Abstract 52: An Evidence Based Animal Model Of Prolonged Ventricular Fibrillation Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Timothy J Mader
Keyword(s):  
Clinical Trials ◽  
Cardiac Arrest ◽  
Evidence Based ◽  
Chest Compressions ◽  
Time Intervals ◽  
Mean Values ◽  
Improved Outcomes ◽  
Response Interval ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: Promising basic science findings in cardiac resuscitation often do not translate into improved outcomes when studied in humans. One explanation is that the current animal models do not adequately reflect the out-of-hospital cardiac arrest (OHCA) clinical trial environment. The author sought to review the literature and devise a new model of prolonged VF with time intervals that more accurately simulate OHCA conditions. Methods: A systematic review of the literature (01/90 –12/06) was conducted using PUBMED and a comprehensive list of appropriate MESH headings. All OHCA human clinical trials were included. The most relevant studies underwent explicit and detailed review. Mean values with 95%CI were calculated for each specified interval. Suitable conditions and establishment of appropriate times were then devised. Results: Twenty-two papers with adequate detail for evaluation were examined, leading to the following recommendations: the duration of non-treatment (assuming no bystander CPR or first-responders) is 11” (3” for recognition and EMS activation, 7” response interval and 1” for paramedics to reach the patient); chest compressions are initiated immediately with passive oxygen insufflation; assuming they can be done simultaneously, IV access and intubation (ETI) are accomplished 4” after arrival; drugs are delivered by minute 16 - well into the metabolic phase; and 2” of CPR are needed to circulate the drugs for the first rescue shock (RS) at minute 18. Conclusions: This proposed evidence based experimental model of prolonged untreated VF cardiac arrest has conditions and time intervals that simulate those of human OHCA clinical trials.

scholarly journals Can Mobile Videocall Assist Laypersons’ Use of Automated External Defibrillators? A Randomized Simulation Study and Qualitative Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jun Young Bang ◽  
Youngsuk Cho ◽  
Gyu Chong Cho ◽  
Jongshill Lee ◽  
In Young Kim
Keyword(s):  
Cardiac Arrest ◽  
Time Interval ◽  
Mobile Video ◽  
Time Intervals ◽  
Automated External Defibrillators ◽  
Significant Difference ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Voice Calls ◽  
Hospital Cardiac Arrest

Background and Importance. The rate of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) has increased rapidly in the past 10 years. However, laypersons’ use of automated external defibrillator (AED) is still low in comparison with bystander CPR. Objective. To investigate the feasibility of mobile videocall guidance to facilitate AED use by laypersons. Design, setting, and participants. A total of 90 laypersons were randomized into three groups: the mobile video call-guided, voice call-guided, and non-guided groups. Participants were exposed to simulated cardiac arrest to use an AED, and guided by video calls, voice calls, or were not guided. We recorded the simulation experiments as a videoclip, and other researchers who were blinded to the simulation assessed the performance according to the prespecified checklist after simulations. Outcomes measure and analysis. We compared the performance score and time intervals from AED arrival to defibrillation among the three groups and analyzed the common errors. Results. There was no significant difference among the three groups in terms of baseline characteristics. Performance scores in the checklist for using AED were higher in the mobile video call-guided group, especially in the category of “Power on AED” and “Correctly attaches pads” than in the other groups. However, the time interval to defibrillation was significantly longer in the mobile video call-guided group. Conclusions. Mobile video call guidance might be an alternative method to facilitate AED use by laypersons. Therefore, further well-designed research is needed to evaluate the feasibility of this approach in OHCA.

Abstract 121: Quality of Cardiopulmonary Resuscitation by Bystanders and Survival After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Chika Nishiyama ◽  
Tetsuhisa Kitamura ◽  
Tomonari Shimamoto ◽  
Takashi Kawamura ◽  
Tetsuya Sakamoto ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Poor Quality ◽  
Hand Position ◽  
Kappa Statistics ◽  
Chest Compressions ◽  
The Poor ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Although quality of cardiopulmonary resuscitation (CPR) is a key to increase survival after out-of-hospital cardiac arrest (OHCA), little is known about the quality of bystander CPR and its association with survival outcomes after OHCA. Objective: To evaluate the association of quality of bystander CPR and patient outcomes after OHCA. Methods: Designs: Population-based cohort study. Cases: All OHCA cases treated by emergency medical services (EMS) personnel in Toyonaka city between September 2011 and August 2013. Data collection and analyses: EMS personnel assessed bystanders’ CPR quality including hand position, depth, and tempo of chest compressions using a specific data form at the scene. Fleiss’ Kappa statistics was used to assess the evaluation reliability among EMS personnel and the Kappa value was 0.81 before the study. The primary outcome was patient one-month survival with favorable neurological outcome and it was compared between the good-quality CPR group and the poor-quality CPR group. Results: Among 877 cases, bystander CPR was attempted in 429 (48.9%). Data on quality of CPR was applicable in 272 (63.4%) of them. In the good-quality CPR group, bystanders were younger, more likely to be health care provider, and have experience of CPR training than in the poor-quality of CPR group. The proportion of patients with neurologically favorable one-month survival was somewhat greater in the good-quality of CPR group (4.6% versus 3.0%), although it was statistically insignificant. Conclusions: Better quality of bystander chest compressions might increase OHCA patient survival. Further efforts to improve quality of CPR by general public are needed.

scholarly journals 156 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

2020 ◽  
Vol 37 (12) ◽  
pp. 825.1-825
Author(s):  
Ed Barnard ◽  
Daniel Sandbach ◽  
Tracy Nicholls ◽  
Alastair Wilson ◽  
Ari Ercole
Keyword(s):  
Overall Survival ◽  
Cardiac Arrest ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Multivariable Analysis ◽  
Discharge Data ◽  
Successful Resuscitation ◽  
Bystander Cpr ◽  
Number Percentage ◽  
Hospital Cardiac Arrest

Aims/Objectives/BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Aim: to compare differential determinants of survival to hospital admission and survival to hospital discharge for traumatic (TCA) and non-traumatic cardiac arrest (NCTA).Methods/DesignAn analysis of 9109 OHCA in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for NTCA and TCA. Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. Data reported as number (percentage), number (percentage (95% CI)) and median (IQR) as appropriate. Continuous data have been analysed with a Mann-Whitney U test, and categorical data have been analysed with a χ2 test. Analyses were performed using the R statistical programming language.Results/ConclusionsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95%CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander-CPR was dependent on geographical socioeconomic status.NTCA and TCA are clinically distinct entities with different predictors for outcome and should be reported separately. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

scholarly journals Outcomes of out-of-hospital cardiac arrest in Beijing: a 5-year cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e041917
Author(s):  
Fei Shao ◽  
Haibin Li ◽  
Shengkui Ma ◽  
Dou Li ◽  
Chunsheng Li
Keyword(s):  
Cardiac Arrest ◽  
Urban Areas ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Term Survival ◽  
Shockable Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

ObjectiveThe purpose of this study was to assess the trends in outcomes of out-of-hospital cardiac arrest (OHCA) in Beijing over 5 years.DesignCross-sectional study.MethodsAdult patients with OHCA of all aetiologies who were treated by the Beijing emergency medical service (EMS) between January 2013 and December 2017 were analysed. Data were collected using the Utstein Style. Cases were followed up for 1 year. Descriptive statistics were used to characterise the sample and logistic regression was performed.ResultsOverall, 5016 patients with OHCA underwent attempted resuscitation by the EMS in urban areas of Beijing during the study period. Survival to hospital discharge was 1.2% in 2013 and 1.6% in 2017 (adjusted rate ratio=1.0, p for trend=0.60). Survival to admission and neurological outcome at discharge did not significantly improve from 2013 to 2017. Patient characteristics and the aetiology and location of cardiac arrest were consistent, but there was a decrease in the initial shockable rhythm (from 6.5% to 5.6%) over the 5 years. The rate of bystander cardiopulmonary resuscitation (CPR) increased steadily over the years (from 10.4% to 19.4%).ConclusionSurvival after OHCA in urban areas of Beijing did not improve significantly over 5 years, with long-term survival being unchanged, although the rate of bystander CPR increased steadily, which enhanced the outcomes of patients who underwent bystander CPR.

Abstract 184: AED Application in Non-Shockable Out-of-Hospital Cardiac Arrest Does Not Reduce Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ross A Pollack ◽  
Siobhan P Brown ◽  
Thomas Rea ◽  
Peter J Kudenchuk ◽  
Myron L Weisfeldt
Keyword(s):  
Cardiac Arrest ◽  
Primary Outcome ◽  
Patient Characteristics ◽  
Neurological Status ◽  
Relative Safety ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Rhythm Analysis ◽  
In Transit ◽  
Hospital Cardiac Arrest

Introduction: It is well established that AEDs improve outcome in shockable out-of-hospital cardiac arrest (OHCA). An increasing proportion (now the majority) of OHCAs present with non-shockable rhythms. Survival from non-shockable OHCA depends on high-quality CPR in transit to definitive care. Studies of AED use in non-shockable in-hospital arrest (as opposed to OHCA) have shown reduced survival with AED application possibly due to CPR interruptions to apply pads and perform rhythm analysis. We sought to determine whether AED application in non-shockable public, witnessed OHCA has a significant association with survival to discharge. Methods: This is a retrospective analysis of OHCA from 2010-2015 at 10 Resuscitation Outcomes Consortium centers. All adult, public, witnessed non-shockable OHCAs were included. Non-shockable arrest was defined as no shock delivered by the AED or by review of defibrillator tracings (10%). The initial rhythm on EMS arrival was used to confirm the rhythm. The primary outcome was survival to hospital discharge with favorable neurological status (modified rankin score <3). The OR was adjusted for the Utstein variables. Results: During the study period there were 1,597 non-shockable public, witnessed OHCA, 9.8% of which had an AED applied. The initial rhythm on EMS arrival was PEA or asystole in 86% of cases. Significantly more OHCA in the AED applied group had CPR performed. 6.5% of those without an AED applied survived with favorable neurologic status compared to 9% with an AED. After adjustment for the Utstein variables including bystander CPR, the aOR for survival with favorable neurologic outcome was 1.38 (95% CI:0.72-2.65). Conclusion: After adjusting for patient characteristics and bystander CPR, the application of an AED in non-shockable public witnessed OHCA had no significant association with survival or neurological outcome supporting the relative safety and potential benefit of AED application in non-shockable OHCA.

Abstract 170: Challenges in Implementing an ECPR Program for Out of Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Meshe Chonde ◽  
Jeremiah Escajeda ◽  
Jonathan Elmer ◽  
Frank X Guyette ◽  
Arthur Boujoukos ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Inclusion Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Implementation Challenges ◽  
Shockable Rhythm ◽  
Bystander Cpr ◽  
Stay And Play ◽  
Load And Go ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapy. Many institutions are interested in developing their own ECPR program. However, there are challenges in logistics and implementation. Hypothesis: Development of an ECPR team and identification of UPMC Presbyterian as a receiving center will increase recognition of potential ECPR candidates. Methods: We developed an infrastructure of Emergency Medical Services (EMS), Medic Command, and an in-hospital ECPR team. We identified inclusion criteria for patients with an out of hospital cardiac arrest (OHCA) likely to have a reversible arrest etiology and developed them into a simple checklist. These criteria were: witnessed arrest with bystander CPR, shockable rhythm, and ages 18 to 60. We trained local EMS crews to screen patients and review the checklist with a Command Physician prior to transport to our hospital. Results: From October 2015 to March 31 st 2018, there were 1165 dispatches for OHCA, of which 664 (57%) were treated and transported to the hospital and 120 to our institution. Of these, five patients underwent ECPR. Of the remaining cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. Prehospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) underwent mechanical CPR with LUCAS device. Time from arrest to arrive on scene was 5 [IQR 4-6] min and time call MD command was 13 [IQR 7-21] min. Time to transport was 20 [IQR 19-21] min. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min. Conclusions: ECPR is a relatively infrequent occurrence. Implementation challenges include prompt identification of patients with reversible OHCA causes, preferential transport to an ECPR capable facility and changing the focus of EMS in these select patients from a “stay and play” to a “load and go” mentality.

Abstract P80: Short-term Outcomes of Vasopressin Administerd with Epinephrine versus Epinephrine Alone in ED for Out-of-hospital Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tae Yun Kim ◽  
Sun Woo Lee ◽  
Kyuseok Kim ◽  
Joong Eui Rhee ◽  
Sung Koo Jung
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
National Registry ◽  
Controlled Clinical Trial ◽  
Emergency Medical Service System ◽  
Short Term ◽  
Combined Administration ◽  
Before And After ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OOHCA) victims are increasing, but emergency medical service system (EMSS) is not ready for them in Korea. A previous randomized, controlled clinical trial has suggested that vasopressin followed epinephrine was superior to epinephrine in patients with asystole. According to the Korean national registry of OOHCA, patients with asystole were more than two thirds of them. In Korean EMSS, no drugs are permitted to administer in the prehospital phase by law. Thereafter epinephrine or vasopressin cannot be administered until patients are transported to emergency departments (EDs). This study was to evaluate whether the combined administration of vasopressin and epinephrine in ED for OOHCA patients would increase the return of spontaneous circulation (ROSC) and survival discharge. Methods: From October 2007 to May 2008, we changed the CPR protocol in adult, nontraumatic OOHCA that 40 U of vasopressin was administered as soon as possible after the first dose of epinephrine (the after group). Cardiac arrest data were collected using the Utstein template. Data from January to September 2007, when vasopressin has not been used, were also collected for comparative analysis (the before group). These two groups were compared in terms of ROSC, and survival discharge Results: There were 45 and 50 patients in the before and after groups, respectively. There was no significant differences in the initial ECG rhythm of asystole (67% vs 78%), witnessed arrest (73% vs 72%), bystander CPR (16% vs 10%), time from collapse to BLS time (6 min vs 8.5 min), and time from collapse to study drugs (23 min vs 26.5 min). The rate of sustained ROSC was similar between the before and after groups (53% vs 48%, P=0.604) as was the survival discharge (27% vs 14%, P=0.123). Conclusions: Vasopressin with administerd with epinephrine does not increase the rate of ROSC nor the survival discharge.

Abstract P82: Implementation Of New Resuscitation Guidelines Takes One-and-a-half Year

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jocelyn Berdowski ◽  
Andra Schmohl ◽  
Rudolph W Koster
Keyword(s):  
Cardiac Arrest ◽  
World Wide ◽  
Prospective Observational Study ◽  
Spontaneous Circulation ◽  
Chest Compressions ◽  
Return Of Spontaneous Circulation ◽  
Resuscitation Guidelines ◽  
Rhythm Analysis ◽  
New Guidelines ◽  
Hospital Cardiac Arrest

Objective- In November 2005, updated resuscitation guidelines were introduced world-wide, and will be revised again in 2010. This study aims to determine how long it takes to implement new guidelines. Methods- This was a prospective observational study. From July 2005 to January 2008, we included all patients with a non traumatic out-of-hospital cardiac arrest. Ambulance paramedics sent all continuous ECG registrations with impedance signal by modem. We excluded ECGs from patients with Return Of Spontaneous Circulation at arrival, incomplete ECG registrations, ECGs with technical deficits or with continuous chest compressions. The same guidelines needed to be used in over 75% of the registration time in order to be labeled. We classified ECGs as guidelines 2000 if the c:v ratio was 15:2, shock blocks were present and there was rhythm analysis after each shock; guidelines 2005 if the c:v ratio was 30:2, a single shock protocol was used and chest compressions was immediately resumed after shock or rhythm analysis in a no shock scenario. We accepted 10% deviations in the amount of compressions (13–17 for 2000 guidelines, 27–33 for 2005). Results- Of the 1703 analyzable ECGs, we classified 827 (48.6%) as guidelines 2000 and 624 (36.6%) as guidelines 2005. In the remaining 252 ECGs (14.8%) 31 used guidelines 1992, 137 applied guidelines 2000 with c:v ratio of 30:2 and 84 did not show distinguishable guideline usage. Since the introduction in November 2005, it took 17 months to apply new guidelines in over 80% of the cases (figure 1 ). Conclusion- Guideline changes are slowly implemented by professionals. This needs to be taken in consideration when new guideline revisions are considered.

Sign in / Sign up

Export Citation Format

Share Document