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Abstract
PURPOSE OF REVIEW Out-of-hospital cardiac arrest (OHCA) is the most devastating and time-critical medical emergency. Survival after OHCA requires an integrated system of care, of which transport by emergency medical services is an integral component. The transport system serves to commence and ensure uninterrupted high-quality resuscitation in suitable patients who would benefit, terminate resuscitation in those that do not, provide critical interventions, as well as convey patients to the next appropriate venue of care. We review recent evidence surrounding contemporary issues in the transport of OHCA, relating to who, where, when and how to transport these patients. RECENT FINDINGS We examine the clinical and systems-related evidence behind issues including: contemporary approaches to field termination of resuscitation in patients in whom continued resuscitation and transport to hospital would be medically futile, OHCA patients and organ donation, on-scene versus intra-transport resuscitation, significance of response time, intra-transport interventions (mechanical chest compression, targeted temperature management, ECMO-facilitated cardiopulmonary resuscitation), OHCA in high-rise locations and cardiac arrest centers. We highlight gaps in current knowledge and areas of active research. SUMMARY There remains limited evidence to guide some decisions in transporting the OHCA patient. Evidence is urgently needed to elucidate the roles of cardiac arrest centers and ECPR in OHCA.
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Heidet M, Da Cunha T, Brami E, Mermet E, Dru M, Simonnard B, Lecarpentier E, Chollet-Xémard C, Bergeron C, Khalid M, Grunau B, Marty J, Audureau E. EMS Access Constraints And Response Time Delays For Deprived Critically Ill Patients Near Paris, France. Health Aff (Millwood) 2021; 39:1175-1184. [PMID: 32634362 DOI: 10.1377/hlthaff.2019.00842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Increased emergency medical services (EMS) response times and areas of low socioeconomic status are both associated with poorer outcomes for several time-sensitive medical conditions attended to by medical personnel before a patient is hospitalized. We evaluated the association between EMS response times, area deprivation level, and on-scene access constraints encountered by EMS in a large urban area in France. We conducted a multicenter prospective cohort study of EMS dispatches occurring in the forty-seven cities in a region southeast of Paris. We fit multilevel mixed-effects linear regression models for multivariate assessment of the predictors of EMS response times and then used multivariate logistic regression on outcomes among a subgroup of patients presenting with out-of-hospital cardiac arrest. We found evidence that access constraints were more frequently encountered by EMS in the most deprived areas compared to less deprived ones, and were associated with increased EMS response times until patient contact and with poorer outcomes from cardiac arrest. Strategies to anticipate and overcome access constraints should be implemented to improve outcomes for emergent conditions attended to by prehospital medical teams.
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Affiliation(s)
- Matthieu Heidet
- Matthieu Heidet is a physician with Service d'aide médicale urgente (SAMU) 94 and with Urgences at Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), in Créteil, France
| | - Thierry Da Cunha
- Thierry Da Cunha is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Elise Brami
- Elise Brami is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Eric Mermet
- Eric Mermet is a scientist at the Centre d'analyse et de mathématique sociales (CAMS), at the Centre national de la recherche scientifique (CNRS) and École des hautes études en sciences sociales (EHESS), in Paris, France
| | - Michel Dru
- Michel Dru is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Béatrice Simonnard
- Béatrice Simonnard is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Eric Lecarpentier
- Eric Lecarpentier is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | | | - Corinne Bergeron
- Corinne Bergeron is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Mohamed Khalid
- Mohamed Khalid is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Brian Grunau
- Brian Grunau is a physician in the Department of Emergency Medicine, University of British Columbia, in Vancouver, British Columbia, Canada
| | - Jean Marty
- Jean Marty is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP, and head of the research team Analysis of Risks in Complex Health Systems (ARCHeS), Université Paris-Est Créteil (UPEC), in Créteil, France
| | - Etienne Audureau
- Etienne Audureau is a public health physician and scientist with the research team Clinical Epidemiology and Ageing Unit (CEpiA), UPEC
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Singer JL, Mosesso VN. After the lights and sirens: Patient access delay in cardiac arrest. Resuscitation 2020; 155:234-235. [PMID: 32810559 PMCID: PMC7428674 DOI: 10.1016/j.resuscitation.2020.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Jordan L Singer
- UPMC Department of Emergency Medicine, Pittsburgh, PA, United States
| | - Vincent N Mosesso
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, United States
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Moon S, Ryoo HW, Ahn JY, Lee DE, Shin SD, Park JH. Association of response time interval with neurological outcomes after out-of-hospital cardiac arrest according to bystander CPR. Am J Emerg Med 2020; 38:1760-1766. [DOI: 10.1016/j.ajem.2020.05.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/22/2020] [Accepted: 05/27/2020] [Indexed: 12/30/2022] Open
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Heidet M, Fraticelli L, Grunau B, Cheskes S, Baert V, Vilhelm C, Hubert H, Tazarourte K, Vaillancourt C, Tallon J, Christenson J, El Khoury C. ReACanROC: Towards the creation of a France–Canada research network for out-of-hospital cardiac arrest. Resuscitation 2020; 152:133-140. [DOI: 10.1016/j.resuscitation.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022]
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Raun L, Pederson J, Campos L, Ensor K, Persse D. Effectiveness of the Dual Dispatch to Cardiac Arrest Policy in Houston, Texas. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:E13-E21. [PMID: 31348172 DOI: 10.1097/phh.0000000000000836] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Houston policy is to dual dispatch medically trained firefighters, in addition to emergency medical services (EMS) units to out-of-hospital cardiac arrest (OHCA) cases. While believed to improve public health outcomes, no research exists supporting the policy that when firefighters respond before a better-equipped EMS unit, they increase the probability of survival. OBJECTIVE To inform EMS policy decisions regarding the effectiveness of dual dispatch by determining the impact of medically trained firefighter dispatch on return of spontaneous circulation (ROSC), a measure of survivability, in OHCA 911 calls while controlling for the subsequent arrival of an EMS unit. DESIGN This retrospective study uses logistic regression to determine the association between ROSC and response time for fire apparatus first responders controlling for arrival of the EMS unit. SETTING Out-of-hospital cardiac arrest cases in Houston between May 2008 and April 2013 when dual dispatch was used. PARTICIPANTS A total of 6961 OHCA cases with the complete data needed for the analysis. MAIN OUTCOME MEASURES Logistic regression of the dependence of OHCA survival using the indicator ROSC, as related to the fire first responder response times controlling for subsequent arrival of the EMS. RESULTS Fire apparatus arrived first in 46.7% of cases, a median value of 1.5 minutes before an EMS unit. Controlling for subsequent arrival time of EMS has no effect on ROSC achieved by the fire first responder. If the firefighters had not responded, the resulting 1.5-minute increase in response time equates to a decrease in probability of attaining ROSC of 20.1% for cases regardless of presenting heart rhythm and a 47.7% decrease for ventricular fibrillation cases in which bystander cardiopulmonary resuscitation was initiated. CONCLUSIONS The firefighter first responder not only improved response time but also greatly increased survivability independent of the arrival time of the better-equipped EMS unit, validating the public health benefit of the dual dispatch policy in Houston.
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Affiliation(s)
- Loren Raun
- Department of Statistics, Rice University, Houston, Texas (Drs Raun and Ensor, Mr Pederson, and Ms Campos); City of Houston Health Department, 7411 Park Place Blvd, Houston, TX 77087, USA (Dr Raun); Emergency Medical Services, City of Houston, Houston, Texas (Dr Persse); and Baylor College of Medicine, Houston, Texas (Dr Persse)
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Sinden S, Heidet M, Scheuermeyer F, Kawano T, Helmer JS, Christenson J, Grunau B. The association of scene-access delay and survival with favourable neurological status in patients with out-of-hospital cardiac arrest. Resuscitation 2020; 155:211-218. [PMID: 32522699 DOI: 10.1016/j.resuscitation.2020.05.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rapid emergency medical service (EMS) response after out-of-hospital cardiac arrest (OHCA) is a major determinant of survival, however this is typically measured until EMS vehicle arrival. We sought to investigate whether the interval from EMS vehicle arrival to patient attendance (curb-to-care interval [CTC]) was associated with patient outcomes. METHODS We performed a secondary analysis of the "CCC Trial" dataset, which includes EMS-treated adult non-traumatic OHCA. We fit an adjusted logistic regression model to estimate the association between CTC interval (divided into quartiles) and the primary outcome (survival with favourable neurologic status at hospital discharge; mRS ≤ 3). We described the CTC interval distribution among enrolling clusters. RESULTS We included 24,685 patients: median age was 68 (IQR 56-81), 23% had initial shockable rhythms, and 7.6% survived with favourable neurological status. Compared to the first quartile (≤62 s), longer CTC quartiles (63-115, 116-180, and ≥181 s) demonstrated the following associations with survival with favourable neurological status: adjusted odds ratios 0.95, 95% CI 0.83-1.09; 0.77, 95% CI 0.66-0.89; 0.66, 95% CI 0.56-0.77, respectively. Of the 49 study clusters, median CTC intervals ranged from 86 (IQR 58-130) to 179 s (IQR 112-256). CONCLUSION A lower CTC interval was associated with improved patient outcomes. These results demonstrate a wide range of access metrics within North America, and provide a rationale to create protocols to mitigate access obstacles. A 2-min CTC threshold may represent an appropriate target for quality improvement.
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Affiliation(s)
- Sean Sinden
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Matthieu Heidet
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, University Hospital Henri Mondor, Créteil, France; University Paris-Est Créteil (UPEC), EA-4390 (ARCHeS), Créteil, France; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada
| | - Frank Scheuermeyer
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Takahisa Kawano
- Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan
| | - Jennie S Helmer
- BC Emergency Health Services, Vancouver, British Columbia, Canada
| | - Jim Christenson
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Brian Grunau
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; St. Paul's Hospital, Vancouver, British Columbia, Canada; BC Emergency Health Services, Vancouver, British Columbia, Canada.
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‘Knocking-fingers’ chest compression technique in infant cardiac arrest: single-rescuer manikin study. Eur J Emerg Med 2019; 26:261-265. [DOI: 10.1097/mej.0000000000000539] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pei L, Liang F, Sun S, Wang H, Dou H. Nursing students' knowledge, willingness, and attitudes toward the first aid behavior as bystanders in traffic accident trauma: A cross-sectional survey. Int J Nurs Sci 2018; 6:65-69. [PMID: 31406871 PMCID: PMC6608657 DOI: 10.1016/j.ijnss.2018.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 08/08/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022] Open
Abstract
Objectives The purpose of the study was to investigate the nursing students’ levels of the knowledge, willingness, and attitudes toward first aid behavior as bystanders in road traffic accident and the related factors. Methods A total of 475 nursing students were recruited by convenience choosing in Tianjin University of Traditional Chinese Medicine. The nursing students’ self-efficacy, core self-evaluation, knowledge, willingness and attitudes toward first aid behavior as bystanders in traffic accidents were investigated with a self-designed questionnaire. Results The scores of knowledge, willingness, and attitudes toward first aid behavior in traffic accident trauma were 7.51 ± 1.93, 15.54 ± 5.03, and 7.73 ± 1.56, respectively. Students who once gained training of first aid showed lower levels of attitude toward first aid behavior than those untrained (t = −2.345, P = 0.019). It was found that self-efficacy was correlated to the knowledge (r = 0.150, P < 0.001), willingness (r = 0.182, P < 0.004) and attitudes toward behavior of the first aid (r = 0.371, P < 0.001) among nursing students. Core self-evaluation was correlated to knowledge (r = 0.193, P < 0.001) and attitudes toward behavior of the first aid (r = 0.199, P < 0.001). Conclusions The first aid knowledge among nursing students was not satisfactory. The study suggested that an unsustainable short first-aid training program may bring negative effects. Countermeasures should be taken to ensure both quality and continuity of first aid training. Meanwhile, more attention should be paid to improving the self-efficacy and core self-evaluation of the nursing students.
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Affiliation(s)
- Li Pei
- Department of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Fangfang Liang
- Department of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shiquan Sun
- Acupuncture and Tuina Department, Tianjin Beichen North Gate Hospital, Tianjin, China
| | - Hongwu Wang
- Department of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Haoying Dou
- Department of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Heidet M, Brami E, Mermet É, Vaux J, Revaux F, Chollet-Xémard C, Lecarpentier E, Da Cunha T, Marty J. Scene time interval in out-of-hospital cardiac arrest: It is time to measure time until patient contact. Am J Emerg Med 2018; 36:1304-1305. [DOI: 10.1016/j.ajem.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022] Open
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Goto Y, Funada A, Goto Y. Relationship Between Emergency Medical Services Response Time and Bystander Intervention in Patients With Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2018; 7:JAHA.117.007568. [PMID: 29703811 PMCID: PMC6015296 DOI: 10.1161/jaha.117.007568] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The response time of emergency medical services (EMS) is an important determinant of survival after out‐of‐hospital cardiac arrest. We sought to identify upper limits of EMS response times and bystander interventions associated with neurologically intact survival. Methods and Results We analyzed the records of 553 426 patients with out‐of‐hospital cardiac arrest in a Japanese registry between 2010 and 2014. The primary study end point was 1‐month neurologically intact survival (Cerebral Performance Category scale 1 or 2). Increased EMS response time was associated with significantly decreased adjusted odds of 1‐month neurologically intact survival (adjusted odds ratio [aOR] for each 1‐minute increase, 0.89; 95% confidence interval [CI], 0.89–0.90), although this relationship was modified by bystander interventions. The bystander interventions and the ranges of EMS response times that were associated with increased adjusted 1‐month neurologically intact survival were as follows: bystander defibrillation, from ≤2 minutes (aOR, 3.10 [95% CI, 1.25–7.31]) to 13 minutes (aOR, 5.55 [95% CI, 2.66–11.2]); bystander conventional cardiopulmonary resuscitation, from 3 minutes (aOR 1.48 [95% CI, 1.02–2.12]) to 11 minutes (aOR 2.41 [95% CI, 1.61–3.56]); and bystander chest‐compression‐only cardiopulmonary resuscitation, from ≤2 minutes (aOR 1.57 [95% CI, 1.01–2.25]) to 11 minutes (aOR 1.92 [95% CI, 1.45–2.56]). However, the increase in neurologically intact survival of those receiving bystander interventions became statistically insignificant compared with no bystander interventions when the EMS response time was outside these ranges. Conclusions The upper limits of the EMS response times associated with improved 1‐month neurologically intact survival were 13 minutes when bystanders provided defibrillation (typically with cardiopulmonary resuscitation) and 11 minutes when bystanders provided cardiopulmonary resuscitation without defibrillation.
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Affiliation(s)
- Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Akira Funada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Yumiko Goto
- Department of Cardiology, Yawata Medical Center, Komatsu, Japan
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