[An urban EMS at the start of a cross-sectoral quality management system: prioritized implementation of the 2010 ERC recommendations and long-term survival after cardiac arrest]

The impact of smartphone-dispatched CPR-trained volunteers on OHCA outcomes is influenced by patient age

The early initiation of cardiopulmonary resuscitation (CPR) measures by non-professionals before the arrival of Emergency Medical Service (EMS) is known to be crucial for improving outcomes after out-of-hospital cardiac arrest (OHCA). We assessed the impact of deploying CPR-trained volunteers via a smartphone-based alerting system on the outcome of OHCA patients. In a retrospective nonrandomized cohort study, all OHCA cases in the city of Aachen over a six-year period were analysed. We compared patient data, CPR metrics, alerting system data as well as outcome data between the intervention and control groups. From June 2017 to May 2023, 101 out of 852 resuscitations were initiated by volunteers alerted via a smartphone-based alerting system in OHCA events. We found no overall rise in the return of spontaneous circulation (ROSC) rate. An age-dependent subgroup analysis indicated an increased incidence of initially shockable rhythms and an increased ROSC rate for patients younger than 60 years in the intervention group, while implying a lower ROSC rate in patients older than 80 years after mobile responder CPR. Although this study was underpowered to yield statistically significant results, our findings suggest the need for an age-sensitive approach when evaluating the effects of first-responder systems on OHCA cases.

Frequency of resuscitation attempts with dying nursing home residents. A full survey in an urban district in Germany based on registry data from 2018-2021

Aim

The realities of emergency care and resuscitation research involving nursing home (NH) residents suggest an overuse of resuscitation attempts in NHs. A complete analysis of all NH resident deaths is needed to provide a complementary perspective of potential underuse. The present research investigated whether residents of different NH homes died at the NH during attempted resuscitation or after transfer to hospital.

Methods

A full survey of resuscitation attempts and deaths among NH residents, via retrospective analysis of data from the death registry and the German Resuscitation Registry for the years 2018 to 2021.

Results

Over the 4-year study period, 14,598 individuals died, of whom 3,288 (22.5%) were residents of 31 different NHs. The mean age of the deceased NH residents was 87 years (±8.6); 2,196 (66.8%) were female, 118 (3.6%) underwent a resuscitation attempt, and 58.5% died at the NH. NH averages were as follows: deaths per NH: 106 (±51; min-max: 36-292); number of beds: 102 (±39; 34-210); deaths per bed per year 0.27 (±0.07; 0.15-0.51); resuscitation attempts per 1,000 beds per year: 9.5 (±5.5; 0-21.1); and ratio of futile resuscitation attempts to deaths: 6.0% (0-12.5%). Considering the entire study region before and during the COVID-19 pandemic, a slight underuse of resuscitation attempts with female NH residents emerged. On a facility level, substantial disparities and opposing trends were found. The incidence of deaths and resuscitation attempts, as well as the place of death and the ratio of futile resuscitation attempts to deaths, varied considerably.

Conclusion

Resuscitation attempts are rarely administered to dying NH residents. However, their frequency varies considerably between NHs.

Rettungsdiensteinsätze am Lebensende: erste Ergebnisse eines sektorenübergreifenden Rückmelde- und Kontrollsystems

Hintergrund Informationen über den Verlauf von Rettungsdienstpatienten kann für Fortbildung und Strukturverbesserung nützlich sein.

Patienten/Material und Methoden Eine systematische Verlinkung von Sterberegister- und Rettungsdienstdaten identifiziert Sterbefälle nach ambulantem Kontakt mit dem Rettungsdienst ohne notärztliche Beteiligung (AKRD) und bietet Anlass für individuelle Einsatznachbesprechungen.

Ergebnisse In den Jahren 2018 und 2019 erfolgten in der Stadt Braunschweig 115 409 Rettungsdiensteinsätze. Es verstarben 7185 Menschen, ihr Alter betrug im Median 78 (0 – 106) Jahre (Min – Max), 3585 (49,9%) waren weiblich. Am Sterbetag oder am Vortag des Todes erfolgten 1003 Einsätze. Diese Patienten waren 78 (0 – 101) Jahre alt, 468 (46,7%) waren weiblich. Dabei wurden 8 AKRD identifiziert. Diese Patienten waren 73 (30 – 90) Jahre alt, 2 waren weiblich.

Schlussfolgerung Sterbefälle nach AKRD waren ähnlich häufig wie international publiziert. Das System bietet verschiedene Nutzungs- und Entwicklungsmöglichkeiten.

Improvement of out-of-hospital cardiac arrest survival rate after implementation of the 2010 resuscitation guidelines

OBJECTIVE

The implementation of cardiopulmonary resuscitation guidelines, updated every five years, appears to improve patient survival rates after Out-Of-Hospital Cardiac Arrest (OHCA). The aim of this study is: 1) to measure the level of improvement in the prognosis of OHCA patient survival rates for the years 2009 and 2010 and the following two years 2011 and 2012; and 2) correlate the improvement in prognosis with the updated 2010 Advanced Cardiovascular Life Support (ACLS) Guidelines.

METHOD

We performed a retrospective observational study based on Geneva's OHCA register that includes data from January 1, 2009 to December 31, 2012. We compared the evolution of prognostic factors that influenced survival at hospital discharge between the periods before and after the implementation of the 2010 guidelines. We then compared the survival rates between each period. Finally, we adjusted the effects on survival in the second period to prognostic factors not linked with the care provided by Emergency Medical Services (EMS) teams, using a multivariable logistic regression model. Changes in advanced resuscitation treatment provided by EMS personnel were also examined.

RESULTS

795 OHCA were resuscitated between 1st January, 2009 and 31st December, 2012. The prognosis of patient survival at the time of hospital discharge rose from 10.33% in 2009-2010 to 17.01% in 2011-2012 (p = 0.007). After making adjustments for the effect of improved survival rates on the second period with factors not related to care provided by EMS teams, the odds ratio (OR) remains comparable (OR = 1.87, 95% CI [1.08-3.22]). Measured changes in treatment provided by EMS personnel were minor.

CONCLUSIONS

Survival rate for OHCA patients improved significantly in 2011-2012. This study suggests that it was probably the improvement in the quality of care provided during CPR and post-cardiac arrest care that have contributed to the increase in survival rates at the time of hospital discharge.