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Baig MNA, Khan N, Naseer R, Akhter S, Shaikh AJ, Razzak JA. Pakistan's Emergency Medical Services (EMS) system & out-of-hospital-cardiac-arrest (OHCA): A narrative review of an EMS system of a low middle income country in context of OHCA. Resusc Plus 2024; 18:100627. [PMID: 38590447 PMCID: PMC11000191 DOI: 10.1016/j.resplu.2024.100627] [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] [Indexed: 04/10/2024] Open
Abstract
Pakistan's Emergency Medical Services (EMS) are a critical component of its healthcare system, providing pre-hospital emergency care across a nation with over 220 million people. This article explores the evolutionary journey of Pakistan's EMS, highlighting both the challenges it faces and the strides it has made, with a specific emphasis on patients experiencing out-of-hospital cardiac arrest (OHCA). To extract relevant information, we searched MEDLINE & Embase data bases using MeSH terms "Emergency Medical Services" OR "EMS" AND "Out-of-Hospital-Cardiac-Arrest" OR "OHCA" AND "Pakistan". In addition, we also retrieved information from the EMS leadership in Pakistan through e-mails. We delve into the significance of key performance indicators for OHCA, advocate for the establishment of OHCA registries to improve patient outcomes, address regional disparities in pre-hospital care, and acknowledge the gradual progress of the EMS system.
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Affiliation(s)
- Mirza Noor Ali Baig
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
- Centre of Excellence for Trauma & Emergencies, The Aga Khan University, Karachi, Pakistan
| | - Nadeemullah Khan
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Abid Jalaluddin Shaikh
- Sindh Emergency Service Rescue 1122, Rehabilitation Department, Government of Sindh, Pakistan
| | - Junaid Abdul Razzak
- Centre of Excellence for Trauma & Emergencies, The Aga Khan University, Karachi, Pakistan
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van Rensburg L, Majiet N, Geldenhuys A, King LL, Stassen W. A resuscitation systems analysis for South Africa: A narrative review. Resusc Plus 2024; 18:100655. [PMID: 38770395 PMCID: PMC11103484 DOI: 10.1016/j.resplu.2024.100655] [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] [Indexed: 05/22/2024] Open
Abstract
With a growing incidence in cardiovascular diseases in Africa, including South Africa, and with it a greater incidence of out-of-hospital cardiac arrest (OHCA) there is a need to understand the readiness of these emergency care systems to support a response. Yet, OHCA is expensive and requires comprehensive development across an entire chain of survival in order to gain any benefit in mortality or morbidity. In this narrative review, we provide a resuscitation systems analysis using the Global Resuscitation Alliance's Frame of Survival. We provide evidence or commentary on the elements of the outer frame and inner frame, and make an assessment of the South African system's readiness to support OHCA care, and provide suggestions for priority areas that need to be developed. The South African resuscitation system demonstrates reasonable readiness to respond to OHCA but is characterised by considerable variation and fragmentation. Given the cost ineffectiveness of many interventions and the anticipated rise in OHCA incidence, there is a pressing need for context-specific strategies in South Africa. These strategies should focus on enhancing both outcomes and resource efficiency, while respecting community ethics and sociocultural dynamics.
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Affiliation(s)
| | - Naqeeb Majiet
- Division of Emergency Medicine, University of Cape Town, South Africa
- Emergency Medical Services, Western Cape Department of Health & Wellness, South Africa
| | | | - Lauren Lai King
- Division of Emergency Medicine, University of Cape Town, South Africa
- African Federation for Emergency Medicine, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, South Africa
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Gerecht RB, Nable JV. Out-of-Hospital Cardiac Arrest. Cardiol Clin 2024; 42:317-331. [PMID: 38631798 DOI: 10.1016/j.ccl.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Survival from out-of-hospital cardiac arrest (OHCA) is predicated on a community and system-wide approach that includes rapid recognition of cardiac arrest, capable bystander CPR, effective basic and advanced life support (BLS and ALS) by EMS providers, and coordinated postresuscitation care. Management of these critically ill patients continues to evolve. This article focuses on the management of OHCA by EMS providers.
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Affiliation(s)
- Ryan B Gerecht
- District of Columbia Fire and EMS Department, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Jose V Nable
- Georgetown University School of Medicine, Georgetown EMS, MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA.
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Ohk T, Cho J, Yang G, Ahn M, Lee S, Kim W, Lee T. Effectiveness of a dispatcher-assisted CPR using an animated image: Simulation study. Am J Emerg Med 2024; 78:132-139. [PMID: 38271790 DOI: 10.1016/j.ajem.2024.01.022] [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: 09/10/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Considering the few studies evaluating bystander cardiopulmonary resuscitation (CPR) performance, we sought to analyze differences in bystander CPR performance with and without the use of our self-developed animated GIFs based on dispatcher-assisted CPR simulation. METHODS A total of 80 adults who had not received CPR training over the past two years participated in the study. Among them, 40 people were classified into the auditory group (receiving CPR instructions only over the phone), and the other 40 people were classified into the audiovisual group (receiving CPR instructions over the phone after receiving images on a smartphone). All participants were asked to perform adult and infant CPR for 2 min. CPR performance was recorded using two video cameras (front and side) and analyzed by two emergency physicians, whereas CPR quality was measured using Resusci Anne & Baby QCPR Mk II (Laerdal). RESULTS In the adult CPR study, the audiovisual group had higher performance scores for adequacy of "knee position," "hand posture," "elbow extension," and "vertical compression," as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). No significant difference in CPR quality was observed between the two groups. In the infant CPR study, audiovisual group had higher performance scores in adequacy of "compression site," "finger posture," and "vertical compression," as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). Regarding CPR quality, the audiovisual group had higher scores for "adequate compression rate ratio" (p = 0.047). CONCLUSION Audiovisual guidance using animated GIFs more effectively improved CPR Standard Posture Completeness and Instruction Performance than did traditional auditory guidance.
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Affiliation(s)
- TaekGeun Ohk
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Republic of Korea; Department of Emergency Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - JunHwi Cho
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Republic of Korea; Department of Emergency Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Goeun Yang
- Department of Radiology, College of Medicine, Kangwon National University, Chuncheon, Republic of Korea; Department of Radiology, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Mooeob Ahn
- Department of Emergency Medicine, Chuncheon Sacred Heart hospital, Hallym College of Medicine, Chuncheon, Republic of Korea
| | - SangJong Lee
- Gangwon Fire Headquarters, Chuncheon, Republic of Korea
| | - WanSoo Kim
- Gangwon Fire Headquarters, Chuncheon, Republic of Korea
| | - TaeHun Lee
- Department of Emergency Medicine, Chuncheon Sacred Heart hospital, Hallym College of Medicine, Chuncheon, Republic of Korea.
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Birkun AA. News reports on cardiac arrest in famous people: The undervalued opportunity to enhance public attitudes towards resuscitation. Am J Emerg Med 2024; 78:221-223. [PMID: 38402101 DOI: 10.1016/j.ajem.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Affiliation(s)
- Alexei A Birkun
- Department of General Surgery, Anaesthesiology, Resuscitation and Emergency Medicine, Medical Institute named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation.
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Starks MA, Blewer AL, Chow C, Sharpe E, Van Vleet L, Arnold E, Buckland DM, Joiner A, Simmons D, Green CL, Mark DB. Incorporation of Drone Technology Into the Chain of Survival for OHCA: Estimation of Time Needed for Bystander Treatment of OHCA and CPR Performance. Circ Cardiovasc Qual Outcomes 2024; 17:e010061. [PMID: 38529632 PMCID: PMC11127748 DOI: 10.1161/circoutcomes.123.010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 01/10/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Drone-delivered automated external defibrillators (AEDs) hold promises in the treatment of out-of-hospital cardiac arrest. Our objective was to estimate the time needed to perform resuscitation with a drone-delivered AED and to measure cardiopulmonary resuscitation (CPR) quality. METHODS Mock out-of-hospital cardiac arrest simulations that included a 9-1-1 call, CPR, and drone-delivered AED were conducted. Each simulation was timed and video-recorded. CPR performance metrics were recorded by a Laerdal Resusci Anne Quality Feedback System. Multivariable regression modeling examined factors associated with time from 9-1-1 call to AED shock and CPR quality metrics (compression rate, depth, recoil, and chest compression fraction). Comparisons were made among those with recent CPR training (≤2 years) versus no recent (>2 years) or prior CPR training. RESULTS We recruited 51 research participants between September 2019 and March 2020. The median age was 34 (Q1-Q3, 23-54) years, 56.9% were female, and 41.2% had recent CPR training. The median time from 9-1-1 call to initiation of CPR was 1:19 (Q1-Q3, 1:06-1:26) minutes. A median time of 1:59 (Q1-Q3, 01:50-02:20) minutes was needed to retrieve a drone-delivered AED and deliver a shock. The median CPR compression rate was 115 (Q1-Q3, 109-124) beats per minute, the correct compression depth percentage was 92% (Q1-Q3, 25-98), and the chest compression fraction was 46.7% (Q1-Q3, 39.9%-50.6%). Recent CPR training was not associated with CPR quality or time from 9-1-1 call to AED shock. Younger age (per 10-year increase; β, 9.97 [95% CI, 4.63-15.31] s; P<0.001) and prior experience with AED (β, -30.0 [95% CI, -50.1 to -10.0] s; P=0.004) were associated with more rapid time from 9-1-1 call to AED shock. Prior AED use (β, 6.71 [95% CI, 1.62-11.79]; P=0.011) was associated with improved chest compression fraction percentage. CONCLUSION Research participants were able to rapidly retrieve an AED from a drone while largely maintaining CPR quality according to American Heart Association guidelines. Chest compression fraction was lower than expected.
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Affiliation(s)
- Monique A Starks
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.A.S.., D.B.M.)
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.A.S., C.L.G., D.B.M.)
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (A.L.B)
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (A.L.B.)
| | - Christine Chow
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.A.S.., D.B.M.)
| | | | | | - Evan Arnold
- Institute for Transportation Research and Education, North Carolina State University, Raleigh, NC (E.A.)
| | - Daniel M Buckland
- Department of Emergency Medicine Duke University School of Medicine, Durham, NC (D.M.B.,A.J.)
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC (D.M.B.)
| | - Anjni Joiner
- Department of Emergency Medicine Duke University School of Medicine, Durham, NC (D.M.B.,A.J.)
- Durham County EMS, NC (L.V.V., A.J.)
| | - Denise Simmons
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC (D.S.)
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (C.L.G)
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.A.S., C.L.G., D.B.M.)
| | - Daniel B Mark
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.A.S.., D.B.M.)
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.A.S., C.L.G., D.B.M.)
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Senman B, Jentzer JC, Barnett CF, Bartos JA, Berg DD, Chih S, Drakos SG, Dudzinski DM, Elliott A, Gage A, Horowitz JM, Miller PE, Sinha SS, Tehrani BN, Yuriditsky E, Vallabhajosyula S, Katz JN. Need for a Cardiogenic Shock Team Collaborative-Promoting a Team-Based Model of Care to Improve Outcomes and Identify Best Practices. J Am Heart Assoc 2024; 13:e031979. [PMID: 38456417 PMCID: PMC11009990 DOI: 10.1161/jaha.123.031979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/17/2024] [Indexed: 03/09/2024]
Abstract
Cardiogenic shock continues to carry a high mortality rate despite contemporary care, with no breakthrough therapies shown to improve survival over the past few decades. It is a time-sensitive condition that commonly results in cardiovascular complications and multisystem organ failure, necessitating multidisciplinary expertise. Managing patients with cardiogenic shock remains challenging even in well-resourced settings, and an important subgroup of patients may require cardiac replacement therapy. As a result, the idea of leveraging the collective cognitive and procedural proficiencies of multiple providers in a collaborative, team-based approach to care (the "shock team") has been advocated by professional societies and implemented at select high-volume clinical centers. A slowly maturing evidence base has suggested that cardiogenic shock teams may improve patient outcomes. Although several registries exist that are beginning to inform care, particularly around therapeutic strategies of pharmacologic and mechanical circulatory support, none of these are currently focused on the shock team approach, multispecialty partnership, education, or process improvement. We propose the creation of a Cardiogenic Shock Team Collaborative-akin to the successful Pulmonary Embolism Response Team Consortium-with a goal to promote sharing of care protocols, education of stakeholders, and discovery of how process and performance may influence patient outcomes, quality, resource consumption, and costs of care.
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Affiliation(s)
| | | | - Christopher F. Barnett
- Division of Cardiology, Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Jason A. Bartos
- Department of Medicine‐Cardiovascular DivisionUniversity of MinnesotaMinneapolisMNUSA
| | - David D. Berg
- Division of Cardiovascular MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
| | | | - Stavros G. Drakos
- Department of Medicine, Division of Cardiovascular Medicine and Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | | | - Andrea Elliott
- Department of Medicine‐Cardiovascular DivisionUniversity of MinnesotaMinneapolisMNUSA
| | - Ann Gage
- Department of Cardiovascular MedicineCentennial Medical CenterNashvilleTNUSA
| | - James M. Horowitz
- Division of CardiologyNew York University Grossman School of MedicineNew YorkNYUSA
| | - P. Elliott Miller
- Section of Cardiovascular Medicine, Yale School of MedicineNew HavenCTUSA
| | - Shashank S. Sinha
- Inova Schar Heart and Vascular, Inova Fairfax Medical CampusFalls ChurchVAUSA
| | - Behnam N. Tehrani
- Inova Schar Heart and Vascular, Inova Fairfax Medical CampusFalls ChurchVAUSA
| | - Eugene Yuriditsky
- Division of CardiologyNew York University Grossman School of MedicineNew YorkNYUSA
| | - Saraschandra Vallabhajosyula
- Division of Cardiology, Department of MedicineWarren Alpert Medical School of Brown University and Lifespan Cardiovascular InstituteProvidenceRIUSA
| | - Jason N. Katz
- Division of CardiologyNYU Grossman School of Medicine & Bellevue Hospital CenterNew YorkNYUSA
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Park JH, Choi Y, Ro YS, Song KJ, Shin SD. Establishing the Korean Out-of-Hospital cardiac arrest registry (KOHCAR). Resusc Plus 2024; 17:100529. [PMID: 38173559 PMCID: PMC10762453 DOI: 10.1016/j.resplu.2023.100529] [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] [Indexed: 01/05/2024] Open
Abstract
Background The Korean out-of-hospital cardiac arrest registry (KOHCAR) serves as the basis for a chain of survival monitoring and quality improvement programs for out-of-hospital cardiac arrest (OHCA). This study describes the development history and current status of KOHCAR. Methods/design The KOHCAR, initiated in 2008, is a population-based OHCA registry that captures all emergency medical service (EMS)-assessed OHCA cases, regardless of etiology. The KOHCAR represents complete nationwide data and aligns with South Korea's comprehensive plan for cardiovascular disease, which has a legal basis. The KOHCAR is a collaboration between the National Fire Agency (NFA) and the Korea Disease Control and Prevention Agency (KDCA). The NFA identifies OHCA patients and provides prehospital information after integrating various EMS records, whereas the KDCA collects hospital information and clinical outcomes through a medical record review. Comprehensive Utstein variables, including patient and arrest characteristics, prehospital and hospital management, and survival outcomes, were collected. Discussion The KOHCAR has significantly contributed to improving OHCA survival rates in South Korea; however, the COVID-19 pandemic has posed challenge. To address the post-pandemic survival rate decline, there is a need to enhance data utilization, expand data sources, and tailor communication with diverse stakeholders.
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Affiliation(s)
- Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yeongho Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Birkun AA. Misinformation on resuscitation and first aid as an uncontrolled problem that demands close attention: a brief scoping review. Public Health 2024; 228:147-149. [PMID: 38354584 DOI: 10.1016/j.puhe.2024.01.005] [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: 12/19/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Misinformation is currently recognised by the World Health Organization as an apparent threat to public health. This study aimed to provide an outline of published evidence on misinformation related to the potentially life-saving interventions - first aid and cardiopulmonary resuscitation (CPR). STUDY DESIGN A scoping review. METHODS The review was conducted in accordance with the PRISMA Extension for Scoping Reviews. English-language publications describing original studies that evaluated the quality of publicly available information on first aid and/or CPR were included without limitations to the year of publication. RESULTS Forty-four original studies published between 1982 and 2023 were reviewed. Annual number of publications varied from 0 to 6. The studies have focused on the evaluation of information concerning initial care of cardiac arrest, choking, heart attack, poisoning, burns, and other emergencies. Forty three studies (97.7 %) have reported varying frequencies of misinformation, when public sources, including websites, YouTube videos, and modern artificial intelligence-based chatbots, omitted life-saving instructions on first aid or CPR or contained incorrect information that contradicted relevant international guidelines. Eleven studies (25.0 %) have also revealed potentially harmful advice, which, if followed by an unsuspecting person, may cause direct injury or death of a victim. CONCLUSIONS Misinformation concerning CPR and first aid cannot be ignored and demands close attention from relevant stakeholders to mitigate its harmful impacts. More studies are urgently needed to determine optimal methods for detecting and measuring misinformation, to understand mechanisms that drive its spread, and to develop effective measures to correct and prevent misinformation.
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Affiliation(s)
- A A Birkun
- Department of General Surgery, Anesthesiology, Resuscitation and Emergency Medicine, Medical Institute Named After S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Lenin Blvd, 5/7, Simferopol, 295051, Russian Federation.
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Kragh AR, Gregers MT, Andelius L, Grabmayr AJ, Kollander L, Kjærulf VE, Kjølbye JS, Sheikh AP, Ersbøll AK, Folke F, Hansen CM. Volunteer Responder Interventions in Out-of-Hospital Cardiac Arrest in Urban, Suburban, and Rural Areas. J Am Heart Assoc 2024; 13:e032629. [PMID: 38348801 PMCID: PMC11010116 DOI: 10.1161/jaha.123.032629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Patients with out-of-hospital cardiac arrest (OHCA) in rural areas experience longer emergency response times and have lower survival rates compared with patients in urban areas. Volunteer responders might improve care and outcomes for patients with OHCA specifically in rural areas. Therefore, we investigated volunteer responder interventions based on the degree of urbanization. METHODS AND RESULTS We included 1310 OHCAs from 3 different regions in Denmark where volunteer responders had arrived at the OHCA location. The location was classified as urban, suburban, or rural according to the Eurostat Degree of Urbanization Tool. A logistic regression model was used to examine associations between the degree of urbanization and volunteer responder arrival before emergency medical services, cardiopulmonary resuscitation, or defibrillation. We found the odds for volunteer responder arrival before emergency medical services more than doubled in rural areas (odds ratio [OR], 2.60 [95% CI, 1.91-3.53]) and suburban areas (OR, 2.05 [95% CI, 1.56-2.69]) compared with urban areas. In OHCA cases where volunteer responders arrived first, odds for bystander cardiopulmonary resuscitation was tripled in rural areas (OR, 3.83 [95% CI, 1.64-8.93]) and doubled in suburban areas (OR, 2.27 [95% CI, 1.17-4.41]) compared with urban areas. Bystander defibrillation was more common in suburban areas (OR, 1.53 [95% CI, 1.02-2.31]), where almost 1 out of 4 patients received bystander defibrillation, compared with urban areas. CONCLUSIONS Volunteer responders are significantly more likely to arrive before emergency medical services in rural and suburban areas than in urban areas. Patients with OHCA received more cardiopulmonary resuscitation in rural and suburban areas and more defibrillation in suburban areas than in urban areas.
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Affiliation(s)
- Astrid Rolin Kragh
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Mads Tofte Gregers
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
| | - Anne Juul Grabmayr
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Louise Kollander
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Victor Elnegaard Kjærulf
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Julie Samsøe Kjølbye
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Annam Pervez Sheikh
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- National Institute of Public Health, University of Southern DenmarkCopenhagenDenmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
- Department of CardiologyHerlev Gentofte University HospitalCopenhagenDenmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
- Department of CardiologyHerlev Gentofte University HospitalCopenhagenDenmark
- Department of CardiologyRigshospitalet, University of CopenhagenBallerupDenmark
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11
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Lazzeri C, Manuela B, Peris A. Out of hospital cardiac arrest and organ donation: the innovative approach for emergency physicians. Eur J Emerg Med 2024; 31:5-6. [PMID: 37800649 DOI: 10.1097/mej.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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12
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Hirsch KG, Abella BS, Amorim E, Bader MK, Barletta JF, Berg K, Callaway CW, Friberg H, Gilmore EJ, Greer DM, Kern KB, Livesay S, May TL, Neumar RW, Nolan JP, Oddo M, Peberdy MA, Poloyac SM, Seder D, Taccone FS, Uzendu A, Walsh B, Zimmerman JL, Geocadin RG. Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society. Neurocrit Care 2024; 40:1-37. [PMID: 38040992 PMCID: PMC10861627 DOI: 10.1007/s12028-023-01871-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 12/03/2023]
Abstract
The critical care management of patients after cardiac arrest is burdened by a lack of high-quality clinical studies and the resultant lack of high-certainty evidence. This results in limited practice guideline recommendations, which may lead to uncertainty and variability in management. Critical care management is crucial in patients after cardiac arrest and affects outcome. Although guidelines address some relevant topics (including temperature control and neurological prognostication of comatose survivors, 2 topics for which there are more robust clinical studies), many important subject areas have limited or nonexistent clinical studies, leading to the absence of guidelines or low-certainty evidence. The American Heart Association Emergency Cardiovascular Care Committee and the Neurocritical Care Society collaborated to address this gap by organizing an expert consensus panel and conference. Twenty-four experienced practitioners (including physicians, nurses, pharmacists, and a respiratory therapist) from multiple medical specialties, levels, institutions, and countries made up the panel. Topics were identified and prioritized by the panel and arranged by organ system to facilitate discussion, debate, and consensus building. Statements related to postarrest management were generated, and 80% agreement was required to approve a statement. Voting was anonymous and web based. Topics addressed include neurological, cardiac, pulmonary, hematological, infectious, gastrointestinal, endocrine, and general critical care management. Areas of uncertainty, areas for which no consensus was reached, and future research directions are also included. Until high-quality studies that inform practice guidelines in these areas are available, the expert panel consensus statements that are provided can advise clinicians on the critical care management of patients after cardiac arrest.
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Affiliation(s)
| | | | - Edilberto Amorim
- San Francisco-Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Mary Kay Bader
- Providence Mission Hospital Nursing Center of Excellence/Critical Care Services, Mission Viejo, USA
| | | | | | | | | | | | | | - Karl B Kern
- Sarver Heart Center, University of Arizona, Tucson, USA
| | | | | | | | - Jerry P Nolan
- Warwick Medical School, University of Warwick, Coventry, UK
- Royal United Hospital, Bath, UK
| | - Mauro Oddo
- CHUV-Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | | | - Anezi Uzendu
- St. Luke's Mid America Heart Institute, Kansas City, USA
| | - Brian Walsh
- University of Texas Medical Branch School of Health Sciences, Galveston, USA
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Tamis-Holland JE, Menon V, Johnson NJ, Kern KB, Lemor A, Mason PJ, Rodgers M, Serrao GW, Yannopoulos D. Cardiac Catheterization Laboratory Management of the Comatose Adult Patient With an Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e274-e295. [PMID: 38112086 DOI: 10.1161/cir.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Out-of-hospital cardiac arrest is a leading cause of death, accounting for ≈50% of all cardiovascular deaths. The prognosis of such individuals is poor, with <10% surviving to hospital discharge. Survival with a favorable neurologic outcome is highest among individuals who present with a witnessed shockable rhythm, received bystander cardiopulmonary resuscitation, achieve return of spontaneous circulation within 15 minutes of arrest, and have evidence of ST-segment elevation on initial ECG after return of spontaneous circulation. The cardiac catheterization laboratory plays an important role in the coordinated Chain of Survival for patients with out-of-hospital cardiac arrest. The catheterization laboratory can be used to provide diagnostic, therapeutic, and resuscitative support after sudden cardiac arrest from many different cardiac causes, but it has a unique importance in the treatment of cardiac arrest resulting from underlying coronary artery disease. Over the past few years, numerous trials have clarified the role of the cardiac catheterization laboratory in the management of resuscitated patients or those with ongoing cardiac arrest. This scientific statement provides an update on the contemporary approach to managing resuscitated patients or those with ongoing cardiac arrest.
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14
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Hirsch KG, Abella BS, Amorim E, Bader MK, Barletta JF, Berg K, Callaway CW, Friberg H, Gilmore EJ, Greer DM, Kern KB, Livesay S, May TL, Neumar RW, Nolan JP, Oddo M, Peberdy MA, Poloyac SM, Seder D, Taccone FS, Uzendu A, Walsh B, Zimmerman JL, Geocadin RG. Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement From the American Heart Association and Neurocritical Care Society. Circulation 2024; 149:e168-e200. [PMID: 38014539 PMCID: PMC10775969 DOI: 10.1161/cir.0000000000001163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
The critical care management of patients after cardiac arrest is burdened by a lack of high-quality clinical studies and the resultant lack of high-certainty evidence. This results in limited practice guideline recommendations, which may lead to uncertainty and variability in management. Critical care management is crucial in patients after cardiac arrest and affects outcome. Although guidelines address some relevant topics (including temperature control and neurological prognostication of comatose survivors, 2 topics for which there are more robust clinical studies), many important subject areas have limited or nonexistent clinical studies, leading to the absence of guidelines or low-certainty evidence. The American Heart Association Emergency Cardiovascular Care Committee and the Neurocritical Care Society collaborated to address this gap by organizing an expert consensus panel and conference. Twenty-four experienced practitioners (including physicians, nurses, pharmacists, and a respiratory therapist) from multiple medical specialties, levels, institutions, and countries made up the panel. Topics were identified and prioritized by the panel and arranged by organ system to facilitate discussion, debate, and consensus building. Statements related to postarrest management were generated, and 80% agreement was required to approve a statement. Voting was anonymous and web based. Topics addressed include neurological, cardiac, pulmonary, hematological, infectious, gastrointestinal, endocrine, and general critical care management. Areas of uncertainty, areas for which no consensus was reached, and future research directions are also included. Until high-quality studies that inform practice guidelines in these areas are available, the expert panel consensus statements that are provided can advise clinicians on the critical care management of patients after cardiac arrest.
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15
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Tanaka C, Tagami T, Kaneko J, Kitamura N, Yasunaga H, Aso S, Takeda M, Kuno M. Impact of the COVID-19 pandemic on prehospital and in-hospital treatment and outcomes of patients after out-of-hospital cardiac arrest: a Japanese multicenter cohort study. BMC Emerg Med 2024; 24:12. [PMID: 38191311 PMCID: PMC10775511 DOI: 10.1186/s12873-024-00929-8] [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: 08/12/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND In the chain of survival for Out-of-hospital cardiac arrest (OHCA), each component of care contributes to improve the prognosis of the patient with OHCA. The SARS-CoV-2 (COVID-19) pandemic potentially affected each part of care in the chain of survival. The aim of this study was to compare prehospital care, in-hospital treatment, and outcomes among OHCA patients before and after the COVID-19 pandemic. METHODS We analyzed data from a multicenter prospective study in Kanto area, Japan, named SOS-KANTO 2017. We enrolled patients who registered during the pre-pandemic period (September 2019 to December 2019) and the post-pandemic period (June 2020 to March 2021). The main outcome measures were 30-day mortality and the proportion of favorable outcomes at 1 month, and secondary outcome measures were changes in prehospital and in-hospital treatments between the pre- and post-pandemic periods. RESULTS There were 2015 patients in the pre-pandemic group, and 5023 in the post-pandemic group. The proportion of advanced airway management by emergency medical service (EMS) increased (p < 0.01), and EMS call-to-hospital time was prolonged (p < 0.01) in the post- versus pre-pandemic group. There were no differences between the groups in defibrillation, extracorporeal membrane oxygenation, or temperature control therapy (p = 0.43, p = 0.14, and p = 0.16, respectively). Survival rate at 1 month and favorable outcome rate at 1 month were lower (p = 0.01 and p < 0.01, respectively) in the post- versus pre-pandemic group. CONCLUSION Survival rate and favorable outcome rate 1 month after return of spontaneous circulation of OHCA worsened, EMS response time was prolonged, and advanced airway management by EMS increased in the post- versus pre-pandemic group; however, most prehospital and in-hospital management did not change between pre- and post-COVID-19 pandemic.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan.
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Tokyo, 1138654, Japan.
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kimitsu, Chiba, 2928535, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Tokyo, 1138654, Japan
| | - Shotaro Aso
- Department of Real-world Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, 1138654, Japan
| | - Munekazu Takeda
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, 1628666, Japan
| | - Masamune Kuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
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Stancati JA, Owyang CG, Araos JD, Agarwal S, Grossestreuer AV, Counts CR, Johnson NJ, Morgan RW, Moskowitz A, Perman SM, Sawyer KN, Yuriditsky E, Horowitz JM, Kaviyarasu A, Palasz J, Abella BS, Teran F. The Latest in Resuscitation Research: Highlights From the 2022 American Heart Association's Resuscitation Science Symposium. J Am Heart Assoc 2023; 12:e031530. [PMID: 38038192 PMCID: PMC10727320 DOI: 10.1161/jaha.123.031530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND Every year the American Heart Association's Resuscitation Science Symposium (ReSS) brings together a community of international resuscitation science researchers focused on advancing cardiac arrest care. METHODS AND RESULTS The American Heart Association's ReSS was held in Chicago, Illinois from November 4th to 6th, 2022. This annual narrative review summarizes ReSS programming, including awards, special sessions and scientific content organized by theme and plenary session. CONCLUSIONS By exploring both the science of resuscitation and important related topics including survivorship, disparities, and community-focused programs, this meeting provided important resuscitation updates.
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Affiliation(s)
| | - Clark G. Owyang
- Department of Emergency MedicineWeill Cornell Medicine/New York Presbyterian HospitalNew YorkNYUSA
- Division of Pulmonary and Critical Care MedicineWeill Cornell Medicine/New York Presbyterian HospitalNew YorkNYUSA
| | - Joaquin D. Araos
- Department of Clinical Sciences, College of Veterinary MedicineCornell UniversityIthacaNYUSA
| | - Sachin Agarwal
- Division of Neurocritical Care & Hospitalist NeurologyColumbia University Irving Medical CenterNew YorkNYUSA
| | | | | | - Nicholas J. Johnson
- Department of Emergency MedicineUniversity of WashingtonSeattleWAUSA
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattleWAUSA
| | - Ryan W. Morgan
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care MedicineChildren’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Ari Moskowitz
- Division of Critical Care MedicineMontefiore Medical CenterBronxNYUSA
| | - Sarah M. Perman
- Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - Kelly N. Sawyer
- Department of Emergency MedicineUniversity of PittsburghPittsburghPAUSA
| | - Eugene Yuriditsky
- Division of Cardiology, Department of MedicineNYU Langone HealthNew YorkNYUSA
| | - James M. Horowitz
- Division of Cardiology, Department of MedicineNYU Langone HealthNew YorkNYUSA
| | - Aarthi Kaviyarasu
- Department of Emergency Medicine, Center for Resuscitation ScienceUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Joanna Palasz
- Department of Emergency MedicineWeill Cornell Medicine/New York Presbyterian HospitalNew YorkNYUSA
| | - Benjamin S. Abella
- Department of Emergency Medicine, Center for Resuscitation ScienceUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Felipe Teran
- Department of Emergency MedicineWeill Cornell Medicine/New York Presbyterian HospitalNew YorkNYUSA
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17
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Chan PS, Greif R, Anderson T, Atiq H, Bittencourt Couto T, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Kah-Lai Leong C, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mustafa Mohamed MT, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Odakha JA, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Nallamothu BK. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Resuscitation 2023; 193:109996. [PMID: 37942937 PMCID: PMC10769812 DOI: 10.1016/j.resuscitation.2023.109996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Paul S Chan
- Mid-America Heart Institute, Kansas City, MO, United States.
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan
| | | | | | - Allan R De Caen
- Division of Pediatric Critical Care, Stollery Children's Hospital, Edmonton, Canada
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA, United States
| | - Matthew J Douma
- Department of Critical Care Medicine, University of Alberta, Canada
| | - Dana P Edelson
- Department of Medicine, University of Chicago Medicine, IL, United States
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China
| | - Judith C Finn
- School of Nursing, Curtin University, Perth, Australia
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica, United States
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, United States
| | | | | | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Peter T Morley
- Department of Intensive Care, The University of Melbourne, Australia
| | - Laurie J Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY, United States
| | | | | | | | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, United States
| | | | | | - Theresa M Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia
| | | | | | | | | | | | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
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18
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Birkun AA, Gautam A. Large Language Model (LLM)-Powered Chatbots Fail to Generate Guideline-Consistent Content on Resuscitation and May Provide Potentially Harmful Advice. Prehosp Disaster Med 2023; 38:757-763. [PMID: 37927093 DOI: 10.1017/s1049023x23006568] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Innovative large language model (LLM)-powered chatbots, which are extremely popular nowadays, represent potential sources of information on resuscitation for the general public. For instance, the chatbot-generated advice could be used for purposes of community resuscitation education or for just-in-time informational support of untrained lay rescuers in a real-life emergency. STUDY OBJECTIVE This study focused on assessing performance of two prominent LLM-based chatbots, particularly in terms of quality of the chatbot-generated advice on how to give help to a non-breathing victim. METHODS In May 2023, the new Bing (Microsoft Corporation, USA) and Bard (Google LLC, USA) chatbots were inquired (n = 20 each): "What to do if someone is not breathing?" Content of the chatbots' responses was evaluated for compliance with the 2021 Resuscitation Council United Kingdom guidelines using a pre-developed checklist. RESULTS Both chatbots provided context-dependent textual responses to the query. However, coverage of the guideline-consistent instructions on help to a non-breathing victim within the responses was poor: mean percentage of the responses completely satisfying the checklist criteria was 9.5% for Bing and 11.4% for Bard (P >.05). Essential elements of the bystander action, including early start and uninterrupted performance of chest compressions with adequate depth, rate, and chest recoil, as well as request for and use of an automated external defibrillator (AED), were missing as a rule. Moreover, 55.0% of Bard's responses contained plausible sounding, but nonsensical guidance, called artificial hallucinations, that create risk for inadequate care and harm to a victim. CONCLUSION The LLM-powered chatbots' advice on help to a non-breathing victim omits essential details of resuscitation technique and occasionally contains deceptive, potentially harmful directives. Further research and regulatory measures are required to mitigate risks related to the chatbot-generated misinformation of public on resuscitation.
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Affiliation(s)
- Alexei A Birkun
- Department of General Surgery, Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol, 295051, Russian Federation
| | - Adhish Gautam
- Regional Government Hospital, Una (H.P.), 174303, India
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19
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AlShehri H, AlKulayb SM, Karhan HS, Al Wargash EA, Althobaiti RM, Alsinan MH, Al Mustanyir HA, Al-Swat G, Almakki RA, Alammari RM. Assessment of Knowledge, Attitudes, and Willingness Among People With and Without Heart Disease Relatives in Saudi Arabia Regarding Cardiopulmonary Resuscitation: A Cross-Sectional Study. Cureus 2023; 15:e51197. [PMID: 38283415 PMCID: PMC10818030 DOI: 10.7759/cureus.51197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Background Cardiopulmonary resuscitation (CPR) is a life-saving procedure that can be performed in many situations where a person's breathing or heartbeat has stopped, such as during a heart attack, suffocation, near drowning, or electrical injuries. Despite its importance, to our knowledge, no research has been conducted yet in our community on the differences in CPR knowledge, attitudes, and willingness between those with and without heart disease relatives. Objective This study aimed to assess the level of knowledge, attitude, and willingness of people with and without heart disease relatives to perform CPR in a case of cardiac arrest. Methods A descriptive cross-sectional study was carried out between July 2023 and October 2023 among the Saudi Arabia population using a self-administered online questionnaire focusing on the sociodemographic characteristics of participants and the level of knowledge, attitude toward CPR, and the willingness to perform CPR in a case of cardiac arrest. Results This study included 799 participants, with 331 males (41.4%) and 468 females (58.6%). Age distribution was mainly in the range of 18-25 years (241 participants, 30.2%). Geographically, the highest proportion was from the southern region (214 participants, 26.8%). The majority had a university degree (533 participants, 66.7%). Employment status varied, with 401 participants (50.2%) working outside the medical field. Monthly income showed that 297 (37.2%) had an income ranging from 2,000 to 10,000 SAR. The average daily sleep duration varied, with the majority (64.7%) reporting six to nine hours of sleep. Also, 44.2% of participants reported exercising. Regarding smoking status, 80.9% reported not smoking. A family history of heart disease was reported by 46.4% of participants, whereas 16.3% reported a personal diagnosis of heart disease. Regarding knowledge, 40.8% correctly identified when CPR should be performed. Only 40.4% correctly identified the first step in a CPR situation, and only 22.9% identified the correct sequence of steps for performing CPR. Additionally, only 66.5% correctly identified the emergency hotline number "Red Crescent." Furthermore, only 8.9% knew the correct compression/ventilation ratio for adults during CPR. As for the attitude, a significant percentage (65.0%) had not taken a CPR course. However, the majority (84.6%) expressed a strong desire to learn CPR. Interestingly, the participants showed a positive attitude toward CPR education. Among the participants, 53.9% responded that they performed CPR when encountering a situation that required it, while 46.1% did not. Regarding the participants' willingness to perform CPR on different individuals, the majority (74.1%) expressed their readiness to perform CPR whenever needed. Conclusion The findings demonstrated knowledge gaps, with misconceptions about CPR. However, participants generally expressed a positive attitude toward CPR education and a willingness to learn. Factors such as age showed a weak association with knowledge level, while gender, region, education, employment, and family history of heart disease did not significantly impact knowledge. The study highlighted the need for improved CPR education and awareness. Hence, we recommend CPR courses to be implemented as a graduation prerequisite. In addition to that, linking some government services to a first aid course would positively impact the general population's practices in CPR and other emergencies.
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20
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Kittleson MM. Management of Heart Failure in Hospitalized Patients. Ann Intern Med 2023; 176:ITC177-ITC192. [PMID: 38079639 DOI: 10.7326/aitc202312190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Heart failure affects more than 6 million people in the United States, and hospitalizations for decompensated heart failure confer a heavy toll in morbidity, mortality, and health care costs. Clinical trials have demonstrated effective interventions; however, hospitalization and mortality rates remain high. Key components of effective hospital care include appropriate diagnostic evaluation, triage and risk stratification, early implementation of guideline-directed medical therapy, adequate diuresis, and appropriate discharge planning.
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Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California (M.M.K.)
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21
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Moens E, Degraeuwe E, Caputo Maria L, Cresta R, Arys R, Van Moorter N, Tackaert T, Benvenuti C, Auricchio A, Vercammen S. A roadmap to building first responder networks: Lessons learned and best practices from Belgium and Switzerland. Resusc Plus 2023; 16:100469. [PMID: 37779882 PMCID: PMC10539931 DOI: 10.1016/j.resplu.2023.100469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Background/Aims Limited bystander assistance and delayed emergency medical service arrival reduce the chances of survival in cardiac arrest victims. Early basic life support through trained first responders (FR) and automatic external defibrillation both improve the outcome. Well-organized FR networks have shown promise, but guidance on effective implementation is lacking. This study evaluates two FR networks, in Belgium and in Switzerland, to identify main advancements in the development of such systems. Method Direct comparison is made of the barriers and facilitators in the development of both FR systems from 2006 up until December 2022, and summarized within a roadmap. Results The Roadmap comprises four integral steps: exploration, installation, initiation, and implementation. Exploration involves understanding the national legislation, engaging with advisory bodies, and establishing local steering committees. The installation phase focuses on FR recruitment, engaging specific professional groups such as firemen, registering public Automated External Defibrillators (AEDs), and requesting feedback. The initiation step includes implementing improvement cycles and fidelity measures. Finally, implementation expands the network, leading to increased survival rates and the integration of these practices into legislation. A significant focus is placed on FR's psychological wellbeing. Moreover, the roadmap highlights the use of efficient geo-mapping to simplify optimal AED placement and automatically assign FRs to tasks. Conclusion The importance of FR networks for early resuscitation is increasingly recognized and various systems are being developed. Key developmental strategies of the EVapp and Ticino Cuore app system may serve as a roadmap for other systems and implementations within Europe and beyond.
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Affiliation(s)
| | - Eva Degraeuwe
- Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
- Emergency Volunteer Application (EVapp) NGO, Belgium
| | - Luce Caputo Maria
- Cardiocentro Ticino Institute, Lugano, Switzerland
- Fondazione Ticino Cuore, Lugano, Switzerland
| | | | - Robin Arys
- Emergency Volunteer Application (EVapp) NGO, Belgium
| | - Nina Van Moorter
- Emergency Volunteer Application (EVapp) NGO, Belgium
- OLVG Hospital, Amsterdam, The Netherlands
| | - Thomas Tackaert
- Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
- Emergency Volunteer Application (EVapp) NGO, Belgium
| | | | - Angelo Auricchio
- Cardiocentro Ticino Institute, Lugano, Switzerland
- Fondazione Ticino Cuore, Lugano, Switzerland
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22
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Leo WZ, Chua D, Tan HC, Ho VK. Chest compression quality and patient outcomes with the use of a CPR feedback device: A retrospective study. Sci Rep 2023; 13:19852. [PMID: 37964016 PMCID: PMC10645752 DOI: 10.1038/s41598-023-46862-x] [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: 06/02/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
Feedback devices were developed to guide resuscitations as targets recommended by various guidelines are difficult to achieve. Yet, there is limited evidence to support their use for in-hospital cardiac arrests (IHCA), and they did not correlate with patient outcomes. Therefore, this study has investigated the compression quality and patient outcomes in IHCA with the use of a feedback device via a retrospective study of inpatient code blue activations in a Singapore hospital over one year. The primary outcome was compression quality and secondary outcomes were survival, downtime and neurological status. 64 of 110 (58.2%) cases were included. Most resuscitations (71.9%) met the recommended chest compression fraction (CCF, defined as the proportion of time spent on compressions during resuscitation) despite overall quality being suboptimal. Greater survival to discharge and better neurological status in resuscitated patients respectively correlated with higher median CCF (p = 0.040 and 0.026 respectively) and shorter downtime (p < 0.001 and 0.001 respectively); independently, a higher CCF correlated with a shorter downtime (p = 0.014). Overall, this study demonstrated that reducing interruptions is crucial for good outcomes in IHCA. However, compression quality remained suboptimal despite feedback device implementation, possibly requiring further simulation training and coaching. Future multicentre studies incorporating these measures should be explored.
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Affiliation(s)
- Wen Zhe Leo
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore.
| | - Damien Chua
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Hui Cheng Tan
- Department of Clinical Governance, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Vui Kian Ho
- Department of Intensive Care Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
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Nallamothu BK, Greif R, Anderson T, Atiq H, Couto TB, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Leong CKL, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mohamed MTM, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Athieno Odakha J, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Chan PS. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Circ Cardiovasc Qual Outcomes 2023; 16:e010491. [PMID: 37947100 PMCID: PMC10659256 DOI: 10.1161/circoutcomes.123.010491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland (R.G.)
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor (B.K.N., T.A.)
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan (H.A.)
| | | | | | - Allan R. De Caen
- Division of Pediatric Critical Care, Stollery Children’s Hospital, Edmonton, Canada (A.R.D.C.)
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden (T.D.)
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA (A.D.)
| | - Matthew J. Douma
- Department of Critical Care Medicine, University of Alberta, Canada (M.J.D.)
| | - Dana P. Edelson
- Department of Medicine, University of Chicago Medicine, IL (D.P.E.)
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China (F.X.)
| | - Judith C. Finn
- School of Nursing, Curtin University, Perth, Australia (J.F.)
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica (G.F.)
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (S.G.)
| | | | - Carrie Kah-Lai Leong
- Department of Emergency Medicine, Singapore General Hospital (C.K.-L.L., S.H.L.)
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital (C.K.-L.L., S.H.L.)
| | - Peter T. Morley
- Department of Intensive Care, The University of Melbourne, Australia (P.T.M.)
| | - Laurie J. Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada (L.J.M.)
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY (A.M.)
| | | | | | | | - Vinay M. Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA (V.N.)
| | - Robert W. Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor (R.W.N.)
| | - Jerry P. Nolan
- University of Warwick, Coventry, United Kingdom (J.P.N., G.D.P.)
| | | | - Theresa M. Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway (T.M.O.)
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia (J.O.)
| | - Gavin D. Perkins
- University of Warwick, Coventry, United Kingdom (J.P.N., G.D.P.)
| | | | | | | | | | - Paul S. Chan
- Mid-America Heart Institute, Kansas City, MO (P.S.C.)
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24
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Birkun A. Performance of an artificial intelligence-based chatbot when acting as EMS dispatcher in a cardiac arrest scenario. Intern Emerg Med 2023; 18:2449-2452. [PMID: 37603142 DOI: 10.1007/s11739-023-03399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Alexei Birkun
- Department of General Surgery, Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy Named After S. I. Georgievsky of V. I. Vernadsky Crimean Federal University, Simferopol, Russian Federation.
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25
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Juul Grabmayr A, Folke F, Tofte Gregers MC, Kollander L, Bo N, Andelius L, Jensen TW, Ettl F, Krammel M, Sulzgruber P, Krychtiuk KA, Torp-Pedersen C, Kjær Ersbøll A, Malta Hansen C. Public Out-of-Hospital Cardiac Arrest in Residential Neighborhoods. J Am Coll Cardiol 2023; 82:1777-1788. [PMID: 37879782 DOI: 10.1016/j.jacc.2023.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/17/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Although one-half of all public out-of-hospital cardiac arrests (OHCAs) occur outside private homes in residential neighborhoods, their characteristics and outcomes remain unexplored. OBJECTIVES The authors assessed interventions before ambulance arrival and survival for public OHCA patients in residential neighborhoods. METHODS Public OHCAs from Vienna (2018-2021) and Copenhagen (2016-2020) were designated residential neighborhoods or nonresidential areas. Interventions (cardiopulmonary resuscitation [CPR], automated external defibrillator [AED] attached, and defibrillation) and 30-day survival were compared using a generalized estimation equation model adjusted for age and time of day and presented as ORs. RESULTS We included 1,052 and 654 public OHCAs from Vienna and Copenhagen, respectively, and 68% and 55% occurred in residential neighborhoods, respectively. The likelihood of CPR, defibrillation, and survival in residential neighborhoods vs nonresidential areas (reference) were as follows: CPR Vienna, 73% vs 78%, OR: 0.78 (95% CI: 0.57-1.06), CPR Copenhagen, 83% vs 90%, OR: 0.54 (95% CI: 0.34-0.88), and CPR combined, 76% vs 84%, OR: 0.70 (95% CI: 0.53-0.90); AED attached Vienna, 36% vs 44%, OR: 0.69 (95% CI: 0.53-0.90), AED attached Copenhagen, 21% vs 43%, OR: 0.33 (95% CI: 0.24-0.48), and AED attached combined, 31% vs 44%, OR: 0.53 (95% CI: 0.42-0.65); defibrillation Vienna, 14% vs 20%, OR: 0.61 (95% CI: 0.43-0.87), defibrillation Copenhagen, 16% vs 36%, OR: 0.35 (95% CI: 0.24-0.51), and defibrillation combined, 15% vs 27%, OR: 0.46 (95% CI: 0.36-0.61); and 30-day survival rate Vienna, 21% vs 26%, OR: 0.84 (95% CI: 0.58-1.20), 30-day survival rate Copenhagen, 33% vs 44%, OR: 0.65 (95% CI: 0.47-0.90), and 30-day survival rate combined, 25% vs 36%, OR: 0.73 (95% CI: 0.58-0.93). CONCLUSIONS Two-thirds of public OHCAs occurred in residential neighborhoods with fewer resuscitative efforts before ambulance arrival and lower survival than in nonresidential areas. Targeted efforts to improve early CPR and defibrillation for public OHCA patients in residential neighborhoods are needed.
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Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte, Denmark
| | - Mads Christian Tofte Gregers
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Louise Kollander
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Bo
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linn Andelius
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Theo Walter Jensen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Mario Krammel
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria; Emergency Medical Service Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria; Department of Internal Medicine II - Division of Cardiology Medical University of Vienna, Vienna, Austria
| | - Konstantin A Krychtiuk
- Department of Internal Medicine II - Division of Cardiology Medical University of Vienna, Vienna, Austria; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Christian Torp-Pedersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark
| | - Annette Kjær Ersbøll
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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26
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Leung KHB, Yousefi N, Chan TCY, Bayoumi AM. Constrained Optimization for Decision Making in Health Care Using Python: A Tutorial. Med Decis Making 2023; 43:760-773. [PMID: 37480282 PMCID: PMC10625722 DOI: 10.1177/0272989x231188027] [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: 10/06/2022] [Accepted: 06/08/2023] [Indexed: 07/23/2023]
Abstract
HIGHLIGHTS This tutorial provides a user-friendly guide to mathematically formulating constrained optimization problems and implementing them using Python.Two examples are presented to illustrate how constrained optimization is used in health applications, with accompanying Python code provided.
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Affiliation(s)
- K. H. Benjamin Leung
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
- Scottish Ambulance Service, Edinburgh, Scotland, UK
| | - Nasrin Yousefi
- Smith School of Business, Queen’s University, Kingston, ON, Canada
| | - Timothy C. Y. Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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27
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Hutton J, Puyat JH, Asamoah-Boaheng M, Sobolev B, Lingawi S, Khalili M, Kuo C, Shadgan B, Christenson J, Grunau B. The effect of recognition on survival after out-of-hospital cardiac arrest and implications for biosensor technologies. Resuscitation 2023; 190:109906. [PMID: 37453691 DOI: 10.1016/j.resuscitation.2023.109906] [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: 06/01/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Biosensor technologies have been proposed as a solution to provide recognition and facilitate earlier responses to unwitnessed out-of-hospital cardiac arrest (OHCA) cases. We sought to estimate the effect of recognition on survival and modelled the potential incremental impact of increased recognition of unwitnessed cases on survival to hospital discharge, to demonstrate the potential benefit of biosensor technologies. METHODS We included cases from the British Columbia Cardiac Arrest Registry (2019-2020), which includes Emergency Medical Services (EMS)-assessed OHCAs. We excluded cases that would not have benefitted from early recognition (EMS-witnessed, terminal illness, or do-not-resuscitate). Using a mediation analysis, we estimated the relative benefits on survival of a witness recognizing vs. intervening in an OHCA; and estimated the expected additional number of survivors resulting from increasing recognition alone using a bootstrap logistic regression framework. RESULTS Of 13,655 EMS-assessed cases, 11,412 were included (6314 EMS-treated, 5098 EMS-untreated). Survival to hospital discharge was 191/8879 (2.2%) in unwitnessed cases and 429/2533 (17%) in bystander-witnessed cases. Of the total effect attributable to a bystander witness, recognition accounted for 84% (95% CI: 72, 86) of the benefit. If all previously unwitnessed cases had been bystander witnessed, we would expect 1198 additional survivors. If these cases had been recognized, but no interventions performed, we would expect 912 additional survivors. CONCLUSION Unwitnessed OHCA account for the majority of OHCAs, yet survival is dismal. Methods to improve recognition, such as with biosensor technologies, may lead to substantial improvements in overall survival.
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Affiliation(s)
- Jacob Hutton
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada.
| | - Joseph H Puyat
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada; School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Michael Asamoah-Boaheng
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
| | - Boris Sobolev
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Saud Lingawi
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, British Columbia, Canada; International Collaboration on Repair Discoveries, British Columbia, Canada
| | - Mahsa Khalili
- School of Biomedical Engineering, University of British Columbia, British Columbia, Canada; International Collaboration on Repair Discoveries, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
| | - Calvin Kuo
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, British Columbia, Canada
| | - Babak Shadgan
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, British Columbia, Canada; Department of Orthopedic Surgery, University of British Columbia, British Columbia, Canada
| | - Jim Christenson
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
| | - Brian Grunau
- Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada
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28
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Gerecht RB, Nable JV. Out-of-Hospital Cardiac Arrest. Emerg Med Clin North Am 2023; 41:433-453. [PMID: 37391243 DOI: 10.1016/j.emc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Survival from out-of-hospital cardiac arrest (OHCA) is predicated on a community and system-wide approach that includes rapid recognition of cardiac arrest, capable bystander CPR, effective basic and advanced life support (BLS and ALS) by EMS providers, and coordinated postresuscitation care. Management of these critically ill patients continues to evolve. This article focuses on the management of OHCA by EMS providers.
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Affiliation(s)
- Ryan B Gerecht
- District of Columbia Fire and EMS Department, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Jose V Nable
- Georgetown University School of Medicine, Georgetown EMS, MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA.
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29
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Bemtgen X, Wengenmayer T. [Out-of-hospital resuscitation: where are we today?]. Dtsch Med Wochenschr 2023; 148:921-933. [PMID: 37493954 DOI: 10.1055/a-1936-5819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
In circulatory arrest, the first minutes and hours are crucial - rapid and adequate care can significantly increase the chances of survival. A large number of disciplines are involved in the recommendations and guidelines for out-of-hospital resuscitation. In particular, the European Resuscitation Council (ERC) as well as the European Society of Cardiology (ESC) and the American Heart Association (AHA) are leading the way. Both the ambulance service and the accepting hospital are faced with major challenges in this regard. This article will illustrate the most important steps during and after resuscitation and discuss innovations.
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Shimada-Sammori K, Shimada T, Miura RE, Kawaguchi R, Yamao Y, Oshima T, Oami T, Tomita K, Shinozaki K, Nakada TA. Machine learning algorithms for predicting days of high incidence for out-of-hospital cardiac arrest. Sci Rep 2023; 13:9950. [PMID: 37336904 DOI: 10.1038/s41598-023-36270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023] Open
Abstract
Predicting out-of-hospital cardiac arrest (OHCA) events might improve outcomes of OHCA patients. We hypothesized that machine learning algorithms using meteorological information would predict OHCA incidences. We used the Japanese population-based repository database of OHCA and weather information. The Tokyo data (2005-2012) was used as the training cohort and datasets of the top six populated prefectures (2013-2015) as the test. Eight various algorithms were evaluated to predict the high-incidence OHCA days, defined as the daily events exceeding 75% tile of our dataset, using meteorological and chronological values: temperature, humidity, air pressure, months, days, national holidays, the day before the holidays, the day after the holidays, and New Year's holidays. Additionally, we evaluated the contribution of each feature by Shapley Additive exPlanations (SHAP) values. The training cohort included 96,597 OHCA patients. The eXtreme Gradient Boosting (XGBoost) had the highest area under the receiver operating curve (AUROC) of 0.906 (95% confidence interval; 0.868-0.944). In the test cohorts, the XGBoost algorithms also had high AUROC (0.862-0.923). The SHAP values indicated that the "mean temperature on the previous day" impacted the most on the model. Algorithms using machine learning with meteorological and chronological information could predict OHCA events accurately.
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Affiliation(s)
- Kaoru Shimada-Sammori
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Tadanaga Shimada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Rie E Miura
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
- Smart119 Inc, 2-5-1, Chuo, Chiba, Japan
| | - Rui Kawaguchi
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Yasuo Yamao
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
- Smart119 Inc, 2-5-1, Chuo, Chiba, Japan
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Takehiko Oami
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Keisuke Tomita
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Koichiro Shinozaki
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
- Department of Emergency Medicine, Zucker School of Medicine, New York, USA
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
- Smart119 Inc, 2-5-1, Chuo, Chiba, Japan.
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Kovoor JG, Marschner S, Amarasekera A, Nageswaran M, Page GJ, Chow CK, Thiagalingam A, Kovoor P. Public attitudes towards automated external defibrillators: results of a survey in the Australian general population. Front Cardiovasc Med 2023; 10:1178148. [PMID: 37332575 PMCID: PMC10272715 DOI: 10.3389/fcvm.2023.1178148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background Swift defibrillation by lay responders using automated external defibrillators (AEDs) increases survival in out-of-hospital cardiac arrest (OHCA). This study evaluated newly designed yellow-red vs. commonly used green-white signage for AEDs and cabinets and assessed public attitudes to using AEDs during OHCA. Methods New yellow-red signage was designed to enable easy identification of AEDs and cabinets. A prospective, cross-sectional study of the Australian public was conducted using an electronic, anonymised questionnaire between November 2021 and June 2022. The validated net promoter score investigated public engagement with the signage. Likert scales and binary comparisons evaluated preference, comfort and likelihood of using AEDs for OHCA. Results The yellow-red signage for AED and cabinet was preferred by 73.0% and 88%, respectively, over the green-white counterparts. Only 32% were uncomfortable with using AEDs, and only 19% indicated a low likelihood of using AEDs in OHCA. Conclusion The majority of the Australian public surveyed preferred yellow-red over green-white signage for AED and cabinet and indicated comfort and likelihood of using AEDs in OHCA. Steps are necessary to standardise yellow-red signage of AED and cabinet and enable widespread availability of AEDs for public access defibrillation.
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Affiliation(s)
- Joshua G. Kovoor
- The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
- Heart of the Nation, Sydney, NSW, Australia
- Health and Information, Adelaide, SA, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anjalee Amarasekera
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Meera Nageswaran
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Clara K. Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Pramesh Kovoor
- Heart of the Nation, Sydney, NSW, Australia
- Health and Information, Adelaide, SA, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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32
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Goldberg SA, Battistini V, Cash RE, Kelleher M, Laporte C, Peters G, Goralnick E. A retrospective review of out of hospital cardiac arrest at Gillette Stadium: 10 years of experience at a large sports venue. Resusc Plus 2023; 14:100386. [PMID: 37056959 PMCID: PMC10085775 DOI: 10.1016/j.resplu.2023.100386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/09/2023] Open
Abstract
Introduction Rates of out-of-hospital cardiac arrest (OHCA) at major sporting events are as high as 0.7 per 100,000 attendees. However, factors contributing to OHCA at mass gatherings have not been well-described. We describe our experience with ten years of medical oversight and OHCA care at a professional football stadium. Methods We performed a retrospective review of OHCA events between August 2010 and January 2020 at a 65,878-seat football stadium, with a single transporting EMS agency and a single receiving hospital. We analyzed EMS incident reports and matched patients to hospital records for outcome data. Results A total of 7,767,345 people attended 115 football games during the study period. There were 21 OHCAs (0.27 per 100,000 attendees). Ninety-five percent of OHCAs were witnessed and 71.4% had an initial shockable rhythm, with bystander AED use in 47.6%. Median EMS response time was 2 minutes (IQR 1-6). For 7 patients defibrillated by EMS, time to defibrillation was 4 minutes (IQR 4-11). Return of spontaneous circulation (ROSC) occurred in 71%, with 47% having good 30-day neurologic survival. All patients with an initial rhythm of asystole died. Conclusion The ROSC rate at our stadium exceeded 70% with almost half surviving with good neurologic outcomes, substantially higher than that reported for the general public. We hope that our experience will provide valuable lessons to other similarly sized stadiums.
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Affiliation(s)
- Scott A. Goldberg
- Brigham and Women’s Hospital, Boston, MA, USA
- Corresponding author at: Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | | | | | | | - Christopher Laporte
- Brigham and Women’s Hospital, Boston, MA, USA
- Foxborough Fire Department, Foxborough, MA, USA
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33
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Rolin Kragh A, Tofte Gregers M, Andelius L, Shahriari P, Kjærholm S, Korsgaard A, Folke F, Malta Hansen C. Follow-up on volunteer responders dispatched for out-of-hospital cardiac arrests: Addressing the psychological and physical impact. Resusc Plus 2023; 14:100402. [PMID: 37287956 PMCID: PMC10242620 DOI: 10.1016/j.resplu.2023.100402] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Introduction Smartphone technology is increasingly used to engage lay people as volunteer responders in resuscitation attempts. Attention has recently been drawn to how resuscitation attempts may impact bystanders. Attempting resuscitation in out-of-hospital cardiac arrests (OHCA) may be an overwhelming experience and, in some cases, difficult to cope with. We developed a volunteer responder follow-up program to systematically measure the psychological and physical impact on volunteer responders dispatched for OHCAs. Methods and Results The nationwide Danish volunteer responder program dispatches volunteer responders for presumed cardiac arrests. 90 min after notification of a potential nearby cardiac arrest, all volunteer responders receive a survey, and are asked to self-report their mental state of mind after the event. The volunteer responders are also asked to disclose any physical injury they sustained in relation to the event. Volunteer responders who report severe mental effects are offered a defusing conversation by a trained nurse. Between 1 September 2017 and 31 December 2022, the Danish volunteer responder program has alerted 177,866 volunteer responders for 10,819 presumed cardiac arrest alerts. Of 177,866 alerted volunteers responders, 62,711 accepted the alarm. In the same period, 7,317 cancelled their registration. From January 2019 to 31 December 31 2022, a total of 535 volunteer responders were offered a defusing consultation. Conclusion The Danish volunteer responder follow-up program is carried out to assess the psychological and physical risks of responding to a suspected OHCA. We suggest a survey-based method for systematic screening of volunteer responders that allow volunteer responders to report any physical injury or need of psychological follow-up. The person providing defusing should be a trained and experienced healthcare professional.
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Affiliation(s)
- Astrid Rolin Kragh
- Copenhagen Emergency Medical Services, Denmark
- University of Copenhagen, Department of Clinical Medicine, Denmark
| | - Mads Tofte Gregers
- Copenhagen Emergency Medical Services, Denmark
- University of Copenhagen, Department of Clinical Medicine, Denmark
| | - Linn Andelius
- Copenhagen Emergency Medical Services, Denmark
- University of Copenhagen, Department of Clinical Medicine, Denmark
| | - Persia Shahriari
- Copenhagen Emergency Medical Services, Denmark
- University of Copenhagen, Department of Clinical Medicine, Denmark
| | | | - Anders Korsgaard
- Department of Psychology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Denmark
- Department of Cardiology, University Hospital Gentofte, Copenhagen, Denmark
- University of Copenhagen, Department of Clinical Medicine, Denmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, Denmark
- Department of Cardiology, University Hospital Gentofte, Copenhagen, Denmark
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Metelmann B, Elschenbroich D, Auricchio A, Baldi E, Beckers SK, Burkart R, Fredman D, Ganter J, Krammel M, Marks T, Metelmann C, Müller MP, Scquizzato T, Stieglis R, Strickmann B, Christian Thies K. Proposal to increase safety of first responders dispatched to cardiac arrest. Resusc Plus 2023; 14:100395. [PMID: 37215185 PMCID: PMC10199241 DOI: 10.1016/j.resplu.2023.100395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Bibiana Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Germany
| | - Daniel Elschenbroich
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | | | - Angelo Auricchio
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Fondazione Ticino Cuore, Breganzona, Switzerland
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefan K. Beckers
- Fire Department & Emergency Medical Service, City of Aachen, Aachen, Germany
- Aachen Institute for Rescue Management & Public Safety, University Hospital RWTH Aachen University & City of Aachen, Aachen, Germany
| | - Roman Burkart
- Swiss Resuscitation Council, Bern, Switzerland
- Interverband für Rettungswesen, Aarau, Switzerland
| | - David Fredman
- Karolinska Institutet, Stockholm, Sweden
- Heartrunner Citizen Responder System, Heartrunner Sweden AB, Solna, Sweden
| | - Julian Ganter
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Freiburg, Germany
| | - Mario Krammel
- Emergency Medical Service Vienna, Vienna, Austria
- PULS Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Tore Marks
- Department of Anaesthesiology, University Medicine Greifswald, Germany
| | - Camilla Metelmann
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josef’s Hospital, Freiburg im Breisgau, Germany
| | - Michael P Müller
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josef’s Hospital, Freiburg im Breisgau, Germany
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Remy Stieglis
- Amsterdam University Medical Center, Location AMC, Department of Cardiology, Amsterdam, the Netherlands
| | - Bernd Strickmann
- Emergency Medical Service, City and District of Gütersloh, Gütersloh, Germany
| | - Karl Christian Thies
- Klinik für Anaesthesiologie, EvKB, Universitätsklinikum OWL der Universitaet Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
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Gregers MCT, Møller SG, Kjoelbye JS, Jakobsen LK, Grabmayr AJ, Kragh AR, Hansen CM, Torp-Pedersen C, Andelius L, Ersbøll AK, Folke F. Association of Degree of Urbanization and Survival in Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2023; 12:e8322. [PMID: 37158087 DOI: 10.1161/jaha.122.028449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background Survival from out-of-hospital cardiac arrest (OHCA) varies across regions. The aim of this study was to evaluate the association between urbanization (rural, suburban, and urban areas), bystander interventions (cardiopulmonary resuscitation and defibrillation), and 30-day survival from OHCAs in Denmark. Methods and Results We included OHCAs not witnessed by ambulance staff in Denmark from January 1, 2016, to December 31, 2020. Patients were divided according to the Eurostat Degree of Urbanization Tool in rural, suburban, and urban areas based on the 98 Danish municipalities. Poisson regression was used to estimate incidence rate ratios. Logistic regression (adjusted for ambulance response time) tested differences between the groups with respect to bystander interventions and survival, according to degree of urbanization. A total of 21 385 OHCAs were included, of which 8496 (40%) occurred in rural areas, 7025 (33%) occurred in suburban areas, and 5864 (27%) occurred in urban areas. Baseline characteristics, as age, sex, location of OHCA, and comorbidities, were comparable between groups. The annual incidence rate ratio of OHCA was higher in rural areas (1.54 [95% CI, 1.48-1.58]) compared with urban areas. Odds for bystander cardiopulmonary resuscitation were lower in suburban (0.86 [95% CI, 0.82-0.96]) and urban areas (0.87 [95% CI, 0.80-0.95]) compared with rural areas, whereas bystander defibrillation was higher in urban areas compared with rural areas (1.15 [95% CI, 1.01-1.31]). Finally, 30-day survival was higher in suburban (1.13 [95% CI, 1.02-1.25]) and urban areas (1.17 [95% CI, 1.05-1.30]) compared with rural areas. Conclusions Degree of urbanization was associated with lower rates of bystander defibrillation and 30-day survival in rural areas compared with urban areas.
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Affiliation(s)
- Mads Christian Tofte Gregers
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | | - Julie Samsoe Kjoelbye
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Louise Kollander Jakobsen
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Anne Juul Grabmayr
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Astrid Rolin Kragh
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Carolina Malta Hansen
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology Copenhagen University Hospital, North Zealand Hospital Copenhagen Denmark
- Department of Public Health University of Copenhagen Copenhagen Denmark
| | - Linn Andelius
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Anaesthesiology Copenhagen University Hospital, Herlev and Gentofte Hospital Copenhagen Denmark
| | - Annette Kjær Ersbøll
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | - Fredrik Folke
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- Department of Cardiology Copenhagen University Hospital, Herlev and Gentofte Hospital Copenhagen Denmark
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Shen CP, Freed BC, Walter DP, Perry JC, Barakat AF, Elashery ARA, Shah KS, Kutty S, McGillion M, Ng FS, Khedraki R, Nayak KR, Rogers JD, Bhavnani SP. Convolution Neural Network Algorithm for Shockable Arrhythmia Classification Within a Digitally Connected Automated External Defibrillator. J Am Heart Assoc 2023; 12:e026974. [PMID: 36942628 DOI: 10.1161/jaha.122.026974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background Diagnosis of shockable rhythms leading to defibrillation remains integral to improving out-of-hospital cardiac arrest outcomes. New machine learning techniques have emerged to diagnose arrhythmias on ECGs. In out-of-hospital cardiac arrest, an algorithm within an automated external defibrillator is the major determinant to deliver defibrillation. This study developed and validated the performance of a convolution neural network (CNN) to diagnose shockable arrhythmias within a novel, miniaturized automated external defibrillator. Methods and Results There were 26 464 single-lead ECGs that comprised the study data set. ECGs of 7-s duration were retrospectively adjudicated by 3 physician readers (N=18 total readers). After exclusions (N=1582), ECGs were divided into training (N=23 156), validation (N=721), and test data sets (N=1005). CNN performance to diagnose shockable and nonshockable rhythms was reported with area under the receiver operating characteristic curve analysis, F1, and sensitivity and specificity calculations. The duration for the CNN to output was reported with the algorithm running within the automated external defibrillator. Internal and external validation analyses included CNN performance among arrhythmias, often mistaken for shockable rhythms, and performance among ECGs modified with noise to mimic artifacts. The CNN algorithm achieved an area under the receiver operating characteristic curve of 0.995 (95% CI, 0.990-1.0), sensitivity of 98%, and specificity of 100% to diagnose shockable rhythms. The F1 scores were 0.990 and 0.995 for shockable and nonshockable rhythms, respectively. After input of a 7-s ECG, the CNN generated an output in 383±29 ms (total time of 7.383 s). The CNN outperformed adjudicators in classifying atrial arrhythmias as nonshockable (specificity of 99.3%-98.1%) and was robust against noise artifacts (area under the receiver operating characteristic curve range, 0.871-0.999). Conclusions We demonstrate high diagnostic performance of a CNN algorithm for shockable and nonshockable rhythm arrhythmia classifications within a digitally connected automated external defibrillator. Registration URL: https://clinicaltrials.gov/ct2/show/NCT03662802; Unique identifier: NCT03662802.
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Affiliation(s)
- Christine P Shen
- Division of Cardiology Healthcare Innovation Laboratory Scripps Clinic San Diego CA
| | | | | | - James C Perry
- University of California San Diego, Rady Children's Hospital San Diego CA
| | - Amr F Barakat
- University of Pittsburg Medical Center Pittsburgh PA
| | | | - Kevin S Shah
- University of Utah Health Sciences Center Salt Lake City UT
| | | | | | - Fu Siong Ng
- Imperial College of London London United Kingdom
| | - Rola Khedraki
- Division of Cardiology Healthcare Innovation Laboratory Scripps Clinic San Diego CA
| | - Keshav R Nayak
- Division of Interventional Cardiology Scripps Mercy Hospital San Diego CA
| | - John D Rogers
- Division of Cardiology Healthcare Innovation Laboratory Scripps Clinic San Diego CA
| | - Sanjeev P Bhavnani
- Division of Cardiology Healthcare Innovation Laboratory Scripps Clinic San Diego CA
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Bartos JA, Clare Agdamag A, Kalra R, Nutting L, Frascone RJ, Burnett A, Vuljaj N, Lick C, Tanghe P, Quinn R, Simpson N, Peterson B, Haley K, Sipprell K, Yannopoulos D. Supraglottic Airway Devices are Associated with Asphyxial Physiology After Prolonged CPR in Patients with Refractory Out-of-Hospital Cardiac Arrest Presenting for Extracorporeal Cardiopulmonary Resuscitation. Resuscitation 2023; 186:109769. [PMID: 36933882 DOI: 10.1016/j.resuscitation.2023.109769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Multiple randomized clinical trials have compared specific airway management strategies during ACLS with conflicting results. However, patients with refractory cardiac arrest died in almost all cases without the availability of extracorporeal cardiopulmonary resuscitation (ECPR). Our aim was to determine if endotracheal intubation (ETI) was associated with improved outcomes compared to supraglottic airways (SGA) in patients with refractory cardiac arrest presenting for ECPR. METHODS We retrospectively studied 420 consecutive adult patients with refractory out-of-hospital cardiac arrest due to shockable presenting rhythms presenting to the University of Minnesota ECPR program. We compared outcomes between patients receiving ETI (n=179) and SGA (n=204). The primary outcome was the pre-cannulation arterial PaO2 upon arrival to the ECMO cannulation center. Secondary outcomes included neurologically favorable survival to hospital discharge and eligibility for VA-ECMO based upon resuscitation continuation criteria applied upon arrival to the ECMO cannulation center. RESULTS Patients receiving ETI had significantly higher median PaO2 (71 vs. 58 mmHg, p=0.001), lower median PaCO2 (55 vs. 75 mmHg, p<0.001), and higher median pH (7.03 vs. 6.93, p<0.001) compared to those receiving SGA. Patients receiving ETI were also significantly more likely to meet VA-ECMO eligibility criteria (85% vs. 74%, p=0.008). Of patients eligible for VA-ECMO, patients receiving ETI had significantly higher neurologically favorable survival compared to SGA (42% vs. 29%, p=0.02). CONCLUSIONS ETI was associated with improved oxygenation and ventilation after prolonged CPR. This resulted in increased rate of candidacy for ECPR and increased neurologically favorable survival to discharge with ETI compared to SGA. Short Title: Airway Effects in Refractory Cardiac Arrest.
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Affiliation(s)
- Jason A Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Arianne Clare Agdamag
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Rajat Kalra
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Lindsay Nutting
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - R J Frascone
- Department of Emergency Medicine, Regions Hospital, St. Paul, MN, USA
| | - Aaron Burnett
- Woodbury and Cottage Grove, Emergency Medical Services, MN, USA
| | - Nik Vuljaj
- M Health Fairview Emergency Medical Services, Minneapolis, MN, USA
| | - Charles Lick
- Allina Health Emergency Medical Services, Minneapolis, MN, USA
| | - Peter Tanghe
- Department of Emergency Medicine, North Memorial Health Ambulance Service, North Memorial Health Medical Center, Robbinsdale, MN, USA
| | | | | | - Bjorn Peterson
- Department of Emergency Medicine, Regions Hospital, St. Paul, MN, USA
| | - Kari Haley
- Department of Emergency Medicine, Regions Hospital, St. Paul, MN, USA
| | - Kevin Sipprell
- Department of Emergency Medicine, Ridgeview Medical Center, Waconia, MN, USA
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
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DeMasi S, Joyce M. The use of spectral Doppler to detect return of spontaneous circulation, a novel alternative to manual palpation. Resuscitation 2023; 184:109717. [PMID: 36740092 DOI: 10.1016/j.resuscitation.2023.109717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Stephanie DeMasi
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, United States.
| | - Michael Joyce
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, United States; Department of Diagnostic Radiology, Virginia Commonwealth University, Richmond, VA, United States
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Birkun AA. Opportunities for better cardiac arrest surveillance with new coding system of International Classification of Diseases (ICD-11). Am J Emerg Med 2023; 67:176-177. [PMID: 37002115 DOI: 10.1016/j.ajem.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
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Geocadin RG, Agarwal S, Goss AL, Callaway CW, Richie M. Cardiac Arrest and Neurologic Recovery: Insights from the Case of Mr. Damar Hamlin. Ann Neurol 2023; 93:871-876. [PMID: 36843142 DOI: 10.1002/ana.26619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 02/28/2023]
Abstract
The association between brain injury after cardiac arrest and poor survival outcomes has led to longstanding pessimism. However, the publicly witnessed cardiac arrest, resuscitation, and acute management of Mr. Damar Hamlin and his favorable neurologic recovery provides some optimism. Mr. Hamlin's case highlights the neurologic advances of the last 2 decades and presents the opportunity to improve outcomes for all cardiac arrest patients in key areas: (1) effectively implementing the American Heart Association "Chain of Survival" to prevent initial brain injury and promote neuroprotection; (2) revisiting the process of neurologic prognostication and re-defining the brain recovery during the early periods, and (3) incorporating neurorehabilitation into existing cardiac rehabilitation models to support holistic recovery. ANN NEUROL 2023.
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Affiliation(s)
- Romergryko G Geocadin
- Departments of Neurology, Anesthesiology-Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sachin Agarwal
- Department of Neurology (Neurocritical Care), Columbia University Irving Medical Center, New York, NY, United States
| | - Adeline L Goss
- Department of Internal Medicine, Highland Hospital, Oakland, CA, United States
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Megan Richie
- Department of Neurology, University of California - San Francisco School of Medicine, San Francisco, CA, United States
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Current Evidence Surrounding the Use of Sodium Bicarbonate in the Critically Ill Patient. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2023. [DOI: 10.1007/s40138-023-00260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Martin-Gill C, Brown KM, Cash RE, Haupt RM, Potts BT, Richards CT, Patterson PD. 2022 Systematic Review of Evidence-Based Guidelines for Prehospital Care. PREHOSP EMERG CARE 2023; 27:131-143. [PMID: 36369826 DOI: 10.1080/10903127.2022.2143603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Multiple national organizations and federal agencies have promoted the development, implementation, and evaluation of evidence-based guidelines (EBGs) for prehospital care. Previous efforts have identified opportunities to improve the quality of prehospital guidelines and highlighted the value of high-quality EBGs to inform initial certification and continued competency activities for EMS personnel. OBJECTIVES We aimed to perform a systematic review of prehospital guidelines published from January 2018 to April 2021, evaluate guideline quality, and identify top-scoring guidelines to facilitate dissemination and educational activities for EMS personnel. METHODS We searched the literature in Ovid Medline and EMBASE from January 2018 to April 2021, excluding guidelines identified in a prior systematic review. Publications were retained if they were relevant to prehospital care, based on organized reviews of the literature, and focused on providing recommendations for clinical care or operations. Included guidelines were appraised to identify if they met the National Academy of Medicine (NAM) criteria for high-quality guidelines and scored across the six domains of the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. RESULTS We identified 75 guidelines addressing a variety of clinical and operational aspects of EMS medicine. About half (n = 39, 52%) addressed time/life-critical conditions and 33 (44%) contained recommendations relevant to non-clinical/operational topics. Fewer than half (n = 35, 47%) were based on systematic reviews of the literature. Nearly one-third (n = 24, 32%) met all NAM criteria for clinical practice guidelines. Only 27 (38%) guidelines scored an average of >75% across AGREE II domains, with content relevant to guideline implementation most commonly missing. CONCLUSIONS This interval systematic review of prehospital EBGs identified many new guidelines relevant to prehospital care; more than all guidelines reported in a prior systematic review. Our review reveals important gaps in the quality of guideline development and the content in their publications, evidenced by the low proportion of guidelines meeting NAM criteria and the scores across AGREE II domains. Efforts to increase guideline dissemination, implementation, and related education may be best focused around the highest quality guidelines identified in this review.
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Affiliation(s)
- Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathleen M Brown
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rachel M Haupt
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Benjamin T Potts
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Peters GA, Ordoobadi AJ, Panchal AR, Cash RE. Differences in Out-of-Hospital Cardiac Arrest Management and Outcomes across Urban, Suburban, and Rural Settings. PREHOSP EMERG CARE 2023; 27:162-169. [PMID: 34913821 DOI: 10.1080/10903127.2021.2018076] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rural prehospital care settings are underrepresented in the out-of-hospital cardiac arrest (OHCA) literature. This study aimed to describe treatment patterns and the odds of a favorable patient outcome (e.g., return of spontaneous circulation (ROSC) or being presumptively alive at the end of the incident) among rural OHCA patients in the U.S. METHODS Using the 2018 National Emergency Medical Services Informational System (NEMSIS) dataset, we analyzed OHCA incidents where an emergency medical services (EMS) unit provided cardiopulmonary resuscitation (CPR) and either terminated the resuscitation or completed transport. We excluded traumatic injuries, pediatric patients, and incidents with response time >60 minutes. The primary outcome was ROSC at any time during the EMS incident. The secondary outcome was a binary end-of-event indicator previously described for use in NEMSIS to estimate longer-term outcomes. Multivariable logistic regression was performed for each outcome measure comparing rural, suburban, and urban settings while controlling for key factors. RESULTS A total of 64,489 OHCA incidents were included, with 5,601 (8.9%) in rural settings. Among the full sample of OHCA incidents, ROSC was achieved in 20,578 (33.6%) cases, including 29.2% in rural settings and 34.1% in urban or suburban settings (p < 0.001). Advanced life support units responded to 95.3% of all calls, and a greater proportion of rural OHCA incidents were managed by basic life support units (7.4% vs. 4.2%, p < 0.001). Rural OHCA incidents had longer response times (7.5 vs. 5.9 minutes, p < 0.001), and rural patients were less likely to receive epinephrine (69.3% vs. 73.3%, p < 0.001). Further, EMS clinicians in rural areas were more likely to use mechanical CPR (29.5% vs. 27.6%, p < 0.01) and were less likely to perform advanced airway management (48.5% vs. 54.2%, p < 0.001). Rural patients had lower odds of achieving ROSC than urban patients after controlling for other factors (OR 0.81, 95% CI: 0.75-0.87). Rural patients also had lower odds of having a positive end-of-event outcome (i.e., presumptively alive) after controlling for other factors (OR 0.86, 95% CI: 0.79-0.93). CONCLUSION In this national sample of EMS-treated OHCAs, rural patients had lower odds of a favorable outcome (e.g., ROSC or presumptively alive) compared to those in urban settings.
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Affiliation(s)
- Gregory A Peters
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Ashish R Panchal
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.,National Registry of Emergency Medical Technicians, Columbus, Ohio
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Sun M, Zhu A, Tang Y. Continuous compression with asynchronous ventilation improves CPR prognosis? A meta-analysis from human and animal studies. Am J Emerg Med 2023; 64:26-36. [PMID: 36435007 DOI: 10.1016/j.ajem.2022.11.003] [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: 08/15/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The cardiopulmonary resuscitation (CPR) compression to ventilation strategy remains controversial. We conducted a meta-analysis to compare the outcomes between continuous chest compressions CPR with asynchronous ventilation (CCC-CPR) and interrupted chest compressions CPR with synchronous ventilation (ICC-CPR) in cardiac arrest. METHODS PubMed, Web of Science, Embase, MEDLINE (Ovid/LWW) and the Cochrane Libraries were searched up from inception to July 31, 2022. Human and animal studies comparing CCC-CPR versus ICC-CPR were included. Outcome variables were return of spontaneous circulation (ROSC), time to ROSC, survival to discharge, 1-month survival, survival at 4 h, good neurological function, mean arterial pressure (MAP) and other clinical parameters. Jadad Scale and Newcastle-Ottawa Scale were used to assess the study quality and risk of bias. RESULTS The systematic search identified eight studies on humans and twelve studies on animal trials. There were no significant differences in ROSC (odd ratios [OR] 1.07; 95% confidence interval [CI]: 0.86-1.32; P = 0.55), survival to hospital discharge (OR 1.04; 95%CI 0.77-1.42; P = 0.79), 1-month survival (OR 1.07; 95%CI 0.84-1.36; P = 0.57), and good neurological outcome (OR 0.92; 95%CI 0.84-1.01, P = 0.09) between CCC-CPR and ICC-CPR in human studies. In animal trials, CCC-CPR had significantly higher rate of ROSC (OR = 1.81; 95% CI: 0.94-3.49; P = 0.07), survival at 4 h (OR 2.57; 95% CI: 1.16-5.72; P = 0.02) and MAP (mean difference [MD] 0.79, 95% CI: 0.04-1.53; P = 0.04), even though no significant differences in ROSC time, arterial potential of hydrogen (pH) and partial tension of carbon dioxide (PaCO2). CONCLUSION CCC-CPR did not show superiority in human outcomes compared with ICC-CPR, but its effect value was significantly increased in animal experiments. We should take the positive outcomes from animals and apply them to human models, and more physiological mechanisms need to be confirmed in CPR patients with different compression-ventilation strategies to improve the prognosis of cardiac arrest.
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Affiliation(s)
- Mengxue Sun
- Xiangya Nursing School of Central South University, Changsha, Hunan, China; Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Aiqun Zhu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Emergency Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Yangyang Tang
- Xiangya Nursing School of Central South University, Changsha, Hunan, China; Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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De-Arteaga M, Elmer J. Self-fulfilling prophecies and machine learning in resuscitation science. Resuscitation 2023; 183:109622. [PMID: 36306959 PMCID: PMC10687765 DOI: 10.1016/j.resuscitation.2022.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/22/2022] [Accepted: 10/17/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Growth of machine learning (ML) in healthcare has increased potential for observational data to guide clinical practice systematically. This can create self-fulfilling prophecies (SFPs), which arise when prediction of an outcome increases the chance that the outcome occurs. METHODS We performed a scoping review, searching PubMed and ArXiv using terms related to machine learning, algorithmic fairness and bias. We reviewed results and selected manuscripts for inclusion based on expert opinion of well-designed or key studies and review articles. We summarized these articles to explore how use of ML can create, perpetuate or compound SFPs, and offer recommendations to mitigate these risks. RESULTS We identify-four key mechanisms through which SFPs may be reproduced or compounded by ML. First, imperfect human beliefs and behavior may be encoded as SFPs when treatment decisions are not accounted for. Since patient outcomes are influenced by a myriad of clinical actions, many of which are not collected in data, this is common. Second, human-machine interaction may compound SFPs through a cycle of mutual reinforcement. Third, ML may introduce new SFPs stemming from incorrect predictions. Finally, historically correct clinical choices may become SFPs in the face of medical progress. CONCLUSION There is a need for broad recognition of SFPs as ML is increasingly applied in resuscitation science and across medicine. Acknowledging this challenge is crucial to inform research and practice that can transform ML from a tool that risks obfuscating and compounding SFPs into one that sheds light on and mitigates SFPs.
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Affiliation(s)
- Maria De-Arteaga
- Information, Risk and Operations Management Department, McCombs School of Business, University of Texas at Austin, Austin, TX, USA
| | - Jonathan Elmer
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Clinical outcomes following out-of-hospital cardiac arrest: The minute-by-minute impact of bystander cardiopulmonary resuscitation. Resuscitation 2023; 185:109693. [PMID: 36646371 DOI: 10.1016/j.resuscitation.2023.109693] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
AIMS The time-dependent prognostic role of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients has not been described with great precision, especially for neurologic outcomes. Our objective was to assess the association between bystander CPR, emergency medical service (EMS) response time, and OHCA patients' outcomes. METHODS This cohort study used the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registries. Bystander-witnessed adult OHCA treated by EMS were included. The primary outcome was survival to hospital discharge and secondary outcome was survival with a good neurologic outcome (modified Rankin scale 0-2). Multivariable logistic regression models were used to assess the associations and interactions between bystander CPR, EMS response time and clinical outcomes. RESULTS Out of 229,637 patients, 41,012 were included (18,867 [46.0%] without bystander CPR and 22,145 [54.0%] with bystander CPR). Bystander CPR was independently associated with higher survival (adjusted odds ratio [AOR] = 1.70 [95%CI 1.61-1.80]) and survival with a good neurologic outcome (AOR = 1.87 [95%CI 1.70-2.06]), while longer EMS response times were independently associated with lower survival to hospital discharge (each additional minute of EMS response time: AOR = 0.92 [95%CI 0.91-0.93], p < 0.001) and lower survival with a good neurologic outcome (AOR = 0.88 [95%CI 0.86-0.89], p < 0.001). There was no interaction between bystander CPR and EMS response time's association with survival (p = 0.12) and neurologic outcomes (p = 0.65). CONCLUSIONS Although bystander CPR is associated with an immediate increase in odds of survival and of good neurologic outcome for OHCA patients, it does not influence the negative association between longer EMS response time and survival and good neurologic outcome.
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Muacevic A, Adler JR, Laher AE, Motara F. Knowledge, Attitudes, and Perceptions Regarding CPR Among Non-medical Staff at a Medical School in South Africa. Cureus 2023; 15:e33506. [PMID: 36756028 PMCID: PMC9904421 DOI: 10.7759/cureus.33506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/09/2023] Open
Abstract
Background Sudden cardiac arrest can occur unexpectedly in any person and at any place including at medical schools. Improved outcomes after cardiac arrest are dependent on the initiation of early first responder high-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation. There is a lack of data pertaining to the knowledge, attitudes, and perceptions of non-medical staff at medical schools regarding CPR. The aim of this study was to determine the knowledge, attitudes, and perceptions of non-medical staff employed at a medical school in South Africa regarding CPR. Methods In this cross-sectional survey study, a paper-based questionnaire was administered to non-medical staff (i.e., all staff without a medical [MBBCh or equivalent] or nursing degree) employed at the medical school. Data were collected between August 1 and October 25, 2020. Results The final study sample comprised 150 participants. Of these, 103 (68.7%) were female, 109 (72.7%) were ≤ 40 years old, 62 (41.3%) had a postgraduate university degree, 72 (48.0%) had witnessed a medical emergency at the medical school premises and 46 (30.7%) had previously undertaken first aid or CPR training. The mean (SD) knowledge score was 4.4 ± 1.6 out of 10 with only 25 (16.7%) participants knowing what the first thing was to look out for during a medical emergency and 28 (18.7%) participants knowing the location of the automated external defibrillator. Most participants (n=136, 90.7%) indicated that CPR training should be mandatory for all employees. Conclusion Non-medical staff surveyed displayed suboptimal knowledge but positive attitudes and perceptions toward CPR. Although this was a single-center study, these results can be used to motivate CPR training of non-medical staff at all medical schools.
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The interaction effect of bystander cardiopulmonary resuscitation (CPR) and dispatcher CPR on outcomes after out-of-hospital cardiac arrest. Sci Rep 2022; 12:22450. [PMID: 36575302 PMCID: PMC9793813 DOI: 10.1038/s41598-022-27096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022] Open
Abstract
This study aimed to evaluate the effects of bystander cardiopulmonary resuscitation (CPR) and dispatcher-assisted CPR (DA-CPR) on outcomes after out-of-hospital cardiac arrest (OHCA). We conducted a prospective observational study using the Korean Cardiac Arrest Research Consortium registry database and enrolled adults aged > 20 years who sustained OHCA. The study population comprised 13,864 patients from October 1, 2015, to June 30, 2021. All enrolled patients were transported to the emergency room and resuscitated by the emergency medical personnel. Patients with terminal illnesses, pregnancy, "do not resuscitate" cards, and insufficient recorded information were excluded. Good neurologic outcomes were noted in 6.5%, 9.9%, and 9.6% of patients in the "no bystander", "standard bystander", and "compression-only bystander" CPR groups, respectively, and differed significantly (p < 0.001). Survival to discharge differed significantly (p < 0.001) between groups at 10.8%, 13.1%, and 13.2%, respectively. In a multivariable model, the interaction between "compression-only" and DA-CPR showed a positive effect on good neurological outcomes and survival to discharge with an odds ratio of 1.93 (Confidence interval, CI 1.28-2.91, p = 0.002) and 1.74 (CI 1.24-2.44, p = 0.001), respectively. In conclusion, the interaction between compression-only CPR and DA-CPR is significantly associated with good neurological and survival outcomes after OHCA. Education for bystanders and dispatchers should adhere to the current guidelines to improve outcomes among OHCA victims.
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Effect of a Targeted Ambulance Treatment Quality Improvement Programme on Outcomes from Out-of-Hospital Cardiac Arrest: A Metropolitan Citywide Intervention Study. J Clin Med 2022; 12:jcm12010163. [PMID: 36614963 PMCID: PMC9820951 DOI: 10.3390/jcm12010163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
The performance of ambulance crew affects the quality of pre-hospital treatment, which is vital to the survival for out-of-hospital cardiac arrest (OHCA) patients, yet remains suboptimal in China. In this retrospective analysis study, we aimed to examine the effect of a citywide quality improvement programme on provision of prehospital advanced life support (ALS) by emergency medical service (EMS) system. EMS-treated adult OHCA patients after the implementation of the programme (1 January 2021 to 30 June 2022) were compared with historical controls (1 June 2019 to 31 August 2020) in Suzhou. Multivariable logistic regression analysis and propensity score matching procedures were applied to compare the outcomes between two periods for total OHCA cases and subgroup of cases treated by fixed or non-fixed ambulance crews. A total of 1465 patients (pre-period/post-period: 610/855) were included. In the 1:1 matched analysis of 591 cases for each period, significant improvement (p < 0.05) was observed for the proportion of intravenous (IV) access (23.4% vs. 68.2%), advanced airway management (49.2% vs. 57.0%), and return of spontaneous circulation (ROSC) at handover (5.4% vs. 9.0%). The fixed ambulance crews performed better than non-fixed group in IV access and advanced airway management for both periods. There were significant increases in IV access (AOR 12.66, 95%CI 9.02−18.10, p < 0.001), advanced airway management (AOR 1.67, 95% CI 1.30−2.16, p < 0.001) and ROSC at handover (AOR 2.37, 95%CI 1.38−4.23, p = 0.002) after intervention in unfixed group, while no significant improvement was observed in fixed group except for IV access (AOR 7.65, 95%CI 9.02−18.10, p < 0.001). In conclusion, the quality improvement program was positively associated with the provision of prehospital ALS interventions and prehospital ROSC following OHCA. The fixed ambulance crews performed better in critical care provision and prehospital outcome, yet increased protocol adherence and targeted training could fill the underperformance of non-fixed crews efficaciously.
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