽  
Alexander Nürnberger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Sudden Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Medical Personnel ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays. Method: Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated. Results: During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing. Conclusion: The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.

Abstract 11503: Mindfulness is Inversely Associated with Psychological Symptoms in Long-Term Cardiac Arrest Survivors

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Alex Presciutti ◽  
Jonathan Greenberg ◽  
Ethan Lester ◽  
Mary M Newman ◽  
Jonathan Elmer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Protective Factor ◽  
Psychological Symptoms ◽  
Sudden Cardiac Arrest ◽  
Survey Study ◽  
Present Moment ◽  
Cross Sectional ◽  
Patient Health

Introduction: We sought to identify correlates with psychological symptoms in long-term cardiac arrest (CA) survivors. Mindfulness, or nonjudgmental awareness of the present moment, is a modifiable protective factor against psychological symptoms in various clinical populations and could be a potential treatment target for CA survivors. Methods: We conducted a longitudinal survey study between 10-11/2019 (baseline) and 10-11/2020 (1-year follow-up) with long-term CA survivor members of the Sudden Cardiac Arrest Foundation. We collected demographic and CA characteristics at baseline. At both timepoints, we assessed posttraumatic stress symptoms (PTS) through the PTSD Checklist-5 (PCL-5) and depression and anxiety symptoms through the Patient Health Questionnaire-4 (PHQ-4). At follow-up, we assessed mindfulness through the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). We used adjusted linear regression to predict 1-year PCL-5 and PHQ-4 scores, with particular consideration of the CAMS-R as a cross-sectional correlate of outcome. Results: We included 129 CA survivors (mean age: 52 years, 52% male, 98% white). At 1-year follow-up, in adjusted models, CAMS-R (β: -0.35, p <0.001) and baseline PCL-5 scores (β: 0.56, p <0.001) were associated with 1-year PCL-5 scores. CAMS-R (β: -0.34, p <0.001) and baseline PHQ-4 scores were associated with 1-year PHQ-4 scores (β: 0.37, p<0.001). Conclusion: Mindfulness was inversely associated with psychological symptoms in long-term CA survivors. Future studies should examine the longitudinal relationship of mindfulness and psychological symptoms after CA.

Abstract 48: Neurological Outcomes of Inpatient Cardiopulmonary Resuscitation in a University Hospital

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Lia M Thomas ◽  
Miguel Benavides ◽  
Pierre Kory ◽  
Samuel Acquah ◽  
Steven Bergmann
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Cardiopulmonary Resuscitation ◽  
Therapeutic Hypothermia ◽  
Cardiopulmonary Arrest ◽  
University Hospital ◽  
Neurological Dysfunction ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Neurologically Intact

Background: Despite advances in out- of- hospital resuscitation practices, the prognosis of most patients after a cardiac arrest remains poor. The long term outcomes of patients successfully resuscitated from cardiac arrest are often complicated by neurological dysfunction. Therapeutic hypothermia has significantly improved neurological outcomes in patients successfully resuscitated from out- of- hospital cardiac arrests. The objective of this study was to look into the neurological outcomes in inpatients after successful cardiopulmonary resuscitation (CPR) in a university hospital setting. Methods: This was a retrospective observational study of 68 adult patients who experienced cardiac or respiratory arrest over an 18 month period at a metropolitan teaching hospital with dedicated, trained code teams. Arrests that occurred in the Emergency Department, Critical Care Units or Operating Rooms were excluded. Results: Of the 68 consecutive patients included in this study, 53% were resuscitated successfully. However, only 12 (18%) survived to discharge from the hospital and only 6 (10%) were discharged with intact neurological status. The initial survival was better in patients who received prompt CPR and in those with less co - morbidities. Pulseless electrical activity (PEA) or asystole were the most common rhythms (47% of the arrests). Most patients who survived and were neurologically intact had PEA (67%). We believe that most PEA arrests were more likely severe hypotension with the inability to palpate a pulse rather than true PEA. The mean time to defibrillation for all patients with an initial shockable rhythm (n=5) was 8.2 minutes. Patients who had an initial shockable rhythm and survived to discharge were shocked within 1 minute (n=2). Conclusion: Despite advances in critical care, survival from inpatient cardiopulmonary arrest to neurologically intact discharge remains poor. Therapeutic hypothermia should be expanded to those resuscitated from in - hospital cardiopulmonary arrest to determine if neurological outcomes would improve.

Abstract 264: The Association of Chest Compression Fraction and Clinical Outcomes from Shockable Out-of-Hospital Cardiac Arrest During the Resuscitation Outcomes Consortium Primed Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheldon Cheskes ◽  
Robert H Schmicker ◽  
Tom Rea ◽  
Judy Powell ◽  
Ian R Drennan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Clinical Outcomes ◽  
Chest Compression ◽  
Reference Group ◽  
Secondary Analysis ◽  
Process Data ◽  
Shockable Rhythm ◽  
The Relationship ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

INTRODUCTION: The role of chest compression fraction (CCF) in resuscitation of shockable out-of-hospital cardiac arrest (OHCA) is uncertain. We evaluated the relationship between CCF and clinical outcomes in a secondary analysis of the Resuscitation Outcomes Consortium (ROC) PRIMED trial. METHODS: We included OHCA patients from the ROC PRIMED trial who suffered cardiac arrest prior to EMS arrival, presented with a shockable rhythm, and had cardiopulmonary resuscitation (CPR) process data for at least one shock. We used multivariable logistic regression adjusting for Utstein variables, CPR metrics of compression rate and perishock pause, and ROC site to determine the relationship between CCF and survival to hospital discharge, return of spontaneous circulation (ROSC), and neurologically intact survival defined with Modified Rankin Score (MRS) ≤ 3. Due to potential confounding between CCF and cases that achieved early ROSC, we also performed an analysis restricted to patients without ROSC in the first 10 minutes of EMS resuscitation. RESULTS: Among the 2,558 eligible patients, median (IQR) age was 65 (54, 76) years, 76.9% were male, and mean (SD) CCF was 0.70 (0.15). Compared to the reference group (CCF < 0.60), the odds ratio (OR) for survival was 0.57 (95%CI: 0.42, 0.78) for CCF 0.60-0.79 and 0.32 (95%CI: 0.22, 0.48) for CCF ≥0.80. Results were similar for outcomes of ROSC and neurologically intact survival. Conversely, when restricted to the cohort who did not achieve ROSC during the first 10 minutes (n=1,660), the relationship between CCF and survival was no longer significant. Compared to the reference group (CCF < 0.60), the OR for survival was 0.85 (95 %CI: 0.58, 1.26) for CCF 0.60-0.79 and OR 0.87 (95%CI: 0.58, 1.36) for CCF ≥0.80. CONCLUSIONS: In this observational cohort study of OHCA patients presenting in a shockable rhythm, CCF when adjusted for Utstein predictors, CPR metrics and ROC site was paradoxically associated with lower odds of survival. The relationship between CCF and clinical outcomes was null in a sensitivity analysis restricted to patients without ROSC in the first 10 minutes. CCF is a complex measure and taken by itself may not be a consistent predictor of clinical outcome.

scholarly journals LO19: AED on the fly: A drone delivery feasibility study for rural and remote out-of-hospital cardiac arrest

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S13-S14
Author(s):  
I. Drennan ◽  
S. Cheskes ◽  
P. Snobelen ◽  
M. Nolan ◽  
T. Chan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Phase 1 ◽  
Sudden Cardiac Arrest ◽  
Optimal Strategies ◽  
Second Phase ◽  
Phase 2 ◽  
Rural And Remote ◽  
Automated External Defibrillators ◽  
Lift Off

Introduction: Time-to-treatment plays a pivotal role in survival from sudden cardiac arrest (SCA). Every minute delay in defibrillation results in a 7-10% reduction in survival. This is particularly problematic in rural and remote regions, where bystander and EMS response is often prolonged and automated external defibrillators (AED) are often not available. Our objective was to examine the feasibility of a novel AED drone delivery method for rural and remote SCA. A secondary objective was to compare times between AED drone delivery and ambulance response to various mock SCA resuscitations. Methods: We conducted 6 simulations in two different rural communities in southern Ontario. During phase 1 (4 simulations) a “mock” call was placed to 911 and a single AED drone and an ambulance were simultaneously dispatched from the same location to a pre-determined destination. Once on scene, trained first responders retrieved the AED from the drone and initiated resuscitative efforts on a manikin. The second phase (2 scenarios) were done in a similar manner save for the drone being dispatched from a regionally optimized location for drone response. Results: Phase 1: The distance from dispatch location to scene varied from 6.6 km to 8.8 km. Mean (SD) response time from 911 call to scene arrival was 11.2 (+/- 1.0) minutes for EMS compared to 8.1 (+/- 0.1) for AED drone delivery. In all four simulations, the AED drone arrived before EMS, ranging from 2.1 to 4.4 minutes faster. The mean time for trained responders to retrieve the AED and apply it to the manikin was 35 (+/- 5) sec. No difficulties were encountered in drone activation by dispatch, drone lift off, landing or removal of the AED from the drone by responders. Phase 2: The ambulance response distance was 20km compared to 9km for the drone. Drones were faster to arrival at the scene by 7 minutes and 8 minutes with AED application 6 and 7 minutes prior to ambulance respectively. Conclusion: This implementation study suggests AED drone delivery is feasible with improvements in response time during a simulated SCA scenario. These results suggest the potential for AED drone delivery to decrease time to first defibrillation in rural and remote communities. Further research is required to determine the appropriate distance for drone delivery of an AED in an integrated EMS system as well as optimal strategies to simplify bystander application of a drone delivered AED.

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.

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