Different defibrillation strategies in survivors after out-of-hospital cardiac arrest

Heart ◽  
2018 ◽  
Vol 104 (23) ◽  
pp. 1929-1936 ◽  
Author(s):  
Jolande A Zijlstra ◽  
Rudolph W Koster ◽  
Marieke T Blom ◽  
Freddy K Lippert ◽  
Leif Svensson ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Medical Service ◽  
Survival Rates ◽  
First Responder ◽  
Automated External Defibrillators ◽  
Survival Status ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest ◽  
Over Time

BackgroundIn the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival.MethodsWe performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded.ResultsA total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm.ConclusionSurvivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.

scholarly journals Bystander vs EMS First-responder CPR: Initial Rhythm and Outcome in Witnessed Nonmonitored Out-of-hospital Cardiac Arrest

1995 ◽  
Vol 2 (6) ◽  
pp. 494-498 ◽  
Author(s):  
Robert A. Swor ◽  
Bernice Boji ◽  
Mark Cynar ◽  
Edward Sadler ◽  
Eliezer Basse ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
First Responder ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

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.

Abstract 18070: Therapies Optimizing Organ Perfusion and Protection After Out-of-hospital Cardiac Arrest Improves Survival With Favorable Neurologic Outcome

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Michael J Jacobs ◽  
Leo S Derevin ◽  
Sue Duval ◽  
James E Pointer ◽  
Karl A Sporer
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Outcome Data ◽  
Neurological Function ◽  
Inverse Association ◽  
Advanced Airway ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Survival rates with favorable neurologic function after out-of-hospital cardiac arrest (OHCA) have remained low for decades. Hypothesis: Use of therapies focused on better perfusion during CPR using mechanical adjuncts and protective post-resuscitation care would improve survival and neurologic outcomes after OHCA compared to conventional CPR and care. Methods: OHCA outcomes in Alameda County, CA, USA, population 1.5 million, from December 2009-2011 when there was incomplete availability and use of impedance threshold device [ITD], mechanical CPR [MCPR], and hospital therapeutic hypothermia [HTH], were compared to 2012 when all were available and more widely used. Return of Spontaneous Circulation (ROSC), survival and Cerebral Performance Category (CPC) scores were compared using univariate and multivariable analyses. Results: Of the 3008 non-traumatic OHCAs who received CPR during the study period, >95% of survival outcome data were available. From 2009-11 to 2012, there was an increase in ROSC from 28.6% to 34.1% (p=0.002; OR=1.28; CI=1.09, 1.51) and a non-significant increase in hospital discharge from 10.5% to 12.3% (p=0.14; OR=1.17; CI=0.92, 1.49). There was, however, an 80% increase in survival with favorable neurological function between the two periods, as determined by CPC≤2, from 4.4% to 7.9% (p<0.001; unadjusted OR=1.85; CI=1.35, 2.54). After adjusting for witnessed arrest, bystander CPR, initial rhythm (VT/VF vs. others), placement of an advanced airway, EMS response time, and age, the adjusted OR was 1.60 (1.11, 2.31; p=0.012). Using a stepwise regression model, the most important independent positive predictors of CPC≤2 were 2012 (p=0.019), witnessed (p<0.001), initial rhythm VT/VF (p<0.001), and advanced airway (inverse association p<0.001). Additional analyses of the three therapies, separately and in combination, demonstrated that for all patients admitted to the hospital, ITD use with HTH had the most impact on survival to discharge with CPC≤2 of 24%. Conclusions: Therapies (ITD, MCPR, HTH) developed to enhance circulation during CPR and cerebral recovery after ROSC, significantly improved survival with favorable neurological function by 80% following OHCA.

scholarly journals Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Abdul H. Qazi ◽  
Paul S. Chan ◽  
Yunshu Zhou ◽  
Mary Vaughan-Sarrazin ◽  
Saket Girotra ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Baseline Period ◽  
Hospital Performance ◽  
Hierarchical Regression ◽  
Similar Proportion ◽  
Large Improvement ◽  
Hospital Cardiac Arrest ◽  
Over Time

Background: A hospital’s risk-standardized survival rate (RSSR) for in-hospital cardiac arrest has emerged as an important metric to benchmark and incentivize hospital resuscitation quality. We examined whether hospital performance on the RSSR metric was stable or dynamic year-over-year and whether low-performing hospitals were able to improve survival outcomes over time. Methods and Results: We used data from 84 089 adult patients with an in-hospital cardiac arrest from 166 hospitals with continuous participation in Get With The Guidelines–Resuscitation from 2012 to 2017. A 2-level hierarchical regression model was used to compute RSSRs during a baseline (2012–2013) and two follow-up periods (2014–2015 and 2016–2017). At baseline, hospitals were classified as top-, middle-, and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25%, respectively, on their RSSR metric during 2012 to 2013. We compared hospital performance on RSSR during follow-up between top, middle, and bottom-performing hospitals’ at baseline. During 2012 to 2013, 42 hospitals were identified as top-performing (median RSSR, 31.7%), 82 as middle-performing (median RSSR, 24.6%), and 42 as bottom-performing (median RSSR, 18.7%). During both follow-up periods, >70% of top-performing hospitals ranked in the top 50%, a substantial proportion remained in the top 25% of RSSR during 2014 to 2015 (54.6%) and 2016 to 2017 (40.4%) follow-up periods. Likewise, nearly 75% of bottom-performing hospitals remained in the bottom 50% during both follow-up periods, with 50.0% in the bottom 25% of RSSR during 2014 to 2015 and 40.5% in the bottom 25% during 2016 to 2017. While percentile rankings were generally consistent over time at ≈45% of study hospitals, ≈1 in 5 (21.4%) bottom-performing hospitals showed large improvement in percentile rankings over time and a similar proportion (23.7%) of top-performing hospitals showed large decline in percentile rankings compared with baseline. Conclusions: Hospital performance on RSSR during baseline period was generally consistent over 4 years of follow-up. However, 1 in 5 bottom-performing hospitals had large improvement in survival over time. Identifying care and quality improvement innovations at these sites may provide opportunities to improve in-hospital cardiac arrest care at other hospitals.

scholarly journals Improved ROSC rates in out-of-hospital cardiac arrest patients after introduction of a text message alert system for trained volunteers

2022 ◽  
Author(s):  
D. M. Oosterveer ◽  
M. de Visser ◽  
C. Heringhaus
Keyword(s):  
Cardiac Arrest ◽  
Multivariate Regression ◽  
Survival Rates ◽  
Text Message ◽  
Positive Association ◽  
Regression Analyses ◽  
Alert System ◽  
Automated External Defibrillators ◽  
Average Survival ◽  
Hospital Cardiac Arrest

Abstract Objective To evaluate whether a text message (TM) alert system for trained volunteers contributed to early cardiopulmonary resuscitation, the use of automated external defibrillators (AEDs), return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest (OHCA) patients in a region with above-average survival rates. Design Data on all OHCA patients in 2012 (non-TM group) were compared with those of all OHCA patients in 2018 (TM group). The association of the presence of a TM alert system with ROSC and survival was assessed with multivariate regression analyses. Results TM responders reached 42 OHCA patients (15.9%) earlier than the first responders or ambulance. They connected 31 of these 42 OHCA patients (73.8%) to an AED before the ambulance arrived, leading to a higher percentage of AEDs being attached in 2018 compared to the 2012 non-TM group (55% vs 46%, p = 0.03). ROSC was achieved more often in the TM group (61.0% vs 29.4%, p < 0.01). Three-month and 1‑year survival did not differ significantly between the two groups (29.3% vs 24.3%, p = 0.19, and 25.9% vs 23.5%, p = 0.51). Multivariate regression analyses confirmed the positive association of ROSC with the TM alert system (odds ratio 1.49, 95% confidence interval 1.02‑2.19, p = 0.04). Conclusion A TM alert system seems to improve the chain of survival; because TM responders reached patients early, AEDs were attached more often and more OHCA patients achieved ROSC. However, the introduction of a TM alert system was not associated with improved 3‑month or 1‑year survival in a region with above-average survival rates.

scholarly journals Survival rate of incoming patients with cardiac arrest at the cardiology infirmary of the emergency department of a public hospital in Greece

2019 ◽  
Vol 5 (2) ◽  
pp. 53
Author(s):  
Styliani Papadopoulou ◽  
Olympia Konstantakopoulou ◽  
Antonia Kalogianni ◽  
Martha Kelesi-Stavropoulou ◽  
Theodore Kapadohos
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Emergency Room ◽  
Survival Rates ◽  
Public Health Problem ◽  
Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Discharged Patients ◽  
Hospital Cardiac Arrest

Introduction: Cardiac arrest is an urgent situation that, despite the improved resuscitation capabilities, the survival rate of out-of-hospital cardiac arrest victims remains low.Aim: Τo investigate the survival rate of the incoming patients with cardiac arrest in the cardiology infirmary of the emergency department of a public hospital.Material-Method: The study included 210 patients who were transferred pulseless and breathless at the cardiology infirmary of the emergency department of “Tzaneio” Hospital, Piraeus, during the period April 2017 - November 2018. Data was collected from the National Center of Emergency Dispatch's printed forms, as well as from the patients’ admission book of the emergency department.Results: More than 10% (11.9%) of patients with cardiac arrest returned to spontaneous circulation in the emergency department, of which 16% was discharged. Patients with known cardiac history, (p=0.002), with a shockable rhythm (p<0.001), and especially ventricular fibrillation (p<0.001) upon arrival at the emergency room, and patients who were defibrillated at the ambulance during admission and at the emergency room, were more likely to survive (p<0.001). No statistically significant correlation was found between the factors studied and survival after cardiac arrest, in the group of patients that were discharged.Conclusions: The survival rate of the incoming patients with cardiac arrest at the emergency department of “Tzaneio” Hospital, Piraeus, was low. As for most health systems, this issue constitutes a fairly complex public health problem. Cardiopulmonary resuscitation and corresponding guidelines require further improvement in order for the survival rates of out-of-hospital cardiac arrest patients to increase.

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 LO72: Implementation of an educational program to improve the cardiac arrest diagnostic accuracy of ambulance communication officers: a concurrent control before-after study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S52-S53
Author(s):  
C. Vaillancourt ◽  
A. Kasaboski ◽  
M. Charette ◽  
L. Calder ◽  
L. Boyle ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Educational Program ◽  
Survival Rates ◽  
Control Site ◽  
Chi Square ◽  
Concurrent Control ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Most ambulance communication officers receive minimal education on agonal breathing, often leading to unrecognized out-of-hospital cardiac arrest (OHCA). We sought to evaluate the impact of an educational program on cardiac arrest recognition, and on bystander CPR and survival rates. Methods: Ambulance communication officers in Ottawa, Canada received additional training on agonal breathing, while the control site (Windsor, Canada) did not. Sites were compared to their pre-study performance (before-after design), and to each other (concurrent control). Trained investigators used a piloted-standardized data collection tool when reviewing the recordings for all potential OHCA cases submitted. OHCA was confirmed using our local OHCA registry, and we requested 9-1-1 recordings for OHCA cases not initially suspected. Two independent investigators reviewed medical records for non-OHCA cases receiving telephone-assisted CPR in Ottawa. We present descriptive and chi-square statistics. Results: There were 988 confirmed and suspected OHCA in the “before” (540 Ottawa; 448 Windsor), and 1,076 in the “after” group (689 Ottawa; 387 Windsor). Characteristics of “after” group OHCA patients were: mean age (68.1 Ottawa, 68.2 Windsor); Male (68.5% Ottawa, 64.8% Windsor); witnessed (45.0% Ottawa, 41.9% Windsor); and initial rhythm VF/VT (Ottawa 28.9, Windsor 22.5%). Before-after comparisons were: for cardiac arrest recognition (from 65.4% to 71.9% in Ottawa p=0.03; from 70.9% to 74.1% in Windsor p=0.37); for bystander CPR rates (from 23.0% to 35.9% in Ottawa p=0.0001; from 28.2% to 39.4% in Windsor p=0.001); and for survival to hospital discharge (from 4.1% to 12.5% in Ottawa p=0.001; from 3.9% to 6.9% in Windsor p=0.03). “After” group comparisons between Ottawa and Windsor (control) were not statistically different, except survival (p=0.02). Agonal breathing was common (25.6% Ottawa, 22.4% Windsor) and present in 18.5% of missed cases (15.8% Ottawa, 22.2% Windsor p=0.27). In Ottawa, 31 patients not in OHCA received chest compressions resulting from telephone-assisted CPR instructions. None suffered injury or adverse effects. Conclusion: While all OHCA outcomes improved over time, the educational intervention significantly improved OHCA recognition in Ottawa, and appeared to mitigate the impact of agonal breathing.

Abstract 111: Age-Dependent Trends in Survival After Adult In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sebastian Wiberg ◽  
Mathias J Holmberg ◽  
Michael Donnino ◽  
Jesper Kjaergaard ◽  
Christian Hassager ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Age Groups ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Absolute Increase ◽  
Hospital Cardiac Arrest ◽  
Over Time

Background: While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims or extends to older patients as well. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016. Methods: This is an observational study of IHCA patients included in the Get With The Guidelines®-Resuscitation registry between January 2000 and December 2016. The primary outcome was survival to hospital discharge, while secondary outcomes included rates of return of spontaneous circulation (ROSC) and neurological outcome at discharge. Patients were stratified into five age groups: < 50 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years. Generalized linear regression was used to obtain absolute survival rates over time. Analyses of interaction were included to assess differences in survival trends between age groups. Results: A total of 234,767 IHCA patients were included for the analyses. The absolute increase in survival per calendar year was 0.8% (95%CI 0.7 - 1.0%, p < 0.001) for patients younger than 50 years, 0.6% (95%CI 0.4 - 0.7%, p < 0.001) for patients between 50 and 59 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 60 and 69 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 70 and 79 years, and 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients older than 80 years. Further, a significant increase in both rates of ROSC and survival with a good neurological outcome was seen for all age groups. In both unadjusted and adjusted analyses of survival, we observed a significant interaction between calendar year and age group ( p < 0.001), indicating that the rate of improvement in survival over time was significantly different between age groups. Conclusions: For patients with IHCA, survival to discharge, ROSC, and survival to discharge with a good neurological outcome have improved significantly from 2000 to 2016 for all age groups.

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