Cardiopulmonary Resuscitation Update

Effect of a multi-tiered dispatch system on out-of-hospital cardiac arrest patients: preliminary report from the Gyeonggi province, South Korea

Objective

In South Korea, the Gyeonggi Fire Services introduced a multi-tiered dispatch system for out-of-hospital cardiac arrest (OHCA) cases in July 2015. In this study, we investigated whether the multi-tiered dispatch system improved the pre-hospital return of the spontaneous circulation (ROSC) rate.

Methods

All non-traumatic adult OHCAs treated and transported by the 119 emergency medical system from July 2015 to December 2015 were included in the study. Demographic and pre-hospital Utstein element-data were collected from the emergency medical system OHCA database. The primary outcome was pre-hospital ROSC as measured at the scene.

Results

Of the included OHCAs, 1,436 (89.0%) were categorized to the single-tiered dispatch group and 162 (10.1%) to the multi-tiered dispatch group. The rate of administration of advanced airway ventilation (61.1% vs. 48.0%, P=0.002) and intravenous access (18.5% vs. 12.5%, P=0.037) was higher in the multi-tiered group compared to that in the single-tiered group. The use of epinephrine was higher in the multi-tiered group (4.9% vs. 1.5%, P=0.002). The pre-hospital ROSC rates in the multi-tiered group were higher when compared with the single-tiered group, but the difference was not significant (10.5% vs. 7.5%, P=0.218). The adjusted odds ratio for pre-hospital ROSC rates in the multi-tiered group was 1.29 (95% confidence interval, 0.69 to 2.40).

Conclusion

The multi-tiered dispatch system was not associated with a significant increase in the pre-hospital ROSC rate during the early phase of its implementation, even though advanced maneuvers were performed more frequently.

Impact of training in Advanced Cardiac Life Support (ACLS) in the professional career and work environment

We sought to evaluate the impact of Advanced Cardiac Life Support (ACLS) training in the professional career and work environment of physicians who took the course in a single center certified by the American Heart Association (AHA). Of the 4631 students (since 1999 to 2009), 2776 were located, 657 letters were returned, with 388 excluded from the analysis for being returned lacking addressees. The final study population was composed of 269 participants allocated in 3 groups (< 3 years, 3-5 and > 5years). Longer training was associated with older age, male gender, having undergone residency training, private office, greater earnings and longer time since graduation and a lower chance to participate in providing care for a cardiac arrest. Regarding personal change, no modification was detected according to time since taking the course. The only change in the work environment was the purchase of an automated external defibrillator (AED) by those who had taken the course more than 5 years ago. In multivariable analysis, however, the implementation of an AED was not independently associated with this group, which showed a lower chance to take a new ACLS course. ACLS courses should emphasize also how physicians could reinforce the survival chain through environmental changes.

Standard versus Abdominal Lifting and Compression CPR

Background. This study compared outcomes of abdominal lifting and compression cardiopulmonary resuscitation (ALP-CPR) with standard CPR (STD-CPR). Materials and Methods. Patients with cardiac arrest seen from April to December 2014 were randomized to receive standard CPR or ALP-CPR performed with a novel abdominal lifting/compression device. The primary outcome was return of spontaneous circulation (ROSC). Results. Patients were randomized to receive ALP-CPR (n = 40) and STD-CPR (n = 43), and the groups had similar baseline characteristics. After CPR, 9 (22.5%) and 7 (16.3%) patients in the ALP-CPR and STD-CPR groups, respectively, obtained ROSC. At 60 minutes after ROSC, 7 (77.8%) and 2 (28.6%) patients, respectively, in the ALP-CPR and STD-CPR groups survived (P = 0.049). Patients in the ALP-CPR group had a significantly higher heart rate and lower mean arterial pressure (MAP) than those in the STD-CPR group (heart rate: 106.8 versus 79.0, P < 0.001; MAP: 60.0 versus 67.3 mm Hg, P = 0.003). The posttreatment PCO₂ was significantly lower in ALP-CPR group than in STD-CPR group (52.33 versus 58.81, P = 0.009). PO₂ was significantly increased after ALP-CPR (45.15 to 60.68, P < 0.001), but it was not changed after STD-CPR. PO₂ after CPR was significantly higher in the ALP-CPR group (60.68 versus 44.47, P < 0.001). There were no differences between genders and for patients who are > 65 or ≤ 65 years of age. Conclusions. The abdominal lifting and compression cardiopulmonary resuscitation device used in this study is associated with a higher survival rate after ROSC than standard CPR.

Implementation of a high-performance cardiopulmonary resuscitation protocol at a collegiate emergency medical services program

Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Although OHCA occurs relatively infrequently in the collegiate environment, educational institutions with on-campus emergency medical services (EMS) agencies are uniquely positioned to provide high-quality resuscitation care in an expedient fashion. Georgetown University's on-campus EMS program recently updated its medical protocols to reflect the latest literature in resuscitation science. In a high-performance CPR (HPCPR) resuscitation, minimally interrupted chest compressions are emphasized, along with a coordinated team-based approach.

Cardiac Arrest Resuscitation

Cardiac arrest is a dynamic disease that tests the multitasking and leadership abilities of emergency physicians. Providers must simultaneously manage the logistics of resuscitation while searching for the cause of cardiac arrest. The astute clinician will also realize that he or she is orchestrating only one portion of a larger series of events, each of which directly affects patient outcomes. Resuscitation science is rapidly evolving, and emergency providers must be familiar with the latest evidence and controversies surrounding resuscitative techniques. This article reviews evidence, discusses controversies, and offers strategies to provide quality cardiac arrest resuscitation.