scholarly journals Task-shift Model in Pre-hospital Care and Standardized Nationwide Data Collection in Japan: Improved Outcomes for Out-of-hospital Cardiac Arrest Patients

JMA Journal ◽  
2021 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Cardiac Arrest ◽  
Data Collection ◽  
Hospital Care ◽  
Improved Outcomes ◽  
Shift Model ◽  
Hospital Cardiac Arrest

Abstract 12173: Out-of-Hospital Cardiac Arrest and Community First Response: Identifying Data Collection and Analysis Priorities via the Nominal Group Technique

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Eithne Heffernan ◽  
Dylan Keegan ◽  
Jenny Mc Sharry ◽  
Tomas Barry ◽  
Andrew Murphy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Data Collection ◽  
Online Survey ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
First Response ◽  
Key Stakeholders ◽  
Virtual Meeting ◽  
Hospital Cardiac Arrest ◽  
Group Technique

Introduction: Community First Response (CFR) is an important intervention for out-of-hospital cardiac arrest (OHCA) in many countries. CFR entails the mobilization of volunteers by the Emergency Medical Services (EMS) to respond to OHCAs in their vicinity. These volunteers include lay-people and professionals (e.g. physicians, fire-fighters). CFR can increase rates of cardiopulmonary resuscitation (CPR) or defibrillation performed prior to EMS arrival. However, its impact on additional outcomes (e.g. survival, cognitive function) requires further study. This research aimed to identify the most important CFR data to collect and analyze, as well as the most important uses of CFR data. Methods: This study used the Nominal Group Technique: a structured consensus process where key stakeholders develop a set of prioritized recommendations. There were 16 participants, including CFR volunteers, an OHCA survivor, researchers, clinicians, EMS personnel, and policy-makers. They completed an online survey to generate lists of the most important (1) CFR data to collect and analyze and (2) uses of CFR data. They then attended a virtual meeting where they discussed the survey results in groups before voting for their top ten priorities from each list. They also identified barriers to CFR data collection. Results: The top ten CFR data to collect and analyze included volunteer response time, interventions performed by volunteers, time of emergency, time of CPR initiation, individuals who performed CPR, and the mental and physical effects of being a volunteer. The top ten uses of CFR data included providing feedback to volunteers, increasing bystander participation in resuscitation, improving volunteer training, measuring CFR effectiveness, and encouraging inter-operability with the EMS. Barriers to data collection included time constraints, prioritization of patient care, and limited training. Conclusions: This study established priorities for the collection, analysis, and use of CFR data in consultation with key stakeholders. These findings have important implications for both CFR research and practice. In particular, they can be used to improve the efficiency, consistency, and utility of CFR data collection and to build evidence for this intervention.

Abstract 229: What is the Real Incidence of Out-Of-Hospital Cardiac Arrest in Norway

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Ingvild B Tjelmeland ◽  
Morten Larsen ◽  
Eirik Skogvoll ◽  
Jo Kramer-Johansen
Keyword(s):  
Cardiac Arrest ◽  
Data Collection ◽  
National Registry ◽  
Population Incidence ◽  
Ambulance Dispatch ◽  
High Incidence ◽  
Close Relationship ◽  
Low Incidence ◽  
Study Sites ◽  
Hospital Cardiac Arrest

Purpose of the study: The Norwegian Cardiac Arrest Registry (NorCAR) is a mandatory national registry of resuscitation attempts that monitors the population incidence, care and outcome for cardiac arrest. Previously, substantial differences in the number of included patients per 100 000 inhabitants were observed in some “atypical” health trusts (HT). It was not known if this is a problem with data collection or reflected genuine population differences. The purpose of this study was to identify all patients that fill NorCAR’s inclusion criteria among these HTs, by imposing consistent methods for data collection. Materials and methods: The registry implemented consistent, standardised and rigorous data collection methods including targeted audits in four “atypical” health trusts, two with a high and two with a low reported population incidence. Registrations from January to March 2019 was compared with similar results from 2018. Results: In 2018, the observed nationwide annual incidence of out-of-hospital cardiac arrest was 64 per 100 000 inhabitants, varying from 40 to 102. At the four study sites the observed population incidence was stable among HT with high incidence (88 and 110) but apparently increased in the two HTs with previous low incidence after implementation of standardised collection method (from 48 to 56, and 46 to 54). Conclusions: The previously “atypical” low incidence probably reflected a problem with data collection. To achieve full coverage of the population, all data collectors need to collect data using the same method with a concise and thorough investigation of ambulance-, air ambulance-, dispatch-, and hospital records. Data collectors need to have a close relationship with ambulance and dispatch, and constant reminders and feedback on reported results are important. Implementing a new method for data collection takes time, and results need to be evaluated over time.

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 52: An Evidence Based Animal Model Of Prolonged Ventricular Fibrillation Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Timothy J Mader
Keyword(s):  
Clinical Trials ◽  
Cardiac Arrest ◽  
Evidence Based ◽  
Chest Compressions ◽  
Time Intervals ◽  
Mean Values ◽  
Improved Outcomes ◽  
Response Interval ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: Promising basic science findings in cardiac resuscitation often do not translate into improved outcomes when studied in humans. One explanation is that the current animal models do not adequately reflect the out-of-hospital cardiac arrest (OHCA) clinical trial environment. The author sought to review the literature and devise a new model of prolonged VF with time intervals that more accurately simulate OHCA conditions. Methods: A systematic review of the literature (01/90 –12/06) was conducted using PUBMED and a comprehensive list of appropriate MESH headings. All OHCA human clinical trials were included. The most relevant studies underwent explicit and detailed review. Mean values with 95%CI were calculated for each specified interval. Suitable conditions and establishment of appropriate times were then devised. Results: Twenty-two papers with adequate detail for evaluation were examined, leading to the following recommendations: the duration of non-treatment (assuming no bystander CPR or first-responders) is 11” (3” for recognition and EMS activation, 7” response interval and 1” for paramedics to reach the patient); chest compressions are initiated immediately with passive oxygen insufflation; assuming they can be done simultaneously, IV access and intubation (ETI) are accomplished 4” after arrival; drugs are delivered by minute 16 - well into the metabolic phase; and 2” of CPR are needed to circulate the drugs for the first rescue shock (RS) at minute 18. Conclusions: This proposed evidence based experimental model of prolonged untreated VF cardiac arrest has conditions and time intervals that simulate those of human OHCA clinical trials.

scholarly journals DISPATCHER-ASSISTED CARDIOPULMONARY RESUSCITATION — AN EFFICIENT WAY FOR IMPROVING SURVIVAL AFTER OUT-OFHOSPITAL CARDIAC ARREST

2019 ◽  
Vol 19 (4) ◽  
pp. 10-16
Author(s):  
A. A. Birkun
Keyword(s):  
Public Health ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Hospital Care ◽  
Human Life ◽  
Potential Barriers ◽  
Leading Role ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Immediate witnesses of out-of-hospital cardiac arrest (OHCA) play the leading role in supporting human life. In cases when basic cardiopulmonary resuscitation (CPR) is not performed by the bystanders, precipitous hypoxia brings chances for recovery almost to zero by the time of emergency medical services (EMS) arrival. Carrying out CPR following the instructions given by EMS dispatcher over the telephone (T-CPR) is the fastest and most efficient way of increasing bystander CPR rates. Implementation of T-CPR programs is proved to increase survival from OHCA. Consequently, T-CPR is defined by the effective guidelines for resuscitation as an essential component of pre-hospital care. This review discusses the modern approaches to organizing and implementing T-CPR programs, as well as potential barriers and international experience of T-CPR implementation. The paper is meant for EMS directors and managers, EMS dispatchers and public health specialists.

Sign in / Sign up

Export Citation Format

Share Document