scholarly journals Effect of Prehospital Epinephrine Use on Survival from Out-of-Hospital Cardiac Arrest and on Emergency Medical Services

2021 ◽  
Vol 11 (1) ◽  
pp. 190
Author(s):  
Song Yi Park ◽  
Daesung Lim ◽  
Seong Chun Kim ◽  
Ji Ho Ryu ◽  
Yong Hwan Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Emergency Medical Services ◽  
Chest Compression ◽  
Response Times ◽  
Discharge Rate ◽  
Medical Services ◽  
Neurological Outcomes ◽  
Mechanical Chest Compression ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

This study was to identify the effect of epinephrine on the survival of out-of-hospital cardiac arrest (OHCA) patients and changes in prehospital emergency medical services (EMSs) after the introduction of prehospital epinephrine use by EMS providers. This was a retrospective observational study comparing two groups (epinephrine group and norepinephrine group). We used propensity score matching of the two groups and identified the association between outcome variables regarding survival and epinephrine use, controlling for confounding factors. The epinephrine group was 339 patients of a total 1943 study population. The survival-to-discharge rate and OR (95% CI) of the epinephrine group were 5.0% (p = 0.215) and 0.72 (0.43–1.21) in the total patient population and 4.7% (p = 0.699) and 1.15 (0.55–2.43) in the 1:1 propensity-matched population. The epinephrine group received more mechanical chest compression and had longer EMS response times and scene times than the norepinephrine group. Mechanical chest compression was a negative prognostic factor for survival to discharge and favorable neurological outcomes in the epinephrine group. The introduction of prehospital epinephrine use in OHCA patients yielded no evidence of improvement in survival to discharge and favorable neurological outcomes and adversely affected the practice of EMS providers, exacerbating the factors negatively associated with survival from OHCA.

Abstract 358: Out-of-hospital Cardiac Arrest and Community First Response: Building Evidence for Policy and Practice

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Eithne Heffernan ◽  
Andrew Murphy ◽  
Cathal O'Donnell ◽  
Jacqueline Egan ◽  
Siobhán Masterson
Keyword(s):  
Cardiac Arrest ◽  
Emergency Medical Services ◽  
Response Times ◽  
Evidence Base ◽  
Medical Services ◽  
Social Fragmentation ◽  
Emergency Medical ◽  
First Response ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality globally. Community First Response (CFR) is an important component of OHCA management in many countries. It entails the mobilisation of volunteers by the Emergency Medical Services to respond to OHCAs in their locality. These volunteers include lay-people and professionals (e.g. nurses, physicians). CFR can increase rates of cardiopulmonary resuscitation or defibrillation performed prior to the Emergency Medical Services’ arrival, though its impact on survival and cognitive function requires further study. This research aimed to improve our understanding of CFR, including volunteers’ motives and activities, the association between volunteer location and social fragmentation/deprivation, and the outcomes that should be measured for this intervention. Methods: This mixed-methods project comprises several key stages: systematic review of the CFR literature, interviews with CFR experts from a range of countries (e.g. USA, Canada, UK, Australia, Singapore), a survey of volunteers, and an analysis of Irish ambulance service records. Results: Various factors affect volunteer motivation, such as personality, family history, legislation, and psychological support. Volunteers undertake many activities in addition to responding to OHCAs, including responding to other emergencies (e.g. stroke), raising awareness of OHCA, providing CPR training, and supporting patients’ relatives. Barriers to responding include problems with technology and recruitment. Volunteer location in Ireland does not appear to be influenced by social fragmentation/deprivation. Outcomes that are measured for CFR include response times and survival. Other potentially important outcomes can prove difficult to measure, particularly the benefits for patients’ relatives and communities. Conclusions: This project has implications for CFR research and practice, especially recruiting and supporting volunteers and measuring outcomes. Improving these processes could help to optimise and build evidence for this intervention. Funding has been obtained to extend this project so that the impact of the coronavirus disease 2019 (COVID-19) pandemic on the CFR evidence base can be examined.

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 <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 <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 <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 <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 < 0.0001; compared with NO-BCPR, aOR 2.31; 95% CI, 1.82–2.94; P < 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 >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 <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 < 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.

scholarly journals Temperature and age–gender effects on out-of-hospital cardiac arrest cases

2018 ◽  
Vol 25 (2) ◽  
pp. 83-90
Author(s):  
Chien Tat Low ◽  
Poh Chin Lai ◽  
Paul Sai Shun Yeung ◽  
Axel Yuet Chung Siu ◽  
Kelvin Tak Yiu Leung ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hong Kong ◽  
Emergency Medical Services ◽  
Large Scale ◽  
Gender Effects ◽  
Medical Services ◽  
Curvilinear Relationship ◽  
Elderly Age ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Introduction: Temperature is a key factor influencing the occurrence of out-of-hospital cardiac arrest, yet there is no equivalent study in Hong Kong. This study reports results involving a large-scale territory-wide investigation on the impacts of ambient temperature and age–gender differences on out-of-hospital cardiac arrest outcome in Hong Kong. Methods: This study included 25,467 out-of-hospital cardiac arrest cases treated by the Hong Kong Fire Services Department between December 2011 and November 2016 inclusive. Simple correlation and regression analyses were used to examine the relationships between out-of-hospital cardiac arrest cases and temperature, age and gender. Calendar charts were used to visualise temporal patterns of pre-hospital emergency medical services related to out-of-hospital cardiac arrest cases. Results: A strong negative curvilinear relationship was found between out-of-hospital cardiac arrest and daily temperature (r2 > 0.9) with prominent effects on elderly people aged ≥85 years. For each unit decrease in mean temperature in °C, there was a maximum of 5.6% increase in out-of-hospital cardiac arrest cases among all age groups and 7.3% increase in the ≥85 years elderly age group. Men were slightly more at risk of out-of-hospital cardiac arrest compared with women. The demand for out-of-hospital cardiac arrest–related emergency medical services was highest between 06:00 and 11:00 in the wintertime. Conclusion: This study provides the first local evidence linking weather and demographic effects with out-of-hospital cardiac arrest in Hong Kong. It offers empirical evidence to policymakers in support of strengthening existing emergency medical services to deal with the expected increase in out-of-hospital cardiac arrest in the wintertime and in regions with a large number of elderly population.

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.

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