Abstract 183: School-Centered CPR Education to Improve Survival from Out-of-Hospital Cardiac Arrest in High-Risk Neighborhoods

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Tom Califf ◽  
René Ramon ◽  
Wendy Morrison ◽  
Ariann Nassel ◽  
Comilla Sasson
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Low Income ◽  
Skills Training ◽  
Seventh Grade ◽  
Post Intervention ◽  
Train The Trainer ◽  
The People ◽  
Cpr Training ◽  
Hospital Cardiac Arrest

Background: Low-income and Latino neighborhoods are at high risk for having low provision of bystander CPR for victims of out-of-hospital cardiac arrest (OHCA). Novel community-based intervention is needed in these neighborhoods to increase awareness of CPR techniques and, ultimately, to decrease mortality from OHCA. Objective: To determine the feasibility of a train-the-trainer hands-only CPR program as a required assignment in a middle school. Methods: Design: Prospective survey-based interventional study. Setting: Public charter school in the Denver, CO metropolitan area. Population: Cohort of 118 subjects was recruited out of 134 eligible seventh grade students. Observations: Participants completed a 6-question test to assess baseline knowledge of CPR. Subjects then completed a group hands-only CPR training lasting 1 hour using the CPR Anytime kit, which included both an educational DVD and hands-on practical skills training with an inflatable mannequin. Participants were then asked to use these kits to train other community members over a 2-week period. At the end of the study, students were asked to complete the same 6-question survey to assess their retention of knowledge. Two-sample t-tests were conducted to assess for differences in hands-only CPR knowledge pre- and post-CPR training. Results: Demographics are given for the entire seventh grade class ( Table 1 ). Students were mostly white (71.6%), and 11 (8.2%) participated in the Free & Reduced Lunch program. Of 134 seventh graders attending the school, 118 (88%) completed a pre-intervention survey and 74 (55%) completed a post-intervention survey. Between the surveys, the mean number of questions answered correctly increased ( Table 2 ), as did performance on the question asking where to place AED pads on the chest (p < .001). Students performed poorest in both pre- and post-testing on identifying the appropriate situation for performing hands-only CPR. Conclusion: Implementation of a school-based train-the-trainee CPR education program is a feasible endeavor. Students demonstrated increased knowledge of CPR techniques two weeks after training compared to baseline. Future studies will need to be conducted to assess the people who are then trained by these students using the CPR Anytime Kits.

Detection of high risk mortality areas after in-hospital cardiac arrest

Resuscitation ◽  
2010 ◽  
Vol 81 (2) ◽  
pp. S35
Author(s):  
J.J. Egea-Guerrero ◽  
I. Maira-Gonzalez ◽  
C. Palacios-Gómez ◽  
A. Vilches-Arenas ◽  
E. Montero-Romero ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Hospital Cardiac Arrest

scholarly journals Multiple cluster analysis for the identification of high-risk census tracts for out-of-hospital cardiac arrest (OHCA) in Denver, Colorado

Resuscitation ◽  
2014 ◽  
Vol 85 (12) ◽  
pp. 1667-1673 ◽  
Author(s):  
Ariann F. Nassel ◽  
Elisabeth D. Root ◽  
Jason S. Haukoos ◽  
Kevin McVaney ◽  
Christopher Colwell ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Cardiac Arrest ◽  
High Risk ◽  
Census Tracts ◽  
Hospital Cardiac Arrest ◽  
Multiple Cluster

Abstract 55: The CAHP (Cardiac Arrest Hospital Prognosis) Score: Predicting Neurological Outcome After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Carole Maupain ◽  
Wulfran Bougouin ◽  
Lamhaut Lionel ◽  
Nicolas Deye ◽  
Daniel Jost ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Neurological Outcome ◽  
Risk Group ◽  
Unfavorable Outcome ◽  
Validation Dataset ◽  
Group Score ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest ◽  
Prognosis Score

Background: Out-of-hospital cardiac arrest (OHCA) carries a very poor prognosis. Early prognostication of patients admitted in ICU after resuscitated OHCA is a key issue but remains challenging. The aim of that study was to establish a new scoring system to predict poor neurological outcome in these patients. Materials and Methods: The CAHP (Cardiac Arrest Hospital Prognosis) score was developed from the Sudden Death Expertise Center registry (SDEC, Paris, France). Objective risk factors were weighted on the basis of a logistic regression analysis. The primary outcome was poor neurological outcome defined as Cerebral Performance Category 3, 4 or 5. Thresholds were defined to distinguish low, moderate and high-risk groups. The CAHP score was then validated in an external dataset (Parisian OHCA Registry). Score calibration and discrimination characteristics were assessed in the validation dataset. Results: The developmental dataset included 819 patients admitted in ICU from May 2011 to December 2012. After logistic regression, 7 variables were independently associated with poor neurological outcome: age, initial shockable rhythm, time form collapse to basic life support (BLS), time from BLS to return of spontaneous circulation (ROSC), location of cardiac arrest, epinephrine dose during resuscitation and arterial pH at admission. These variables were included in the CAHP score. 3 risks groups were identified: a low risk group (score ≤ 150, 39 % of unfavorable outcome), medium risk group (score 150-200, 81% of unfavorable outcome) and high-risk group (CAHP score ≥ 200, 100 % of unfavorable outcome). AUC of the CAHP score was 0.93. In the external validation dataset, discrimination value of the CAHP score was consistent with an AUC of 0.85. Conclusion: The CAHP score is a simple and objective tool for early assessment of prognosis in patients admitted to ICU after OHCA. Moreover it allows to stratify the probability of poor neurological outcome by identifying a very high-risk category of patients (score ≥ 200).

scholarly journals Public Opinion on Community Basic Cardiopulmonary Resuscitation Training: a Survey of Inhabitants of the Crimean Peninsula

2019 ◽  
Vol 7 (4) ◽  
pp. 311-318 ◽  
Author(s):  
A. A. Birkun ◽  
Y. A. Kosova
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Fatal Outcome ◽  
Motivation To Learn ◽  
Potential Health ◽  
Crimean Peninsula ◽  
Resuscitation Training ◽  
Cpr Training ◽  
Hospital Cardiac Arrest ◽  
The Crimean Peninsula

Background.The chances of fatal outcome in out-of-hospital cardiac arrest are exceeding 90%. However, the early initiation of bystander cardiopulmonary resuscitation (CPR) substantially improves the probability of survival. The study was aimed to determine the extent of community CPR training, level of CPR knowledge, willingness and motivation to learn CPR among the population of the Crimea.Materials and methods.The representative sample of adult residents of the Crimean Peninsula (n=384) has been surveyed by means of individual structured interview from November 2017 to January 2018. The results were analyzed with social statistics.Results.According to the survey, 53% of respondents were previously trained in CPR. The training was performed mainly (82%) at work, school, college/technical school or university, or when acquiring a driver's license. The majority of females, people over 60, unemployed and retired, widowed and those with monthly income lower than 20,000 roubles are not trained. Of previously trained, 44% respondents attended a single CPR course, 72% were trained more than one year ago, 47% of participants had no previous training in CPR, mostly never thinking about the need to go for training. Being dependent from previous CPR training, the knowledge of CPR is generally poor: the proportions of correct answering as of the proper location and rate of chest compressions were 46% and 4%, respectively. Among the respondents, 56% expressed their willingness to attend CPR training. The main motivating factors to attend CPR training were awareness of importance of CPR training, potential health problems in relatives/friends and free-of-charge training.Conclusion.The Crimean population is insufficiently and non-uniformly trained in CPR, has limited knowledge of CPR and low motivation to learn. In order to increase the commitment of the community to provide first aid in out-of-hospital cardiac arrest, mass CPR training programs should be implemented with active involvement of the least trained and motivated social strata.

Abstract 446: Availability and Quality of Cardiopulmonary Resuscitation Films Featuring a Female Victim on the Internet: A Cross-Sectional Study

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Carlos Lynes ◽  
Lorrel Brown
Keyword(s):  
Cardiac Arrest ◽  
Gender Disparity ◽  
Hand Position ◽  
Female Victim ◽  
High Quality ◽  
Cross Sectional ◽  
Key Aspects ◽  
Cpr Training ◽  
Hospital Cardiac Arrest ◽  
The U.S

Introduction: Bystander cardiopulmonary (CPR) improves survival following out-of-hospital cardiac arrest (OHCA). However, women are less likely than men to receive CPR in public locations. Female-specific issues such as fear of touching breasts have been identified as barriers to performing CPR on women. The purpose of this study was to quantify and evaluate online CPR instructional films featuring a female victim. Methods: Using the search query “how to do CPR” via Google and YouTube, 374 and 500 films (38 and 25 result pages), respectively, were reviewed in May 2019. Exclusion criteria included: non-English, non-instructional, pediatric or animal victim, duplicates, parity, or in-hospital cardiac arrest. We identified 11 films featuring a female victim. These films were scored on 6 key aspects of CPR education: scene safety, check responsiveness, activate Emergency Medical Services, proper hand position, accurate rate, and appropriate depth of compressions. Results: Of the 874 reviewed films, 11 featured a female victim. Just 5 films were high-quality (correctly addressing 5 or 6 key aspects of CPR training, Figure 1). Furthermore, 2 of the 5 high-quality instructional films taught rescue breathing, which is no longer a recommended component of bystander CPR in the U.S. The remaining 3 films were all created outside the U.S. (Australia, New Zealand, England). None of the films explicitly addressed barriers to performing CPR on a female, including fear of touching breasts or concerns about causing harm. Conclusion: Out of the billions of films available online, we identified only 3 high-quality instructional films teaching modern, hands-only CPR featuring a female victim, none of which addressed specific female-related CPR issues. This gender disparity can be addressed with high-quality CPR training films that feature a female victim and explicitly address previously-identified barriers to performing CPR on a female.

Abstract 208: A Comprehensive Simulation-Based Training for E-CPR Improves the Neurological Outcome in Patients With Refractory Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Takashi Unoki ◽  
Daisuke Takagi ◽  
Yudai Tamura ◽  
Hiroto Suzuyama ◽  
Eiji Taguchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Intervention Period ◽  
Post Intervention ◽  
Shockable Rhythm ◽  
Time Period ◽  
Simulation Based ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Prolonged conventional cardiopulmonary resuscitation (C-CPR) is associated with a poor prognosis in out-of-hospital cardiac arrest (OHCA) patients. Extracorporeal cardiopulmonary resuscitation (E-CPR) has been utilized as a rescue strategy for patients with cardiac arrest unresponsive to C-CPR. However, the indication and optimal duration to switch from C-CPR to E-CPR are not well established. In addition, the opportunities to develop teamwork skills and expertise to mitigate risks are few. We thus developed the implementation protocol for the E-CPR simulation program, and investigated whether the faster deployment of extracorporeal membrane oxygenation (ECMO) improves the neurological outcome in patients with refractory OHCA. Methods: A total of 42 consecutive patients (age 58±16 years, male ratio 90%, and initial shockable rhythm 64%) received E-CPR (3% of OHCA) during the study period. Among them, 32 (76%) were deployed ECMO during the pre-intervention time period (Pre: from January 2012 to September 2017), whereas 10 (24%) were deployed during the post-intervention time period (Post: October 2017 to May 2019). We compared the door to E-CPR time, collapse to E-CPR time, 30-day mortality, and favorable neurological outcome (Cerebral Performance Categories 1, 2) between the two periods. Results: There was no significant difference in age, the rates of male sex and shockable rhythm, and the time form collapse to emergency room admission between the two periods. The door to E-CPR time and the collapse to E-CPR time were significantly shorter in the post-intervention period compared to the pre-intervention period (Pre: 39 min [IQR; 30-50] vs. Post: 29 min [IQR; 22-31]; P=0.007, Pre: 76 min [IQR; 58-87] vs. Post: 59 min [IQR; 44-68]; P=0.02, respectively). The 30-day mortality was similar between the two periods (Pre: 88% vs. Post: 80%; P=0.6). In contrast, the rate of favorable neurological outcome at the time of discharge was significantly higher in post-intervention period (Pre: 0% vs. Post: 20%; P=0.01) compared to the pre-intervention period. Conclusion: A comprehensive simulation-based training for E-CPR seems to improve the neurological outcome in patients with refractory OHCA patients.

Identifying patients at risk of futile resuscitation: palliative care indicators in out-of-hospital cardiac arrest

2019 ◽  
pp. bmjspcare-2019-001828
Author(s):  
Mia Cokljat ◽  
Adam Lloyd ◽  
Scott Clarke ◽  
Anna Crawford ◽  
Gareth Clegg
Keyword(s):  
At Risk ◽  
Palliative Care ◽  
Cardiac Arrest ◽  
High Risk ◽  
Low Risk ◽  
Intermediate Risk ◽  
Patients At Risk ◽  
Risk Patients ◽  
Record Review ◽  
Hospital Cardiac Arrest

ObjectivesPatients with indicators for palliative care, such as those with advanced life-limiting conditions, are at risk of futile cardiopulmonary resuscitation (CPR) if they suffer out-of-hospital cardiac arrest (OHCA). Patients at risk of futile CPR could benefit from anticipatory care planning (ACP); however, the proportion of OHCA patients with indicators for palliative care is unknown. This study quantifies the extent of palliative care indicators and risk of CPR futility in OHCA patients.MethodsA retrospective medical record review was performed on all OHCA patients presenting to an emergency department (ED) in Edinburgh, Scotland in 2015. The risk of CPR futility was stratified using the Supportive and Palliative Care Indicators Tool. Patients with 0–2 indicators had a ‘low risk’ of futile CPR; 3–4 indicators had an ‘intermediate risk’; 5+ indicators had a ‘high risk’.ResultsOf the 283 OHCA patients, 12.4% (35) had a high risk of futile CPR, while 16.3% (46) had an intermediate risk and 71.4% (202) had a low risk. 84.0% (68) of intermediate-to-high risk patients were pronounced dead in the ED or ED step-down ward; only 2.5% (2) of these patients survived to discharge.ConclusionsUp to 30% of OHCA patients are being subjected to advanced resuscitation despite having at least three indicators for palliative care. More than 80% of patients with an intermediate-to-high risk of CPR futility are dying soon after conveyance to hospital, suggesting that ACP can benefit some OHCA patients. This study recommends optimising emergency treatment planning to help reduce inappropriate CPR attempts.

scholarly journals Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI)

2020 ◽  
Author(s):  
Diana A Gorog ◽  
Susanna Price ◽  
Dirk Sibbing ◽  
Andreas Baumbach ◽  
Davide Capodanno ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Antithrombotic Therapy ◽  
Left Ventricular ◽  
Position Paper ◽  
Ventricular Assist Devices ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Abstract Timely and effective antithrombotic therapy is critical to improving outcome, including survival, in patients with acute coronary syndrome (ACS). Achieving effective platelet inhibition and anticoagulation, with minimal risk, is particularly important in high-risk ACS patients, especially those with cardiogenic shock (CS) or those successfully resuscitated following out-of-hospital cardiac arrest (OHCA), who have a 30-50% risk of death or a recurrent ischaemic event over the subsequent 30 days. There are unique challenges to achieving effective and safe antithrombotic treatment in this cohort of patients that are not encountered in most other ACS patients. This position paper focuses on patients presenting with CS or immediately post-OHCA, of presumed ischaemic aetiology, and examines issues related to thrombosis and bleeding risk. Both the physical and pharmacological impacts of CS, namely impaired drug absorption, metabolism, altered distribution and/or excretion, associated multiorgan failure, co-morbidities and co-administered treatments such as opiates, targeted temperature management, renal replacement therapy and circulatory or left ventricular assist devices, can have major impact on the effectiveness and safety of antithrombotic drugs. Careful attention to the choice of antithrombotic agent(s), route of administration, drug-drug interactions, therapeutic drug monitoring and factors that affect drug efficacy and safety, may reduce the risk of sub- or supra-therapeutic dosing and associated adverse events. This paper provides expert opinion, based on best available evidence, and consensus statements on optimising antithrombotic therapy in these very high-risk patients, in whom minimising the risk of thrombosis and bleeding is critical to improving outcome.

Abstract 294: Different Effect of Bystander CPR According to Dispatcher-Assistance on Neurologic Outcome in Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Jieun Pak ◽  
Tae Han Kim ◽  
Min Woo Kim ◽  
Jong Hwan Kim ◽  
Ki Jeong Hong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Final Analysis ◽  
Neurologic Outcome ◽  
Multivariable Logistic Regression Model ◽  
Emergency Medical Dispatch ◽  
Ambulance Transport ◽  
Bystander Cpr ◽  
Cpr Training ◽  
Hospital Cardiac Arrest

Introduction: Bystander CPR is an important prognostic factor for outcome in out-of-hospital cardiac arrest (OHCA). Dispatcher-assisted(DA) CPR program have shown to successfully increase rate of bystander CPR in communities. However DA-CPR is usually targeted for bystanders with no or lower level of CPR training compared to bystanders who are able to perform CPR without dispatcher assistance. We evaluated the effect of bystander CPR separately according to presence of dispatcher assistance on neurologic outcome. Methods: Retrospective analysis was performed using nationwide OHCA database from 2014 to 2017. Adult EMS treated OHCA with presumed cardiac origin were enrolled. EMS witnessed arrest and arrest occurred during ambulance transport were excluded. Bystander CPR was classified into 2 groups according to presence of DA-CPR instruction from emergency medical dispatch center. Rate of favorable neurologic outcome (CPC 1 or 2) was compared according to type of bystander CPR. Multivariable logistic regression model was used to estimate effect of bystander CPR type on outcomes. Results: Total of 72,314 eligible OHCA were enrolled for final analysis. Proportion of patients with favorable neurologic outcome was highest in bystander CPR without dispatcher assistance. (8.6% for bystander CPR without DA, 5.0% for bystander CPR with DA and 2.9% for no bystander CPR, p<0.01). Bystander CPR with DA was associated with higher chance of good neurological recovery than no bystander CPR, effect on neurologic outcome was significantly different than bystander CPR without DA(adjusted OR with 95% CI (bystander CPR with DA as reference): 0.61[0.55-0.67] for no-bystander CPR , 1.24[1.14–1.36] for bystander CPR without DA) Conclusion: Bystander CPR with DA showed positive effect on neurologic outcome compared to no-bystander CPR. However bystander CPR with DA was less effective than bystander CPR performed without dispatcher assistance. To improve quality of bystander CPR with dispatcher assistance, strategy to monitor and give feedback bystander CPR during dispatcher assistance should be developed and implemented in dispatch center.

Abstract 15297: A Bundled Approach to Improving Code Team Response for In-hospital Cardiac Arrest to Decrease Overcrowding and Improve Role Clarity and Leadership

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Marion Leary ◽  
Daniel N Holena ◽  
Stacie Neefe ◽  
Leah Davis ◽  
Boris Tsypenyuk ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Role Ambiguity ◽  
Intervention Group ◽  
Median Number ◽  
Secondary Outcome ◽  
Categorical Variables ◽  
Role Clarity ◽  
Continuous Variables ◽  
Post Intervention ◽  
Hospital Cardiac Arrest

Background: Little is known about how non-technical factors such as inadequate role definition and overcrowding may impact in-hospital cardiac arrest (IHCA) outcomes. Using a bundled intervention, we sought to decrease overcrowding while improving provider role ambiguity and leadership at IHCA events. Objective: To examine interventions targeted at decreasing overcrowding, improving role ambiguity and leadership during IHCA. Methods: As part of a performance improvement initiative, a multidisciplinary team implemented four countermeasures to improve IHCA code response: an MD/RN leadership dyad, assigned optimal team composition, scripted role definitions, and visual (stickers)/verbal (role-checks) cues. Between 4/2013-4/2014, the number and discipline of providers responding to ICHA events were recorded at each pulse check, and a 10-point Likert scale survey assessing communication and leadership was performed pre- and post-intervention. The primary outcome was the number of providers present after the role checks. Secondary outcome examined communication and leadership performance. Mann-Whitney test was used for continuous variables and chi-squared or Fischer’s exact test was used to compare categorical variables. Results: 20 pre-intervention and 34 post-intervention IHCA events were captured. During both periods, MDs and RNs comprised the majority of the total providers present (61%, 57%). The median number of MDs present in the post-intervention group was lower than in the pre-intervention group (4 (IQR 4-5) vs. 7 (IQR 5-9), p= 0.004), as was the number of total overall providers (14 (IQR 12-16) vs. 18 (IQR 14-22), p=0.04). The number of RNs did not differ post-intervention (data not shown). Survey results showed no significant differences in perceptions of communications or physician leadership post-intervention. However, the overwhelming majority of both the MD code leaders (90%) and primary nurses (97%) identified that there was a clear RN leader and rated the leadership provided by RN lead consistently high with a median score of 9 out of 10 possible points. Conclusions: Using an innovative bundle can decrease overcrowding and improve role ambiguity and leadership during non-ICU IHCA events.

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