Abstract 98: The Association Between Manual Mode Defibrillation, Preshock Pause Duration and Appropriate Shock Delivery When Employed by Basic Life Support Paramedics During Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheldon Cheskes ◽  
Morgan Hillier ◽  
Cathy Zhan ◽  
Adam Byers ◽  
P R Verbeek ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Pause Duration ◽  
Absolute Difference ◽  
Secondary Outcome ◽  
Correct Identification ◽  
Shock Delivery ◽  
Inappropriate Shocks ◽  
Shockable Rhythm ◽  
Manual Mode

BACKGROUND: Pre-shock pause duration of < 20 seconds is associated with improved survival after cardiac arrest. Manual mode defibrillation has been associated with the shortest duration of pre-shock pause but is largely practiced by paramedics (EMT-P) whereas defibrillator only providers (EMT-D) routinely use the defibrillator in automatic mode. OBJECTIVE: We sought to explore the relationship between manual mode defibrillation, pre-shock pause duration and shock appropriateness when defibrillation is provided by EMT-P vs. EMT-D level of providers. METHODS: We performed a retrospective review of all treated non-traumatic adult OHCA presenting in a shockable rhythm over a one year period beginning January 1, 2012. Our primary outcome measure was the proportion of manual mode shocks delivered by EMT-D’s with pre- shock pause duration of < 20 secs when compared to EMT-P’s. Our secondary outcome measures were the duration of pre-, post- and peri-shock pause and the proportion of appropriate shocks (defined as correct identification and shock delivery to patients in a shockable rhythm) delivered by either level of provider. This study had a power of 90% to detect an absolute difference of 15% between provider levels in proportion of shocks delivered with pre-shock pause duration <20 secs. RESULTS: Among 2019 treated OHCA, 335(20%) presented in a shockable rhythm. Manual defibrillation was performed in 155 (46%) of these cases (196 shocks by EMT-P, 143 shocks by EMT-D). There were no differences in the proportion of shocks delivered with pre-shock pause duration <20 secs (EMT-P 82.8% vs EMT-D 84.8%, p =.65) nor pre-shock pause duration (sec) (median, Q1, Q3); EMT-P: 12.0 (7.0,17.0) vs. EMT-D: 11.0 (5.0,17.0), p= .13 while EMT-D had shorter peri- shock pause duration (sec) (median, Q1, Q3); EMT-P: 17.0 (12.0, 23.0) vs. EMT-D: 15.0 (9.0, 22.0), p =.03. There were no differences in the rate of inappropriate shocks (EMT-P 1.0% vs EMT-D 0.7%), p=1.0. CONCLUSIONS: Manual mode defibrillation by EMT-D’s produced similar measures of pre-shock pause when compared to EMT-P’s without increasing the rate of inappropriate shocks. More widespread use of EMT-D manual mode defibrillation may have the potential to decrease shock pause duration and improve survival.

Abstract 01: The Importance of Time to Cooling in Out-Of-Hospital Cardiac Arrest Patients to Influence Neurologically Intact Survival: A Sub-Analysis of the Princess Trial

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Akil Awad ◽  
Fabio Silvio Taccone ◽  
Martin Jonsson ◽  
Sune Forsberg ◽  
Jacob Hollenberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Secondary Outcome ◽  
Control Group ◽  
Shockable Rhythm ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

Background: Early initiation of hypothermia has shown to be important to reduce brain injuries in experimental cardiac arrest models. The aim of this study was to investigate the association between time to initiate cooling and neurological intact survival in patients with out-of-hospital cardiac arrest (OHCA). Methods: A secondary analysis of prospectively collected data from the PRINCESS trial (NCT01400373) including 677 OHCA patients randomized to transnasal evaporative intra-arrest cooling or standard advanced life support and cooling started subsequent to hospital arrival. Time to randomization was used a proxy measurement for time to initiate cooling. An early treatment group was defined as patients randomized by the EMS <20 minutes from the time of the cardiac arrest. Propensity scores were used to find matching patients in the control group. Patients with initial shockable rhythms were analyzed as a predefined subgroup. The primary outcome was good neurologic outcome, Cerebral Performance Category (CPC) 1-2 at 90 days. Secondary outcome was complete recovery (CPC 1). Results: In total 406 patients were randomized <20 minutes from the cardiac arrest and were propensity score matched (1:1). In the propensity score matched analysis the proportion of patients with CPC 1-2 was 21.7% in the intervention and 17.2% in the control group, odds ratio (OR) 1.33, 95% confidence interval (CI) 0.80-2.21, p=0.273. In patients with initial shockable rhythm (79 intervention, 79 control) the difference in CPC 1-2 was 48.1% versus 32.0%, OR 2.05, 95%CI 1.00-4.21, p=0.0498. The proportion of patients with complete neurologic recovery, CPC 1, was 19.7% in the intervention and 13.3% in the control group, OR 1.60, 95% CI 0.92-2.79, p=0.097. In patients with initial shockable rhythm the proportion with CPC 1 was 45.6% versus 24.6%, OR 2.81, 95% CI 1.23-6.42, p=0.014. Conclusions: In this ancillary study of OHCA patients receiving intra-arrest cooling, there were differences in survival with good neurologic outcome and in complete neurological recovery in favor of early intra-arrest cooling patient group compared to standard care. These differences were statistically significant in the subgroup of patients with initial shockable rhythms.

scholarly journals LO03: Impact of the conversion to a shockable rhythm from a non-shockable rhythm for patients suffering from out-of-hospital cardiac arrest

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S7-S7
Author(s):  
A. Cournoyer ◽  
E. Notebaert ◽  
S. Cossette ◽  
J. Morris ◽  
L. de Montigny ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Outcome Measure ◽  
Prognostic Significance ◽  
Pulseless Electrical Activity ◽  
Primary Outcome Measure ◽  
Absolute Difference ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Patients suffering from out-of-hospital cardiac arrest (OHCA) with an initial shockable rhythm (ventricular tachycardia or ventricular fibrillation) have higher odds of survival than those suffering from non-shockable rhythm (asystole or pulseless electrical activity). Because of that prognostic significance, patients with an initial non-shockable rhythm are often not considered for advanced resuscitation therapies such as extracorporeal resuscitation. However, the prognostic significance of the conversion to a shockable rhythm from an initially non-shockable rhythm remains uncertain. This study aimed to determine the degree of association between the conversion (or not) of a non-shockable rhythm to a shockable rhythm and resuscitation outcomes in patients with OHCA. It was hypothesized that such a conversion would be associated with a higher survival to discharge. Methods: The present study used a registry of adult OHCA between 2010 and 2015 in Montreal, Canada. Adult patients with non-traumatic OHCA and an initial non-shockable rhythm were included. The primary outcome measure was survival to hospital discharge, and the secondary outcome measure was prehospital return of spontaneous circulation (ROSC). The associations of interest were evaluated with univariate logistic regressions and multivariate models controlling for demographic and clinical variables (e.g. age, gender, type of initial non-shockable rhythm, witnessed arrest, bystander cardiopulmonary resuscitation). Assuming a survival rate of 3% and 25% of the variability explained by the control variables, including more than 4580 patients would allow to detect an absolute difference of 4% in survival between both groups with a power of more than 90%. Results: A total of 4893 patients (2869 men and 2024 women) with a mean age of 70 years (standard deviation 17) were included, of whom 450 (9.2%) experienced a conversion to a shockable rhythm during the course of their prehospital resuscitation. Among all patients, 146 patients (3.0%) survived to discharge and 633 (12.9%) experienced prehospital ROSC. In the univariate models, there was no association between the conversion to a shockable rhythm and survival (odds ratio [OR] 1.14 [95% confidence interval {CI} 0.66-1.95]), but a significant assocation was observed with ROSC (OR 2.00 [95% CI 1.57-2.55], p<0.001). However, there was no independent association between the conversion to a shockable rhythm and survival (adjusted OR [AOR] 0.92 [95% CI 0.51-1.66], p=0.78) and prehospital ROSC (AOR 1.30 [95% CI 0.98-1.72], p=0.073). Conclusion: There is no clinically significant association between the conversion to a shockable rhythm and resuscitation outcomes in patients suffering from OHCA. The initial rhythm remains a much better outcome predictor than subsequent rhythms and should be preferred when evaluating the eligibility for advanced resuscitation procedures.

scholarly journals External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era

2020 ◽  
Author(s):  
Haewon Jung ◽  
Mijin Lee ◽  
Jae Wan Cho ◽  
Sang Hun Lee ◽  
Suk Hee Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Disease Transmission ◽  
Life Support ◽  
External Validation ◽  
Advanced Life Support ◽  
Survival Outcomes ◽  
Shock Delivery ◽  
Treatment Protocols ◽  
Multicenter Observational Study ◽  
Hospital Cardiac Arrest

Abstract Background: Futile resuscitation for out-of-hospital cardiac arrest (OHCA) patients in the coronavirus disease (COVID)-19 era can lead to risk of disease transmission and unnecessary transport. Various existing basic or advanced life support (BLS or ALS, respectively) rules for the termination of resuscitation (TOR) have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era.Methods: This was a multicenter observational study using the WinCOVID-19 Daegu registry data collected during February 18–March 31, 2020. The subjects were patients who showed cardiac arrest of presumed cardiac etiology. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity, specificity, false positive value (FPV), and positive predictive value (PPV) of each TOR rule were evaluated. Results: In total, 170 of the 184 OHCA patients were eligible and evaluated. TOR was recommended for 122 patients based on the international basic life support termination of resuscitation (BLS-TOR) rule, which showed 85% specificity, 74% sensitivity, 0.8% FPV, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPV (upper limit of 95% confidence interval <5%), specificity (100%), and PPV (>99%) criteria, only the KoCARC TOR rule I, which included a combination of three factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or return of spontaneous circulation, was found to be superior to all other TOR rules. Conclusion: Among the previous nine BLS and ALS TOR rules, KoCARC TOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.

Abstract 147: Rapid Responder Operating Times for Out-of-hospital Cardiac Arrest Using Three Automated External Defibrillator Models

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Mengqi Gao ◽  
Chenguang Liu ◽  
Dawn Jorgenson
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Operating Time ◽  
Sudden Cardiac Arrest ◽  
The United States ◽  
Automated External Defibrillator ◽  
Simulation Studies ◽  
Time Intervals ◽  
Shock Delivery ◽  
External Defibrillator

Background: Early defibrillation with an automated external defibrillator (AED) is crucial for improving the survival rate in out-of-hospital resuscitation from sudden cardiac arrest (SCA). Chance of survival decreases by 7% to 10% for every minute that defibrillation is delayed. While simulation studies have been used to assess AED usability factors, our objective was to report the actual operating time for three Philips AED models used in SCA responses. Methods: A convenience dataset recorded by Philips AEDs (HS1, FRx, or FR3) was obtained from Europe and the United States from 2007 - 2018. The HS1 is intended for minimally trained or untrained individuals, the FRx is for Basic Life Support (BLS), and the FR3 is for both BLS and Advanced Life Support (ALS) responders. A retrospective analysis was conducted to report the operating time intervals for cases where a shock was delivered after initial rhythm analysis. The study analyzed 90 HS1, 46 FRx and 32 FR3 cases. Results: Compared with HS1, both FRx (p < 0.001) and FR3 (p = 0.001) responders spent less time in placing pads on the patient after powering on the AED (Figure 1) as expected. Similarly, time intervals from the start of shock advised prompt to first shock delivery for FRx (p = 0.02) and FR3 (p < 0.01) are shorter than for HS1. Time from AED power-on to first shock was within 90 seconds in 74.4% (67 of 90) HS1 cases, 97.8% (45 of 46) FRx cases, and 100% (32 of 32) FR3 cases. On average, the FR3 and FRx responders were able to deliver the first shock within 48 seconds. Conclusions: The analysis shows that responders were able to quickly apply the AEDs and respond to the shock advisory prompt for all three AED models despite different training levels. This real-world performance is better than most reported simulation studies, however, this analysis cannot convey variety of activities that account for the differences in timing (e.g. pads applied before power-on, or compressions began before applying pads, etc.).

scholarly journals Hands-on defibrillation and electrocardiogram artefact filtering technology increases chest compression fraction and decreases peri-shock pause duration in a simulation model of cardiac arrest

CJEM ◽  
2015 ◽  
Vol 18 (4) ◽  
pp. 270-275 ◽  
Author(s):  
Shannon M. Fernando ◽  
Sheldon Cheskes ◽  
Daniel Howes
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Standard Of Care ◽  
Pause Duration ◽  
Shock Delivery ◽  
Hands On ◽  
Before And After ◽  
Post Shock ◽  
Rhythm Analysis ◽  
Electrocardiogram Ecg

AbstractBackgroundReducing pauses during cardiopulmonary resuscitation (CPR) compressions result in better outcomes in cardiac arrest. Artefact filtering technology (AFT) gives rescuers the opportunity to visualize the underlying electrocardiogram (ECG) rhythm during chest compressions, and reduces the pauses that occur before and after delivering a shock. We conducted a simulation study to measure the reduction of peri-shock pause and impact on chest compression fraction (CCF) through AFT.MethodsIn a simulator setting, participants were given a standardized cardiac arrest scenario and were randomly assigned to perform CPR/defibrillation using the protocol from one of three experimental arms: 1) Standard of Care (pauses for rhythm analysis and shock delivery); 2) AFT (no pauses for rhythm analysis, but a pause for defibrillation); or 3) AFT with hands-on defibrillation (no pauses for rhythm analysis or defibrillation). The primary outcomes were CCF and peri-shock pause duration, with secondary outcomes of pre- and post-shock pause duration.ResultsAFT with hands-on defibrillation was found to have the highest CCF (86.4%), as compared to AFT alone (83.8%, p<0.001), and both groups significantly improved CCF in comparison with the Standard of Care (76.7%, p<0.001). AFT with hands-on defibrillation was associated with a reduced peri-shock pause (2.6 seconds) as compared to AFT alone (5.3 seconds, p<0.001), and the Standard of Care (7.4 seconds, p<0.001).ConclusionsIn this cardiac arrest model, AFT results in a greater CCF by reducing peri-shock pause duration. There is also a small but detectable improvement in CCF with the addition of hands-on defibrillation.

scholarly journals How many prehospital defibrillation attempts should be performed in out-of-hospital cardiac arrest patients with shockable rhythm?

2020 ◽  
Author(s):  
Byuk Sung Ko ◽  
Youn-Jung Kim ◽  
Kap Su Han ◽  
You Hwan Jo ◽  
Jonghwan Shin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Odds Ratio ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
Secondary Outcome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Shockable Rhythm ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

Abstract Background: Early defibrillation is vital to improve outcomes after out-of-hospital cardiac arrest (OHCA) with shockable rhythm. Currently, there is no agreed consensus on the number of defibrillation attempts before transfer to a hospital. This study aimed to evaluate the correlation between the number of defibrillations on the prehospital return of spontaneous circulation (ROSC).Methods: A multicenter, prospective, observational registry-based study was conducted for OHCA in patients with presumed cardiac etiology that underwent prehospital defibrillation between October 2015 and June 2017. The primary outcome was prehospital ROSC, and the secondary outcome was a good neurologic outcome at hospital discharge, defined as Cerebral Performance Category score 1 or 2. Results: Among 2,155 OHCA patients’ data, 178 patients with missing data were excluded, a total of 1,983 OHCA patients who received prehospital defibrillation were included. The median age was 61 years and prehospital ROSC was observed in 738 patients (37.2%). The median time from arrest to first defibrillation was 10 (interquartile range: 7-15) minutes. The cumulative ROSC rates and good neurologic outcome from the initial defibrillation to the sixth defibrillation were 43%, 68%, 81%, 90%, 95%, 98% and 42%, 66%, 81%, 90%, 95%, 98%, respectively. After clinical characteristics adjustment and time to defibrillation, the number of defibrillations were independently associated with ROSC (odds ratio 0.81 95% CI 0.76-0.86) and good neurologic outcome (odds ratio 0.86 95% CI 0.80-0.91). Moreover, subgroup analysis results with patients that underwent the initial defibrillation within 10 minutes from arrest were consistent (95% up to five times).Conclusion: More than 95% of prehospital ROSC was achieved within five times of defibrillation in OHCA patients. This result provides a basis for the ideal number of defibrillation attempts before transfer to hospital with the possibility of extracorporeal cardiopulmonary resuscitation in these refractory ventricular fibrillation patients.

scholarly journals Utility of opening rhythms in predicting time to return of spontaneous circulation in cardiac arrest victims in a resource constrained setting: a single centre prospective observational study

2019 ◽  
Vol 7 (12) ◽  
pp. 4709
Author(s):  
Appu Suseel ◽  
Siju V. Abraham ◽  
Radha K. R.
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Cardiopulmonary Arrest ◽  
Spontaneous Circulation ◽  
Secondary Outcome ◽  
Resource Constrained ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Mean Time

Background: Time to ROSC has been shown to be an important and independent predictor of mortality and adverse neurological outcome. In resource limited situations judicious deployment of resources is crucial. Prognostication of arrest victims may aid in better resource allocation. This study aimed to assess the time to Return of Spontaneous Circulation (ROSC) in cardiac arrest victims and its relationship with opening rhythms.Methods: Consecutive victims of cardiopulmonary arrest who presented to a single center were included in this study if they met the inclusion and exclusion criteria. Time at which opening rhythm was analyzed and time at which ROSC was achieved was noted. This was done for all cases and mean time to ROSC was calculated for each opening rhythm. All those patients who achieved ROSC were followed up till hospital discharge or death.  Primary outcome measured was achievement of ROSC and the secondary outcome was the survival to hospital discharge.Results: A sample size of 100 was calculated to yield a significance criterion of 0.05 and a power of 0.80 based on prior studies. Out of 100 patients studied. 58% had shockable rhythms and 42% had non-shockable rhythms.  Mean time to ROSC for shockable rhythm was 5.55±3.51 minutes, and for non-shockable rhythm is 17.29±4.18 minutes.  There was a statistically significant difference between opening rhythms in terms of survival to hospital discharge (p=0.0329).Conclusions: Cardiac arrests with shockable rhythms attained ROSC faster when compared to nonshockable rhythms. Shockable rhythms have a better survival to hospital discharge when compared to shockable rhythms. Opening rhythms may aid the clinician in better utility of resources in a resource constrained setting.

scholarly journals Use, Outcomes and Policy on the Placement of Automated External Defibrillators on Commercial Aircraft for the Management of In-flight Cardiac Arrest; A Scoping Review

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Patrick Sheehan ◽  
Tom Quinn
Keyword(s):  
Cardiac Arrest ◽  
Scoping Review ◽  
Extraction Methods ◽  
Commercial Aircraft ◽  
Public Places ◽  
Shock Delivery ◽  
Automated External Defibrillators ◽  
Shockable Rhythm ◽  
Online Databases ◽  
International Policies

<p><strong>ABSTRACT</strong></p><p><strong>Introduction </strong></p><p>Automated external defibrillators (AEDs) are increasingly available in public places for the treatment of cardiac arrest. Some commercial aircraft carry an AED, but little is known about international policies and requirements. The aim is to review policy regarding AED placement on commercial aircraft, summarising reported incidence and outcomes of AED utilisation for individuals experiencing an in-flight cardiac arrest (IFCA).</p><p><strong>Methods</strong></p><p>A scoping review was undertaken. Online databases (Medline and CINAHL) were searched using prespecified terms to identify reports evidencing use, outcome and policy of AEDS for IFCA on commercial aircraft. Reports were screened and data extracted following scoping review extraction methods. Data were analysed to describe incidence of AED use and outcomes following IFCA, and policies regarding AED placement on commercial aircraft.</p><p><strong>Results</strong>  </p><p>9 observational studies were identified. 8 reported instances of successful shock delivery using AED. No published reports of safety incidents involving in-flight AED use were found. 7 studies reported survival following AED use: of these, 6 reported administration of a shock for IFCA survivors, whilst 1 study reported deployment of an AED without shock delivery.  Overall, survival following in-flight AED use was 9%, with 37% survival reported where patients presented with shockable rhythm. Only one policy mandating AED placement on commercial aircraft was identified.</p><p><strong>Conclusion</strong></p><p>Despite the small, retrospective and observational nature of the reports identified, findings suggest in-flight AED use is feasible and associated with improved outcomes from IFCA.</p><p><strong>Keywords:</strong> cardiac arrest; defibrillators; AED; aircraft; flight </p>

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