Abstract 271: Care Patterns for Out Of Hospital Cardiac Arrest Differ From Other Emergency Care Sensitive Conditions

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
David G Buckler ◽  
Douglas Wiebe ◽  
Sarah Sims ◽  
Ronan Doorley ◽  
Alexis Zebrowski ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Emergency Care ◽  
Systems Of Care ◽  
Heart Association ◽  
Care Utilization ◽  
Fee For Service ◽  
Care Patterns ◽  
Utilization Patterns ◽  
Hospital Cardiac Arrest ◽  
Sensitive Conditions

Background: Understanding utilization patterns for out of hospital cardiac arrest (OHCA) is critical to organizing regional systems of care as recommended by the American Heart Association. We examined the agreement between regional utilization patterns for out-of-hospital cardiac arrest (OHCA) and other emergency care sensitive conditions (ECSCs). Methods: We used Medicare fee-for-service outpatient and inpatient claims from 2013-2014 to describe geographic utilization patterns for 5 emergency care conditions as has been done previously. We compared these regional clusters developed for OHCA to similarly created clusters for other emergency cardiovascular (ECV) conditions (by adding STEMI and stroke). Regional ZIP code attributions were compared using a modified Jaccard index, measuring the agreement between region membership. We also calculated patient-level risk-adjusted survival probabilities (controlling for patient age, sex, race and presenting condition) and summarized for each region as an observed-to-expected (O:E) ratio. O:E ratios higher than 1 indicate better than expected survival. Each region was ranked based on its O:E ratio and ranks between the two sets of conditions were compared. Results: The analysis included 3,279,013 ECSC claims containing 246,342 OHCA and 1,037,472 ECV claims grouped into 234 OHCA regions and 343 ECV regions. When comparing OHCA only to all ECV utilization (clusters), agreement was 64%. O:E survival to hospital discharge for OHCA regions showed greater variability compared to ECV regions (OHCA: 0.53-2.2 vs. ECV: 0.90 - 1.10). In comparing ranked O:E outcomes between OHCA and ECV regions, we found 72% discordance in quartile rankings (κ = 0.28). Conclusion: Care utilization pattern and risk-adjusted survival for OHCA in older adults vary greatly when compared to other emergency cardiovascular conditions and should be benchmarked separately. Further research is needed to understand the role strong regionalization of care policies could play in improving outcomes and streamlining care processes.

scholarly journals Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

Circulation ◽  
2018 ◽  
Vol 137 (21) ◽  
Author(s):  
James J. McCarthy ◽  
Brendan Carr ◽  
Comilla Sasson ◽  
Bentley J. Bobrow ◽  
Clifton W. Callaway ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
American Heart Association ◽  
American Heart ◽  
Systems Of Care ◽  
Heart Association ◽  
Scientific Statement ◽  
Hospital Cardiac Arrest

scholarly journals 2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and Cardiac Arrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Circulation ◽  
2019 ◽  
Vol 140 (24) ◽  
Author(s):  
Ashish R. Panchal ◽  
Katherine M. Berg ◽  
José G. Cabañas ◽  
Michael C. Kurz ◽  
Mark S. Link ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
American Heart Association ◽  
American Heart ◽  
Systems Of Care ◽  
Heart Association ◽  
Integrated System ◽  
Care Chain ◽  
Published Evidence ◽  
Hospital Cardiac Arrest

Survival after out-of-hospital cardiac arrest requires an integrated system of care (chain of survival) between the community elements responding to an event and the healthcare professionals who continue to care for and transport the patient for appropriate interventions. As a result of the dynamic nature of the prehospital setting, coordination and communication can be challenging, and identification of methods to optimize care is essential. This 2019 focused update to the American Heart Association systems of care guidelines summarizes the most recent published evidence for and recommendations on the use of dispatcher-assisted cardiopulmonary resuscitation and cardiac arrest centers. This article includes the revised recommendations that emergency dispatch centers should offer and instruct bystanders in cardiopulmonary resuscitation during out-of-hospital cardiac arrest and that a regionalized approach to post–cardiac arrest care may be reasonable when comprehensive postarrest care is not available at local facilities.

scholarly journals Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia)

Circulation ◽  
2019 ◽  
Vol 140 (18) ◽  
Author(s):  
Jerry P. Nolan ◽  
Robert A. Berg ◽  
Lars W. Andersen ◽  
Farhan Bhanji ◽  
Paul S. Chan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Systems Of Care ◽  
Task Force ◽  
Heart Association ◽  
Liaison Committee ◽  
Modified Delphi ◽  
Reporting Templates ◽  
Improvement Programs ◽  
Data Elements ◽  
Hospital Cardiac Arrest

Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.

scholarly journals Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Circulation ◽  
2020 ◽  
Vol 142 (16_suppl_2) ◽  
Author(s):  
Katherine M. Berg ◽  
Adam Cheng ◽  
Ashish R. Panchal ◽  
Alexis A. Topjian ◽  
Khalid Aziz ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
American Heart Association ◽  
American Heart ◽  
Systems Of Care ◽  
Heart Association ◽  
Integrated System ◽  
Public Access ◽  
Cardiovascular Care ◽  
Hospital Cardiac Arrest

Survival after cardiac arrest requires an integrated system of people, training, equipment, and organizations working together to achieve a common goal. Part 7 of the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, with an emphasis on elements that are relevant to a broad range of resuscitation situations. Previous systems of care guidelines have identified a Chain of Survival, beginning with prevention and early identification of cardiac arrest and proceeding through resuscitation to post–cardiac arrest care. This concept is reinforced by the addition of recovery as an important stage in cardiac arrest survival. Debriefing and other quality improvement strategies were previously mentioned and are now emphasized. Specific to out-of-hospital cardiac arrest, this Part contains recommendations about community initiatives to promote cardiac arrest recognition, cardiopulmonary resuscitation, public access defibrillation, mobile phone technologies to summon first responders, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about the recognition and stabilization of hospital patients at risk for developing cardiac arrest. This Part also includes recommendations about clinical debriefing, transport to specialized cardiac arrest centers, organ donation, and performance measurement across the continuum of resuscitation situations.

Abstract 038: American Heart Association Mission: Lifeline Breakthrough Series Collaborative Improving the Survival Rates for Out of Hospital Cardiac Arrest by Focusing on Early CPR With an Emphasis on Chest Compressions

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Charles R Siegel ◽  
Anjan Chakrabarti ◽  
Lewis Siegel ◽  
Forrest Winslow ◽  
Thomas Hall
Keyword(s):  
Cardiac Arrest ◽  
Quality Improvement ◽  
Performance Measures ◽  
Effective Diffusion ◽  
Survival Rates ◽  
Public Health Problem ◽  
Heart Association ◽  
Performance Measure ◽  
Compression Rate ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) remains a highly morbid public health problem. Despite improving practices and clear guidelines, mortality from this condition remains high at 90%, with survivors often suffering from poor neurologic outcomes. To determine the feasibility of quality improvement collaboratives to narrow gaps between evidence-based practice and patient care for OHCA, we conducted a pilot study of the AHA Resuscitation Collaborative. Methods: Eight emergency medical service agencies participated in the quality improvement collaborative pilot project. We identified several OHCA performance measures to assess the quality of care, guide collaborative activities, and monitor change in performance over time. Over the course of four learning sessions, participants were trained in quality improvement and performance measurement, analyzed performance measure results, and shared successes and challenges. Results: Five remaining agencies underwent the process outlined in Figure 1. Adherence to performance measures, including compression rate compliance (Figure 2), improved over the course of the collaborative. Compression rate compliance in Figure 2 corresponds to the process improvement efforts of the Chesapeake Fire Department with achievement of goals for optimal range of chest compression rate between 100 and 120 compressions per minute during resuscitations. Conclusion: As demonstrated in Virginia, the collaborative approach was an effective framework to improve OHCA care. Improvement in performance measures, the evident commitment of dedicated peers and colleagues, consistent collaboration, and the effective diffusion of best practices all support the continued use of this model.

Abstract 64: A Tale of Seven EMS Systems: An Impedance Threshold Device and Improved CPR Techniques Double Survival Rates After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Tom P Aufderheide ◽  
Marvin Birnbaum ◽  
Charles Lick ◽  
Brent Myers ◽  
Laurie Romig ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Life Support ◽  
Survival Rates ◽  
Heart Association ◽  
Outcome Data ◽  
Therapeutic Interventions ◽  
Threshold Device ◽  
Hospital Cardiac Arrest ◽  
Impedance Threshold Device

Introduction: Maximizing outcomes after cardiac arrest depends on optimizing a sequence of interventions from collapse to hospital discharge. The 2005 American Heart Association (AHA) Guidelines recommended many new interventions during CPR (‘New CPR’) including use of an Impedance Threshold Device (ITD). Hypothesis: The combination of the ITD and ‘New CPR’ will increase return of spontaneous circulation (ROSC) and hospital discharge (HD) rates in patients with an out-of-hospital cardiac arrest. Methods: Quality assurance data were pooled from 7 emergency medical services (EMS) systems (Anoka Co., MN; Harris Co., TX; Madison, WI; Milwaukee, WI; Omaha, NE; Pinellas Co., FL; and Wake Co., NC) where the ITD (ResQPOD®, Advanced Circulatory Systems; Minneapolis, MN) was deployed for >3 months. Historical or concurrent control data were used for comparison. The EMS systems simultaneously implemented ‘New CPR’ including compression/ventilation strategies to provide more compressions/min and continuous compressions during Advanced Life Support. All sites stressed the importance of full chest wall recoil. The sites have a combined population of ~ 3.2 M. ROSC data were available from all sites; HD data were available as of June 2007 from 5 sites (MN, TX, Milwaukee, NE, NC). Results: A total of 893 patients treated with ‘New CPR’ + ITD were compared with 1424 control patients. The average age of both study populations was 64 years; 65% were male. Comparison of the ITD vs controls (all patients) for ROSC and HD [Odds ratios (OR), (95% confidence intervals), and Fisher’s Exact Test] were: 37.9% vs 33.8% [1.2, (1.02, 1.40), p=0.022] and 15.7% vs 7.9% [2.2, (1.53, 3.07), p<0.001], respectively. Patients with ventricular fibrillation had the best outcomes in both groups. Neurological outcome data are pending. Therapeutic hypothermia was used in some patients (MN, NC) after ROSC. Conclusion: Adoption of the ITD + ‘New CPR’ resulted in only a >10% increase in ROSC rates but a doubling of hospital discharge rates, from 7.9% to 15.7%, (p<0.001). These data represent a currently optimized sequence of therapeutic interventions during the performance of CPR for patients in cardiac arrest and support the widespread use of the 2005 AHA CPR Guidelines including use of the ITD.

Induced Moderate Hypothermia After Cardiac Arrest

2009 ◽  
Vol 20 (4) ◽  
pp. 343-355
Author(s):  
Staci McKean
Keyword(s):  
Cardiac Arrest ◽  
Best Practice ◽  
Mild Hypothermia ◽  
Head Injuries ◽  
Heart Association ◽  
Spontaneous Circulation ◽  
Moderate Hypothermia ◽  
Induced Hypothermia ◽  
Nursing Management ◽  
Hospital Cardiac Arrest

The use of induced hypothermia has been considered for treatment of head injuries since the 1900s. However, it was not until 2 landmark studies were published in 2002 that induced hypothermia was considered best practice for patients after cardiac arrest. In 2005, the American Heart Association included recommendations in the postresuscitation support guidelines recommending consideration of mild hypothermia for unconscious adult patients with return of spontaneous circulation following out-of-hospital cardiac arrest due to ventricular fibrillation. This article provides an overview on the history and supportive research for inducing mild hypothermia after cardiac arrest, the pathophysiology associated with cerebral ischemia occurring with hypothermia, nursing management for this patient population, and the development of a protocol for induced hypothermia after cardiac arrest.

scholarly journals Post out-of-hospital cardiac arrest care in a tertiary care center in southern Thailand: From emergency department to intensive care unit

2019 ◽  
Vol 27 (3) ◽  
pp. 155-161 ◽  
Author(s):  
Veerapong Vattanavanit ◽  
Supattra Uppanisakorn ◽  
Thanapon Nilmoje
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
American Heart Association ◽  
American Heart ◽  
Medical Intensive Care Unit ◽  
Heart Association ◽  
Temperature Management ◽  
Medical Intensive Care ◽  
Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest results in a high mortality rate. The 2015 American Heart Association guideline for post-cardiac arrest was launched and adopted into our institutional policy. Objectives: We aimed to evaluate post-cardiac arrest care and compare the results with the 2015 American Heart Association guideline and clinical outcomes of out-of-hospital cardiac arrest patients. Methods Included in this study were all adult patients who survived out-of-hospital cardiac arrest and were admitted to the Medical Intensive Care Unit of Songklanagarind Hospital, Thailand. The retrospective review was from 1 January 2016 to 31 December 2017. Results: From a total of 161 post-cardiac arrest patients admitted to the medical intensive care unit, 69 out-of-hospital cardiac arrest patients were identified. The most common cause of arrest was presumed cardiac in origin (45.0%) in which the majority was acute myocardial infarction (67.8%). Coronary intervention and targeted temperature management were performed in 27.5% and 13% of all out-of-hospital cardiac arrest patients, respectively. Survival to hospital discharge was 42%. Independent factors associated with survival to discharge were shockable rhythms, lower adrenaline doses, and the absence of hypotension at medical intensive care unit admission. Conclusion: Compliance with the 2015 American Heart Association post-cardiac arrest care guideline was low in our institution, especially in coronary intervention and targeted temperature management.

scholarly journals Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest

2019 ◽  
Vol 40 (47) ◽  
pp. 3824-3834 ◽  
Author(s):  
Marieke T Blom ◽  
Iris Oving ◽  
Jocelyn Berdowski ◽  
Irene G M van Valkengoed ◽  
Abdenasser Bardai ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cardiac Arrest ◽  
Sex Differences ◽  
Hospital Admission ◽  
Survival Rates ◽  
Hospital Treatment ◽  
Care Utilization ◽  
Entire Study ◽  
Hospital Cardiac Arrest ◽  
Resuscitation Attempt

AbstractAimsPrevious studies on sex differences in out-of-hospital cardiac arrest (OHCA) had limited scope and yielded conflicting results. We aimed to provide a comprehensive overall view on sex differences in care utilization, and outcome of OHCA.Methods and resultsWe performed a population-based cohort-study, analysing all emergency medical service (EMS) treated resuscitation attempts in one province of the Netherlands (2006–2012). We calculated odds ratios (ORs) for the association of sex and chance of a resuscitation attempt by EMS, shockable initial rhythm (SIR), and in-hospital treatment using logistic regression analysis. Additionally, we provided an overview of sex differences in overall survival and survival at successive stages of care, in the entire study population and in patients with SIR. We identified 5717 EMS-treated OHCAs (28.0% female). Women with OHCA were less likely than men to receive a resuscitation attempt by a bystander (67.9% vs. 72.7%; P &lt; 0.001), even when OHCA was witnessed (69.2% vs. 73.9%; P &lt; 0.001). Women who were resuscitated had lower odds than men for overall survival to hospital discharge [OR 0.57; 95% confidence interval (CI) 0.48–0.67; 12.5% vs. 20.1%; P &lt; 0.001], survival from OHCA to hospital admission (OR 0.88; 95% CI 0.78–0.99; 33.6% vs. 36.6%; P = 0.033), and survival from hospital admission to discharge (OR 0.49, 95% CI 0.40–0.60; 33.1% vs. 51.7%). This was explained by a lower rate of SIR in women (33.7% vs. 52.7%; P &lt; 0.001). After adjustment for resuscitation parameters, female sex remained independently associated with lower SIR rate.ConclusionIn case of OHCA, women are less often resuscitated by bystanders than men. When resuscitation is attempted, women have lower survival rates at each successive stage of care. These sex gaps are likely explained by lower rate of SIR in women, which can only partly be explained by resuscitation characteristics.

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