scholarly journals Factors Associated with High-Quality Cardiopulmonary Resuscitation Performed by Bystander

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Hye Ji Park ◽  
Won Jung Jeong ◽  
Hyung Jun Moon ◽  
Gi Woon Kim ◽  
Jin Seong Cho ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Age Groups ◽  
Sudden Cardiac Arrest ◽  
Advanced Life Support ◽  
Fold Increase ◽  
High Quality ◽  
Neurological Outcomes ◽  
Bystander Cpr ◽  
Cpr Quality

Bystander cardiopulmonary dresuscitation (CPR) improves the survival and neurological outcomes of sudden cardiac arrest patients. The rate of bystander CPR is increasing; however, its performance quality has not been evaluated in detail. In this study, emergency medical technicians (EMTs) in the field evaluated bystander CPR quality, and we aimed to investigate the association between bystander information and CPR quality. This retrospective cohort study was based on data included in the Smart Advanced Life Support (SALS) registry between January 2016 and December 2017. We included patients older than 18 years who experienced an out-of-hospital cardiac arrest (OHCA) due to medical causes. Bystander CPR quality was judged to be “high” when the hand positions were appropriate and when compression rates of at least 100/min and compression depths of at least 5 cm were achieved. Among 6,769 eligible patients, 3,799 (58.7%) received bystander CPR, and 6% of bystanders performed high-quality CPR. After adjustment, the occurrence of cardiac arrest at home (adjusted odds ratio (aOR), 95% confidence interval (CI); 0.42, 0.27–0.64), witnessed cardiac arrest (1.45, 1.03–2.06), and younger bystander age all showed associations with one another. High-quality CPR led to a 4.29-fold increase in the chance of neurological recovery. In particular, high-quality CPR in patients aged 60 years showed a significant association compared with other age groups (7.61, 1.41–41.04). The main factor affecting CPR quality in this study was the age of the bystander, and older bystanders found it more difficult to maintain CPR quality. To improve the quality of bystander CPR, training among older bystanders should be the focus.

Abstract 344: The Association Between ALS Response Interval and Out-of Hospital Cardiac Arrest Outcomes

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Brian Grunau ◽  
Takahisa Kawano ◽  
John Tallon ◽  
Frank Scheuermeyer ◽  
Joshua Reynolds ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Secondary Analysis ◽  
Advanced Life Support ◽  
Median Response ◽  
Neurological Outcomes ◽  
Spline Curves ◽  
Response Interval ◽  
Optimal Deployment ◽  
Hospital Cardiac Arrest

Objective: There is conflicting data in studies investigating the effectiveness of advanced life support (ALS) for out-of-hospital cardiac arrest (OHCA). Within a tiered BLS-ALS system, we sought to determine if the ALS response interval was associated with patient outcomes. Methods: This secondary analysis examined prospectively identified consecutive non-traumatic adult OHCAs from 2006-2016 in British Columbia. We excluded EMS-witnessed arrests and those not treated by ALS. The primary and secondary outcomes were survival and favorable neurological outcomes (mRS ≤3) at hospital discharge. Using logistic regression we estimated the association of ALS response interval (9-1-1 call to ALS arrival) and outcomes, adjusting for treatment year, response interval of the first EMS unit, and other baseline characteristics. We drew spline curves to illustrate this relationship. Results: Of 12,722 included cases, survival was 12%. The median response interval for the first EMS unit was 6.4 minutes (IQR 5.2 - 8.3) and for ALS was 11.8 minutes (IQR 8.7 - 16.5).The adjusted odds of survival and favourable neurological outcome for each additional minute in ALS response interval were 0.98 (95 % CI 0.96-0.99) and 0.98, (95% CI 0.97-0.99) respectively. The spline curve demonstrated an initial decline in survival probability that moderated at approximately 11 minutes. Conclusion: Among ALS-treated subjects within our tiered EMS system, earlier ALS arrival was associated with improved survival and favorable neurological outcomes. The greatest yield of ALS care may be prior to 11 minutes. This may help inform the optimal deployment configuration of prehospital providers.

scholarly journals Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system

CJEM ◽  
2001 ◽  
Vol 3 (03) ◽  
pp. 186-192 ◽  
Author(s):  
David A. Petrie ◽  
Valerie De Maio ◽  
Ian G. Stiell ◽  
Jonathan Dreyer ◽  
Michael Martin ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Basic Life Support ◽  
Life Support ◽  
Ethical Decision Making ◽  
Pulseless Electrical Activity ◽  
Advanced Life Support ◽  
Stepwise Logistic Regression ◽  
Bystander Cpr

ABSTRACT Objectives: Previous studies have shown a low but meaningful survival rate in cases of prehospital cardiac arrest with an initial rhythm of asystole. There may be, however, an identifiable subgroup in which resuscitation efforts are futile. This study identified potential field criteria for predicting 100% nonsurvival when the presenting rhythm is asystole in a Basic Life Support-Defibrillation (BLS-D) system. Methods: This prospective cohort study, a component of Phases I and II of the Ontario Prehospital Advanced Life Support (OPALS) Study, was conducted in 21 Ontario communities with BLS-D level of care, and included all adult arrests of presumed cardiac etiology according to the Utstein Style Guidelines. Analyses included descriptive and appropriate univariate tests, as well as multivariate stepwise logistic regression to determine predictors of survival. Results: From 1991 to 1997, 9899 consecutive cardiac arrest cases with the following characteristics: male (67.2%), bystander-witnessed (44.7%), bystander CPR (14.2%), call–response interval (CRI) ≤ 8 minutes (82%) and overall survival (4.3%) were enrolled. Of 9529 cases with available rhythm strip recordings, initial arrest rhythms were asystole in 40.8%, pulseless electrical activity in 21.2% and ventricular fibrillation or ventricular tachycardia in 38%. Of 3888 asystolic patients, 9 (0.2%) survived to discharge; 3 of these cases were unwitnessed arrests with no bystander CPR. There were no survivors if the CRI exceeded 8 minutes. Logistic regression analysis demonstrated that independent predictors of survival to admission were “CRI in minutes” (odds ratio [OR] = 0.87; 95% confidence interval [CI], 0.77–0.98) and “bystander-witnessed” (OR = 2.6; 95% CI, 1.5–4.4). Conclusions: In a BLS-D system, there is a very low but measurable survival rate for prehospital asystolic cardiac arrest. CRIs of over 8 minutes were associated with 100% nonsurvival, whereas unwitnessed arrests with no bystander CPR were not. These data add to the growing literature that will help guide ethical decision-making for protocol development in emergency medical services systems.

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.

The Role of Bystander-initiated Basic Life Support in Sports-related Sudden Cardiac Arrest: A Systematic Review

2021 ◽  
Author(s):  
Braeden Hill ◽  
Nicholas Grubic ◽  
Dermot M. Phelan ◽  
Aaron L. Baggish ◽  
Paul Dorian ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Full Text ◽  
Basic Life Support ◽  
Life Support ◽  
Sudden Cardiac Arrest ◽  
Survival Outcomes ◽  
Full Text Review ◽  
Bystander Cpr ◽  
Median Rate

Background: Sudden cardiac arrest is the leading medical cause of death amongst athletes and a common cause of death during exercise. The provision of cardiopulmonary resuscitation (CPR) and automatic external defibrillator (AED) use by bystanders can greatly improve survival outcomes in sudden cardiac arrest. However, the effectiveness of these interventions within exertional settings requires further investigation. Objective: To evaluate the role of bystander-initiated CPR and AED use on survival outcomes amongst sports-related sudden cardiac arrest (SrSCA). Methods: Several databases and grey literature sources were queried from inception until November 2020 using a comprehensive search strategy. Abstract screening, full-text review, and data extraction of eligible studies were conducted independently by two reviewers. SrSCA was defined as a cardiac arrest which occurred during (or within 1-hour of) physical activity, sport, or exercise. Bystander CPR and AED rates, as well as appropriate survival outcomes, were extracted from each study, and overall summary measures were calculated. Results: A total of 2,850 unique records were identified, with 176 articles selected for full-text review, of which 32 studies were included in this review. The median rate of bystander CPR and AED use was 75% and 24%, respectively. Survival to hospital discharge ranged from 11%-93%, with a median rate of 33%. Conclusions: Majority of SrSCAs received bystander CPR and achieved a high rate of survival to hospital discharge, yet AED use was low. These findings encourage layperson education in basic life support, the availability of AEDs in athletic facilities, and emergency action plans to ensure timely resuscitation.

scholarly journals Sudden cardiac arrest in hypertrophic cardiomyopathy with dynamic cavity obstruction: The case for a decatecholaminisation strategy

2017 ◽  
Vol 19 (1) ◽  
pp. 69-75 ◽  
Author(s):  
Cosmin Balan ◽  
Adrian View-Kim Wong
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Hypertrophy ◽  
Life Support ◽  
Sudden Cardiac Arrest ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
End Diastolic Volume ◽  
Death Spiral ◽  
Hospital Cardiac Arrest

Catecholamines are entrenched in the management of shock states. A paradigm shift has pervaded the critical care arena in recent years acknowledging their propensity to cause harm and fuel a ‘death-spiral’. We present the case of a 21-year-old male following a witnessed out-of-hospital cardiac arrest who received high-quality cardiopulmonary resuscitation and standard advanced life support for refractory ventricular fibrillation until return of spontaneous circulation after 70 min. Early post-admission echocardiography revealed severe diffuse sub-basal left ventricular hypertrophy with dynamic mid-cavity obstruction and akinetic apical pouching. Within this context, a decatecholaminised strategy comprising a beta-blocker was used to augment the left ventricular end-diastolic volume and attain cardiovascular stability.

Abstract 20: Intraosseous vs. Intravenously Administered Advanced Life Support Drugs in Patients With Out-of-Hospital Cardiac Arrest: Insights From the Resuscitation Outcomes Consortium Continuous Chest Compression Trial

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Purav Mody ◽  
Siobhan Brown ◽  
Rohan Khera ◽  
Ambarish Pandey ◽  
Colby Ayers ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Neurological Function ◽  
Access Route ◽  
Epinephrine Administration ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: There is an urgent need to identify strategies which improve outcomes for out-of-hospital cardiac arrest (OHCA). Determining the optimal access route to deliver medications during resuscitation from OHCA may be one such strategy. Methods: Using data from the Continuous Chest compression trial between 2011 and 2016, we examined rates of sustained return of spontaneous circulation (ROSC) i.e. ROSC on ER arrival, survival to discharge and survival with favorable neurological function (modified Rankin scale ≤3) among patients with attempted IV and IO access. Results: Among 19,731 patients with available access information, IO or IV access was attempted in 3,068 (15.5%) and 16,663 (84.5%) patients, respectively and was successful in 2,975 (97%) and 15,485 (92%) of these patients. Overall, patients with attempted IO access were younger, more likely female, received less bystander CPR, had lower proportions of shockable and witnessed arrests, marginally faster times to access and to epinephrine administration, and less frequently received therapeutic hypothermia and coronary angiography as compared with patients with IV access ( Table ) . Unadjusted rates of sustained ROSC, discharge survival and survival with favorable neurological function were significantly lower in patients with attempted IO access ( Table) . After adjustment for age, sex, initial rhythm, bystander CPR, public location, witnessed status, EMS response time and trial cluster, attempted IO access was associated with lower sustained ROSC rates (OR 0.79, 95% CI 0.71-0.89, p<0.001) but not with discharge survival (OR 0.88, 95% CI 0.71-1.08, p=0.21) or survival with favorable neurological function (OR 0.86, 95% CI 0.67-1.1, p=0.26). Conclusions: Among patients with OHCA, intraosseous access was attempted in 1 in 7 OHCA patients and associated with worse ROSC rates but no difference in survival. Further studies are necessary to elucidate the optimal access route among OHCA patients.

Sudden cardiac arrest pharmacotherapy with prefilled syringes improves adherence to Advanced Life Support protocol in understaffed resuscitation pre-hospital care teams

2020 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Simulation Study ◽  
Life Support ◽  
Sudden Cardiac Arrest ◽  
Advanced Life Support ◽  
Control Group ◽  
Performance Quality ◽  
Prefilled Syringes ◽  
The Impact

Every procedural facilitation or a change in available equipment in treatment of out-of-hospital arrest (OHCA) by two-person teams may significantly enhance their performance quality. The aim of this study was to assess the impact of adrenaline in prefilled syringes on improving the adherence to Advanced Life Support protocol by understaffed teams. The research was based on a randomized cross-over high-fidelity simulation study. Two-person teams took part in two 10-minute simulation scenarios featuring sudden cardiac arrest in ventricular fibrillation (VF). The control group (group C) had at its disposal standard ampoules, whereas the experimental group (group E) prefilled syringes. The execution times of CPR start, defibrillation shocks, intravenous (IV) access, epinephrine and amiodarone doses were measured. Additionally, the chest compression fraction (CCF) was calculated. The designed two-minute loops were considerably prolonged in group C. Nineteen teams (31.1%) in group C but 49 (80.3%) in group E carried out the fifth defibrillation (P < 0.001). After two minutes of CPR nobody in group C switched to perform chest compressions. IV access was obtained significantly earlier in group E (114.7 ± 52.2 sec) than in group C (150.2 ± 68.6 sec)(P = 0.002). Two doses of adrenaline were administered in group E, whereas its second dose only by 12 teams in group C. The simulation study has proved that for understaffed teams a use of prefilled syringes not only did enhance the flow of ALS procedure, but it also improved the quality of cardiopulmonary resuscitation.

Abstract 296: Quality Analysis of Cardiopulmonary Resuscitation From Two Emergency Medical Service Systems Using a Feedback Device

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mengqi Gao ◽  
Chenguang Liu ◽  
Stacy Gehman ◽  
Thomas Rea ◽  
Jennifer E Blackwood ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Critical Role ◽  
Sudden Cardiac Arrest ◽  
Quality Analysis ◽  
High Quality ◽  
Emergency Medical ◽  
Mecklenburg County ◽  
Cpr Quality ◽  
N 93

Background: High quality cardiopulmonary resuscitation (CPR) plays a critical role in the success of out-of-hospital resuscitation from sudden cardiac arrest (SCA). AHA guidelines provide protocol to achieve recommended targets for CPR quality metrics including chest compression fraction (CCF), percentage of chest compressions (CCs) with full chest recoil, CC rate and CC depth. Our objective was to report the CPR quality of two emergency medical services (EMS) agencies with different basic life support (BLS) CPR protocols. Methods: Data from 673 patients, 2015 to 2017, suffering out-of-hospital SCA were obtained from Philips FR3 AEDs. The Philips Q-CPR tool was used for real-time CPR feedback, and CC waveforms were recorded for retrospective CPR analysis using Philips Event Review Pro 5.0 and custom software. The two EMS systems had BLS protocol differences: Site 1(King County, WA, n = 93) applied a compression - ventilation ratio of 30:2, while Site 2 (Mecklenburg County, NC, n = 580) applied 200 compressions in each CPR interval and ventilations were performed during CCs. Analyses were performed comparing CPR metrics between sites and to AHA targets. Results: There were 3,460 minutes of resuscitation data analyzed, representing the initial phase of resuscitation prior to ALS. The proportion of cases with shocks was 21.5% (20 of 93) for site 1 and 16.9% (98 of 580) for site 2 (p = 0.3). Both sites achieved guideline metrics though there were statistical differences (Table 1). Compared to site 1, site 2 was associated with a higher CCF, faster CC rate, but less CC depth on average (p < 0.001). Conclusions: High quality CPR defined by AHA guidelines was achieved with both sites during the early phase of AED resuscitation though some differences were observed. Additional investigation should identify equipment, or rescuer characteristics that are important to consistently achieve high quality CPR and how the combination might be tailored to optimize individual patient outcome.

scholarly journals (P2-12) Emergency Medical Procedures Provided by Paramedics in Prehospital Sudden Cardiac Arrest — Analysis of the Example of District Siedlce (Poland)

2011 ◽  
Vol 26 (S1) ◽  
pp. s139-s139
Author(s):  
S. Pilip ◽  
D. Celiński ◽  
R. Wiśniewski ◽  
A. Binkowska ◽  
G. Michalak
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Medical Training ◽  
Sudden Cardiac Arrest ◽  
Advanced Life Support ◽  
Medical Emergency ◽  
Emergency Medical ◽  
Early Implementation ◽  
Life Saving ◽  
Automated External Defibrillation

IntroductionThe organization of the medical emergency system in Poland has been revised substantially since 2007. Rescuers were able to perform certain life-saving procedures and to administrate some drugs without doctor's order.AimThe efficiency of advanced life support (ALS) performed by emergency medical service with paramedics (without doctor) was assessed for cases of cardiac arrest (CA) in prehospital conditions. It was correlated with quantity of basic life support (BLS) procedures undertaken by casual witnesses and with the knowledge of automated external defibrillation (AED) in people without medical training.MethodForty-eight cases of CA were analyzed, which took place in District Siedlce in the first three quarters of 2009. Data were collected retrospectively, from medical reports. Advanced life support procedures adhering to the guidelines of the European Resuscitation Council were investigated in terms of pharmaco-and electrotherapy. Additionally, the study of the knowledge of AED was conducted through a survey, in which 103 randomly selected persons without medical training took part.ResultsAdrenaline and amiodarone were given by paramedics correctly in 94% of patients. Defibrillation was performed in all patients with documented ventricular fibrillation or pulseless ventricular tachycardia valid values of energy. Cardiopulmonary resuscitation was successful in 33% of the cases. At the scene of the accident BLS was performed before the arrival of ambulance in only 7% of cases. Of the respondents, 41% (non-medic) could use the AED safely, but only 13% of them knew the guidelines for using defibrillators.ConclusionsParamedics were properly implementing ALS procedures for prehospital CA. The percent of effective cardiopulmonary resuscitations may improve the early implementation of BLS, including the use of AED. It is necessary to educate people without medical training in this field.

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

2021 ◽  
Vol 18 (16) ◽  
pp. 8323
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 ◽  
Prehospital Emergency ◽  
Bystander Cpr ◽  
Comorbidity Index ◽  
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 1 January 2009 to 1 January 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 cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) 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.

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