scholarly journals One out of three bystanders of out-of-hospital cardiac arrests suffers pathological psychological processing a few weeks after the incident- results from a systematic telephone interview

2020 ◽  
Author(s):  
Peter Brinkrolf ◽  
Bibiana Metelmann ◽  
Camilla Metelmann ◽  
Mina Baumgarten ◽  
Carolin Scharte ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Health Sector ◽  
Traumatic Experience ◽  
Exclusion Criteria ◽  
Telephone Interviews ◽  
Open Questions ◽  
Psychological Processing ◽  
Relationship Of ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract BackgroundWitnessing an out-of-hospital cardiac arrest (OHCA) is a traumatic experience. It is known, that some bystanders struggle with coping of these events. The impact of (part-) performing CPR vs. passive observing OHCA and of being a stranger as bystander vs. family and friends of the patient is still unknown.MethodsBetween December 2014 and April 2016 bystanders, who witnessed an OHCA of an adult patient (>18 years) were interviewed by telephone a few weeks after the event. In a semi-standardized questionnaire the paramount emotion at the time of the interview was asked. The statements given in response to open questions were rated into the categories “signs of pathological psychological processing”, “physiological psychological processing” and “good mental constitution” by independent researchers.ResultsObserving the exclusion criteria 89 telephone interviews could be included in the analyses. In 27 out of 89 cases (30.3%) signs of pathological psychological processing could be detected. Signs of pathological psychological processing were significantly less in bystanders, who received instructions by the dispatcher or autonomously performed CPR. No statistical significant differences in the psychological processing could be shown for gender, age, relationship to the patient, current employment in the health sector, location of cardiac arrest or number of additional bystanders.ConclusionsOne out of three bystanders of OHCA suffers sings of pathological psychological processing. This was independent of age, gender and relationship of the bystander to the patient. Bystanders who performed CPR with or without receiving instructions had a lower risk.

scholarly journals One out of three bystanders of out-of-hospital cardiac arrests shows signs of pathological psychological processing weeks after the incident - results from structured telephone interviews

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Peter Brinkrolf ◽  
Bibiana Metelmann ◽  
Camilla Metelmann ◽  
Mina Baumgarten ◽  
Carolin Scharte ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Psychological Distress ◽  
Health Sector ◽  
Traumatic Experience ◽  
Telephone Interviews ◽  
Interview Survey ◽  
Psychological Processing ◽  
Post Hoc ◽  
The Relationship ◽  
Hospital Cardiac Arrest

Abstract Background Witnessing an out-of-hospital cardiac arrest (OHCA) is a traumatic experience. This study analyses bystanders` psychological processing of OHCA. We examined the potential impact of bystanders performing resuscitation and the influence of the relationship between bystander and patient (stranger vs. family/friend of the patient) on the psychological processing. Methods A telephone interview survey with bystanders, who witnessed an OHCA of an adult patient was performed weeks after the event between December 2014 and April 2016. The semi-standardized questionnaire contained a question regarding the paramount emotion at the time of the interview. In a post-hoc analysis statements given in response were rated by independent researchers into the categories “signs of pathological psychological processing”, “physiological psychological processing” and “no signs of psychological distress due to the OHCA”. Results In this analysis 89 telephone interviews were included. In 27 cases (30.3%) signs of pathological psychological processing could be detected. Bystanders performing resuscitation had a higher rate of “no signs of psychological distress after witnessing OHCA” compared to those not resuscitating (54.7% vs. 26.7%, p < 0.05; relative risk 2.01; 95%CI 1.08, 3.89). No statistical significant differences in the psychological processing could be shown for gender, age, relationship to the patient, current employment in the health sector, location of cardiac arrest or number of additional bystanders. Conclusions One out of three bystanders of OHCA suffers signs of pathological psychological processing. This was independent of bystander´s age, gender and relationship to the patient. Performing resuscitation seems to help coping with witnessing OHCA.

scholarly journals Air pollution and out-of-hospital cardiac arrest risk

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Moderato ◽  
D Lazzeroni ◽  
A Biagi ◽  
T Spezzano ◽  
B Matrone ◽  
...  
Keyword(s):  
Air Pollution ◽  
Cardiac Arrest ◽  
Ambient Air ◽  
Ambient Air Pollution ◽  
External Temperature ◽  
Pm 2.5 ◽  
Pm10 And Pm2.5 ◽  
Short Term Exposure ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Introduction Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide; it accounts for up to 50% of all cardiovascular deaths.It is well established that ambient air pollution triggers fatal and non-fatal cardiovascular events. However, the impact of air pollution on OHCA is still controversial. The objective of this study was to investigate the impact of short-term exposure to outdoor air pollutants on the incidence of OHCA in the urban area of Piacenza, Italy, one of the most polluted area in Europe. Methods From 01/01/2010 to 31/12/2017 day-by-day PM10 and PM2.5 levels, as well as climatic data, were extracted from Environmental Protection Agency (ARPA) local monitoring stations. OHCA were extracted from the prospective registry of Community-based automated external defibrillator Cardiac arrest “Progetto Vita”. OHCA data were included: audio recordings, event information and ECG tracings. Logistic regression analysis was used to estimate the association between the risk of OHC, expressed as odds ratios (OR), associated with the PM10 and PM2.5 levels. Results Mean PM10 levels were 33±29 μg/m3 and the safety threshold (50 μg/m3) recommended by both WHO and Italian legislation has been exceeded for 535 days (17.5%). Mean PM 5 levels were 33±29 μg/m3. During the follow-up period, 880 OHCA were recorded on 750 days; the remaining 2174 days without OHCA were used as control days. Mean age of OHCA patients was 76±15 years; male gender was prevalent (55% male vs 45% female; &lt;0.001). Concentration of PM10 and PM 2.5 were significantly higher on days with the occurrence of OHCA (PM10 levels: 37.7±22 μg/m3 vs 32.7±19 μg/m3; p&lt;0.001; PM 2.5 levels: 26±16 vs 22±15 p&lt;0.001). Risk of OHCA was significantly increased with the progressive increase of PM10 (OR: 1.009, 95% CI 1.004–1.015; p&lt;0.001) and PM2.5 levels (OR 1.012, 95% CI 1.007–1.017; p&lt;0.001). Interestingly, the above mentioned results remain independent even when correct for external temperature or season (PM 2.5 levels: p=0.01 – PM 10 levels: p=0.002), Moreover, dividing PM10 values in quintiles, a 1.9 fold higher risk of cardiac arrest has been showed in the highest quintile (Highest quintile cut-off: &lt;48μg/m3) Conclusions In large cohort of patients from a high pollution area, both PM10 and PM2.5 levels are associated with the risk of Out-of-hospital cardiac arrest. PM10 and PM2.5 levels and risk of OHCA Funding Acknowledgement Type of funding source: None

Abstract 18656: The Effect of Targeted Temperature Management is Dependent Upon the Duration of Out-of-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ian R Drennan ◽  
Steve Lin ◽  
Kevin E Thorpe ◽  
Jason E Buick ◽  
Sheldon Cheskes ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Neurologic Injury ◽  
Good Neurologic Outcome ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Targeted temperature management (TTM) reduces neurologic injury from out-of-hospital cardiac arrest (OHCA). As the risk of neurologic injury increases with prolonged cardiac arrests, the benefit of TTM may depend upon cardiac arrest duration. We hypothesized that there is a time-dependent effect of TTM on neurologic outcomes from OHCA. Methods: Retrospective, observational study of the Toronto RescuNET Epistry-Cardiac Arrest database from 2007 to 2014. We included adult (>18) OHCA of presumed cardiac etiology that remained comatose (GCS<10) after a return of spontaneous circulation. We used multivariable logistic regression to determine the effect of TTM and the duration of cardiac arrest on good neurologic outcome (Modified Rankin Scale (mRS) 0-3) and survival to hospital discharge while controlling for other known predictors. Results: There were 1496 patients who met our inclusion criteria, of whom 981 (66%) received TTM. Of the patients who received TTM, 59% had a good neurologic outcome compared to 39% of patients who did not receive TTM (p< 0.001). After adjusting for the Utstein variables, use of TTM was associated with improved neurologic outcome (OR 1.60, 95% CI 1.10-2.32; p = 0.01) but not with survival to discharge (OR 1.23, 95% CI 0.90-1.67; p = 0.19). The impact of TTM on neurologic outcome was dependent on the duration of cardiac arrest (p<0.05) (Fig 1). Other significant predictors of good neurologic outcome were younger age, public location, initial shockable rhythm, and shorter duration of cardiac arrest (all p values < 0.05). A subgroup analysis found the use of TTM to be associated with neurologic outcome in both shockable (p = 0.01) and non-shockable rhythms (p = 0.04) but was not associated with survival to discharge in either group (p = 0.12 and p = 0.14 respectively). Conclusion: The use of TTM was associated with improved neurologic outcome at hospital discharge. Patients with prolonged durations of cardiac arrest benefited more from TTM.

Qualitative and quantitative analysis of emergency department cardiac arrest publications

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Prediction Models ◽  
Patient Characteristics ◽  
Research Direction ◽  
Medical Emergency ◽  
Aggregated Data ◽  
Academic Publications ◽  
Relationship Of ◽  
Hospital Cardiac Arrest

Cardiac arrest is a medical emergency with a poor prognosis. Patient characteristics and outcomes are associated with location and are traditionally categorized into out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Increasing evidence has revealed that cardiac arrest occurring in the emergency department is distinct from OHCA or IHCA in other locations in hospitals, but most academic publications combine these populations and apply the knowledge arising from OHCA or IHCA to patients with emergency department cardiac arrest (EDCA). The aim of this study was to identify the research direction of EDCA in the past 20 years and to analyze the characteristics and content of academic publications. We searched the MEDLINE and EMBASE databases for eligible articles until May 30, 2021. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data underwent a scoping review and analyzed qualitatively and quantitatively. In total, 52 original articles investigating EDCA were included; only 15 articles simply focused on EDCA, while other articles involved OHCA or IHCA simultaneously. There were 3 articles discussing the relationship of overcrowdedness and EDCA, 12 articles for prediction and risk factors associated with EDCA, 15 articles for epidemiology and prognosis, and 22 articles for specific diagnostic or resuscitation skills with regard to EDCA. Studies focusing on EDCA are increasing but still scarce. Applying the knowledge arising from OHCA or IHCA to EDCA is questionable, and research focused on EDCA is necessary. ED overcrowdedness-associated EDCA and prediction models for EDCA are essential topics that need further investigation.

Abstract 18207: Role of Coronary Angiography with Successful Percutaneous Coronary Intervention in Patients with Out-of-Hospital Cardiac Arrest without ST-Segment Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yader Sandoval ◽  
David F Miranda ◽  
Steven R Goldsmith ◽  
Bradley A Bart ◽  
Stephen W Smith ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Impact ◽  
Referral Bias ◽  
Hospital Cardiac Arrest

Background: Emerging data have supported a strategy of earlier access to cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA). However, there are as yet no randomized controlled trials (RCT) addressing the issue, and the impact of percutaneous coronary intervention (PCI) on outcome is unclear in the absence of STEMI. We report here the characteristics and outcomes of patients with OHCA without STEMI undergoing coronary angiography (CA) with PCI vs. no PCI, in contrast to patients not undergoing CA. Methods: Single center, retrospective study of 195 patients with OHCA without STEMI between July 2007 and April 2014. Patients were categorized into CA vs. no CA (control), and among those undergoing CA we compared those treated with PCI vs. no PCI. Mortality was assessed along with key relevant clinical and angiographic variables in each group (Table). Results: 195 cases with OHCA without STEMI were reviewed, among which 102 (52%) did not undergo CA. 93 (48%) patients underwent CA, of which 21 (23%) underwent PCI, whereas 72 (77%) did not require PCI. Acute culprit lesion was identified in only 19 out of 93 (20.4%) Inpatient mortality was similar in those undergoing PCI vs. no PCI (19% vs. 14%, p=0.56). Patients that did not undergo CA had a significantly worse mortality, in comparison to patients undergoing CA (p<0.001). Conclusions: In this series of consecutive patients with OHCA without STEMI, culprit lesions were uncommon when CA was performed. Overall outcomes in patients receiving CA were better than in those not receiving CA, likely reflecting referral bias based on disease severity. However, successful PCI in patients with obstructive CAD and culprit lesions was not associated with improved inpatient survival. These findings emphasize the need for RCTs to guide the need for CA and/or PCI in these patients.

Abstract 249: The Effect of Response Time on Out-Of-Hospital Cardiac Arrest Survival Varies by Patient Subpopulation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Clara Stoesser ◽  
Justin Boutilier ◽  
Christopher L Sun ◽  
Katie N Dainty ◽  
Steve Lin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Regression Analysis ◽  
Response Time ◽  
Time Interval ◽  
Probability Of Survival ◽  
Subgroup Analyses ◽  
Impact On Survival ◽  
The Impact ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Itroduction: Previous research has quantified the impact of EMS response time on the probability of survival from OHCA, but the impact on different subpopulations is currently unknown. Aim: To investigate how response time affects OHCA survival for different patient subpopulations. Methods: We conducted a logistic regression analysis on non-EMS witnessed OHCAs of presumed cardiac etiology from the Toronto Regional RescuNet between January 1, 2007 and December 31, 2016. We predicted survival using age, sex, public location, presenting rhythm, bystander witnessed, bystander resuscitation, and response time, defined as the time interval from 911 call to EMS arrival at the patient. We conducted subgroup analyses to quantify the effect of response time on survival for eight different subpopulations: public, private, bystander resuscitation, no bystander resuscitation, patients ≥65, patients <65, witnessed, and unwitnessed OHCA. We also quantified the effect of response time on survival for pairwise intersections of the subpopulations. We compared our results to Valenzuela et al. (1997), which suggests survival odds decrease by 10% for each minute delay in response time. Results: We identified 22,988 OHCAs. Overall, a one-minute delay in EMS response time was associated with a 13.2% reduction in the odds of survival. The reduction varied by subpopulation, ranging from a 7.2% reduction in survival odds for unwitnessed arrests to a 16.4% reduction in survival odds for arrests with bystander resuscitation. Response time had the largest impact on survival for the subpopulation of OHCAs that were both witnessed and received bystander resuscitation (17.4% reduction in survival odds). Conclusion: The effect of a one-minute delay in EMS response on the odds of survival from OHCA can be as low as a 7.2% reduction and as high as a 17.4% reduction. This variability contrasts with the currently accepted 10% rule that is assumed across the entire population.

scholarly journals What Do Adolescents Learn from a 50 Minute Cardiopulmonary Resuscitation/Automated External Defibrillator Education in a Rural Area: A Pre-Post Design

2019 ◽  
Vol 16 (6) ◽  
pp. 1053
Author(s):  
Ming-Fen Tsai ◽  
Li-Hsiang Wang ◽  
Ming-Shyan Lin ◽  
Mei-Yen Chen
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Education Program ◽  
Individual Performance ◽  
Automated External Defibrillator ◽  
Quasi Experimental ◽  
Rescue Time ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
External Defibrillator

Background: Literature indicates that patients who receive cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) from bystanders have a greater chance of surviving out-of-hospital cardiac arrest (OHCA). A few evaluative studies involving CPR/AED education programs for rural adolescents have been initiated. This study aimed to examine the impact of a 50 min education program that combined CPR with AED training in two rural campuses. Methods: A quasi-experimental pre-post design was used. The 50 min CPR/AED training and individual performance using a Resusci Anne manikin was implemented with seventh grade students between August and December 2018. Results: A total of 336 participants were included in this study. The findings indicated that the 50 min CPR/AED education program significantly improved participant knowledge of emergency responses (p < 0.001), correct actions at home (p < 0.01) and outside (p < 0.001) during an emergency, and willingness to perform CPR if necessary (p < 0.001). Many participants described that “I felt more confident to perform CPR/AED,” and that “It reduces my anxiety and saves the valuable rescue time.” Conclusions: The brief education program significantly improved the immediate knowledge of cardiac emergency in participants and empowered them to act as first responders when they witnessed someone experiencing a cardiac arrest. Further studies should consider the study design and explore the effectiveness of such brief programs.

What is the impact of physicians in prehospital treatment for patients in need of acute critical care? – An overview of reviews

2019 ◽  
Vol 35 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Gitte Valentin ◽  
Lotte Groth Jensen
Keyword(s):  
Cardiac Arrest ◽  
Systematic Reviews ◽  
Critical Conditions ◽  
Current Evidence ◽  
Cochrane Library ◽  
Future Research ◽  
Success Rates ◽  
Prehospital Treatment ◽  
The Impact ◽  
Hospital Cardiac Arrest

AbstractObjectivesThe aim of this overview was to systematically identify and synthesize existing evidence from systematic reviews on the impact of prehospital physician involvement.MethodsThe Medline, Embase, and Cochrane library were searched from 1 January 2000 to 17 November 2017. We included systematic reviews comparing physician-based with non–physician-based prehospital treatment in patients with one of five critical conditions requiring a rapid response.ResultsTen reviews published from 2009 to 2017 were included. Physician treatment was associated with increased survival in patients with out-of-hospital cardiac arrest and patients with severe trauma; in the latter group, the result was based on more limited evidence. The success rate of prehospital endotracheal intubation (ETI) has improved over the years, but ETI by physicians is still associated with higher success rates than intubation by paramedics. In patients with severe traumatic brain injury, intubation by paramedics who were not well skilled to do so markedly increased mortality.ConclusionsCurrent evidence is hinting at a benefit of physicians in selected aspects of prehospital emergency services, including treatment of patients with out-of-hospital cardiac arrest and critically ill or injured patients in need of prehospital intubation. Evidence is, however, limited by confounding and bias, and comparison is hampered by differences in case mix and the organization of emergency medical services. Future research should strive to design studies that enable appropriate control of baseline confounding and obtain follow-up data for the proportion of patients who die in the prehospital setting.

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