scholarly journals Trend in survival after out-of-hospital cardiac arrest and its relationship with bystander cardiopulmonary resuscitation: a six-year prospective observational study in Beijing

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuling Chen ◽  
Peng Yue ◽  
Ying Wu ◽  
Jia Li ◽  
Yanni Lei ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Indirect Effect ◽  
Prospective Observational Study ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA), a global health problem with a survival rate ranging from 2 to 22% across different countries, has been a leading cause of premature death for decades. The aim of this study was to evaluate the trends of survival after OHCA over time and its relationship with bystander cardiopulmonary resuscitation (CPR), initial shockable rhythm, return of spontaneous circulation (ROSC), and survived event. Methods In this prospective observational study, data of OHCA patients were collected following the “Utstein style” by the Beijing, China, Emergency Medical Service (EMS) from January 2011 (data from February to June in 2011 was not collected) to October 2016. Patients who had a cardiac arrest and for whom an ambulance was dispatched were included in this study. All cases were followed up to determine hospital discharge or death. The trend of OHCA survival was analyzed using the Chi-square test. The relationship among bystander CPR, initial shockable rhythm, ROSC, survived event, and OHCA survival rate was analyzed using multivariate path analyses with maximum standard likelihood estimation. Results A total of 25,421 cases were transferred by the Beijing EMS; among them, 5042 (19.8%) were OHCA (median age: 78 years, interquartile range: 63–85, 60.1% male), and 484 (9.6%) received bystander CPR. The survival rate was 0.6%, which did not improve from 2012 to 2015 (P = 0.569). Overall, bystander CPR was indirectly associated with an 8.0% (β = 0.080, 95% confidence interval [CI] = 0.064–0.095, P = 0.002) increase in survival rate. The indirect effect of bystander CPR on survival rate through survived event was 6.6% (β = 0.066, 95% CI = 0.051–0.081, P = 0.002), which accounted for 82.5% (0.066 of 0.080) of the total indirect effect. With every 1 increase in survived event, the possibility of survival rate will directly increase by 53.5% (β = 0.535, 95% CI = 0.512–0.554, P = 0.003). Conclusions The survival rate after OHCA was low in Beijing which has not improved between 2012 and 2015. The effect of bystander CPR on survival rate was mainly mediated by survived event. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-12002149 (2 May, 2012, retrospectively registered). http://www.chictr.org.cn/showproj.aspx?proj=7400

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.

scholarly journals Implementation of a National 5‐Year Plan for Prehospital Emergency Care in Singapore and Impact on Out‐of‐Hospital Cardiac Arrest Outcomes From 2011 to 2016

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Andrew Fu Wah Ho ◽  
Nurun Nisa Amatullah De Souza ◽  
Audrey L. Blewer ◽  
Win Wah ◽  
Nur Shahidah ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Care ◽  
Survival Rates ◽  
Prehospital Emergency Care ◽  
Shockable Rhythm ◽  
Automated External Defibrillation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Prehospital Emergency ◽  
Hospital Cardiac Arrest

Background Outcomes of patients from out‐of‐hospital cardiac arrest (OHCA) vary widely globally because of differences in prehospital systems of emergency care. National efforts had gone into improving OHCA outcomes in Singapore in recent years including community and prehospital initiatives. We aimed to document the impact of implementation of a national 5‐year Plan for prehospital emergency care in Singapore on OHCA outcomes from 2011 to 2016. Methods and Results Prospective, population‐based data of OHCA brought to Emergency Departments were obtained from the Pan‐Asian Resuscitation Outcomes Study cohort. The primary outcome was Utstein (bystander witnessed, shockable rhythm) survival‐to‐discharge or 30‐day postarrest. Mid‐year population estimates were used to calculate age‐standardized incidence. Multivariable logistic regression was performed to identify prehospital characteristics associated with survival‐to‐discharge across time. A total of 11 465 cases qualified for analysis. Age‐standardized incidence increased from 26.1 per 100 000 in 2011 to 39.2 per 100 000 in 2016. From 2011 to 2016, Utstein survival rates nearly doubled from 11.6% to 23.1% ( P =0.006). Overall survival rates improved from 3.6% to 6.5% ( P <0.001). Bystander cardiopulmonary resuscitation rates more than doubled from 21.9% to 56.3% and bystander automated external defibrillation rates also increased from 1.8% to 4.6%. Age ≤65 years, nonresidential location, witnessed arrest, shockable rhythm, bystander automated external defibrillation, and year 2016 were independently associated with improved survival. Conclusions Implementation of a national prehospital strategy doubled OHCA survival in Singapore from 2011 to 2016, along with corresponding increases in bystander cardiopulmonary resuscitation and bystander automated external defibrillation. This can be an implementation model for other systems trying to improve OHCA outcomes.

scholarly journals Persepsi Perlindungan Hukum dan Aspek Etik terhadap Keinginan Perawat IGD Melakukan CPR pada Out-of-Hospital Cardiac Arrest (OHCA)

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Wiwin Winarti ◽  
Rosiana Rosiana
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Ethical Issues ◽  
Legal Protection ◽  
The Elderly ◽  
Legal Aspects ◽  
Cross Sectional ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

ABSTRAKKejadian henti jantung dapat terjadi dimana saja baik di rumah sakit maupun di luar rumah sakit atau Out-of-Hospital Cardiac Arrest (OHCA). Usaha untuk meningkatkan survival rate kejadian henti jantung adalah pemberian Cardiopulmonary resuscitation (CPR)/ resusitasi jantung paru (RJP) yang berkualitas. Faktor yang mempengaruhi seseorang untuk mau menjadi bystander CPR bukan hanya terkait pengetahuan dan teknik melakukan CPR namun juga dipengaruhi oleh faktor sosial, kerelaan melakukan, kesiapan psikologis dan faktor lainnya seperti aspek etik dan hukum. Tujuan penelitian ini untuk mengetahui pengaruh persepsi perlindungan hukum dan aspek etik terhadap keinginan perawat dalam memberikan tindakan CPR pada kejadian Out-of-Hospital Cardiac Arrest. Penelitian menggunakan desain cross-sectional dengan metode kuisioner yang dikembangkan oleh peneliti dan menggunakan total sampling yang melibatkan seluruh perawat IGD RSUD Budhi Asih sebanyak 30 orang. Analisis menggunakan uji Fisher’s Exact dan Cochran-Mantel Haenszel. Hasil penelitian menunjukkan mayoritas responden (56,7%) memiliki persepsi yang negatif terhadap perlindungan hukum terhadap bystander CPR pada OHCA. Meskipun demikian, perawat cenderung memiliki persepsi yang positif ketika menjawab pertanyaan terkait isu etik CPR pada korban anak-anak, wanita maupun lansia. Sebanyak 43,33% (13 perawat) memiliki keinginan positif untuk melakukan CPR pada OHCA sementara 56,67% (17 perawat) lainnya memiliki keinginan negatif sebagai bystander CPR. Hasil uji Cochran-Mantel Haenszel menunjukkan persepsi terhadap perlindungan hukum mempengaruhi keinginan perawat dalam memberikan CPR pada OHCA dan akan diperbesar kemungkinan memberikan CPR apabila perawat tersebut berusia ≥ 30 tahun (p 0,014; OR 14,133; 95% CI 2,081-95,947) dan memiliki masa kerja ≥ 5 tahun (p 0,008; OR 25,667; 95% CI 2,253-292,462). Promosi mengenai aspek legal dan etik, serta landasan hukum perlindungan terhadap bystander CPR menjadi penting untuk dapat meningkatkan keinginan perawat dan jumlah bystander CPR. ABSTRACTCardiac arrest can occur anywhere in the hospital or outside the hospital, which is called Out-of-Hospital Cardiac Arrest (OHCA). An effort to increase the survival rate of cardiac arrest is the provision of quality Cardiopulmonary resuscitation (CPR). Factors that influence a person's willingness to become a bystander CPR are not only related to the knowledge and techniques of conducting CPR but are also influenced by social factors, willingness, psychological readiness, and other factors such as ethical and legal aspects. The purpose of this study is to determine the effect of perceptions of legal protection and ethical issues on the nurses' willingness to provide CPR in the OHCA incident. This study used a cross-sectional design using a questionnaire developed by researchers, conducted at Emergency Department Budhi Asih Regional Hospital in East Jakarta, and used a total sampling method involving 30 ED nurses. Fisher's Exact and Cochran-Mantel Haenszel tests were used to analyze the data. The study findings show that the majority of respondents (56.7%) have a negative perception of the legal protection of bystander CPR in OHCA. However, nurses have a positive perception when answering questions related to the ethical issue of CPR in victims of children, women, and the elderly. 43.33% (13 nurses) have a positive willingness to perform CPR on OHCA, while 56.67% (17 nurses) have a negative willingness as a bystander CPR. The results of the Cochran-Mantel Haenszel test show that perceptions of legal protection may influence nurses' willingness to provide CPPR to OHCA patient, and it will increase the likelihood of giving CPR if the nurse age is ≥ 30 years old (p 0.014; OR 14,133; 95% CI 2,081-95,947) and has been working for ≥ 5 years (p 0.008; OR 25,667; 95% CI 2,253-292,462). Promotion of the legal aspects, ethical issues, and protection to bystander CPR are essential to increase the willingness of nurses and the number of bystander CPR. 

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.

P4169The crucial role of the bystander in out-of-hospital cardiac arrest resuscitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Campos ◽  
V Baert ◽  
H Hubert ◽  
E Wiel ◽  
N Benameur
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Survival Data ◽  
Health Concern ◽  
Propensity Analysis ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a major public health concern in France, given that there are 61.5 cases per 100,000 inhabitants a year. The impact of bystander action, performed before the arrival of emergency medical services (EMS), on survival has never been studied in France. Purpose Determine whether bystander cardiopulmonary resuscitation (CPR), performed before the arrival of EMS, was correlated with an increased 30-day survival rate after an OHCA. Methods 24,885 out-of-hospital cardiac arrests witnessed in France from 1 January 2012 to 1 May 2018 were analysed to determine whether CPR, performed before the arrival of EMS, was correlated with survival. Data from the Electronic Registry of Cardiac Arrests was used. The association between the effect of CPR performed before the arrival of EMS and 30-day survival rate was studied, using propensity analysis (which included variables such as age and sex of the patient, location, cause, and year of cardiac arrest, initial cardiac rhythm, EMS response time and no-flow time). Results CPR was performed before the arrival of EMS in 14,904 cases (59.9%) and was not performed in 9,981 cases (40.1%). The 30-day survival rate was 10.2% when CRP was performed by bystanders versus 3.9% when CRP was not performed before the EMS arrival (p<0.001). CPR performed by bystanders was associated with an increased 30-day survival rate (odds ratio 1.269; 1.207 to 1.334). The effect of bystander CPR on survival Conclusion Bystander CPR performed before the arrival of EMS was associated with an increased 30-day survival rate after an out-of-hospital cardiac arrest in France.

scholarly journals Effectiveness of bystander cardiopulmonary resuscitation in improving the survival and neurological recovery of patients with out-of-hospital cardiac arrest: A nationwide patient cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243757
Author(s):  
Joongyub Lee ◽  
Woojoo Lee ◽  
Yu Jin Lee ◽  
Hyunman Sim ◽  
Won Kyung Lee
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Directed Acyclic Graph ◽  
Neurological Recovery ◽  
Outcome Variable ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Male Patients ◽  
Unbiased Estimates ◽  
Hospital Cardiac Arrest

Introduction Few studies have focused on enhancing causality and yielding unbiased estimates on the effectiveness of bystander cardiopulmonary resuscitation (BCPR) on the outcomes of out-of-hospital cardiac arrest (OHCA) in a real-world setting. Therefore, this study evaluated the effect of BCPR on the outcomes of OHCA and its differences according to the characteristics of OHCA. Methods This study enrolled all patients with OHCA of cardiac etiology treated by emergency medical services (EMS) in Korea from 2012 to 2015. The endpoints were survival and neurological recovery at discharge, and the main exposure was BCPR conducted by a layperson. The effect of BCPR was analyzed after adjusting for confounders, determined using a directed acyclic graph, by inverse probability of treatment weighting (IPTW) and model-based standardization (STR). Moreover, differences in subgroups and time trends were evaluated. Results Among 10,505 eligible patients after excluding those with missing data on BCPR, 7,721 patients received BCPR, accounting for 74.3% of EMS-treated OHCA patients. BCPR increased the odds of survival and good neurological recovery at discharge by 1.67- (95% confidence interval (CI): 1.44–1.93) and 1.93- (95% CI: 1.56–2.39) fold, respectively, in the IPTW analysis. These findings were comparable to those obtained with STR. The odds ratios were 2.39 (95% CI: 1.91–2.94) and 2.70 (95% CI: 1.94–3.41), respectively, in the sensitivity analysis of the missing BCPR information considering confounders and the outcome variable. However, the effect of qualified BCPR was not evenly distributed, and it did not increase with time. BCPR was likely to be more effective in male patients aged <65 years, those who experienced an OHCA in a private place or non-capital region, and those with shockable rhythm at the scene. Conclusion Based on data from a nationwide registry, the estimated effect of BCPR on survival and neurological recovery was moderate and did not improve from 2012 to 2015.

scholarly journals Comorbidity and bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Heart ◽  
2020 ◽  
Vol 106 (14) ◽  
pp. 1087-1093
Author(s):  
Geir Hirlekar ◽  
Martin Jonsson ◽  
Thomas Karlsson ◽  
Maria Bäck ◽  
Araz Rawshani ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Multiple Logistic Regression ◽  
Multivariable Model ◽  
National Patient Registry ◽  
National Patient ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Comorbidity Index ◽  
Hospital Cardiac Arrest

​ObjectiveCardiopulmonary resuscitation (CPR) performed before the arrival of emergency medical services (EMS) is associated with increased survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to determine whether patients who receive bystander CPR have a different comorbidity compared with patients who do not, and to determine the association between bystander CPR and 30-day survival when adjusting for such a possible difference.​MethodsPatients with witnessed OHCA in the Swedish Registry for Cardiopulmonary Resuscitation between 2011 and 2015 were included, and merged with the National Patient Registry. The Charlson Comorbidity Index (CCI) was used to measure comorbidity. Multiple logistic regression was used to examine the effect of CCI on the association between bystander CPR and outcome.​ResultsIn total, 11 955 patients with OHCA were included, 71% of whom received bystander CPR. Patients who received bystander CPR had somewhat lower comorbidity (CCI) than those who did not (mean±SD: 2.2±2.3 vs 2.5±2.4; p<0.0001). However, this difference in comorbidity had no influence on the association between bystander CPR and 30-day survival in a multivariable model including other possible confounders (OR 2.34 (95% CI 2.01 to 2.74) without adjustment for CCI and OR 2.32 (95% CI 1.98 to 2.71) with adjustment for CCI).​ConclusionPatients who undergo CPR before the arrival of EMS have a somewhat lower degree of comorbidity than those who do not. Taking this difference into account, bystander CPR is still associated with a marked increase in 30-day survival after OHCA.

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