scholarly journals Management of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S82-S89
Author(s):  
Michael Poppe ◽  
Mario Krammel ◽  
Christian Clodi ◽  
Christoph Schriefl ◽  
Alexandra-Maria Warenits ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Medical Services ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Objective Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. Methods All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Results Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96). Conclusion An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.

scholarly journals Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

2014 ◽  
Vol 22 (4) ◽  
pp. 562-568 ◽  
Author(s):  
Daniela Aparecida Morais ◽  
Daclé Vilma Carvalho ◽  
Allana dos Reis Correa
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Basic Life Support ◽  
Life Support ◽  
Advanced Life Support ◽  
Medical Services ◽  
Determinant Factors ◽  
Emergency Medical ◽  
Advanced Support

OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%), "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%), "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%), and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%).CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest.

scholarly journals Unrecognized Out of Hospital Cardiac Arrest Symptoms during Thailand’s Emergency Medical Services

2021 ◽  
Vol 9 (E) ◽  
pp. 1-4
Author(s):  
Thanat Tangpaisarn ◽  
Tachaya Srinopparatanakul ◽  
Ratchanan Artpru ◽  
Praew Kotruchin ◽  
Kamonwon Ienghong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Emergency Medical Services ◽  
Life Support ◽  
Recognition Rate ◽  
Spontaneous Circulation ◽  
Medical Services ◽  
Common Symptom ◽  
Emergency Medical ◽  
Underlying Causes ◽  
Hospital Cardiac Arrest

BACKGROUND: To improve survival rate, the main focus of adult cardiac arrest management includes rapid recognition, prompt administration of cardiopulmonary resuscitation (CPR), defibrillation for shockable rhythms, post-return of spontaneous circulation (ROSC) care, and identification and treatment of underlying causes. This study aimed to identify the determinants of unrecognized cardiac arrest, and to study the recognition rate of out-of-hospital cardiac arrest (OHCA) by emergency medical services call handlers. METHODS: We included OHCA patients who were transferred to hospital via Emergency Medical Services (EMS) of Srinagarind hospital, Khon Kaen, Thailand, from 1st January 2020 to 31st December 2020. The primary outcome was to identify symptoms that lead to an unrecognized cardiac arrest by the EMS call handlers. Secondary outcomes were to identify the recognition rate of OHCA by emergency medical services call handlers, and assess the outcome of CPR performed on OHCA patients. RESULTS: There were a total of 58 patients in the present study, 26 patients (44.8%) and 32 patients (55.2%) belonged to the unrecognized and recognized cardiac arrest groups, respectively. The most common symptoms that led to unrecognized cardiac arrest were a state of unconsciousness (46.2%), major trauma (15.4%), and seizure-like activity (11.5%). The rate of ROSC was higher in the unrecognized cardiac arrest group (34.6% vs. 15.6%) but the rate of survival to hospital discharge was higher in the recognized cardiac arrest group (6.3% vs 0%). CONCLUSIONS: Falling unconscious is the most common symptom of unrecognized OHCA cases seen by EMS in Thailand. Basic life support, especially an immediate assessment of a patient’s respiratory status should be taught in health programs in school or through public service channels.

scholarly journals Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

2021 ◽  
Author(s):  
Pramod Chandru ◽  
Tatum Priyambada Mitra ◽  
Nitesh Dutt Dhanekula ◽  
Mark Dennis ◽  
Adam Eslick ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Rescue Therapy ◽  
A Priori ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

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.

P4170Survival after dispatcher assisted CPR in out of hospital cardiac arrest compared to CPR without dispatcher assistance and no CPR before emergency medical services arrival – a nationwide study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Riva ◽  
M Jonsson ◽  
M Ringh ◽  
A Claesson ◽  
T Djarv ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Time Delays ◽  
Medical Services ◽  
Absolute Difference ◽  
Nationwide Study ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Abstract Background Cardiopulmonary resuscitation (CPR) before arrival of emergency medical services (EMS) is associated with survival in out-of hospital cardiac arrest. Dispatcher assisted CPR (DA-CPR) has been shown to increase CPR rates. However there are several challenges to successful DA-CPR, such as identification of cardiac arrest, time delays to CPR instructions, time delays to start of chest compression and quality of CPR. Purpose The aim of this study is to assess survival in out of hospital cardiac arrest after no CPR, DA-CPR and CPR without dispatcher assistance before EMS arrival in a nationwide cardiac arrest register. Methods A register based observational study. All consecutive Out of Hospital Cardiac Arrests reported to the Swedish Register for Cardiopulmonary Resuscitation in 2010–2017 were collected. Patients with cardiac arrest witnessed by EMS, who received CPR by off-duty medical professionals, missing data on CPR, DA-CPR or survival were excluded. Exposure was categorized as either; no CPR before EMS arrival (NO-CPR), dispatcher assisted CPR before EMS arrival (DA-CPR) and CPR before EMS arrival without dispatcher assistance, spontaneous CPR (S-CPR). Propensity score matched cohorts were used for comparison between groups. Primary endpoint was 30-day survival. Results Out of 36309, a total of 15471 patients were included, 41.6% received NO-CPR 31.0% received DA-CPR and 27.4% received S-CPR. In propensity score matched cohorts survival to 30-days was 9.0% after NO-CPR, 13.6% after DA-CPR and 15.8% after S-CPR. Using DA-CPR as reference, NO-CPR was associated with lower survival (Conditional OR 0.61, 95% CI 0.52–0.72), absolute difference 4.6% (95% CI 3.0%-6.2%) and S-CPR was associated with higher survival (Conditional OR 1.21 (95% CI 1.05–1.39), absolute difference 2.3% (95% CI 0.5%-4.0%). 30-day survival Conclusion In this nationwide study spontaneous CPR was associated with the highest survival. When spontaneous CPR is not initiated DA-CPR is a reasonable option. Acknowledgement/Funding Swedish Heart and Lung Foundation

scholarly journals Mode of Death after Extracorporeal Cardiopulmonary Resuscitation

Membranes ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 270
Author(s):  
Viviane Zotzmann ◽  
Corinna N. Lang ◽  
Xavier Bemtgen ◽  
Markus Jaeckel ◽  
Annabelle Fluegler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Cerebral Damage ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Refractory Shock ◽  
Lactate Levels ◽  
Mode Of Death

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact mode of death in these patients. Methods: Retrospective registry analysis of all consecutive patients undergoing ECPR between May 2011 and May 2020 at a single center. Mode of death was judged by two researchers. Results: A total of 274 ECPR cases were included (age 60.0 years, 47.1% shockable initial rhythm, median time-to-extracorporeal membrane oxygenation (ECMO) 53.8min, hospital survival 25.9%). The 71 survivors had shorter time-to-ECMO durations (46.0 ± 27.9 vs. 56.6 ± 28.8min, p < 0.01), lower initial lactate levels (7.9 ± 4.5 vs. 11.6 ± 8.4 mg/dL, p < 0.01), higher PREDICT-6h (41.7 ± 17.0% vs. 25.3 ± 19.0%, p < 0.01), and SAVE (0.4 ± 4.8 vs. −0.8 ± 4.4, p < 0.01) scores. Most common mode of death in 203 deceased patients was therapy resistant shock in 105/203 (51.7%) and anoxic brain injury in 69/203 (34.0%). Comparing patients deceased with shock to those with cerebral damage, patients with shock were significantly older (63.2 ± 11.5 vs. 54.3 ± 16.5 years, p < 0.01), more frequently resuscitated in-hospital (64.4% vs. 29.9%, p < 0.01) and had shorter time-to-ECMO durations (52.3 ± 26.8 vs. 69.3 ± 29.1min p < 0.01). Conclusions: Most patients after ECPR decease due to refractory shock. Older patients with in-hospital cardiac arrest might be prone to development of refractory shock. Only a minority die from cerebral damage. Research should focus on preventing post-CPR shock and treating the shock in these patients.

Healthcare professionals’ knowledge on cardiopulmonary resuscitation correlated with return of spontaneous circulation rates after in-hospital cardiac arrests: A multicentric study between university hospitals in 12 European countries

2020 ◽  
Vol 19 (5) ◽  
pp. 401-410
Author(s):  
Christos Kourek ◽  
Robert Greif ◽  
Georgios Georgiopoulos ◽  
Maaret Castrén ◽  
Bernd Böttiger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Healthcare Professionals ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
European Countries ◽  
University Hospitals ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Background: In-hospital cardiac arrest is a major cause of death in European countries, and survival of patients remains low ranging from 20% to 25%. Aims: The purpose of this study was to assess healthcare professionals’ knowledge on cardiopulmonary resuscitation among university hospitals in 12 European countries and correlate it with the return of spontaneous circulation rates of their patients after in-hospital cardiac arrest. Methods and results: A total of 570 healthcare professionals from cardiology, anaesthesiology and intensive care medicine departments of European university hospitals in Italy, Poland, Hungary, Belgium, Spain, Slovakia, Germany, Finland, The Netherlands, Switzerland, France and Greece completed a questionnaire. The questionnaire consisted of 12 questions based on epidemiology data and cardiopulmonary resuscitation training and 26 multiple choice questions on cardiopulmonary resuscitation knowledge. Hospitals in Switzerland scored highest on basic life support ( P=0.005) while Belgium hospitals scored highest on advanced life support ( P<0.001) and total score in cardiopulmonary resuscitation knowledge ( P=0.01). The Swiss hospitals scored highest in cardiopulmonary resuscitation training ( P<0.001). Correlation between cardiopulmonary resuscitation knowledge and return of spontaneous circulation rates of patients with in-hospital cardiac arrest demonstrated that each additional correct answer on the advanced life support score results in a further increase in return of spontaneous circulation rates (odds ratio 3.94; 95% confidence interval 2.78 to 5.57; P<0.001). Conclusion: Differences in knowledge about resuscitation and course attendance were found between university hospitals in 12 European countries. Education in cardiopulmonary resuscitation is considered to be vital for patients’ return of spontaneous circulation rates after in-hospital cardiac arrest. A higher level of knowledge in advanced life support results in higher return of spontaneous circulation rates.

P489Survival in children with out-of-hospital cardiac arrest after standard or chest compression-only bystander cardiopulmonary resuscitation before emergency medical services arrival

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Y Goto ◽  
A Funada ◽  
T Maeda ◽  
F Okada ◽  
Y Goto
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Chest Compression ◽  
Medical Services ◽  
Emergency Medical ◽  
Traumatic Origin ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest ◽  
Over Time

Abstract Funding Acknowledgements Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999) Background For out-of-hospital cardiac arrest (OHCA), current cardiopulmonary resuscitation (CPR) guidelines recommend chest compression-only bystander CPR (C- BCPR) for both untrained and trained bystanders unwilling to perform rescue breaths before emergency medical services personnel arrival. However, during 3 consecutive guideline periods, changes in type of BCPR and neurologically intact survival rate are unclear in paediatric OHCA cases. Purpose We aimed to determine the change in the rate and type of BCPR in correlation to the 1-month neurologically intact survival and causes of OHCA. Methods We reviewed 5461 children with bystander witnessed OHCA included in the All-Japan Utstein-style registry from 2005 to 2017. Patients were divided into 3 groups according to the type of BCPR: no BCPR (NO-BCPR), standard BCPR with rescue breaths (S-BCPR), and C-BCPR. Guideline periods 2005 to 2010 (pre-G2010), 2011 to 2015 (G2010), and 2016 to 2017 (G2015) were used for comparison over time. The study endpoint was 1-month neurologically intact survival (Cerebral Performance Category [CPC] scale 1 or 2; CPC 1–2). Results The rates of patients receiving any BCPR and 1-month CPC 1–2 by year significantly increased from 46.2% and 9.4% in 2005 to 61.3% and 15.7% in 2017 (all P for trend &lt;0.0001), respectively. The rates of patients receiving C-BCPR in the pre-G2010 period significantly increased from 21.6% to 35.5% in the G2010 period, and to 40.4% in the G2015 period (P for trend &lt;0.0001); the overall proportion of cases with 1-month CPC 1–2 increased from 9.1% to 10.8% and 14.7%, respectively (P for trend &lt;0.0001). Particularly, in patients receiving C-BCPR, CPC 1–2 rate significantly increased from 9.5% in the pre-G2010 period to 19.0% in the G2015 period (P for trend &lt;0.0001). For all time periods, 1-month CPC 1–2 rate in the S-BCPR (17.2%) cohort was significantly higher than those in the C-BCPR (12.5%) and NO-BCPR (6.4%) cohorts (adjusted odds ratio [aOR] of S-BCPR compared with C-BCPR, 1.59; 95% confidence interval [CI], 1.25–2.01; P &lt; 0.0001; compared with NO-BCPR, aOR 2.31; 95% CI, 1.82–2.94; P &lt; 0.0001). No significant difference between S-BCPR and C-BCPR was found in 1-month CPC 1–2 rate for patients with non-traumatic origin (17.7% vs. 16.3%; aOR, 1.23, 95% CI, 0.95–1.59, all P &gt;0.05). However, in patients with traumatic origin, S-BCPR was superior to C-BCPR (15.1% vs. 3.4%; aOR, 4.53, 95% CI, 2.39–8.61, all P &lt;0.0001). During the 3 guidelines periods, the CPC 1–2 rate in patients with non-traumatic origin significantly increased from 11.8% to 19.7% (P for trend &lt; 0.0001), but not in patients with traumatic origin (from 4.9% to 4.1%, P for trend = 0.29). Conclusions During the 3 guidelines periods, the rate of C-BCPR and 1-month CPC 1–2 increased by approximately 2-fold each over time. C-BCPR was associated with increased odds of 1-month CPC 1–2 similar to S-BCPR for children with non-traumatic origin but not in those with traumatic origin.

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