Abstract 12436: App-Based EMS to ED Communication May Improve Survival to Discharge Rates for OHCA Survivors

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Christian Abrahim ◽  
Alina Capatina ◽  
Arvind Kalyan-Sundaram ◽  
Amir Lotfi
Keyword(s):  
Mobile Application ◽  
Emergency Services ◽  
Survival Rates ◽  
Gps Tracking ◽  
Standard Group ◽  
Single Center ◽  
Appropriate Care ◽  
Discharge Rates ◽  
Improvement In Survival ◽  
Hospital Cardiac Arrest

Background: Survival rates for Out-of-Hospital Cardiac Arrest (OHCA) remain low despite advances in therapeutics. Although it seems intuitive, there is little evidence to support a benefit from early activation of emergency services at receiving hospitals from improved Emergency Medical Services provider (EMS) communication. We hypothesize that early, app-based communication from EMS in the field to in-hospital providers may improve survival to discharge rates. Methods: We utilized the General Devices Company, Inc. e-BridgeTM mobile application. EMS Providers were trained to use the app and dedicated devices and staff were stationed to monitor EMS transmissions to the emergency department (ED). A single-center, retrospective observational study was conducted on patients transferred to our institution for resuscitated OHCA. We identified 45 cases with OHCA admitted to our institution between February and July 2020 that utilized the app. We excluded interfacility transfers as well as patients certified deceased on the field. Given that standard, radio-based communication with EMS occurs 5 minutes prior to presentation, we used 5 minutes as the cutoff between our standard and intervention groups. Results: Of 45 cases, 29 had established communication using the app prior to 5 minutes, with the remaining 16 being considered in the standard group. We noted that 24% of patients (7 of 29) with early EMS notification survived to discharge compared to 0 of the 16 patients in the standard group. There was also an improvement in door-admission times from the ED to appropriate care units in this group (156 versus 228 minutes). Conclusion: Implementation of app-based communication between EMS providers and in-hospital providers with GPS tracking led to a trend to improvement in survival to discharge as well as time to admission from the ED in patients admitted for OHCA.

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.

Abstract 14806: Predictors of Survival and Favourable Functional Outcomes Following an Out of Hospital Cardiac Arrest in Patients Systematically Brought to a Dedicated Heart Attack Centre

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
M Bilal Iqbal ◽  
Abtehale Al-Hussaini ◽  
Gareth Rosser ◽  
Saleem Salehi ◽  
Maria Phylactou ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Functional Status ◽  
Heart Attack ◽  
Functional Outcomes ◽  
Emergency Services ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Term Survival ◽  
Poor Functional Status ◽  
Hospital Cardiac Arrest

BACKGROUND: Despite advances in cardiopulmonary resuscitation, survival remains low after out of hospital cardiac arrest (OOHCA), with less than 20% of patients surviving to hospital discharge. Acute coronary ischaemia is the predominating cause and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients in London with OOHCA, in whom a cardiac aetiology is suspected, are brought to dedicated Heart Attack Centres (HACs). OBJECTIVES: We sought to determine the predictors for survival and favourable functional outcomes following OOHCA in this setting. METHODS: We analysed 182 consecutive OOHCA patients brought by the emergency services to Harefield Hospital - a designated HAC in London. Of these, 174 patients achieved return of spontaneous circulation. We analysed (a) all-cause mortality at 1 year; and (b) functional status at discharge using a modified Rankins score (mRS:0-6, where mRS0-3=favourable functional status). We used multivariate models to determine predictors of survival and favourable functional status. RESULTS: The overall survival rates were 66.7% at 30 days and 62.1% at 1 year. Of the 174 patients, 95 patients (54.5%) had favourable functional status at discharge. Patients with favourable functional status had significantly reduced mortality rates compared to those with poor functional status: 30 days (1.2% vs. 72.2%, p<0.001) and 1 year (5.3% vs. 77.2%, p<0.001). Multivariate analyses identified a shorter duration of resuscitation and absence of cardiogenic shock as consistent independent predictors of both favourable functional status and long-term survival (figure). CONCLUSIONS: The strategic delivery of OOHCA patients to HACs is associated with improved functional status and survival. Those with favourable functional status at discharge have significantly improved survival. Our study supports the standardisation of care for such patients with the widespread adoption of dedicated facilities.

Abstract 114: Does Size Matter? Comparing Cardiac Arrest Survival to Discharge Rates Based on Number of Hospital Beds

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Kathie Thomas ◽  
Renaud Gueret ◽  
Art Miller ◽  
Gary Myers
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
The United States ◽  
Spontaneous Circulation ◽  
Stressful Event ◽  
Successful Resuscitation ◽  
Discharge Rates ◽  
Get With The Guidelines ◽  
Size Matter ◽  
Hospital Cardiac Arrest

Background and Objectives: In-hospital cardiac arrest can be challenging. The frequency of events outside of critical care units is typically low which makes it a stressful event for staff. According to the HEROIC study, there were 209,000 in-hospital cardiac arrests in the United States in 2016. Only 24.9% survived. Get With the Guidelines-Resuscitation is a quality improvement tool for hospitals to measure and evaluate their in-house codes and resuscitation rates. It may be assumed that survival rates are better at larger hospitals. The objective of this study was to examine the association between in-hospital cardiac arrest rates based on the bed size of a hospital. Methods: By using number of beds as a comparison and data from Get With the Guidelines-Resuscitation we sampled 46 hospitals in the eleven-state AHA Midwest Affiliate, (IL, IN, IA, KS, MI, MN, MO, NE, ND, SD, WI), comparing survival to discharge from cardiac arrest, with and without shockable rhythms from January 1, 2013-December 31, 2016. All patients are included in a risk adjusted formula that resides within Get With the Guidelines-Resuscitation. Results: In our comparison, we included hospitals with licensed and/or staffed beds of <100, 100-199, 200-299, 300-399 and 400 or more beds. Our data showed that higher sustained return of spontaneous circulation rates with survival to discharge are not dictated by the size of a hospital. In fact, in all 4 years shown, successful resuscitation rates were higher at hospitals with fewer beds verses larger facilities. Conclusions: Survival to discharge from in-hospital cardiac arrest is not dependent on hospital bed size. It is important that hospitals collect and analyze data regarding in-hospital cardiac arrests to improve survival rates beyond the 24.9% identified in the HEROIC study. A further examination looking at discharge destinations with CPC scores should be considered for a future study.

scholarly journals Survival rates and prognostic factors in right- and left-sided colon cancer stage I–IV: an unselected retrospective single-center trial

2021 ◽  
Author(s):  
Claudius E. Degro ◽  
Richard Strozynski ◽  
Florian N. Loch ◽  
Christian Schineis ◽  
Fiona Speichinger ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Blood Level ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Cancer Stage ◽  
Single Center ◽  
Significant Difference

Abstract Purpose Colorectal cancer revealed over the last decades a remarkable shift with an increasing proportion of a right- compared to a left-sided tumor location. In the current study, we aimed to disclose clinicopathological differences between right- and left-sided colon cancer (rCC and lCC) with respect to mortality and outcome predictors. Methods In total, 417 patients with colon cancer stage I–IV were analyzed in the present retrospective single-center study. Survival rates were assessed using the Kaplan–Meier method and uni/multivariate analyses were performed with a Cox proportional hazards regression model. Results Our study showed no significant difference of the overall survival between rCC and lCC stage I–IV (p = 0.354). Multivariate analysis revealed in the rCC cohort the worst outcome for ASA (American Society of Anesthesiologists) score IV patients (hazard ratio [HR]: 16.0; CI 95%: 2.1–123.5), CEA (carcinoembryonic antigen) blood level > 100 µg/l (HR: 3.3; CI 95%: 1.2–9.0), increased lymph node ratio of 0.6–1.0 (HR: 5.3; CI 95%: 1.7–16.1), and grade 4 tumors (G4) (HR: 120.6; CI 95%: 6.7–2179.6) whereas in the lCC population, ASA score IV (HR: 8.9; CI 95%: 0.9–91.9), CEA blood level 20.1–100 µg/l (HR: 5.4; CI 95%: 2.4–12.4), conversion to laparotomy (HR: 14.1; CI 95%: 4.0–49.0), and severe surgical complications (Clavien-Dindo III–IV) (HR: 2.9; CI 95%: 1.5–5.5) were identified as predictors of a diminished overall survival. Conclusion Laterality disclosed no significant effect on the overall prognosis of colon cancer patients. However, group differences and distinct survival predictors could be identified in rCC and lCC patients.

scholarly journals SURF: identifying and allocating resources during Out-of-Hospital Cardiac Arrest

2020 ◽  
Vol 20 (S11) ◽  
Author(s):  
Gaurav Rao ◽  
Salimur Choudhury ◽  
Pawan Lingras ◽  
David Savage ◽  
Vijay Mago
Keyword(s):  
Cardiac Arrest ◽  
Linear Programming ◽  
Integer Linear Programming ◽  
Processing Time ◽  
Emergency Services ◽  
Linear Programming Method ◽  
Bipartite Matching ◽  
Matching Algorithm ◽  
Hospital Cardiac Arrest ◽  
Cardiac Emergency

Abstract Background When an Out-of-Hospital Cardiac Arrest (OHCA) incident is reported to emergency services, the 911 agent dispatches Emergency Medical Services to the location and activates responder network system (RNS), if the option is available. The RNS notifies all the registered users in the vicinity of the cardiac arrest patient by sending alerts to their mobile devices, which contains the location of the emergency. The main objective of this research is to find the best match between the user who could support the OHCA patient. Methods For performing matching among the user and the AEDs, we used Bipartite Matching and Integer Linear Programming. However, these approaches take a longer processing time; therefore, a new method Preprocessed Integer Linear Programming is proposed that solves the problem faster than the other two techniques. Results The average processing time for the experimentation data was   1850 s using Bipartite matching,   32 s using the Integer Linear Programming and  2 s when using the Preprocessed Integer Linear Programming method. The proposed algorithm performs matching among users and AEDs faster than the existing matching algorithm and thus allowing it to be used in the real world. Conclusion: This research proposes an efficient algorithm that will allow matching of users with AED in real-time during cardiac emergency. Implementation of this system can help in reducing the time to resuscitate the patient.

scholarly journals Mobile application to optimize care for STEMI patients in a large healthcare system, STEMIcathAID. Rationale and design

2021 ◽  
Author(s):  
Parasuram Krishnamoorthy ◽  
Andriy Vengrenyuk ◽  
Brian Wasielewski ◽  
Nitin Barman ◽  
Jeffrey Bander ◽  
...  
Keyword(s):  
Healthcare System ◽  
Mobile Application ◽  
Performance Metrics ◽  
Clinical Status ◽  
Coronary Intervention ◽  
Mobile App ◽  
Gps Tracking ◽  
St Segment Elevation ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory

Abstract Technological advancements have transformed healthcare. System delays in transferring patients with ST- segment elevation myocardial infarction (STEMI) to a primary percutaneous coronary intervention (PCI) center are associated with worse clinical outcomes. Our aim was to design and develop a secure mobile application, STEMIcathAID, streamlining communication and coordination between the STEMI care teams to reduce ischemia time and improve patient outcomes. The app was designed for transfer of patients with STEMI to a cardiac catheterization laboratory (CCL) from an emergency department (ED) of either a PCI capable or a non-PCI capable hospital. When a suspected STEMI arrives to a non-PCI hospital ED, the ED physician uploads the EKG and relevant patient information. An instant notification is simultaneously sent to the on-call CCL attending and transfer center. The attending reviews the information, makes a video call and decides to either accept or reject the transfer. If accepted, on-call CCL team members receive an immediate push notification and begin communicating with the ED team via a HIPPA compliant chat. The app provides live GPS tracking of the ambulance and frequent clinical status updates of the patient. In addition, it allows for screening of STEMI patients in cardiogenic shock. Prior to discharge important data elements have to be entered to close the case. In conclusion, we developed a novel mobile app to optimize care for STEMI patients and facilitate electronic extraction of relevant performance metrics to improve allocation of resources and reduction of costs.

Abstract 18: Trends in Median CPR Duration Over Time in Patients With and Without Return of Spontaneous Circulation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Katherine M Berg ◽  
Michael Donnino ◽  
Ari Moskowitz ◽  
Mathias J Holmberg ◽  
Sebastian Wiberg ◽  
...  
Keyword(s):  
Survival Rates ◽  
Nonparametric Test ◽  
Spontaneous Circulation ◽  
Hospital Level ◽  
Gender And Race ◽  
Increasing Trend ◽  
Trends Over Time ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest ◽  
Over Time

Introduction: Survival after in-hospital cardiac arrest (IHCA) is increasing. In the Get-With-The-Guidelines-Resuscitation (GWTG-R) registry, longer median CPR duration in patients not achieving ROSC is associated with higher survival rates at the hospital level. We analyzed trends over time in median CPR duration by hospital in patients who achieved ROSC and those who did not, and stratified this analysis by age, gender and race. Methods: We included adult IHCA cases in GWTG-R from 2001-2017, excluding data from a given hospital and year if fewer than 5 eligible arrests were recorded. A nonparametric test for trend was done to evaluate median CPR duration over time in those with and without ROSC, in all patients and in groups stratified by age (<60, 61-80 and >80 years), gender, and race (white and black). Linear regression was done to evaluate the amount of change per year. Association with survival was tested using Pearsons correlation. Results: Of 359,107 IHCA events, 31,189 were excluded, leaving 327,918 for analysis. Over time, there was a significant increase in median CPR duration in patients who did not achieve ROSC, and a decrease in those who did attain ROSC.(Fig.) These trends persisted when stratified by gender, race and age. Each year was associated with a decrease in median CPR duration of 0.37 min (95% CI -0.41 to -0.33 min) in those with ROSC and an increase of 0.29 min (95% CI 0.25 to 0.33 min) in those without. There was a small but significant correlation between median CPR duration in those without ROSC and adjusted survival by hospital over time (r=0.224, p<0.0001). Conclusions: In the GWTG-R registry, median duration of CPR is decreasing over time in patients achieving ROSC, but increasing in those not achieving ROSC. The increasing trend in CPR duration in those without ROSC correlates positively with the trend in survival. Whether the increase in median CPR duration in those without ROSC is contributing causally to improvements in survival warrants further study.

Abstract 213: Secondary CPR Training via Mobile Application Compared to Video Self Instruction Kit

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Andrew Murray ◽  
Shaun McGovern ◽  
Marion Leary ◽  
Benjamin Abella ◽  
Audrey L Blewer
Keyword(s):  
Mobile Application ◽  
Mobile App ◽  
Training Material ◽  
Health Apps ◽  
Training Materials ◽  
Public Health Information ◽  
Self Instruction ◽  
Cpr Training ◽  
Number Of Individuals ◽  
Hospital Cardiac Arrest

Introduction: Hands-only CPR training via a video self-instruction (VSI) kit (DVD & manikin) or a mobile application (app, video-only) allows trainees to share the training materials with others (“secondary training”). This secondary training can amplify the number of individuals trained in CPR, thus increasing the chances of bystander intervention in an out-of-hospital cardiac arrest. Health apps are an emerging tool through which public health information and education can be disseminated. No study has examined whether laypersons trained in CPR via an app share the training as frequently as those trained via VSI. Hypothesis: We hypothesized that laypersons trained via mobile app will share the training material more than those trained with VSI. Methods: This work represents a sub-investigation of an in-hospital CPR training study for families of cardiac patients. Subjects were trained with either a VSI kit or a mobile app and completed an interview 6-month post-training that measured whether training materials were shared and with how many others they were shared. Multivariate logistic regression was performed controlling for age, race and level of education to determine the likelihood that an individual shared the training. Results: Of 697 participants who completed the interview between 6/2016-5/2018, 281 stated they shared the training with at least 1 person (VSI n=213/356, App n=68/341). Subjects who received VSI training were more likely to share than those trained with the app (OR: 7.16, 95% CI: 4.91-10.43, p<0.01). Subjects trained with VSI had an average multiplier rate of 2.27 ±4.13 versus 0.56 ±1.66 (p<0.01) for those trained with the app. Subject-level analysis revealed that increased age is associated with decreased likelihood that an individual shared the training in both training arms (App OR: 0.98, 95% CI: 0.96-0.99, VSI OR: 0.98, 95% CI: 0.97-0.99). Conclusion: Subjects in the app arm were less likely to share CPR training. While it has been widely assumed that app-based solutions may afford unique dissemination opportunities, these results suggest the most effective solution to increasing hands-only CPR training may lie in kit-based options currently available. Further work is needed to determine why app-based training is shared less.

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