Abstract 212: Advantage of CPR-First Over Call-First Basic Life Support Actions in Out-of-Hospital Cardiac Arrest of Noncardiac Etiology and Young Adults/Children

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hose Iwasaki ◽  
Takahisa Kamikura ◽  
Testuo Maeda ◽  
Minoru Kubo ◽  
Yutaka Takei ◽  
...  
Keyword(s):  
Young Adults ◽  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Multiple Logistic Regression Analysis ◽  
Emergency Call ◽  
Time Interval ◽  
Bystander Cpr ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Aim: To assess the benefit of immediate call-first or CPR-first basic life support (BLS) in promoting a better outcome of out-of-hospital cardiac arrest (OHCA). Methods: From the nation-wide database of 2005 to 2012, we extracted bystander-witnessed OHCAs in which both emergency call and CPR were performed by bystanders on their own initiative (without instruction over telephone) within 6 min of witnessing patient collapse. These cases were categorized into the following four groups; immediate Call+CPR group (N=10,195 ,emergency call and/or CPR within 2 min of witness, call-CPR time interval = 0 or 1 min), immediate Call-First group (N=1,820 , emergency call within 2 min of witness, call-CPR interval = 2[[Unable to Display Character: &#8210;]]4 min), immediate CPR-First group (N=5,446 , bystander CPR within 2 min of witness, CPR-call interval =2[[Unable to Display Character: &#8210;]]4 min), the delayed Call/CPR group (N=4,671, the remaining cases). We compared the rates of neurologically favorable survival at 1-month among the four groups for all OHCAs and subgroups of OHCAs. Results: The overall survival rate was highest in Call-First group and lowest in delayed Call/CPR group (Figure). The rate of Call-First group was significantly higher than that of CPR-First group in OHCAs of presumed cardiac etiology (17.2% vs. 14.1%, unadjusted OR; 95% CI, 1.26; 1.05[[Unable to Display Character: &#8210;]]1.52). The rate of CPR-First group was significantly higher than that of Call-First group in OHCAs of presumed non-cardiac etiology (7.7% vs. 5.0%, 1.59; 1.11[[Unable to Display Character: &#8210;]]2.33) and young adults/children (age<35y, 32.8% vs. 17.8%, 2.25; 1.33[[Unable to Display Character: &#8210;]]3.95). Multiple logistic regression analysis confirmed the results of univariate analyses and disclosed that delayed Call/CPR is associated with poor outcomes. Conclusions: The immediate (within 2 min) CPR-first BLS action followed by emergency call without a large (>4 min) delay may be recommended when a single bystander having a fundamental skill to initiate CPR witnesses OHCAs of non-cardiac etiology and young adults/children.

scholarly journals 2019 American Heart Association Focused Update on Pediatric Basic Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Circulation ◽  
2019 ◽  
Vol 140 (24) ◽  
Author(s):  
Jonathan P. Duff ◽  
Alexis A. Topjian ◽  
Marc D. Berg ◽  
Melissa Chan ◽  
Sarah E. Haskell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
American Heart Association ◽  
Basic Life Support ◽  
Life Support ◽  
American Heart ◽  
Heart Association ◽  
Liaison Committee ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation’s continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress.

Abstract 19542: A North American Survey of Public Opinion on the Acceptability of Crowdsourcing Basic Life Support for Out-of-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Katie N Dainty ◽  
Steven Brooks
Keyword(s):  
Cardiac Arrest ◽  
North American ◽  
Basic Life Support ◽  
Life Support ◽  
Public Access ◽  
The North ◽  
The Usa ◽  
Bystander Cpr ◽  
Use Of Social Media ◽  
Hospital Cardiac Arrest

Introduction: Performance of bystander CPR and early defibrillation following out-of-hospital cardiac arrest (OHCA) have been shown to increase the odds of survival to hospital discharge more than 3-fold. The PulsePoint Respond™ Application (App) is a novel system that can be implemented by EMS to crowdsource basic life support for victims of OHCA. The system sends cardiac arrest notifications to a user’s mobile device which includes the location of the emergency and nearby public access defibrillators to facilitate bystander CPR and AED use while EMS personnel are en route. We conducted a North American survey to evaluate public perceptions of such an application, including acceptability and willingness to respond to alerts. Methods: The web-based survey was conducted in Canada and the USA by an established external polling vendor, Ipsos Reid. Sampling was designed to ensure broad representation of gender, age, geography, and spoken language following recent census statistics. Respondents were presented with a short concept description of cardiac arrest and the Pulsepoint app in text format followed by 6 closed-ended and 4 open-ended questions. Results: A random sample of 2,415 total surveys were collected (1106 from Canada and 1309 from the US). 70% of Canadian respondents but only 47% of US respondents had been trained in CPR at some point. On average, 79.5% of respondents agreed that Pulsepoint is something they would like to see in their community and 59.5% said they would download the App. 80% of Canadians and 77% of Americans were comfortable with receiving help in a public setting (street, office, etc) and 72 and 68% respectively, indicated they would be comfortable with receiving help in a private setting (home). Less than 40% of respondents identified concerns; as expected those identified included training concerns and trust issues. An average of 89% of the sample from both countries felt it was important that responders have up-to-date CPR certification. Conclusions: Overall, the North American public find the concept of the Pulsepoint application and crowdsourcing basic life support for OHCA acceptable and would be willing to respond. This is encouraging insight to support the use of social media to increasing bystander CPR rates in North America.

scholarly journals Outcomes of arrest patients resuscitated in an emergency department: a prospective, observational study

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Life Support ◽  
Survival Rates ◽  
Secondary Outcome ◽  
Time Interval ◽  
Trauma Patients ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

In developing countries, a lack of knowledge about basic life support and overcrowded emergency departments (EDs) may cause problems related to the quality of cardiopul-monary resuscitation and postresuscitation care. We aimed to investigate which factors affect the return of spontaneous circulation (ROSC) and survival rates among out-of-hospital and in-hospital arrest patients in an upper-middle income country. The study was prospectively conducted from January 2018 to April 2019. All patients resuscitated in the ED, except trauma patients, were included. The out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) groups were followed up for 30 days. The primary outcome was the 30-day-survival rate, while the secondary outcome was the ROSC rate. A total of 177 patients were included in the study (80 OHCA and 97 IHCA patients). Among the OHCA patients, ROSC was achieved at a rate of 58.8%, and a 30-day survival rate of 12.5% was observed. None of the OHCA patients underwent bystander CPR. One of the main factors affecting survival in this group was the time interval until the patient reached the ED. ROSC was achieved in 54.4% of IHCA patients, while 17.5% of them were alive at 30 days. Patients who survived 30 days were significantly younger than those who died within 30 days (56 (46–74) vs. 73 (64.2–83.7) years, respectively). In the IHCA group, patients with creatinine and potassium levels closer to normal survived for 30 days. Effective and rapid fluid-electrolyte treatments of patients with high lactate and potassium levels may improve the mortality rates of these patients. We think that a focus on improving the quality of the prehospital CPR practice in OHCA patients and increasing the rates of bystander CPR by educating the public can positively contribute to outcomes.

Knowledge and Skills of Lay Participants Training with Basic Life Support Program in Case of Cardiac Arrest

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S44-S48
Keyword(s):  
Cardiac Arrest ◽  
Training Program ◽  
Basic Life Support ◽  
Life Support ◽  
Training Session ◽  
Smartphone Application ◽  
Knowledge And Skills ◽  
Lay People ◽  
Before And After ◽  
Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest is an important cause that leads to hospital admission and death. Improving lay people’s knowledge and skills in basic life support (BLS) may lead to reduced death associated with out-of-hospital cardiac arrest. “BLS NU KKU” is a BLS training program developed from up-to-date literature as a smartphone application used to train lay people in the community. Objective: To evaluate BLS-related knowledge and skills of participants before and after BLS training. Materials and Methods: A one group pretest-posttest design was used to implement the present study in Khon Kaen, Thailand. Participants were 350 individuals age 18 and older. An 8-hour BLS training session was offered to 10 groups of 35 participants over the period of 10 months between November 2018 and August 2019. Self-administered questionnaires were used to assess BLS knowledge and Cardiopulmonary resuscitation (CPR) skills. Results: The mean score for BLS-related knowledge significantly increased after the BLS training (mean = 15.05, SD = 2.51) compared to the scores before the training (mean = 10.47, SD = 3.43) (p<0.05). BLS skills improved from 0% to 100% (p<0.001) will all skills rated with mostly “excellent” and “good”. Satisfaction with the training program was also rated mostly with “excellent” and “good”. Conclusion: The BLS training program effectively improved participants’ knowledge and skills for basic life support. This program should be disseminated to train lay people in other settings. Keywords: Basic life support, Cardiac arrest, Mobile application

scholarly journals Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

2021 ◽  
Author(s):  
Pramod Chandru ◽  
Tatum Priyambada Mitra ◽  
Nitesh Dutt Dhanekula ◽  
Mark Dennis ◽  
Adam Eslick ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Rescue Therapy ◽  
A Priori ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

scholarly journals Strengthening Links in the “Chain of Survival”: A Singapore Perspective

2002 ◽  
Vol 9 (3) ◽  
pp. 121-125 ◽  
Author(s):  
Ra Charles ◽  
F Lateef ◽  
V Anantharaman
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Basic Cardiac Life Support ◽  
Chain Of Survival ◽  
Bystander Cpr ◽  
Mean Time ◽  
Hospital Cardiac Arrest ◽  
Ambulance Crew

Introduction The concept of the chain of survival is widely accepted. The four links viz. early access, early cardiopulmonary resuscitation (CPR), early defibrillation and early Advanced Cardiac Life Support (ACLS) are related to survival after pre-hospital cardiac arrest. Owing to the dismal survival-to-discharge figures locally, we conducted this study to identify any weaknesses in the chain, looking in particular at bystander CPR rates and times to Basic Cardiac Life Support (BCLS) and ACLS. Methods and materials A retrospective cohort study was conducted in the Emergency Department of an urban tertiary 1500-bed hospital. Over a 12-month period, all cases of non-trauma out-of-hospital cardiac arrest were evaluated. Results A total of 142 cases of non-trauma out-of-hospital cardiac arrest were identified; the majority being Chinese (103/142, 72.5%) and male (71.8%) with a mean age of 64.3±7.8 years (range 23–89 yrs). Most patients (111/142, 78.2%) did not receive any form of life support until arrival of the ambulance crew. Mean time from collapse to arrival of the ambulance crew and initiation of BCLS and defibrillation was 9.2±3.5 minutes. Mean time from collapse to arrival in the Emergency Department (and thus ACLS) was 16.8±7.1 minutes. Three patients (2.11%) survived to discharge. Conclusion There is a need to (i) facilitate layperson training in bystander CPR, and (ii) enhance paramedic training to include ACLS, in order to improve the current dismal survival outcomes from out-of-hospital cardiac arrest in Singapore.

scholarly journals Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system

CJEM ◽  
2001 ◽  
Vol 3 (03) ◽  
pp. 186-192 ◽  
Author(s):  
David A. Petrie ◽  
Valerie De Maio ◽  
Ian G. Stiell ◽  
Jonathan Dreyer ◽  
Michael Martin ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Basic Life Support ◽  
Life Support ◽  
Ethical Decision Making ◽  
Pulseless Electrical Activity ◽  
Advanced Life Support ◽  
Stepwise Logistic Regression ◽  
Bystander Cpr

ABSTRACT Objectives: Previous studies have shown a low but meaningful survival rate in cases of prehospital cardiac arrest with an initial rhythm of asystole. There may be, however, an identifiable subgroup in which resuscitation efforts are futile. This study identified potential field criteria for predicting 100% nonsurvival when the presenting rhythm is asystole in a Basic Life Support-Defibrillation (BLS-D) system. Methods: This prospective cohort study, a component of Phases I and II of the Ontario Prehospital Advanced Life Support (OPALS) Study, was conducted in 21 Ontario communities with BLS-D level of care, and included all adult arrests of presumed cardiac etiology according to the Utstein Style Guidelines. Analyses included descriptive and appropriate univariate tests, as well as multivariate stepwise logistic regression to determine predictors of survival. Results: From 1991 to 1997, 9899 consecutive cardiac arrest cases with the following characteristics: male (67.2%), bystander-witnessed (44.7%), bystander CPR (14.2%), call–response interval (CRI) ≤ 8 minutes (82%) and overall survival (4.3%) were enrolled. Of 9529 cases with available rhythm strip recordings, initial arrest rhythms were asystole in 40.8%, pulseless electrical activity in 21.2% and ventricular fibrillation or ventricular tachycardia in 38%. Of 3888 asystolic patients, 9 (0.2%) survived to discharge; 3 of these cases were unwitnessed arrests with no bystander CPR. There were no survivors if the CRI exceeded 8 minutes. Logistic regression analysis demonstrated that independent predictors of survival to admission were “CRI in minutes” (odds ratio [OR] = 0.87; 95% confidence interval [CI], 0.77–0.98) and “bystander-witnessed” (OR = 2.6; 95% CI, 1.5–4.4). Conclusions: In a BLS-D system, there is a very low but measurable survival rate for prehospital asystolic cardiac arrest. CRIs of over 8 minutes were associated with 100% nonsurvival, whereas unwitnessed arrests with no bystander CPR were not. These data add to the growing literature that will help guide ethical decision-making for protocol development in emergency medical services systems.

Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest

2019 ◽  
Vol 36 (8) ◽  
pp. 479-484 ◽  
Author(s):  
Mark H Ebell ◽  
Akke Vellinga ◽  
Siobhan Masterson ◽  
Phillip Yun
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Meta Analysis ◽  
Advanced Life Support ◽  
Study Quality ◽  
European Resuscitation Council ◽  
Comprehensive Search ◽  
Hospital Cardiac Arrest ◽  
Low Rate

BackgroundOur objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA).MethodsWe performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R.ResultsWe identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%).ConclusionsThe BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.

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