READINESS OF THE CRIMEAN POPULATION TO PERFORM CARDIO PULMONARY RESUSCITATION IN OUT-OF-HOSPITAL CARDIAC ARREST

2019 ◽  
Vol 65 (1) ◽  
pp. 5-5
Author(s):  
A.A. Birkun ◽  
◽  
Y.A. Kosova ◽  
Keyword(s):  
Cardiac Arrest ◽  
Cardio Pulmonary Resuscitation ◽  
Hospital Cardiac Arrest

scholarly journals Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

2021 ◽  
Author(s):  
Charles Payot ◽  
Christophe A Fehlmann ◽  
Laurent Suppan ◽  
Marc Niquille ◽  
Christelle Lardi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Multivariable Logistic Regression Model ◽  
Physician Decision Making ◽  
Factors Influencing ◽  
Cardio Pulmonary Resuscitation ◽  
Prehospital Emergency ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

Abstract 483: Out of Hospital Cardiac Arrest Outcomes After Transitioning to Pit Crew Model

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mohinder Reddy Vindhyal ◽  
Paul M Ndunda ◽  
Shravani Vindhyal ◽  
Brent Duran
Keyword(s):  
Cardiac Arrest ◽  
Vegetative State ◽  
Fire Department ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Cardio Pulmonary Resuscitation ◽  
Improved Outcomes ◽  
Before And After ◽  
Hospital Cardiac Arrest ◽  
Model Approach

Introduction: One of the leading causes of untimely death as per the Resuscitation Outcomes Consortium Epistry for cardiac arrest is out of hospital cardiac arrest (OHCA). Adoption of the choreographed approach of the pit crew model resuscitation improved outcomes after OHCA in some previous studies. Hypothesis: Compare outcomes post OHCA before and after adopting a pit crew model approach in one of the largest counties in Kansas. Methods: The data was collected before (2010 – 2012) and after the pit crew (2013-2016) approach from 2010 to 2016. The patient demographics and resuscitation variables were similar and comparable including the emergency and fire department personnel. The primary outcome was the proportion of patients having sustained return of spontaneous circulation (ROSC). Secondary outcomes were average number of pauses >10 seconds, cerebral performance post return of spontaneous circulation, and average cardio-pulmonary resuscitation (CPR) cycles to ROSC. Results: The patients who had sustained ROSC post pit crew approach was 67.9% vs 32.1% (p=< 0.001). Average number of CPR pause time > 10 seconds post pit crew model was 1 vs 5 (p=0.01). Cerebral performance post return of spontaneous circulation using pit crew approach with good cerebral performance was 47% vs 56% (p=0.2), moderate cerebral disability was 17% vs 23% (p=0.19), severe cerebral disability was 8% vs 11% (p=0.44) and in coma/vegetative state was 8% vs 16% (p=0.001). Average CPR cycles to ROSC was 6.63. Conclusion: This focused model of high-quality CPR performance with individualized assigned tasks with minimal interruptions has shown increased numbers of sustained ROSC. The pit crew model approach also has showed decline in the rates of cerebral performance especially with moderate and severe cerebral performance including the patients in coma or vegetative state which is mainly through continuous cerebral perfusion pressures. More studies with better follow-up care in coordination with hospital outcomes will be key for the pit crew approach to be adopted.

Abstract 11964: Citizen Responders Provide Emotional Support for Relatives to Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Astrid Rolin Kragh ◽  
Linn Andelius ◽  
Mads Christian Tofte Gregers ◽  
Julie Kjoelbye ◽  
Line Zinckernagel ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Emotional Support ◽  
Health Care Professionals ◽  
Smartphone Application ◽  
Cardio Pulmonary Resuscitation ◽  
Cr System ◽  
Hospital Cardiac Arrest ◽  
External Defibrillator ◽  
Resuscitation Attempt

Introduction: A citizen responder (CR) system to activate volunteer citizens by a smartphone application (HeartRunner) to nearby cardiac arrests was implemented in 2017 in the Capital Region of Denmark. Participating in resuscitation may not only involve provision of cardio-pulmonary resuscitation (CPR) but also include provision of emotional support for relatives to the cardiac arrest patient. We examined the proportion of CR who reported provision of support to relatives to out-of-hospital cardiac arrest (OHCA) patients during resuscitation attempt. Hypothesis: We hypothesized that CR not only deliver CPR but also provide emotional support to relatives of OHCA patients. Methods: All CR activated by the HeartRunner app received a follow-up questionnaire 90 minutes after the alarm including questions about how CRs participated in resuscitation and whether they provided emotional support to relatives present during the resuscitation attempt. All surveys from March 12, 2020 to June 1, 2021, from CR who accepted an alarm and arrived at the cardiac arrest location were included. Results: A total of 1,868 CR responded to the survey (median age 37 years (IQR 28-37). Half (54.4%) were male and 23.9% health care professionals. CRs arrived before the emergency medical services (EMS) in almost 1/3 (28.9%) of OHCA cases with CR activation, with 227 CRs (41.9%) performing CPR and 139 (25.7%) attaching an automated external defibrillator. In total, more than 433 CRs (23.2%) reported provision of support for relatives at the OHCA location. Even though a higher proportion of support was observed among CR who arrived before the EMS, almost 12% reported provision of support to relatives even when arriving after EMS (Figure). Conclusions: Citizen responders provide not only resuscitative efforts but offer emotional support to relatives to OHCA patients. Citizen responders may be an important resource for both EMS personnel and relatives who are present at the cardiac arrest scene.

Abstract 207: The Association of Academia With Neurological Outcome Among Out-Of-Cardiac Arrest Patients Who Undergo Extracorporeal Cardio-Pulmonary Resuscitation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Yohei Okada ◽  
Takeyuki Kiguchi ◽  
Tetsuhisa Kitamura ◽  
Takashi Kawamura ◽  
Taku Iwami
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Critical Study ◽  
Hospital Arrival ◽  
Cardio Pulmonary Resuscitation ◽  
Poor Neurological Outcome ◽  
Favorable Neurological Outcome ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Background: Our study aim was to identify the association of acidemia with neurological outcome among the out-of-hospital cardiac arrest patients who undergo extracorporeal cardio-pulmonary resuscitation (E-CPR). Method: We analyzed the data from multi-institutional prospective cohort study (CRITICAL study: Comprehensive Registry of Intensive Cares for out-of-hospital cardiac arrest Survival) including 14 emergency departments in Osaka, Japan. We included adult out-of-hospital cardiac arrest patients aged ≥18 years who undergo E-CPR. The exposure of interest was serum pH measured before start to E-CPR on admission, and it was divided to tertiles. The primary outcome was 30-days favorable neurological outcome defined as cerebral performance category 1 or 2. We calculated the adjusted odds ratio (OR) with 95% confidence intervals (CI) using logistic regression model, adjusted by age, sex, witness of collapse, by-stander CPR, cardiac rhythm on hospital arrival, and time to hospital arrival. Results: Among 9,822 patients in Critical study database, 303 patients were included in the analysis. The median (interquartile range) of the age was 62 (48-71) years-old. The range of serum pH in each tertile was as below; Tertile 1[ pH≥7.02, (n=101)], Tertile 2 [pH 6.87-7.02, (n=100)], Tertile 3 [pH <6.87, (n=102)]. The adjusted OR with 95%CI of tertile2, and 3 for favorable neurological outcome were 0.23 (0.09 to 0.58), and 0.18 (0.06 to 0.52) referred to Tertile 1, respectively. Conclusion: Among the out-of-hospital cardiac arrest patients who undergo E-CPR, severe acidemia (pH < 7.02) on arrival was associated with 30-days poor neurological outcome. Serum pH measurement might be useful to consider the indication of E-CPR.

PP15 Association between admission to a cardiac centre and survival to hospital discharge for adults following out-of-hospital cardiac arrest

2021 ◽  
Vol 38 (9) ◽  
pp. A7.2-A7
Author(s):  
Johannes von Vopelius-Feldt ◽  
Gavin Perkins ◽  
Jonathan Benger
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Hospital Discharge ◽  
Missing Values ◽  
High Volume ◽  
Hospital Treatment ◽  
Cardio Pulmonary Resuscitation ◽  
Improvement In Survival ◽  
Hospital Cardiac Arrest

BackgroundSurvival following out-of-hospital cardiac arrest (OHCA) depends on the Chain of Survival, which spans from bystander cardio-pulmonary resuscitation to in-hospital treatment. There is an increased interest in regionalisation of post-OHCA care, which includes ambulances bypassing the nearest hospital in favour of OHCA centres. This study examined the association between admission to OHCA centres and survival to hospital discharge for adults following OHCA of presumed cardiac aetiology.MethodsWe undertook a multicentre retrospective observational study of patients transferred to hospital after OHCA of presumed cardiac aetiology in three ambulance services in England. We used propensity score matching to compare rates of survival to hospital discharge in patients admitted to OHCA centres (defined as either 24/7 PPCI availability or >100 OHCA admissions per year) to rates of survival of patients admitted to non-centres.ResultsBetween January 2017 and December 2018, 10,650 patients with OHCA were included in the analysis. After propensity score matching, admission to a hospital with 24/7 PPCI availability or a high-volume centre was associated with an absolute improvement in survival to hospital discharge of 2.5% and 2.8%, respectively. The corresponding odds ratios and 95% confidence intervals were 1.69 (1.28 to 2.23) and 1.41 (1.14 to 1.75), respectively. The results were similar when missing values were imputed. In subgroup analyses, the association between admission to an OHCA centre and improved rates of survival was mainly seen in patients with OHCA due to shockable rhythms, with no or minimal potential benefit for patients with asystole as first presenting rhythm.ConclusionsFollowing OHCA, admission to an OHCA centre is associated with a moderate improvement in survival to hospital discharge. A corresponding bypass policy would need to consider the resulting increased workload for OHCA centres and longer ambulance transfer times.

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