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Rahim Khan U, Baig N, Bhojwani KM, Raheem A, Khan R, Ilyas A, Khursheed M, Ahraz Hussain M, Razzak JA, Eng Hock Ong M, Ahmed F, Hanif B, Saleem G, Jamali S, Kashan A, Saad A, Kerai S, Kanza S, Sajid S, Ullah Khan N. Epidemiology and outcomes of out of hospital cardiac arrest in Karachi, Pakistan - A longitudinal study. Resusc Plus 2024; 20:100773. [PMID: 39314253 PMCID: PMC11417593 DOI: 10.1016/j.resplu.2024.100773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 09/04/2024] [Accepted: 09/05/2024] [Indexed: 09/25/2024] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a major cause of morbidity and mortality globally, with survival outcomes remaining poor particularly in many low- and middle-income countries. We aimed to establish a pilot OHCA registry in Karachi, Pakistan to provide insights into OHCA patient demographics, pre-hospital and in-hospital care, and outcomes. Methods A multicenter longitudinal study was conducted from August 2015-October 2019 across 11 Karachi hospitals, using a standardized Utstein-based survey form. Data was retrospectively obtained from medical records, patients, and next-of-kin interviews at hospitals with accessible medical records, while hospitals without medical records system used on-site data collectors. Demographics, arrest characteristics, prehospital events, and survival outcomes were collected. Survivors underwent follow-up at 1 month, 6 months, 1 year, and 5 years. Results In total, 1068 OHCA patients were included. Mean age was 55 years, 61.1 % (n = 653) male. Witnessed arrests accounted for 94.9 % of the cases (n = 1013), whereas 89.4 % of the cases (n = 955) were transported via non-EMS. Bystander CPR was performed in 10.3 % (n = 110) cases whereas pre-hospital defibrillation performed in 0.4 % (n = 4). In-hospital defibrillation was performed in 9.9 % (n = 106) cases despite < 5 % shockable rhythms. Overall survival to discharge was 0.75 % (n = 8). Of these 8 patients, 7 patients survived to 1-year and 2 to 5-years. Neurological outcomes correlated with long-term survival. Conclusion OHCA survival rates are extremely low, necessitating public awareness interventions like CPR training, developing robust pre-hospital systems, and improving in-hospital emergency care through standardized training programs. This pilot registry lays the foundation for implementing interventions to improve survival and emergency medical infrastructure.
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Affiliation(s)
- Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Noor Baig
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Kamlesh M. Bhojwani
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Rubaba Khan
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Ayaz Ilyas
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Munawar Khursheed
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Mohammad Ahraz Hussain
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Junaid A. Razzak
- Department of Emergency Medicine, Weill Cornell Medicine, New-York, USA
- Center of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, Pakistan
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Duke-NUS Medical School, Singapore
| | - Fareed Ahmed
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | | | - Ghazanfar Saleem
- Department of Emergency Medicine, The Indus Hospital Karachi, Pakistan
| | - Seemin Jamali
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | | | - Alvia Saad
- Memon Medical Institute, Karachi, Pakistan
| | - Salima Kerai
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Syeda Kanza
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Saadia Sajid
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
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Cimino J, Braun C. Clinical Research in Prehospital Care: Current and Future Challenges. Clin Pract 2023; 13:1266-1285. [PMID: 37887090 PMCID: PMC10605888 DOI: 10.3390/clinpract13050114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/08/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Prehospital care plays a critical role in improving patient outcomes, particularly in cases of time-sensitive emergencies such as trauma, cardiac failure, stroke, bleeding, breathing difficulties, systemic infections, etc. In recent years, there has been a growing interest in clinical research in prehospital care, and several challenges and opportunities have emerged. There is an urgent need to adapt clinical research methodology to a context of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. Among these, this review allows the highlighting of limited resources and infrastructure, ethical and regulatory considerations, time constraints, privacy, safety concerns, data collection and analysis, selection of a homogeneous study group, etc. The analysis of the literature also highlights solutions such as strong collaboration between emergency medical services (EMS) and hospital care, use of (mobile) health technologies and artificial intelligence, use of standardized protocols and guidelines, etc. Overall, the purpose of this narrative review is to examine the current state of clinical research in prehospital care and identify gaps in knowledge, including the challenges and opportunities for future research.
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Affiliation(s)
- Jonathan Cimino
- Clinical Research Unit, Fondation Hôpitaux Robert Schuman, 44 Rue d’Anvers, 1130 Luxembourg, Luxembourg
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540 Luxembourg, Luxembourg
| | - Claude Braun
- Clinical Research Unit, Fondation Hôpitaux Robert Schuman, 44 Rue d’Anvers, 1130 Luxembourg, Luxembourg
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540 Luxembourg, Luxembourg
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Schnaubelt S, Garg R, Atiq H, Baig N, Bernardino M, Bigham B, Dickson S, Geduld H, Al-Hilali Z, Karki S, Lahri S, Maconochie I, Montealegre F, Tageldin Mustafa M, Niermeyer S, Athieno Odakha J, Perlman JM, Monsieurs KG, Greif R. Cardiopulmonary resuscitation in low-resource settings: a statement by the International Liaison Committee on Resuscitation, supported by the AFEM, EUSEM, IFEM, and IFRC. Lancet Glob Health 2023; 11:e1444-e1453. [PMID: 37591590 DOI: 10.1016/s2214-109x(23)00302-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/19/2023]
Abstract
Most recommendations on cardiopulmonary resuscitation were developed from the perspective of high-resource settings with the aim of applying them in these settings. These so-called international guidelines are often not applicable in low-resource settings. Organisations including the International Liaison Committee on Resuscitation (ILCOR) have not sufficiently addressed this problem. We formed a collaborative group of experts from various settings including low-income, middle-income, and high-income countries, and conducted a prospective, multiphase consensus process to formulate this ILCOR Task Force statement. We highlight the discrepancy between current cardiopulmonary resuscitation guidelines and their applicability in low-resource settings. Successful existing initiatives such as the Helping Babies Breathe programme and the WHO Emergency Care Systems Framework are acknowledged. The concept of the chainmail of survival as an adaptive approach towards a framework of resuscitation, the potential enablers of and barriers to this framework, and gaps in the knowledge are discussed, focusing on low-resource settings. Action points are proposed, which might be expanded into future recommendations and suggestions, addressing a large diversity of addressees from caregivers to stakeholders. This statement serves as a stepping-stone to developing a truly global approach to guide resuscitation care and science, including in health-care systems worldwide.
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Affiliation(s)
- Sebastian Schnaubelt
- European Resuscitation Council, Niel, Belgium; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr Braich All India Institute of Medical Sciences, New Delhi, India
| | - Huba Atiq
- Department of Anaesthesiology, Centre of Excellence for Trauma & Emergency, The Aga Khan University Hospital, Karachi, Pakistan
| | - Noor Baig
- Department of Emergency Medicine, Centre of Excellence for Trauma & Emergency, The Aga Khan University Hospital, Karachi, Pakistan
| | - Marta Bernardino
- Centro de Simulacion, Hospital Universitario Fundacion Alcorcon, Madrid, Spain; Spanish Society of Anaesthesiology and Intensive Care, Madrid, Spain
| | - Blair Bigham
- Department of Anesthesia, Division of Critical Care, Stanford University, Palo Alto, CA, USA
| | | | - Heike Geduld
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | | | - Sanjaya Karki
- Department of Emergency and Pre-hospital Care, Mediciti Hospital, Bhaisepati, Lalitpur, Nepal
| | - Sa'ad Lahri
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Imperial College Healthcare Trust, London, UK
| | - Fernando Montealegre
- Department of Anaesthesiology, José Casimiro Ulloa Emergency Hospital, Peruvian Resuscitation Council, Lima, Peru
| | | | - Susan Niermeyer
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Justine Athieno Odakha
- Department of Emergency Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jeffrey M Perlman
- Department of Pediatrics, Division of Newborn Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, NY, USA
| | - Koenraad G Monsieurs
- European Resuscitation Council, Niel, Belgium; Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Robert Greif
- European Resuscitation Council, Niel, Belgium; University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Bhattarai HK, Bhusal S, Barone-Adesi F, Hubloue I. Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review. Prehosp Disaster Med 2023; 38:495-512. [PMID: 37492946 PMCID: PMC10445116 DOI: 10.1017/s1049023x23006088] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/08/2023] [Accepted: 06/17/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND An under-developed and fragmented prehospital Emergency Medical Services (EMS) system is a major obstacle to the timely care of emergency patients. Insufficient emphasis on prehospital emergency systems in low- and middle-income countries (LMICs) currently causes a substantial number of avoidable deaths from time-sensitive illnesses, highlighting a critical need for improved prehospital emergency care systems. Therefore, this systematic review aimed to assess the prehospital emergency care services across LMICs. METHODS This systematic review used four electronic databases, namely: PubMed/MEDLINE, CINAHL, EMBASE, and SCOPUS, to search for published reports on prehospital emergency medical care in LMICs. Only peer-reviewed studies published in English language from January 1, 2010 through November 1, 2022 were included in the review. The Newcastle-Ottawa Scale (NOS) and Critical Appraisal Skills Programme (CASP) checklist were used to assess the methodological quality of the included studies. Further, the protocol of this systematic review has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (Ref: CRD42022371936) and has been conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of the 4,909 identified studies, a total of 87 studies met the inclusion criteria and were therefore included in the review. Prehospital emergency care structure, transport care, prehospital times, health outcomes, quality of information exchange, and patient satisfaction were the most reported outcomes in the considered studies. CONCLUSIONS The prehospital care system in LMICs is fragmented and uncoordinated, lacking trained medical personnel and first responders, inadequate basic materials, and substandard infrastructure.
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Affiliation(s)
- Hari Krishna Bhattarai
- Program in Global Health, Humanitarian Aid and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy, and Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Francesco Barone-Adesi
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Ives Hubloue
- Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium Research Group on Emergency and Disaster Medicine, Medical School, Vrije Universiteit Brussel, Brussels, Belgium
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5
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Stassen W, Theron E, Slingsby T, Wylie C. Out-of-hospital cardiac arrests in the city of Cape Town metropole of the Western Cape province of South Africa: a spatio-temporal analysis. Cardiovasc J Afr 2022; 33:260-266. [PMID: 35687073 PMCID: PMC9887433 DOI: 10.5830/cvja-2022-019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/01/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The incidence of out-of-hospital cardiac arrest (OHCA) is expected to increase in sub-Saharan Africa along with the incidence of cardiovascular disease. In low-resource settings (LRS), OHCA carries a negligible survival rate. Interventions to improve OHCA survival might not be cost effective for many LRS, and therefore need to be targeted to areas of high incidence. The aim of this study was to describe the temporal and geographic distribution of OHCA in the City of Cape Town, South Africa, and their proximity to percutaneous coronary intervention (PCI) resources. METHODS In this retrospective study, OHCA data between 1 January and 31 December 2018 were extracted from public and one private emergency medical services in the Western Cape. For temporal analysis, distribution of OHCA according to time of day, day of the week and month of the year were subjected to chi-squared testing. For geospatial analysis, cluster and outlier, and hotspot analyses were performed. Proximity analysis was employed to determine the driving time from OHCA location to the closest PCI-capable facility. RESULTS A total of 929 patients with OHCA received an emergency medical services response in the City of Cape Town, corresponding to an annual prevalence of 23.2 per 100 000 persons. The distribution of OHCA incidence was not explained by month of the year (p = 0.08) or day of the week (p = 0.67). A statistically significant variation in OHCA incidence was explained by time of day (p < 0.01) with 30% (n = 279) of all OHCAs occurring from 05:00 to 09:59. Geospatial analysis yielded a large area of hotspots (99% confidence interval) over the centre of the metropole, Cape Flats and southern suburbs. The median (interquartile range) driving time from the incident to the closest PCI-capable facility was 10:22 (08:05) minutes. CONCLUSIONS Incidents of OHCA occurred predominantly at home during the mid-morning, with hotspots around the city centre and residential suburbs of Cape Town. While the incidents occurred close to PCI-capable facilities, some areas remained underserved and access to PCI for OHCA victims may be impossible due to socio-economic factors. With an increase in OHCA incidence expected, it is essential that contextual, cost-effective management interventions be developed and implemented.
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Affiliation(s)
- Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
| | - Elzarie Theron
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Thomas Slingsby
- Geographic Information Systems Support, Digital Library Services, University of Cape Town, Cape Town, South Africa
| | - Craig Wylie
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa; Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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6
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Shaik Alavudeen S, Basharat V, Khaled Bahamdan A, Easwaran V, Khaled Bahamdan G, Akhtar MS, Alshahrani S, Alqahtani A, Venkatesan K. Knowledge, attitude and preparedness of healthcare students toward basic life support at King Khalid University, Abha, Kingdom of Saudi Arabia. Clin Exp Hypertens 2022; 44:634-640. [PMID: 35922057 DOI: 10.1080/10641963.2022.2103145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Worldwide, millions of people die of sudden cardiac arrest every year. A well-timed cardiopulmonary resuscitation (CPR) increases the possibility of survival by two- to fourfolds. This study aimed to assess the knowledge, attitude, and preparedness of health care students toward basic life support (BLS) at King Khalid University. METHODS A cross-sectional study was conducted among the health care students of King Khalid University from August to October 2020. Data were collected using a pretested, semi-structured questionnaire and the data were analyzed using Statistical Package for the Social Sciences. RESULRS The total number of participants was 346. Overall, the participant's knowledge regarding the BLS was inadequate. Majority of the participants were not aware of the acronyms used in BLS. The level of education has a significant impact on the knowledge, whereas gender has no significant impact on the knowledge. The answers to the attitude and the preparedness items were also not satisfying. Lack of knowledge is one of the common reasons for not performing BLS. Periodical training program and refresher courses were the most recommended methods to increase the knowledge toward the BLS. CONCLUSION It is evident from the current study that there is a lack of knowledge and preparedness toward BLS among most health care students. It is recommended to incorporate more BLS training and refresher courses in the health care college curricula.
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Affiliation(s)
| | - Viqar Basharat
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, KSA
| | | | - Vigneshwaran Easwaran
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, KSA
| | - Ghadah Khaled Bahamdan
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, KSA
| | - Md Sayeed Akhtar
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, KSA
| | - Sultan Alshahrani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, KSA
| | - Ali Alqahtani
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha, KSA
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Oliveira TMN, Moreira ACMG, Martins EAP. simulação da reanimação cardiopulmonar e o conhecimento de socorristas. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.39427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objetivo: comparar o conhecimento de socorristas antes e depois da capacitação de reanimação cardiopulmonar com o método da simulação realística. Método: estudo quase-experimental realizado com 41 socorristas do Suporte Básico de Vida que contemplam 8 bases da 18° Regional de Saúde do Paraná. Os socorristas responderam ao Instrumento para Avaliação da capacitação em Ressuscitação Cardiopulmonar aplicado antes e depois da simulação realística. Resultados: obteve-se diferença estatisticamente significativa (p < 0,02) em 6 das 10 questões, as quais abordaram: a sequência das manobras de reanimação cardiopulmonar; a carga elétrica do desfibrilador externo automático; a posição, a profundidade e a velocidade das compressões torácicas; a relação compressão/ventilação; e o manuseio do desfibrilador externo automático. Já em outras duas questões — reconhecimento da parada cardiorrespiratória e dispositivo de ventilação com pressão positiva — não houve mudança quanto à alternativa de resposta. Encontraram-se 60% de acertos das questões quando avaliado o conhecimento prévio e 90% de acertos após as fases da simulação realística. Conclusão: os socorristas não atingiram com totalidade o questionário de pré-teste; entretanto, após a estratégia da simulação realística, houve um aumento significativo desse conhecimento. Esses resultados demonstraram melhoria no conhecimento cognitivo dos socorristas após simulação, o que foi comprovado pelo aumento de conhecimento expresso no pós-teste. Essa metodologia também pode ser aplicada com sucesso a essa categoria profissional.
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COVID-19: cardiovascular manifestations-a review of the cardiac effects. J Geriatr Cardiol 2022; 19:245-250. [PMID: 35464648 PMCID: PMC9002085 DOI: 10.11909/j.issn.1671-5411.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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Musi ME, Perman SM. Mode of transportation of out-of-hospital cardiac arrest patients, the role of community actions and interventions. Resuscitation 2022; 173:144-146. [PMID: 35276313 DOI: 10.1016/j.resuscitation.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
The Emergency Medical Services constitutes a critical component in treating patients with out-of-hospital cardiac arrest (OHCA). Activating the EMS system is the first important step in deploying resources, but community involvement in the care of emergent patients is multifaceted and complex. How does the public access EMS services versus other modes of transport remains under investigated; and if the public opts for a different mode of transport to the hospital, how does this affect outcomes?
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Affiliation(s)
- Martin E Musi
- Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA. Mail Stop B-215, 12401 17(th) Avenue, Aurora, CO, 80045, USA.
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA. Mail Stop B-215, 12401 17(th) Avenue, Aurora, CO, 80045, USA.
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Abou Dagher G, Bou Chebl R, Safa R, Assaf M, Kattouf N, Hajjar K, El Khuri C, Berbari I, Makki M, El Sayed M. The prevalence of bacteremia in out of hospital cardiac arrest patients presenting to the emergency department of a tertiary care hospital. Ann Med 2021; 53:1207-1215. [PMID: 34282693 PMCID: PMC8293943 DOI: 10.1080/07853890.2021.1953703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) remains one of the most common causes of death. There is a scarcity of evidence concerning the prevalence of bacteraemia in cardiac arrest patients presenting to the Emergency Department (ED). We aimed to determine the prevalence of bacteraemia in OHCA patients presenting to the ED, as well as study the association between bacteraemia and in-hospital mortality in OHCA patients. In addition, the association between antibiotic use during resuscitation and in-hospital mortality was examined. METHODS AND RESULTS This was a study of 200 adult OHCA patients who presented to the ED between 2015 and 2019. Bacteraemia was confirmed if at least one of the blood culture bottles grew a non-skin flora pathogen or if two blood culture bottles grew a skin flora pathogen from two different sites. The prevalence of bacteraemia was 46.5%. Gram positive bacteria, specifically Staphylococcus species, were the most common pathogens isolated from the bacteremic group. 42 patients survived to hospital admission. The multivariate analysis revealed that there was no association between bacteraemia and hospital mortality in OHCA patients (OR = 1.3, 95% CI= 0.2-9.2) with a p-value of .8. There was no association between antibiotic administration during resuscitation and hospital mortality (OR = 0.6, 95% CI= 0.1 - 3.8) with a p-value of .6. CONCLUSION In our study, the prevalence of bacteraemia among OHCA patients presenting to the ED was found to be 46.5%. Bacteremic and non-bacteremic OHCA patients had similar initial baseline characteristics and laboratory parameters except for higher serum creatinine and BUN in the bacteremic group. In OHCA patients who survived their ED stay there was no association between hospital mortality and bacteraemia or antibiotic administration during resuscitation. There is a need for randomised controlled trials with a strong patient oriented primary outcome to better understand the association between in-hospital mortality and bacteraemia or antibiotic administration in OHCA patients.KEY MESSAGESWe aimed to determine the prevalence of bacteraemia in OHCA patients presenting to the Emergency Department. In our study, we found that 46.5% of patients presenting to our ED with OHCA were bacteremic.Bacteremic and non-bacteremic OHCA patients had similar initial baseline characteristics and laboratory parameters except for higher serum creatinine and BUN in the bacteremic group.We found no association between bacteraemia and hospital mortality. There was no association between antibiotic administration during resuscitation and hospital mortality.There is a need for randomised controlled trials with a strong patient oriented primary outcome to better understand the association between in-hospital mortality and bacteraemia or antibiotic administration in OHCA patients.
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Affiliation(s)
- Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Ralph Bou Chebl
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Rawan Safa
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohammad Assaf
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadim Kattouf
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Karim Hajjar
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Christopher El Khuri
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Iskandar Berbari
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha Makki
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
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11
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Stassen W, Wylie C, Djärv T, Wallis LA. Out-of-hospital cardiac arrests in the city of Cape Town, South Africa: a retrospective, descriptive analysis of prehospital patient records. BMJ Open 2021; 11:e049141. [PMID: 34400458 PMCID: PMC8370552 DOI: 10.1136/bmjopen-2021-049141] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES While prospective epidemiological data for out-of-hospital cardiac arrest (OHCA) exists in many high-income settings, there is a dearth of such data for the African continent. The aim of this study was to describe OHCA in the Cape Town metropole, South Africa. DESIGN Observational study with a retrospective descriptive design. SETTING Cape Town metropole, Western Cape province, South Africa. PARTICIPANTS All patients with OHCA for the period 1 January 2018-31 December 2018 were extracted from public and private emergency medical services (EMS) and described. OUTCOME MEASURES Description of patients with OHCA in terms of demographics, treatment and short-term outcome. RESULTS A total of 929 patients with OHCA received an EMS response in the Cape Town metropole, corresponding to an annual prevalence of 23.2 per 100 000 persons. Most patients were adult (n=885; 96.5%) and male (n=526; 56.6%) with a median (IQR) age of 63 (26) years. The majority of cardiac arrests occurred in private residences (n=740; 79.7%) and presented with asystole (n=322; 34.6%). EMS resuscitation was only attempted in 7.4% (n=69) of cases and return of spontaneous circulation (ROSC) occurred in 1.3% (n=13) of cases. Almost all patients (n=909; 97.8%) were declared dead on the scene. CONCLUSION To our knowledge, this was the largest study investigating OHCA ever undertaken in Africa. We found that while the incidence of OHCA in Cape Town was similar to the literature, resuscitation is attempted in very few patients and ROSC-rates are negligible. This may be as a consequence of protracted response times, poor patient prognosis or an underdeveloped and under-resourced Chain of Survival in low- to middle-income countries, like South Africa. The development of contextual guidelines given resources and disease burden is essential.
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Affiliation(s)
- Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Craig Wylie
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Therese Djärv
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Epidemiology, etiology, and outcomes of in-hospital cardiac arrest in Lebanon. J Geriatr Cardiol 2021; 18:416-425. [PMID: 34220971 PMCID: PMC8220382 DOI: 10.11909/j.issn.1671-5411.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) constitutes a significant cause of morbidity and mortality. As data is scarce in the Middle East and Lebanon, we devised this study to shed some light on it to better inform both hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon. METHODS We analyzed retrospective data from 680 IHCA events at the American University of Beirut Medical Center between July 1, 2016 and May 2, 2019. Sociodemographic variables included age and sex, in addition to the comorbidities listed in the Charlson comorbidity index. IHCA event variables were day, event location, time from activation to arrival, initial cardiac rhythm, and the total number of IHCA events. We also looked at the months and years. We considered the return of spontaneous circulation (ROSC) and survival to discharge (StD) to be our outcomes of interest. RESULTS The incidence of IHCA was 6.58 per 1,000 hospital admissions (95% CI: 6.09-7.08). Non-shockable rhythms were 90.7% of IHCAs. Most IHCA cases occurred in the closed units (87.9%) (intensive care unit, respiratory care unit, neurology care unit, and cardiology care unit) and on weekdays (76.5%). ROSC followed more than half the IHCA events (56%). However, only 5.4% of IHCA events achieved StD. Both ROSC and StD were higher in cases with a shockable rhythm. Survival outcomes were not significantly different between day, evening, and nightshifts. ROSC was not significantly different between weekdays and weekends; however, StD was higher in events that happened during weekdays than weekends (6.7%vs. 1.9%, P = 0.002). CONCLUSIONS The incidence of IHCA was high, and its outcomes were lower compared to other developed countries. Survival outcomes were better for patients who had a shockable rhythm and were similar between the time of day and days of the week. These findings may help inform hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.
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Wang YC, Sung FC, Chen YJ, Cheng CP, Lin YK. Effects of extreme temperatures, fine particles and ozone on hourly ambulance dispatches. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 765:142706. [PMID: 33071137 DOI: 10.1016/j.scitotenv.2020.142706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
There is a dearth of research on the hourly risk of ambulance dispatches with respect to ambient conditions. We evaluated hourly relative risks (RR) and 95% confidence interval (CI) of ambulance dispatches in Taiwan to treat respiratory distress, coma and unconsciousness, and out-of-hospital cardiac arrest (OHCA), from 2006 to 2015. We considered island-wide ambient temperatures, fine particulate matter (PM2.5), and ozone (O3) at lag 0-180 h while using a distributed lag nonlinear model and meta-analysis. Results showed the pooled risks peaked at lag 16-18 h for all ambulance dispatches at 99th percentile of hourly temperature (32 °C, versus reference temperature of 25 °C), with significant excess risk of 0.11% (95% CI; 0.06, 0.17) for coma and unconsciousness, and 0.06% (95% CI; 0.01, 0.11) for OHCA. The risks of exposure to 90th percentile of hourly O3 of 52.3 ppb relative to the Q1 level of 17.3 ppb peaked at lag 14 h, with excess risk of 0.17% (95% CI; 0.11, 0.23) for respiratory distress, 0.11% (95% CI; 0.06, 0.16) for coma and unconsciousness, and 0.07% (95% CI; 0.01, 0.14) for OHCA. The population exposed to reference temperatures of 28 °C, 20 °C, and 26 °C were exposed to the lowest levels of ambulance dispatches risk for respiratory distress, coma and unconsciousness, and OHCA, respectively; the highest cumulative 0-96 h RRs of ambulance dispatches were 1.27 (95% CI; 1.19, 1.35) for OHCA at 5th percentile temperatures and 1.25 (95% CI; 1.11, 1.41) for OHCA at 99th percentile temperatures. Following an accumulating lag of 0-96 h, no significant risk was identified for hourly levels of PM2.5 and O3. In conclusion, the analytical results of hourly data speak to immediate and real-time responses to environmental changes, rather than to short-term relationships. In our analyses, we emphasized health events in extreme heat; thus, we recommend a comparative study of daily versus hourly associations.
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Affiliation(s)
- Yu-Chun Wang
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli 320, Taiwan
| | - Fung-Chang Sung
- Department of Health Services Administration, China Medical University, 91 Hsueh-Shih Road, Taichung 404, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan; Department of Food Nutrition and Health Biotechnology, Asia University, Taichung 413, Taiwan
| | - Yi-Jhih Chen
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli 320, Taiwan
| | - Chia-Pei Cheng
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli 320, Taiwan
| | - Yu-Kai Lin
- Department of Health and Welfare, University of Taipei, 101 Zhongcheng Road Sec. 2, Taipei 111, Taiwan.
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Schnaubelt S, Monsieurs KG, Semeraro F, Schlieber J, Cheng A, Bigham BL, Garg R, Finn JC, Greif R. Clinical outcomes from out-of-hospital cardiac arrest in low-resource settings - A scoping review. Resuscitation 2020; 156:137-145. [PMID: 32920113 DOI: 10.1016/j.resuscitation.2020.08.126] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
AIM OF THE SCOPING REVIEW Scientific recommendations on resuscitation are typically formulated from the perspective of an ideal resource environment, with little consideration of applicability in lower-income countries. We aimed to determine clinical outcomes from out-of-hospital cardiac arrest (OHCA) in low-resource countries, to identify shortcomings related to resuscitation in these areas and possible solutions, and to suggest future research priorities. DATA SOURCES This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We identified low-resource countries as countries with a low- or middle gross national income per capita (World Bank data). We performed a literature search on outcomes after OHCA in these countries, and we extracted data on the outcome. We applied descriptive statistics and conducted a post-hoc correlation analysis of cohort size and ROSC rates. RESULTS We defined 24 eligible studies originating from middle-income countries, but none from low-income regions, suggesting a reporting bias. The number of reported patients in these studies ranged from 54 to 3214. Utstein-style reporting was rarely used. Return of spontaneous circulation varied from 0% to 62%. Fifteen studies reported on survival to hospital discharge (between 1.0 and 16.7%) or favourable neurological outcome (between 1.0 and 9.3%). An inverse correlation was found for study cohort size and the rate of return of spontaneous circulation (ρ = -0.48, p = 0.034). CONCLUSION Studies of OHCA outcomes in low-resource countries are heterogeneous and may be compromised by reporting bias. Minimum cardiopulmonary resuscitation standards for low-resource settings should be developed collaboratively involving local experts, respecting culture and context while balancing competing health priorities.
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Affiliation(s)
- S Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Austria.
| | - K G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital Bologna, Italy
| | - J Schlieber
- Department of Anaesthesia and Intensive Care, Allgemeine Unfallversicherungsanstalt, Trauma Centre Salzburg, Salzburg, Austria
| | - A Cheng
- Departments of Paediatrics and Emergency Medicine, University of Calgary, Calgary, Canada
| | - B L Bigham
- Department of Medicine, Stanford University, CA, USA
| | - R Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr Braich, All India Institute of Medical Sciences, New Delhi, India
| | - J C Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - R Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S222-S283. [PMID: 33084395 DOI: 10.1161/cir.0000000000000896] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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16
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC, Baldi E, Beck S, Beckers SK, Blewer AL, Boulton A, Cheng-Heng L, Yang CW, Coppola A, Dainty KN, Damjanovic D, Djärv T, Donoghue A, Georgiou M, Gunson I, Krob JL, Kuzovlev A, Ko YC, Leary M, Lin Y, Mancini ME, Matsuyama T, Navarro K, Nehme Z, Orkin AM, Pellis T, Pflanzl-Knizacek L, Pisapia L, Saviani M, Sawyer T, Scapigliati A, Schnaubelt S, Scholefield B, Semeraro F, Shammet S, Smyth MA, Ward A, Zace D. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A188-A239. [PMID: 33098918 DOI: 10.1016/j.resuscitation.2020.09.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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17
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Awadalla NJ, Al Humayed RS, Mahfouz AA. Experience of Basic Life Support among King Khalid University Health Profession Students, Southwestern Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4822. [PMID: 32635499 PMCID: PMC7370157 DOI: 10.3390/ijerph17134822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Satisfactory experience about basic life support (BLS) is crucial to ensure rapid and efficient delivery of essential life-saving care during emergency situations. OBJECTIVES To assess BLS experience among health profession students at King Khalid University (KKU), Southwestern Saudi Arabia. METHODS A cross-sectional study was conducted on a representative sample of male and female health profession students, during the academic year 2019-2020. A self-reported questionnaire was utilized to collect data about BLS experiences, which included receiving BLS training, reasons for not having BLS training, suggestions to improve BLS training, encountering a situation that required the use of BLS, practicing BLS when needed and reasons for not practicing BLS when needed. RESULTS Out of 1261 health profession students, 590 received formal BLS training with a prevalence rate of 46.8% (95% CI: 44.0-49.6), and 46.0% of them trained at the university. Important obstacles for non-attendance included busy academic schedule (54.7%) and high cost of the training course (18%). Overall, 84.1% supported integration of BLS training into their college curricula. Almost 26% encountered a situation that required BLS; however, only 32.4% responded. Through multivariate regression, the significant determinant of response was having formal BLS training (aOR = 4.24, 95% CI: 2.38-7.54). The frequent reasons for non-response were lack of adequate BLS knowledge (35.0%), nervousness (22.8%), and that the victim was of opposite sex (9.0%). CONCLUSION It is recommended that more emphasis should be given to BLS training among undergraduates of health profession colleges in Southwestern Saudi Arabia. It is recommended that BLS training be integrated into health profession college curricula. Including BLS training as a graduation requirement for health profession students might motivate students to attain BLS training courses.
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Affiliation(s)
- Nabil J. Awadalla
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (N.J.A.); (R.S.A.H.)
- Department of Community Medicine, College of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Razan S. Al Humayed
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (N.J.A.); (R.S.A.H.)
| | - Ahmed A. Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (N.J.A.); (R.S.A.H.)
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21511, Egypt
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18
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Epidemiology and Outcomes from Out-of-Hospital Cardiac Arrest in Kuwait. Emerg Med Int 2020; 2020:9861798. [PMID: 32377439 PMCID: PMC7195672 DOI: 10.1155/2020/9861798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/04/2022] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) survival remains low in most countries. Few studies examine OHCA outcomes out of the Middle East region. This is the first study to describe characteristics and outcomes of patients with OHCA treated by emergency medical services (EMS) in regions of Kuwait. Objectives To describe characteristics and outcomes of adult patients affected with OHCA in regions of Kuwait. Methods This was a retrospective observational study on all adult OHCA patients transported by EMS to regional emergency departments over a 10- month period (21 February–31 December 2017). Data were collected from various sources: national emergency medical services archived data, emergency department, intensive care unit, and cardiac care unit of two hospitals. Results A total of 332 EMS-treated OHCA cases were reviewed, and 286 incidents with OHCA from cardiac aetiology were included in the study. Most were non-Kuwaiti (60.8%) males (67.1%) with mean age 61 (+−16) years. Most OHCA cases occurred at home (76%) but with low witness rate (11.5%). Bystander CPR rate was low (8.7%). ROSC was achieved in ten patients (3.5%), but only 1 (0.3%) patient survived to hospital discharge. Conclusion OHCA survival rates in this region of Kuwait are low. Targeted measures such as creating cardiac registry, dispatcher-assisted CPR with ongoing training and quality improvement, and community-based CPR education program are needed to improve the survival rates of OHCA victims.
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Ambulance Services Associated with Extreme Temperatures and Fine Particles in a Subtropical Island. Sci Rep 2020; 10:2855. [PMID: 32071336 PMCID: PMC7029034 DOI: 10.1038/s41598-020-59294-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/20/2020] [Indexed: 11/13/2022] Open
Abstract
This study evaluated the association between the risk of events requiring ambulance services and the ambient temperature and particulate matter of 2.5 μm (PM2.5) and 10 μm (PM10) for populations living in subtropical Taiwan. We used a distributed lag nonlinear model with a quasi-Poisson function to assess the roles of ambient temperature, PM10 and PM2.5 in the use of ambulance services for respiratory distress, coma and unconsciousness, chest pain, lying down in public, headaches/dizziness/vertigo/fainting/syncope and out-of-hospital cardiac arrest (OHCA). The relative risk (RR) and 95% confidence interval (CI) of each specific event were calculated in association with the ambient conditions. In general, the events that required ambulance services had a V-shaped or J-shaped association with the temperature, where the risks were higher at extreme temperatures. The RR of each event was significant when the patients were exposed to temperatures in the 5th percentile (<15 °C); patients with OHCA had the highest adjusted RR of 1.61 (95% CI = 1.47–1.77). The risks were also significant for coma/unconsciousness, headaches/dizziness/vertigo/fainting/syncope, and OHCA but not for respiratory distress, chest pain and lying down in public, after exposure to the 99th percentile temperatures of >30 °C. The risks for use of ambulance services increased with PM exposure and were significant for events of respiratory distress, chest pain and OHCA after exposure to the 99th percentile PM2.5 after controlling for temperatures. Events requiring ambulance services were more likely to occur when the ambient temperature was low than when it was high for the population on the subtropical island of Taiwan. The association of the risk of events requiring ambulance services with PM were not as strong as the association with low temperatures.
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Isma'eel H, Noureddine S, Mohammad M, Zgheib A, Abou Arbid S, Njeim M, Nasr S, Bassil R, Sarkis A, Abi Saleh B, El Sayed M. Out-of-hospital cardiopulmonary resuscitation: a position statement of the Lebanese Society of Cardiology and the Lebanese Society of Emergency Medicine. Cardiovasc Diagn Ther 2019; 9:609-612. [PMID: 32038951 DOI: 10.21037/cdt.2019.11.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Out of hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Early cardiopulmonary resuscitation (CPR) and early defibrillation are key to improving outcomes of patients with OHCA including return of spontaneous circulation (ROSC) and survival to hospital discharge with good neurologic outcomes. Lebanon like other developing countries, suffers from absence of organized prehospital cardiac arrest care bundle and from absence of a legal framework for community involvement in cardiac arrest care. Scientific societies, involved non-governmental organizations (NGOs) and local governmental stakeholders organized a national meeting to launch a strategy aiming at improving OHCA outcomes in Lebanon. This article represents a position statement of the Lebanese Society of Cardiology and the Lebanese Society of Emergency Medicine summarizing the strategy to improve out-of-hospital CPR. Participating stakeholders developed and submitted a law proposal of a "Good Samaritan Law" to the Lebanese parliament. Several of activities were also launched aiming at establishing public access defibrillation programs and at training bystanders in different areas in Lebanon to perform bystander CPR and use automated external defibrillators (AEDs). Additional recommendations were proposed to local emergency medical system (EMS) agencies to improve prehospital care and introduce medical direction to prehospital activities.
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Affiliation(s)
- Hussain Isma'eel
- Clinical Medicine, Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samar Noureddine
- Graduate Division, School of Nursing, American University of Beirut, Beirut, Lebanon
| | | | - Ali Zgheib
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samer Abou Arbid
- Division of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mario Njeim
- Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Samer Nasr
- Department of Cardiology, Mount Lebanon Hospital, Beirut, Lebanon
| | - Rania Bassil
- Saint Joseph University and Keserwan Medical Center, Beirut, Lebanon
| | - Anthony Sarkis
- Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Bernard Abi Saleh
- Section of Electrophysiology, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Emergency Medical Services and Prehospital Care, Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Refaat MM, Kozhaya K, Abou‐Zeid F, Abdulhai F, Faour K, Mourani SC, Abi‐Gerges C, Bachir R, Musharrafieh U, El Sayed M. Epidemiology, etiology, and outcomes of out‐of‐hospital cardiac arrest in young patients in lebanon. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1390-1395. [DOI: 10.1111/pace.13801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/26/2019] [Accepted: 08/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Marwan M. Refaat
- Division of Cardiology, Department of Internal MedicineAmerican University of Beirut Medical Center Beirut Lebanon
| | - Karim Kozhaya
- American University of Beirut Medical SchoolAmerican University of Beirut Medical center Beirut Lebanon
| | - Farah Abou‐Zeid
- American University of Beirut Medical SchoolAmerican University of Beirut Medical center Beirut Lebanon
| | - Farah Abdulhai
- American University of Beirut Medical SchoolAmerican University of Beirut Medical center Beirut Lebanon
| | - Kawthar Faour
- American University of Beirut Medical SchoolAmerican University of Beirut Medical center Beirut Lebanon
| | - Sara Catherine Mourani
- American University of Beirut Medical SchoolAmerican University of Beirut Medical center Beirut Lebanon
| | - Carine Abi‐Gerges
- American University of Beirut Medical SchoolAmerican University of Beirut Medical center Beirut Lebanon
| | - Rana Bachir
- Clinical Research InstituteAmerican University of Beirut Medical Center Beirut Lebanon
| | - Umayya Musharrafieh
- Department of Family MedicineAmerican University of Beirut Medical Center Beirut Lebanon
| | - Mazen El Sayed
- Department of Emergency MedicineAmerican University of Beirut Medical Center Beirut Lebanon
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Ahmad A, Akhter N, Mandal RK, Areeshi MY, Lohani M, Irshad M, Alwadaani M, Haque S. Knowledge of basic life support among the students of Jazan University, Saudi Arabia: Is it adequate to save a life? ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2018.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Awais Ahmad
- Research and Scientific Studies Unit, College of Nursing & Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Naseem Akhter
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Albaha University, Albaha, 65431, Saudi Arabia
| | - Raju K. Mandal
- Research and Scientific Studies Unit, College of Nursing & Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Mohammed Y. Areeshi
- Research and Scientific Studies Unit, College of Nursing & Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Mohtashim Lohani
- Research and Scientific Studies Unit, College of Nursing & Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Mohammad Irshad
- Department of Bioclinical Sciences, Faculty of Dentistry, Health Sciences Centre, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait
| | - Mohsen Alwadaani
- Research and Scientific Studies Unit, College of Nursing & Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing & Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia
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Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091532. [PMID: 31052200 PMCID: PMC6539897 DOI: 10.3390/ijerph16091532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
The aim of the study was to identify the characteristics of missions performed by HEMS (Helicopter Emergency Medical Service) crews and the analysis of health problems, which are the most common cause of intervention in rural areas in Poland. The study was conducted using a retrospective analysis based on the medical records of patients provided by the HEMS crew, who were present for the emergencies in rural areas in the period from January 2011 to December 2018. The final analysis included 37,085 cases of intervention by HEMS crews, which accounted for 54.91% of all the missions carried out in the study period. The majority (67.4%) of patients rescued were male, and just under a quarter of those rescued were aged between 50-64 years. Injuries (51.04%) and cardiovascular diseases (36.49%) were the main diagnoses found in the study group. Whereas injuries were significantly higher in the male group and patients below 64 years of age, cardiovascular diseases were higher in women and elderly patients (p < 0.001). Moreover, in the group of women myocardial infarction was significantly more frequent (30.95%) than men, while in the group of men head injuries (27.10%), multiple and multi-organ injuries (25.93%), sudden cardiac arrest (14.52%), stroke (12.19%), and epilepsy (4.95%) was significantly higher. Factors that are associated with the most common health problems of rural patients are: gender and age, as well as the seasons of the year and the values of the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and National Advisory Committee for Aeronautics (NACA) used to assess the clinical status of patients.
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Meghoo CA, Gaievskyi S, Linchevskyy O, Oommen B, Stetsenko K. Prehospital response to respiratory distress by the public ambulance system in a Ukrainian city. World J Emerg Med 2019; 10:42-45. [PMID: 30598717 DOI: 10.5847/wjem.j.1920-8642.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The capability of the public ambulance system in Ukraine to address urgent medical complaints in a prehospital environment is unknown. Evaluation using reliable sources of patient data is needed to provide insight into current treatments and outcomes. METHODS We obtained access to de-identified computer records from the emergency medical services (EMS) dispatch center in Poltava, a medium-sized city in central Ukraine. Covering a five-month period, we retrieved data for urgent calls with a patient complaint of respiratory distress. We evaluated ambulance response and treatment times, field diagnoses, and patient disposition, and analyzed factors related to fatal outcomes. RESULTS Over the five-month period of the study, 2,029 urgent calls for respiratory distress were made to the Poltava EMS dispatch center. A physician-led ambulance typically responded within 10 minutes. Seventy-seven percent of patients were treated and released, twenty percent were taken to hospital, and three percent died in the prehospital phase. On univariate analysis, age over 60 and altered mental status at the time of the call were strongly associated with a fatal outcome. CONCLUSION The EMS dispatch center in a medium-sized city in Ukraine has adequate organizational infrastructure to ensure that a physician-led public ambulance responds rapidly to complaints of respiratory distress. That EMS system was able to manage most patients without requiring hospital admission. However, a prehospital fatality rate of three percent suggests that further research is warranted to determine training, equipment, or procedural needs of the public ambulance system to manage urgent medical conditions.
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Affiliation(s)
| | | | | | - Bindhu Oommen
- Hunt Regional Medical Center, Greenville, Texas, USA
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Sabra M, Refaat MM. The Sudden Cardiac Arrest-mortality score (SCA-MS): A novel score to predict long-term survival after sudden cardiac arrest. Pacing Clin Electrophysiol 2018; 41:1591-1592. [DOI: 10.1111/pace.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Mohammad Sabra
- Division of Cardiology; American University of Beirut Medical Center; Beirut Lebanon
| | - Marwan M. Refaat
- Division of Cardiology; American University of Beirut Medical Center; Beirut Lebanon
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Rebeiz A, Sasso R, Bachir R, Mneimneh Z, Jabbour R, El Sayed M. Emergency Medical Services Utilization and Outcomes of Patients with ST-Elevation Myocardial Infarction in Lebanon. J Emerg Med 2018; 55:827-835. [PMID: 30301584 DOI: 10.1016/j.jemermed.2018.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/30/2018] [Accepted: 09/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Arrival of patients with ST-elevation myocardial infarction (STEMI) by Emergency Medical Services (EMS) results in shorter reperfusion times and lower mortality in developed countries. OBJECTIVES This study examines EMS use by STEMI patients in Lebanon and associated clinical outcomes. METHODS A retrospective observational study with chart review was carried out for STEMI patients arriving to the Emergency Department of a tertiary care center in Lebanon between January 1, 2013 and August 31, 2016. A descriptive analysis was done and followed by a bivariate analysis comparing two groups of patients (EMS vs. Non-EMS). RESULTS A total of 280 patients were included in the study. They were mostly male (71.8%). Mean age was 65.1 years (95% confidence interval [CI] 63.4-66.9). Only 12.5% (95% CI 8.6-16.4) presented by EMS. Chest pain (81.1%) was the most common presenting symptom. Anterior myocardial infarction was the most common electrocardiogram (ECG) diagnosis (51.4%). Most patients were admitted (98.2%), and 72.0% of these patients were treated with primary percutaneous coronary intervention. Cardiogenic shock was the most frequent in-hospital complication (6.2%). The mortality rate was 7.1%. Mean door-to-ECG and door-to-balloon times were 10.8 (95% CI 7.1-14.4) min and 106.2 (95% CI 95.9-116.6) min, respectively. Patients' characteristics, presenting symptoms, outcomes, and performance metrics were similar between the two groups. CONCLUSION EMS is underutilized by STEMI patients in Lebanon and is not associated with improvement in clinical outcomes. Medical oversight and quality initiatives focusing on outcomes of patients with timely sensitive emergencies are needed to advance the prehospital care system in Lebanon.
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Affiliation(s)
- Abdallah Rebeiz
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roula Sasso
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Bachir
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Mneimneh
- Quality, Accreditation & Risk Management Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Jabbour
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; EMS and Prehospital Care Program, Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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