scholarly journals Out-of-hospital cardiac arrest in high-rise buildings: delays to patient care and effect on survival

2016 ◽  
Vol 188 (6) ◽  
pp. 413-419 ◽  
Author(s):  
Ian R. Drennan ◽  
Ryan P. Strum ◽  
Adam Byers ◽  
Jason E. Buick ◽  
Steve Lin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Patient Care ◽  
High Rise ◽  
Hospital Cardiac Arrest

Balancing Between Closeness and Distance: Emergency Medical Services Personnel’s Experiences of Caring for Families at Out-of-Hospital Cardiac Arrest and Sudden Death

2012 ◽  
Vol 27 (1) ◽  
pp. 42-52 ◽  
Author(s):  
Anders Bremer ◽  
Karin Dahlberg ◽  
Lars Sandman
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Sudden Death ◽  
Patient Care ◽  
Emergency Medical Services ◽  
Family Members ◽  
Family Care ◽  
Emergency Medical ◽  
Bereaved Family ◽  
Hospital Cardiac Arrest

AbstractIntroduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects between 236,000 and 325,000 people in the United States each year. As resuscitation attempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services (EMS) personnel often face the needs of bereaved family members.Problem: Decisions to continue or terminate resuscitation at OHCA are influenced by factors other than patient clinical characteristics, such as EMS personnel’s knowledge, attitudes, and beliefs regarding family emotional preparedness. However, there is little research exploring how EMS personnel care for bereaved family members, or how they are affected by family dynamics and the emotional contexts. The aim of this study is to analyze EMS personnel’s experiences of caring for families when patients suffer cardiac arrest and sudden death.Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviews were conducted with 10 EMS personnel from an EMS agency in southern Sweden.Results: The EMS personnel interviewed felt responsible for both patient care and family care, and sometimes failed to prioritize these responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care implied a movement from well-structured guidance to a situational response, where the personnel were forced to balance between interpretive reasoning and a more direct emotional response, at their own discretion. With such affective responses in decision-making, the personnel risked erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people’s existential questions and needs was essential. It was dependent on the EMS personnel’s balance between closeness and distance, and on their courage in facing the emotional expressions of the families, as well as the personnel’s own vulnerability. The presence of family members placed great demands on mobility (moving from patient care to family care) in the decision-making process, invoking a need for ethical competence.Conclusion: Ethical caring competence is needed in the care of bereaved family members to avoid additional suffering. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Support in dealing with personal discomfort and clear guidelines on family support could benefit EMS personnel.

scholarly journals Inaccuracy of patient care reports for identification of critical resuscitation events during out-of-hospital cardiac arrest

2015 ◽  
Vol 33 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Matthew L. Sundermann ◽  
David D. Salcido ◽  
Allison C. Koller ◽  
James J. Menegazzi
Keyword(s):  
Cardiac Arrest ◽  
Patient Care ◽  
Hospital Cardiac Arrest

Abstract 13209: Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Luke A Wohlford ◽  
Bruce J Barnhart ◽  
Daniel W Spaite ◽  
Joshua B Gaither ◽  
Amber D Rice ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Law Enforcement ◽  
Cardiopulmonary Resuscitation ◽  
Patient Care ◽  
Hospital Discharge ◽  
System Response ◽  
Healthcare Facilities ◽  
Bystander Cpr ◽  
Provision Of Care ◽  
Hospital Cardiac Arrest

Background: Little is known about the provision of care by law enforcement (LE) personnel within modern EMS systems. We evaluated LE performance of bystander CPR (BCPR) and associated outcomes in OHCA across Arizona. Methods: A total of 5,654 OHCA cases (1/1/2019-12/31/2019) were evaluated using the Save Hearts in Arizona Registry and Education (SHARE) cardiac arrest registry. Data were abstracted from all EMS patient care records (PCRs). If two parties provided BCPR, the first to give compressions was considered the provider for this analysis. Cases identified as “Stranger” or “Unknown” BCPR were manually evaluated for narrative data to identify BCPR provider when possible. Results: BCPR was provided in 2285 cases [48.8%; (95% CIs 47.4%, 50.3%)] after excluding 850 cases that occurred in healthcare facilities where personnel are duty-bound to provide CPR. LE provided BCPR in 444 patients [19.4% (17.8%, 21.1%)], second only to family/spouse [1143 pts; 50.0% (48.0%, 52.1%)]. Overall, 279 patients survived to hospital discharge [12.2%, (10.9%, 13.6%)]. The Table shows the rates of BCPR in each provider category and the associated rates of survival. Of note is that the rate of bystander AED use was more than four times higher in LE BCPR [6.3% (4.23%, 8.99%)] than family-provided BCPR [1.5% (0.87%, 2.37%; p < 0.0001)], but was still very low. Conclusions: In this statewide study that included more than 130 EMS agencies from frontier to urban settings, LE personnel were frequently involved in the care of OHCA patients within the 911 system response. To our knowledge, this magnitude of provision of BCPR by LE (nearly one in five BCPR cases) has not been reported previously. Furthermore, the consequential rate of LE response to OHCA provides the opportunity to significantly increase AED use. Our findings support the widespread and intentional training of LE in CPR and AED use and has the potential to improve survival in diverse settings.

scholarly journals The Effect of a Mechanical Compression Device and Supraglottic Airway on Flow Time: A Simulation Study of Out-of-Hospital Cardiac Arrest in a High-Rise Building

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Jongho Kim ◽  
Lyle Brewster ◽  
Sonja Maria ◽  
Jundong Moon
Keyword(s):  
Cardiac Arrest ◽  
Flow Time ◽  
Supraglottic Airway ◽  
Mechanical Compression ◽  
Manual Compression ◽  
High Rise ◽  
High Rise Building ◽  
Cpr Quality ◽  
Mechanical Compression Device ◽  
Hospital Cardiac Arrest

High-rise buildings present unique challenges to providing high-quality CPR. We investigated the effect of using a mechanical compressor and supraglottic airway on flow time and CPR quality in simulated cardiac arrests occurring within a high-rise building. Twelve teams of EMS providers performed CPR according to 4 scenarios: manual compression and ventilation through bag-valve-mask (MAB) or supraglottic airway (MAS); mechanical compression and ventilation through bag-valve-mask (MEB) or supraglottic airway (MES). Chest compression indices did not differ significantly among the groups. The mechanical compression groups had a higher flow time fraction from exiting the elevator until the manikin was loaded into the ambulance than the manual compression groups. The supraglottic airway groups had higher flow time fractions from entering the elevator until the end of the scenario than the bag-valve-mask groups. The total flow time fraction was lowest in the MAB group and was highest in the MEB group (P < 0.001). In simulated cardiac arrest in a high-rise building, the use of a supraglottic airway maintained flow time at a level similar to that observed with the use of a mechanical compressor. Moreover, the use of a mechanical compressor and a supraglottic airway increased the flow time most effectively.

Empirical Hospital and Professional Charges for Patient Care Associated with Out of Hospital Cardiac Arrest Before and After Implementation of Therapeutic Hypothermia for Comatose Survivors

Resuscitation ◽  
2012 ◽  
Vol 83 (10) ◽  
pp. 1265-1270 ◽  
Author(s):  
Michael J. Paulsen ◽  
Alison J. Haddock ◽  
Robert Silbergleit ◽  
William J. Meurer ◽  
Michelle L. Macy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Patient Care ◽  
Therapeutic Hypothermia ◽  
Before And After ◽  
Hospital Cardiac Arrest

High-rise buildings and neurologically favorable outcome after out-of-hospital cardiac arrest

2016 ◽  
Vol 224 ◽  
pp. 178-182 ◽  
Author(s):  
Daisuke Kobayashi ◽  
Tetsuhisa Kitamura ◽  
Kosuke Kiyohara ◽  
Chika Nishiyama ◽  
Sumito Hayashida ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Favorable Outcome ◽  
High Rise ◽  
Hospital Cardiac Arrest

scholarly journals Patient consent in emergency cardiovascular medicine: lessons from the ARREST trial in out-of-hospital cardiac arrest

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Perkins ◽  
T Patterson ◽  
R Evans ◽  
T Clayton ◽  
R Fothergill ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Patient Care ◽  
Funding Source ◽  
Sources Of Information ◽  
Cardiovascular Medicine ◽  
Quality Research ◽  
Deferred Consent ◽  
Patient Consent ◽  
Hospital Cardiac Arrest

Abstract Introduction Randomised trials in emergency cardiovascular medicine are challenging but vital for improving patient care. Obtaining informed consent in such an environment is a particular issue and can be controversial. The ARREST trial is assessing whether out-of-hospital cardiac arrest patients without an obvious cause should be taken to a specialist heart centre or the closest emergency department in London, UK. This patient group presents specific difficulties: patients lack capacity to consent, presentation is unpredictable, care must not be delayed, and mortality rates can be &gt;50%. Purpose Within existing consent and methodological frameworks we aimed to design a randomised clinical trial to pragmatically, safely and ethically recruit cardiac arrest patients pre-hospital. Methods During the set-up of ARREST we accessed the following sources of information: 1) ARREST research team; 2) cardiovascular patient groups; 3) researchers running similar trials; 4) regulatory bodies; and, 5) published literature on research in emergency contexts. The information that we collected guided the design of the trial with a focus on patient consent, documentation and follow-up. Results The ARREST trial uses deferred consent with remote online randomisation to enrol patients without delaying care. To minimise the risk of bias, baseline and primary endpoint data are collected on patients who die or are discharged prior to consent. Remote follow-up using electronic health records reduces the burden on the patients and researchers. Full ethical approval was received in January 2018 and the first patient was enrolled in February 2018. ARREST is recruiting to target and is on track to finish within the projected timelines. Conclusions Deferred consent has been key to the success of ARREST and patients have been receptive. However, further research into the experience of patients in emergency cardiovascular medicine trials using deferred consent is needed to better understand when it is an appropriate model. More broadly, there is a shortfall in high quality research in challenging environments such as emergency cardiovascular care. Innovation in consent methods and proportional research governance would facilitate higher quality research and benefit patient care. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

Sign in / Sign up

Export Citation Format

Share Document