scholarly journals Bystander Cardiopulmonary Resuscitation Quality: Potential for Improvements in Cardiac Arrest Resuscitation

2021 ◽  
Author(s):  
Richard Chocron ◽  
Julia Jobe ◽  
Sally Guan ◽  
Madeleine Kim ◽  
Mia Shigemura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Performance Metrics ◽  
Medical System ◽  
Emergency Medical System ◽  
Compression Rate ◽  
Emergency Medical ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out‐of‐hospital cardiac arrest. We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator CPR (TCPR). Methods and Results We investigated non‐traumatic out‐of‐hospital cardiac arrest occurring in a large metropolitan emergency medical system during a 6‐month period. Information about bystander care was ascertained through review of the 9‐1‐1 recordings in addition to emergency medical system and hospital records to determine bystander CPR status (none versus TCPR versus unassisted), the number of bystanders on‐scene, and CPR performance metrics of compression fraction and compression rate. Of the 428 eligible out‐of‐hospital cardiac arrest, 76.4% received bystander CPR including 43.7% unassisted CPR and 56.3% TCPR; 35.2% had one bystander, 33.3% had 2 bystanders, and 31.5% had ≥3 bystanders. Overall compression fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (fraction=52%, rate=87 per minute for TCPR versus fraction=69%, rate=102 for unassisted CPR, P <0.05 for each comparison) and the number of bystanders (fraction=55%, rate=87 per minute for 1 bystander, fraction=59%, rate=89 for 2 bystanders, fraction=65%, rate=97 for ≥3 bystanders, test for trend P <0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an automated external defibrillator (8.0%). Conclusions Bystander CPR quality as gauged by compression fraction and rate approached guideline goals though performance depended upon the type of CPR and number of bystanders.

Outcome after out-of-hospital cardiac arrest in a physician-staffed emergency medical system according to the Utstein style

2007 ◽  
Vol 153 (5) ◽  
pp. 792-799 ◽  
Author(s):  
Heidi L. Estner ◽  
Christian Günzel ◽  
Gjin Ndrepepa ◽  
Frederic William ◽  
Dirk Blaumeiser ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Medical System ◽  
Emergency Medical System ◽  
Emergency Medical ◽  
Utstein Style ◽  
Hospital Cardiac Arrest

scholarly journals Insights From the Ventricular Fibrillation Waveform Into the Mechanism of Survival Benefit From Bystander Cardiopulmonary Resuscitation

2021 ◽  
Vol 10 (19) ◽  
Author(s):  
Brooke Bessen ◽  
Jason Coult ◽  
Jennifer Blackwood ◽  
Cindy H. Hsu ◽  
Peter Kudenchuk ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Survival Benefit ◽  
Amplitude Spectrum ◽  
Peak Frequency ◽  
Spectrum Area ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background The mechanism by which bystander cardiopulmonary resuscitation (CPR) improves survival following out‐of‐hospital cardiac arrest is unclear. We hypothesized that ventricular fibrillation (VF) waveform measures, as surrogates of myocardial physiology, mediate the relationship between bystander CPR and survival. Methods and Results We performed a retrospective cohort study of adult, bystander‐witnessed patients with out‐of‐hospital cardiac arrest with an initial rhythm of VF who were treated by a metropolitan emergency medical services system from 2005 to 2018. Patient, resuscitation, and outcome variables were extracted from emergency medical services and hospital records. A total of 3 VF waveform measures (amplitude spectrum area, peak frequency, and median peak amplitude) were computed from a 3‐second ECG segment before the initial shock. Multivariable logistic regression estimated the association between bystander CPR and survival to hospital discharge adjusted for Utstein elements. Causal mediation analysis quantified the proportion of survival benefit that was mediated by each VF waveform measure. Of 1069 patients, survival to hospital discharge was significantly higher among the 814 patients who received bystander CPR than those who did not (0.52 versus 0.43, respectively; P <0.01). The multivariable‐adjusted odds ratio for bystander CPR and survival was 1.6 (95% CI, 1.2, 2.1), and each VF waveform measure attenuated this association. Depending on the specific waveform measure, the proportion of mediation varied: 53% for amplitude spectrum area, 31% for peak frequency, and 29% for median peak amplitude. Conclusions Bystander CPR correlated with more robust initial VF waveform measures, which in turn mediated up to one‐half of the survival benefit associated with bystander CPR. These results provide insight into the biological mechanism of bystander CPR in VF out‐of‐hospital cardiac arrest.

scholarly journals Incidence and Outcomes of Out‐of‐Hospital Cardiac Arrest in Singapore and Victoria: A Collaborative Study

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Shir Lynn Lim ◽  
Karen Smith ◽  
Kylie Dyson ◽  
Siew Pang Chan ◽  
Arul Earnest ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Prehospital Care ◽  
Survival Rates ◽  
World Health ◽  
Medical Services ◽  
Emergency Medical ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Background Incidence and outcomes of out‐of‐hospital cardiac arrest (OHCA) vary between communities. We aimed to examine differences in patient characteristics, prehospital care, and outcomes in Singapore and Victoria. Methods and Results Using the prospective Singapore Pan‐Asian Resuscitation Outcomes Study and Victorian Ambulance Cardiac Arrest Registry, we identified 11 061 and 32 003 emergency medical services‐attended adult OHCAs between 2011 and 2016 respectively. Incidence and survival rates were directly age adjusted using the World Health Organization population. Survival was analyzed with logistic regression, with model selection via backward elimination. Of the 11 061 and 14 834 emergency medical services‐treated OHCAs (overall mean age±SD 65.5±17.2; 67.4% males) in Singapore and Victoria respectively, 11 054 (99.9%) and 5595 (37.7%) were transported, and 440 (4.0%) and 2009 (13.6%) survived. Compared with Victoria, people with OHCA in Singapore were older (66.7±16.5 versus 64.6±17.7), had less shockable rhythms (17.7% versus 30.3%), and received less bystander cardiopulmonary resuscitation (45.7% versus 58.5%) and defibrillation (1.3% versus 2.5%) (all P <0.001). Age‐adjusted OHCA incidence and survival rates increased in Singapore between 2011 and 2016 ( P <0.01 for trend), but remained stable, though higher, in Victoria. Likelihood of survival increased significantly ( P <0.001) with arrest in public locations (adjusted odds ratio [aOR] 1.81), witnessed arrest (aOR 2.14), bystander cardiopulmonary resuscitation (aOR 1.72), initial shockable rhythm (aOR 9.82), and bystander defibrillation (aOR 2.04) but decreased with increasing age (aOR 0.98) and emergency medical services response time (aOR 0.91). Conclusions Singapore reported increasing OHCA incidence and survival rates between 2011 and 2016, compared with stable, albeit higher, rates in Victoria. Survival differences might be related to different emergency medical services practices including patient selection for resuscitation and transport.

Analysis of out-hospital cardiac arrest advanced life support by the emergency medical system in Andalusia (061)

Resuscitation ◽  
2006 ◽  
Vol 70 (2) ◽  
pp. 303-304
Author(s):  
Rafael Canto Neguillo ◽  
Márquez Sergio ◽  
Chacón Coral ◽  
Martín Carmen ◽  
Olavarría Luís
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Medical System ◽  
Emergency Medical System ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Outcome of out-of-hospital cardiac arrest in a two tired emergency medical system in a central European mixed rural–urban area

Resuscitation ◽  
2012 ◽  
Vol 83 ◽  
pp. e24
Author(s):  
Mario Krammel ◽  
Karl Schebesta ◽  
Thomas Hamp ◽  
Astrid Grant Hay ◽  
Hans Domanovits ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Urban Area ◽  
Medical System ◽  
Emergency Medical System ◽  
Central European ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Abstract 273: Exploring the Role of the Emergency Medical System in Promoting Bystander Cardiopulmonary Resuscitation During Out-of-hospital Cardiac Arrests

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Sydney Fouche ◽  
Mahshid Abir ◽  
Jessica Lehrich ◽  
Stuart Hammond ◽  
Wilson Nham ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Medical System ◽  
Emergency Medical System ◽  
Survival Outcomes ◽  
Medical Systems ◽  
Emergency Medical ◽  
Bystander Response ◽  
Emergency Medical Systems

Introduction: Early bystander initiated cardiopulmonary resuscitation (BCPR) is a key link in the cardiac arrest chain of survival. Prior work indicates that BCPR has a greater impact on survival outcomes when arrests are witnessed, and bystanders are actively prepared. This study explores the role of the emergency medical system—including dispatch, police, fire, and emergency medical services (EMS), in promoting timely bystander response during an out-of-hospital cardiac arrest (OHCA) event. Methods: This sequential mixed-methods study used 2014-2017 data from the Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) to analyze the effect of BCPR on OHCA survival outcomes. Logistic regression models were used to analyze the effect of BCPR on sustained ROSC with pulse upon emergency department (ED) arrival and secondary outcomes. These data were supplemented with semi-structured key informant interviews and multidisciplinary focus groups conducted during site visits to 9 emergency medical systems across Michigan including dispatch, police, fire, EMS, and ED. Results: A total of 21,044 OHCA incidents met inclusion criteria. OHCA patients who received BCPR had 1.32 times higher odds of achieving ROSC with pulse upon ED arrival than those that did not after multivariable adjustment (Table 1). Qualitative data from interviews suggest that emergency medical systems can play a critical role in promoting BCPR. Several salient themes emerged across stakeholders including: 1) Preparing the community for proactive bystander response through educational campaigns; 2) Facilitating BCPR during an event through dispatch-assisted CPR and on-scene responders providing positive reinforcement to bystanders; and 3) Reinforcing the importance of performing bystander CPR to the involved community after post arrest care. Conclusion: We found that BCPR was associated with statistically significant improvements in survival outcomes compared to those that did not receive BCPR. These findings emphasize the importance of training bystanders to initiate and perform CPR, and points to engaging the emergency medical system as a leader for this initiative to improve OHCA survival across US communities.

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