Abstract 11295: Out-of-Hospital Cardiac Arrest Characteristics According to Arrest Location in Urban, Suburban, and Rural Areas of Denmark

Introduction: Cardiopulmonary resuscitation (CPR) and early defibrillation are two of the most important factors for survival after out-of-hospital cardiac arrest (OHCA). However, little is known whether bystander interventions and survival are impaired in rural areas compared to more urbanized areas in Denmark. We hypothesized that bystander interventions and survival are lower in rural areas compared to urbanized areas. Methods: We included all non-EMS witnessed OHCAs with known GPS-location in Denmark (January 1, 2016 to December 31, 2019) and geocoded them according to county. All counties in Denmark were classified either as urban, suburban, or rural according to the degree of urbanization tool defined by the European Statistical Agency. Results: A total of 16,670 OHCAs were included, of which 4,555 (27%), 5,457 (33%), and 6,658 (40%) arrests occurred in urban, suburban, and rural areas respectively. The median age (73 vs. 74 vs. 73 years, p=0.003), ambulance response time (6 vs. 7 vs. 8 minutes, p<0.0001), and proportion of arrests occurring in residential areas (77 vs. 79 vs. 78%, p=0.05) differed significantly between degrees of urbanization (from high to low). Fewer OHCAs received bystander CPR in urban and suburban areas compared to rural (76 vs. 77 vs. 79%, p=0.0002). The proportion of patients defibrillated by bystanders remained equal across urbanization. However, return of spontaneous circulation (ROSC) (27 vs. 27 vs. 24%, p<0.0001) and 30-day survival was lower in rural areas (15 vs. 14 vs. 12, p<0.0001) (Figure 1). Conclusion: Degree of urbanization was associated with increased rates of bystander CPR in rural areas. Despite this, ROSC and 30-day survival were higher in urban and suburban areas compared to rural areas which could not be explained by cardiac arrest characteristics.

Immediate Bystander Cardiopulmonary Resuscitation to Sudden Cardiac Arrest During Sports is Associated with Improved Survival—a Video Analysis

Background Sudden cardiac arrest (SCA) during sports can be the first symptom of yet undetected cardiovascular conditions. Immediate chest compressions and early defibrillation offer SCA victims the best chance of survival, which requires prompt bystander cardiopulmonary resuscitation (CPR). Aims To determine the effect of rapid bystander CPR to SCA during sports by searching for and analyzing videos of these SCA/SCD events from the internet. Methods We searched images.google.com, video.google.com, and YouTube.com, and included any camera-witnessed non-traumatic SCA during sports. The rapidity of starting bystander chest compressions and defibrillation was classified as < 3, 3–5, or > 5 min. Results We identified and included 29 victims of average age 27.6 ± 8.5 years. Twenty-eight were males, 23 performed at an elite level, and 18 participated in soccer. Bystander CPR < 3 min (7/29) or 3–5 min (1/29) and defibrillation < 3 min was associated with 100% survival. Not performing chest compressions and defibrillation was associated with death (14/29), and > 5 min delay of intervention with worse outcome (death 4/29, severe neurologic dysfunction 1/29). Conclusions Analysis of internet videos showed that immediate bystander CPR to non-traumatic SCA during sports was associated with improved survival. This suggests that immediate chest compressions and early defibrillation are crucially important in SCA during sport, as they are in other settings. Optimal use of both will most likely result in survival. Most videos showing recent events did not show an improvement in the proportion of athletes who received early resuscitation, suggesting that the problem of cardiac arrest during sports activity is poorly recognized.

Assessment of the knowledge level and experience of healthcare personnel concerning CPR and early defibrillation: an internal survey

Background In‐hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. Rapid cardiopulmonary resuscitation and early defibrillation is extremely connected to patient outcome. In this study, we aimed to assess the effects of a basic life support and defibrillation course in improving knowledge in IHCA management. Methods We performed a prospective observational study recruiting healthcare personnel working at Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. Study consisted in the administration of two questionnaires before and after BLS-D course. The course was structured as an informative meeting and it was held according to European Resuscitation Council guidelines. Results 78 participants completed pre- and post-course questionnaires. Only 31.9% of the participants had taken part in a BLS-D before our study. After the course, we found a significative increase in the percentage of participants that evaluated their skills adequate in IHCA management (17.9% vs 42.3%; p < 0.01) and in the correct use of defibrillator (38.8% vs 67.9% p < 0.001). However, 51.3% of respondents still consider their preparation not entirely appropriate after the course. Even more, we observed a significant increase in the number of corrected responses after the course, especially about sequence performed in case of absent vital sign, CPR maneuvers and use of defibrillator. Conclusions The training course resulted in significant increase in the level of knowledge about the general management of IHCA in hospital staff. Therefore, a simple intervention such as an informative meetings improved significantly the knowledge about IHCA and, consequently, can lead to a reduction of morbidity and mortality.

Decreasing the Stress of Medication Management During Cardiac Arrest

Cardiac arrest affects more than 500 000 people every year, with significant associated morbidity and mortality. In addition to high-quality cardiopulmonary resuscitation and early defibrillation, medications are included in treatment algorithms. Epinephrine and amiodarone are commonly used, with other medications being used in specific situations of cardiac arrest. Although participating in the care of a patient in cardiac arrest is complex and stressful, having a baseline understanding of the medications being used, routes of administration, and special considerations can be helpful in mitigating some of the stress in these situations.

Advanced Cardiovascular Life Support Post–Cardiac Surgery

This chapter explores advanced cardiovascular life support (ACLS) after cardiac surgery. In 2009, the European Association of Cardiothoracic Surgeons provided recommendations for the management of post–cardiac surgery arrest, which have since been augmented by publication of consensus guidelines from the European Resuscitation Council in 2015 and the Society of Thoracic Surgeons in 2017. These guidelines are preferred over traditional ACLS guidelines for cardiac arrest resuscitation of post–cardiac surgery patients. Ventricular fibrillation is the cause of 25%–50% of cardiac arrests in post–cardiac surgery patients. Guidelines recommend up to 3 attempted shocks prior to external cardiac massage (ECM) if they can be delivered within 1 minute of arrest. Early defibrillation is often successful in this population and minimizes potential intrathoracic trauma from ECM on a fresh sternotomy. In patients with severe bradycardia or asystole, the epicardial pacer should be set to emergency mode, which provides dual-chamber, asynchronous pacing at 80–100 bpm with maximum atrial and ventricular amperage. Resternotomy within 5 minutes is recommended when resuscitation after cardiac arrest has been unsuccessful or when cardiac arrest from tamponade is highly likely.

Impact of Application of Multifunction Electrode (MFE) Pads on Cardiopulmonary Resuscitation Quality

Background. Early defibrillation and high-quality chest compressions are crucial in treatment of sudden cardiac arrest (SCA) subjects. The aim of this study was to assess an impact of defibrillation methods on cardiopulmonary resuscitation (CPR) quality. Methods. A randomized simulation cross-study was designed, in which 100 two-person paramedical teams participated. Two 10-minute scenarios of SCA in the mechanism of ventricular fibrillation were analysed. In the first one, teams had at their disposal defibrillator with hard paddles (group C), whereas in the second one, adhesive electrodes were used (group MFE). The CPR quality was evaluated on the basis of the chest compression parameters (rate, depth, recoil, compression fraction (CCF), and no-flow time), airways patency achievement, and successful emergency drug administration. Results. Substituting standard hard paddles with adhesive electrodes led to an increase in CCF (77% vs 73%; p < 0.05 ), higher rate of complete chest recoil, and a decrease in no-flow time (6.0 ± 1.1 vs. 7.3 ± 1.1; p < 0.001 ). The airway patency was ensured sooner in group MFE (271 ± 118 s vs. 322 ± 106 s in group C; p < 0.001 ). All teams in scenario with adhesive electrodes were able to administer two doses of adrenaline, meanwhile only 74% of them in group C ( p < 0.001 ). Moreover, in 8% of group C scenarios, paramedics did not have enough time to administer amiodarone. Conclusion. Our simulation-based analysis revealed that use of adhesive electrodes during defibrillation instead of standard hard paddles may improve the quality of CPR performed by two-person emergency team.

Immediate Bystander Response to Sudden Cardiac Arrest During Sports is Associated with Improved Survival -- A Video Analysis.

Background Sudden cardiac arrest (SCA) during sports can be the first symptom of yet undetected cardiovascular conditions. Immediate chest compressions and early defibrillation offer SCA victims the best chance of survival, which requires prompt bystander response.Aims To determine the effect of rapid bystander response to SCA during sports by searching for and analyzing videos of these SCA/SCD events from the internet.Methods We searched images.google.com, video.google.com and YouTube.com, and included any camera-witnessed non-traumatic SCA in athletes and other sports participants at any sports facility. The rapidity of starting bystander chest compressions and defibrillation was classified as <3, 3-5, or >5 minutes. The year SCA occurred was allocated to 1990-2009, 2010-2014 or 2015 onwards, compatible with the current guidelines.ResultsWe identified and included 28 victims of average age 27.9 years (SD=9.8); 27 were males, 22 elite athletes, and 17 participated in soccer. Bystander response <3 minutes (6/28) or 3-5 minutes (1/28) and defibrillation <3 minutes was associated with 100% survival. Not performing chest compressions and defibrillation was associated with death (14/28), and >5 minutes delay of intervention with worse outcome (death 4/28, severe neurologic dysfunction 1/28). Survival was highest between 2010-2014 (71.4%).ConclusionsAnalysis of internet videos showed that immediate bystander response to non-traumatic SCA during sports was associated with improved survival. This suggests that immediate chest compressions and early defibrillation are crucially important in SCA during sport, as they are in other settings. Optimal use of both will most likely result in survival. The observed bystander responses to SCA during sports do not show awareness of current guidelines.

Cardiac arrest

Cardiovascular disease is the most common cause of sudden cardiac arrest, which causes over 60% of adult coronary heart disease deaths. Most cardiac arrests are preventable. Survival depends on early recognition and prompt initiation of chest compressions and ventilations (cardiopulmonary resuscitation), and early defibrillation if appropriate. High-quality cardiopulmonary resuscitation is defined by compressions to a depth of 5–6 cm, at a rate of 100–120 per minute, full release of pressure between compressions and minimal interruptions to chest compression. Drugs have a limited role in treating cardiac arrest. If initial resuscitation is successful the quality of post-resuscitation care determines the patient’s final outcome. Use emergency care treatment plans to record in advance, recommendations for emergency treatments, including CPR.

Importância do enfermeiro frente a implementação do protocolo de RCP

A assistência em situações emergenciais como a parada cardiorrespiratória, ocasionou o surgimento de diversos serviços de saúde no atendimento a essas vítimas. O atendimento eficaz na RCP contribui para a sobrevida. Cerca de 54 a 74% dos ritmos de PCR são por fibrilação átrio ventricular, na qual o tratamento é a desfibrilação associado as compressões cardíacas. O papel do enfermeiro está relacionado à articulação, integração da equipe em uma inter-relação nas diversas situações no PCR. O objetivo desta pesquisa foi identificar a importância do papel do enfermeiro na implementação das mudanças do protocolo de reanimação no adulto. A metodologia está baseada na análise temporal dos protocolos de RCP considerando a primeira diretriz. O qual foi possível afirmar que os elementos iniciais e críticos da RCP são compressões torácicas e desfibrilação precoce, no qual sinalizamos a importância do papel do enfermeiro frente as modificações e implementação destas mudanças.Descritores: Reanimação Cardiopulmonar, Parada Cardíaca, Tamponamento Cardíaco. Importance of the nurse against the implementation of the CPR protocolAbstract: Assistance in emergency situations such as cardiorespiratory arrest, led to the appearance of several health services in the care of these victims. Effective care in CPR contributes to survival. About 54 to 74% of the CRP rhythms are ventricular atrial fibrillation, in which the treatment is defibrillation associated with cardiac compressions. The role of the nurse is related to the articulation, integration of the team in an interrelationship in the diverse situations in the RCP. The objective of this research was to identify the importance of the role of nurses in the implementation of adult resuscitation protocol changes. The methodology is based on the temporal analysis of the CPR protocols considering the first guideline. It was possible to affirm that the initial and critical elements of CPR are chest compressions and early defibrillation, in which we signal the importance of the role of the nurse in face of the modifications and implementation of these changes.Descritores: Cardiopulmonary Resucitation, Heart Arrest, Cardiac Tamponade. Importancia de las enfermeras contra la implementación del protocolo de RCPResumen: La asistencia en situaciones de emergencia, como el paro cardiopulmonar, ha llevado a la aparición de diversos servicios de salud en la atención de estas víctimas. La atención eficaz de la RCP contribuye a la supervivencia. Alrededor del 54 al 74% de las tasas de PCR se deben a la fibrilación auricular ventricular, en la cual el tratamiento es la desfibrilación asociada con las compresiones cardíacas. El papel de la enfermera está relacionado con la articulación, la integración del equipo en una interrelación en las diversas situaciones en la PCR. El objetivo de esta investigación fue identificar la importancia del papel de la enfermera en la implementación de cambios en el protocolo de reanimación en adultos. La metodología se basa en el análisis temporal de los protocolos de RCP considerando la primera directriz. Fue posible afirmar que los elementos iniciales y críticos de la RCP son las compresiones torácicas y la desfibrilación temprana, en las que señalamos la importancia del papel de la enfermera frente a los cambios y la implementación de estos cambios.Descriptores: Reanimación Cardiopulmonar, Paro Cardíaco, Taponamiento Cardíaco.