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Smits RL, Tan HL, van Valkengoed IG. Sex Differences in Out-of-Hospital Cardiac Arrest Survival Trends. J Am Heart Assoc 2024; 13:e032179. [PMID: 38410948 PMCID: PMC10944070 DOI: 10.1161/jaha.123.032179] [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: 08/16/2023] [Accepted: 01/05/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest survival rates have improved over time. This study established whether improvements were similar for women and men, and to what extent resuscitation characteristics or in-hospital procedures contributed to sex differences in temporal trends. METHODS AND RESULTS This retrospective cohort study included 3386 women and 8564 men from North Holland, the Netherlands, who experienced an out-of-hospital cardiac arrest from a cardiac cause in 2005 to 2017. Yearly rates of 30-day survival and secondary outcomes were calculated. Sex differences in temporal trends were evaluated with age-adjusted Poisson regression analysis, including interaction for sex and out-of-hospital cardiac arrest year. Resuscitation characteristics and in-hospital procedures were added to the model, and a spline at 2013 was considered. During the study period, the average 30-day survival was 24.9% in men and 15.7% in women. The 30-day survival rate increased in men (20% to 27.2%; P<0.001) but not in women (15.0% to 11.6%; P=0.40). The increase in the 30-day survival rate was 3% higher per year in men than in women (rate ratio, 1.03 [95% CI, 1.00-1.05]), with a stronger difference after 2013. Men had a larger increase in survival rate to the hospital arrival than women in 2005 to 2013, and, after 2013, an advantage over women in survival rate after hospital arrival. The sex differences were partly explained by differing trends in shockable initial rhythm (eg, adjusted rate ratio, 1.01 [95% CI, 0.99-1.03] for 30-day survival) and provision of in-hospital procedures. CONCLUSIONS Changes in rates of 30-day survival, survival to hospital arrival, and, after 2013, survival from hospital arrival to 30 days were more beneficial in men than women. The differences in trends were partly explained by shockable initial rhythm and in-hospital procedures.
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Affiliation(s)
- Robin L.A. Smits
- Department of Public and Occupational HealthAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular SciencesAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
| | - Irene G.M. van Valkengoed
- Department of Public and Occupational HealthAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
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Dainty KN, Yng Ng Y, Pin Pek P, Koster RW, Eng Hock Ong M. Wolf creek XVII part 4: Amplifying lay-rescuer response. Resusc Plus 2024; 17:100547. [PMID: 38292468 PMCID: PMC10827540 DOI: 10.1016/j.resplu.2023.100547] [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: 02/01/2024] Open
Abstract
Introduction Amplifying lay-rescuer response is a key priority to increase survival from out-of-hospital cardiac arrest (OHCA). We describe the current state of lay-rescuer response, how we envision the future, and the gaps, barriers, and research priorities that will amplify response to OHCA. Methods 'Amplifying Lay-Rescuer Response' was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17, 2023, in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of cardiac arrest resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results The top five knowledge gaps as ranked by the panel, reflected a recognition of the need to better understand the psycho-social aspects of lay response. The top five barriers to translation reflected issues at the individual, community, societal, structural, and governmental levels. The top five research priorities were focused on understanding the social/psychological and emotional barriers to action, finding the most effective/cost-effective strategies to educate lay persons and implement community life-saving interventions, evaluation of new technological solutions and how to enhance the role of dispatch working with lay-rescuers. Conclusion Future research in lay rescuer response should incorporate technology innovations, understand the "humanity" of the situation, leverage implementation science and systems thinking to save lives. This will require the field of resuscitation to engage with scholars outside our traditional ranks and to be open to new ways of thinking about old problems.
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Affiliation(s)
- Katie N. Dainty
- Patient-Centered Outcomes, North York General Hospital Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Yih Yng Ng
- Digital and Smart Health Office, Ng Teng Fong Centre for Healthcare Innovation Department of Preventive and Population Medicine, Tan Tock Seng Hospital Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Pin Pin Pek
- Prehospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School Department of Emergency Medicine, Singapore General Hospital Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rudolph W. Koster
- Department of Cardiology, Amsterdam University Medical Centers, The Netherlands
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Andelius L, Folke F. On-site bystanders or dispatched volunteer responders for bystander defibrillation: Same goal, different paths. Resuscitation 2024; 195:110105. [PMID: 38184179 DOI: 10.1016/j.resuscitation.2023.110105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Linn Andelius
- Research Department, Copenhagen University Hospital, Copenhagen Emergency Medical Services, Denmark
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital, Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
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Ahmed A, Mewes JC, Lepage-Nefkens I, Tan HL, Vrijhoef HJM. Early modelling of the effects and healthcare costs of the Dutch citizen-rescuer system for out-of-hospital cardiac arrests. PLoS One 2023; 18:e0293965. [PMID: 37948427 PMCID: PMC10637662 DOI: 10.1371/journal.pone.0293965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES 1) to analyse the total average healthcare costs of a patient with an out-of-hospital cardiac arrest (OHCA), as well as estimating the operational costs of the citizen-rescuer system (CRS); 2) to conduct an early modelling of the effects and healthcare costs of the Dutch CRS in comparison to no CRS. METHODS A health economic modelling study was conducted. Adult patients with OHCA from cardiac causes in the province of Limburg (the Netherlands) were included. The time horizon was from OHCA occurrence up to one year after hospital discharge. First, the total average healthcare costs of OHCA patients were analysed as well as the yearly operating costs of the CRS. Second, an early modelling was conducted to compare from the healthcare perspective the healthcare costs of OHCA patients with the CRS being activated but no responders attended (CRS-NV) versus the CRS being activated with attendance of ≥1 responder(s) (CRS-V). RESULTS The total average healthcare costs per patient are €42,533. The yearly operating costs for the CRS are approximately €1.5 million per year in the Netherlands. The early modelling of costs and effects showed that the incremental healthcare costs per patient thus were €4,131 in the CRS-V versus the CRS-NV group (€25,184 in the CRS-V group and €21,053 in the CRS-NV group). Incremental quality-adjusted life years (QALYs) was 5 per 100 patients (16 per 100 patients in the CRS-V group versus 11 per 100 patients in the CRS-NV group). The incremental cost-effectiveness ratio (ICER) was €79,662 per QALY for the CRS-V group. CONCLUSION This study shows that patients in the CSR-V group had additional health care costs of €4,131 per patient compared to patients in the CRS-NV group. This increase is caused by patients surviving more often, who then continue to utilise health services, which results in a (logic) increase in healthcare costs. For future research, accurate and up-to-date data on effectiveness and costs of the CRS needs to be collected.
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Affiliation(s)
- Anam Ahmed
- Panaxea B.V., Den Bosch, The Netherlands
| | | | | | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
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Buter R, van Schuppen H, Koffijberg H, Hans EW, Stieglis R, Demirtas D. Where do we need to improve resuscitation? Spatial analysis of out-of-hospital cardiac arrest incidence and mortality. Scand J Trauma Resusc Emerg Med 2023; 31:63. [PMID: 37885039 PMCID: PMC10605336 DOI: 10.1186/s13049-023-01131-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Robin Buter
- Center for Healthcare Operations Improvement and Research, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, the Netherlands.
- Industrial Engineering and Business Information Systems, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, the Netherlands.
| | - Hans van Schuppen
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - Hendrik Koffijberg
- Health Technology & Services Research, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, the Netherlands
| | - Erwin W Hans
- Center for Healthcare Operations Improvement and Research, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, the Netherlands
- Industrial Engineering and Business Information Systems, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, the Netherlands
| | - Remy Stieglis
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - Derya Demirtas
- Center for Healthcare Operations Improvement and Research, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, the Netherlands
- Industrial Engineering and Business Information Systems, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, the Netherlands
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Gaisendrees C, Jaeger D, Kalra R, Kosmopoulos M, Harkins K, Marquez A, Hodgson L, Kollmar L, Bartos J, Yannopoulos D. The Minnesota first-responder AED project: Aiming to increase survival in out-of-hospital cardiac arrest. Resusc Plus 2023; 15:100437. [PMID: 37576444 PMCID: PMC10416018 DOI: 10.1016/j.resplu.2023.100437] [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: 08/15/2023] Open
Abstract
There are 350,000 out-of-hospital cardiac arrest (OHCA) cases annually in the United States of America. Using automated external defibrillators (AEDs) has increased survival in cardiac arrests (CA) with an initial shockable rhythm. Thus, guidelines recommend complete geographical coverage with AEDs. To fill in the gaps in Minnesota, the Center for Resuscitation Medicine at the University of Minnesota raised an $18.8 million grant from the Helmsley Charitable Trust to supply law enforcement first responders with AEDs and, thus, increase survival rates after OHCA by reducing the time to first shock. This report elaborates on the decision-making, fundraising, and logistic strategy required to reach statewide AED coverage. Methods The baseline need for AEDs was analyzed using a questionnaire sent out to state law enforcement agencies, state patrols, city and county agencies, and tribal agencies in 2021. Furthermore, OHCA cases of 2021 were reviewed. The combination of this information led to an action plan to equip and train all agencies throughout the state's eight regions with AEDs. Results The electronic survey was initially sent out to 358 agencies. The initial response rate was 77% (n = 276). This resulted in a total need of 8300 AEDs to be deployed over three years (2022-2025). As of 2023, over 4769 AEDs have been distributed, covering 237 sites. Conclusion By equipping first responders with AED systems, the Center for Resuscitation Medicine aims to shorten the gap in statewide AED coverage, thus increasing the chances of survival after OHCA.
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Affiliation(s)
- Christopher Gaisendrees
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Germany
| | - Deborah Jaeger
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
- INSERM U 1116, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Rajat Kalra
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Kimberly Harkins
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Alexandra Marquez
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Lucinda Hodgson
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Loren Kollmar
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Jason Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
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Haskins B, Nehme Z, Andrew E, Bernard S, Cameron P, Smith K. One-year quality-of-life outcomes of cardiac arrest survivors by initial defibrillation provider. Heart 2023; 109:1363-1371. [PMID: 36928241 DOI: 10.1136/heartjnl-2021-320559] [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: 12/20/2021] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE To assess the long-term functional and health-related quality-of-life (HRQoL) outcomes for out-of-hospital cardiac arrest (OHCA) survivors stratified by initial defibrillation provider. METHODS This retrospective study included adult non-traumatic OHCA with initial shockable rhythms between 2010 and 2019. Survivors at 12 months after arrest were invited to participate in structured telephone interviews. Outcomes were identified using the Glasgow Outcome Scale-Extended (GOS-E), EuroQol-5 Dimension (EQ-5D), 12-Item Short Form Health Survey and living and work status-related questions. RESULTS 6050 patients had initial shockable rhythms, 3211 (53.1%) had a pulse on hospital arrival, while 1879 (31.1%) were discharged alive. Bystander defibrillation using the closest automated external defibrillator had the highest survival rate (52.8%), followed by dispatched first responders (36.7%) and paramedics (27.9%). 1802 (29.8%) patients survived to 12-month postarrest; of these 1520 (84.4%) were interviewed. 1088 (71.6%) were initially shocked by paramedics, 271 (17.8%) by first responders and 161 (10.6%) by bystanders. Bystander-shocked survivors reported higher rates of living at home without care (87.5%, 75.2%, 77.0%, p<0.001), upper good recovery (GOS-E=8) (41.7%, 30.4%, 30.6%, p=0.002) and EQ-5D visual analogue scale (VAS) ≥80 (64.9%, 55.9%, 52.9%, p=0.003) compared with first responder and paramedics, respectively. After adjustment, initial bystander defibrillation was associated with higher odds of EQ-5D VAS ≥80 (adjusted OR (AOR) 1.56, 95% CI 1.15-2.10; p=0.004), good functional recovery (GOS-E ≥7) (AOR 1.53, 95% CI 1.12-2.11; p=0.009), living at home without care (AOR 1.77, 95% CI 1.16-2.71; p=0.009) and returning to work (AOR 1.72, 95% CI 1.05-2.81; p=0.031) compared with paramedic defibrillation. CONCLUSION Survivors receiving initial bystander defibrillation reported better functional and HRQoL outcomes at 12 months after arrest compared with those initially defibrillated by paramedics.
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Affiliation(s)
- Brian Haskins
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Paramedicine, Victoria University, Melbourne, Victoria, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Paramedicine, Monash University, Clayton, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Emily Andrew
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Stephen Bernard
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
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Horning J, Griffith D, Slovis C, Brady W. Pre-Arrival Care of the Out-of-Hospital Cardiac Arrest Victim. Emerg Med Clin North Am 2023; 41:413-432. [PMID: 37391242 DOI: 10.1016/j.emc.2023.03.001] [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
Lay rescuers play a pivotal role in the recognition and initial management of out-of-hospital cardiac arrest. The provision of timely pre-arrival care by lay responders, including cardiopulmonary resuscitation and the use of automated external defibrillator before emergency medical service arrival, is important link in the chain of survival and has been shown to improve outcomes from cardiac arrest. Although physicians are not directly involved in bystander response to cardiac arrest, they play a key role in emphasizing the importance of bystander interventions.
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Affiliation(s)
- Jillian Horning
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Daniel Griffith
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Corey Slovis
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA; Department of Emergency Medicine, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - William Brady
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA.
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Aranda-García S, Otero-Agra M, Fernández-Méndez F, Herrera-Pedroviejo E, Darné M, Barcala-Furelos R, Rodríguez-Núñez A. Augmented reality training in basic life support with the help of smart glasses. A pilot study. Resusc Plus 2023; 14:100391. [PMID: 37128627 PMCID: PMC10148024 DOI: 10.1016/j.resplu.2023.100391] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Introduction Laypeople should be trained in basic life support and traditional and innovative methodologies may help to obtain this goal. However, there is a knowledge gap about the ideal basic life support training methods. Smart glasses could have a role facilitating laypeople learning of basic life support. Aim To analyze the potential impact on basic life support learning of a very brief training supported by smart glasses video communication. Methods Twelve laypeople were basic life support tele-trained by means of smart glasses by an instructor in this pilot study. During training (assisted trough smart glasses) and after the training (unassisted) participants' performance and quality of basic life support and automated external defibrillation procedure were assessed on a standardized simulated scenario. Results After the training all participants were able to deliver good quality basic life support, with results comparable to those obtained when real time remotely guided by the instructor through the smart glasses. Mean chest compression rate was significantly higher when not guided (113 /min vs. 103 /min, p = 0.001). When not assisted, the participants spent less time delivering the sequential basic life support steps than when assisted while training. Conclusions A very brief remote training supported by instructor and smart glasses seems to be an effective educational method that could facilitate basic life support learning by laypeople. This technology could be considered in cases where instructors are not locally available or in general in remote areas, providing basic internet connection is available. Smart glasses could also be useful for laypeople rolling-refreshers.
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Affiliation(s)
- Silvia Aranda-García
- GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), University of Barcelona, Barcelona, Spain
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
- Corresponding author at: Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), Av de l’Estadi 22, 08038, Barcelona, Spain.
| | - Martín Otero-Agra
- REMOSS Research Group, Faculty of Physical Activity and Educational Science, University of Vigo, Pontevedra, Spain
- Pontevedra School of Nursing, University of Vigo, Pontevedra, Spain
| | - Felipe Fernández-Méndez
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
- REMOSS Research Group, Faculty of Physical Activity and Educational Science, University of Vigo, Pontevedra, Spain
- Pontevedra School of Nursing, University of Vigo, Pontevedra, Spain
| | | | - Marc Darné
- GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), University of Barcelona, Barcelona, Spain
| | - Roberto Barcala-Furelos
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
- REMOSS Research Group, Faculty of Physical Activity and Educational Science, University of Vigo, Pontevedra, Spain
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
- Pediatric Critical, Intermediate and Palliative Care Section, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), RD21/0012/0025, Instituto de Salud Carlos III, Madrid, Spain
- SICRUS Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Nikolaj Blomberg S, Jensen TW, Porsborg Andersen M, Folke F, Kjær Ersbøll A, Torp-Petersen C, Lippert F, Collatz Christensen H. When the machine is wrong. Characteristics of true and false predictions of Out-of-Hospital Cardiac arrests in emergency calls using a machine-learning model. Resuscitation 2023; 183:109689. [PMID: 36634755 DOI: 10.1016/j.resuscitation.2023.109689] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND A machine-learning model trained to recognize emergency calls regarding Out-of-Hospital Cardiac Arrest (OHCA) was tested in clinical practice at Copenhagen Emergency Medical Services (EMS) from September 2018 to December 2019. We aimed to investigate emergency call characteristics where the machine-learning model failed to recognize OHCA or misinterpreted a call as being OHCA. METHODS All emergency calls were linked to the dispatch database and verified OHCAs were identified by linkage to the Danish Cardiac Arrest Registry. Calls with either false negative or false positive predictions of OHCA were evaluated by trained auditors. Descriptive analyses were performed with absolute numbers and percentages reported. RESULTS The machine-learning model processed 169,236 calls to Copenhagen EMS and suspected 5,811 (3.4%) of the calls as OHCA, resulting in 84.5% sensitivity and 97.1% specificity. Among OHCAs not recognised by machine-learning model, a condition completely different from OHCA was presented by caller in 31% of the cases. In 28% of unrecognised calls, patient was reported breathing normally, and language barriers were identified in 23% of the cases. Among falsely suspected OHCA, the patient was reported unconscious in 28% of the cases, and in 13% of the false positive cases the machine-learning model interpreted calls regarding dead patients with irreversible signs of death as OHCA. CONCLUSION Continuous optimization of the language model is needed to improve the prediction of OHCA and thereby improve sensitivity and specificity of the machine-learning model on recognising OHCA in emergency telephone calls.
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Affiliation(s)
- Stig Nikolaj Blomberg
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Theo W Jensen
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Fredrik Folke
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical Services, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Petersen
- Department of Cardiology, Nordsjællands Hospital, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Falck, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark
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11
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Bassi MD, Farina JM, Bombau J, Fitz Maurice M, Bortman G, Nuñez E, Márquez M, Bornancini N, Baranchuk A. Sudden Cardiac Arrest in Basketball and Soccer Stadiums, the Role of Automated External Defibrillators: A Review. For the BELTRAN Study (BaskEtbaLl and soccer sTadiums: Registry on Automatic exterNal defibrillators). Arrhythm Electrophysiol Rev 2023; 12:e03. [PMID: 36845166 PMCID: PMC9945480 DOI: 10.15420/aer.2022.30] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/29/2022] [Indexed: 02/03/2023] Open
Abstract
Sudden cardiac arrest (SCA) during sports events has a dramatic impact on stadium-goers and the public and is often associated with poor outcomes unless treated with an automated external defibrillator (AED). Despite this, stadiums vary in AED use. This review aims to identify the risks and incidences of SCA, and the use of AEDs in soccer and basketball stadiums. A narrative review of all relevant papers was conducted. Athletes across all sports face an SCA risk of 1:50,000 athlete-years, with the greatest risk of SCA in young male athletes (1:35,000 person-years) and black male athletes (1:18,000 person-years). Africa and South America have the poorest soccer SCA outcomes at 3% and 4% survival. AED use on-site improves survival greater than defibrillation by emergency services. Many stadiums do not have AEDs implemented into medical plans and the AEDs are often unrecognisable or are obstructed. Therefore, AEDs should be used on-site, use clear signalling, have certified trained personnel, and be incorporated into stadiums' medical plans.
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Affiliation(s)
- Mario D. Bassi
- Department of Medicine, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada
| | - Juan M. Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona, US
| | - Jorge Bombau
- Internal Medicine, National University of La Plata, Argentina
| | - Mario Fitz Maurice
- Department of Cardiology, Hospital de Agudos Bernardino Rivadavia, Buenos Aires, Argentina
| | | | - Elaine Nuñez
- Servicio de Cardiología, Cedimat Centro Cardiovascular, Santo Domingo, República Dominicana
| | - Manlio Márquez
- Department of Electrophysiology, Centro Médico ABC (American British Cowdray), Ciudad de México, México
| | - Norberto Bornancini
- Department of Cardiology, Hospital General de Agudos “General Manuel Belgrano”, Buenos Aires, Argentina
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada,Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
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12
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Andelius L, Malta Hansen C, Jonsson M, Gerds TA, Rajan S, Torp-Pedersen C, Claesson A, Lippert F, Tofte Gregers MC, Berglund E, Gislason GH, Køber L, Hollenberg J, Ringh M, Folke F. Smartphone-activated volunteer responders and bystander defibrillation for out-of-hospital cardiac arrest in private homes and public locations. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 12:87-95. [PMID: 36574433 PMCID: PMC9910568 DOI: 10.1093/ehjacc/zuac165] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
AIMS To investigate the association between the arrival of smartphone-activated volunteer responders before the Emergency Medical Services (EMS) and bystander defibrillation in out-of-hospital cardiac arrest (OHCA) at home and public locations. METHODS AND RESULTS This is a retrospective study (1 September 2017-14 May 2019) from the Stockholm Region of Sweden and the Capital Region of Denmark. We included 1271 OHCAs, of which 1029 (81.0%) occurred in private homes and 242 (19.0%) in public locations. The main outcome was bystander defibrillation. At least one volunteer responder arrived before EMS in 381 (37.0%) of OHCAs at home and 84 (34.7%) in public. More patients received bystander defibrillation when a volunteer responder arrived before EMS at home (15.5 vs. 2.2%, P < 0.001) and in public locations (32.1 vs. 19.6%, P = 0.030). Similar results were found among the 361 patients with an initial shockable heart rhythm (52.7 vs. 11.5%, P < 0.001 at home and 60.0 vs. 37.8%, P = 0.025 in public). The standardized probability of receiving bystander defibrillation increased with longer EMS response times in private homes. The 30-day survival was not significantly higher when volunteer responders arrived before EMS (9.2 vs. 7.7% in private homes, P = 0.41; and 40.5 vs. 35.4% in public locations, P = 0.44). CONCLUSION Bystander defibrillation was significantly more common in private homes and public locations when a volunteer responder arrived before the EMS. The standardized probability of bystander defibrillation increased with longer EMS response times in private homes. Our findings support the activation of volunteer responders and suggest that volunteer responders could increase bystander defibrillation, particularly in private homes.
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Affiliation(s)
| | - Carolina Malta Hansen
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Thomas A Gerds
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5,1014 Copenhagen, Denmark
| | - Shahzleen Rajan
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Copenhagen University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark,Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Freddy Lippert
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark
| | - Mads Chr Tofte Gregers
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ellinor Berglund
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Gunnar H Gislason
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Fredrik Folke
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
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Alrasheedi SM, Alrashdi MN, Almutairi KF, Alruways AF, Almutairi IN, Alfehaid SN, Alrashdi OA, Alkhdairi A, Alrashidi AS, Aloraini YN. Awareness, Knowledge, and Attitudes Regarding Basic Life Support Among the Population With Relatives Suffering From Heart Diseases in the Al-Qassim Region, Saudi Arabia. Cureus 2022; 14:e31530. [DOI: 10.7759/cureus.31530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
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14
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Minna S, Leena H, Tommi K. How to evaluate first aid skills after training: a systematic review. Scand J Trauma Resusc Emerg Med 2022; 30:56. [DOI: 10.1186/s13049-022-01043-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To be able to help and save lives, laypersons are recommended to undergo first aid trainings. The aim of this review was to explore the variety of the elements of the measuring systems to assess the effects of first aid trainings on different aspects of first aid skills including practical skills, knowledge, and emotional perspectives.
Methods
This systematic literature review used Scopus and PubMed databases and searched for studies published between January, 2000, and December, 2020. Out of 2,162 studies meeting the search criteria, 15 studies with quantitative and repeatable evaluation methods to assess first aid skills after first aid training for adults were included in the final analysis.
Results
Practical skills, especially on the ability to perform cardiopulmonary resuscitation (CPR) and to use an automated external defibrillator, were the most studied first aid skills after first aid training. This evaluation was based on several standardized measurements and assessed often with the help of a combination of resuscitation manikin and observer. Evaluation methods of performance in other emergency situations are not well standardized. Questionnaires used to assess knowledge of first aid, though seemingly based on guidelines, were also not standardized, either. Emotional aspects of first aid (willingness or self-confidence) were evaluated by highly simplified questionnaires, and answers were graded by five-point Likert scale.
Conclusion
According to our review, the focus of evaluation methods after first aid training has been on practical skills and especially on CPR. Though the evaluation of first-aid knowledge seems to be straightforward, it is not performed systematically. Evaluation methods for emotional aspects are highly simplified. Overall, standardized measurements and evaluation methods to assess all aspects of first aid skills are needed.
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15
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Nielsen CG, Folke F, Andelius L, Hansen CM, Væggemose U, Christensen EF, Torp-Pedersen C, Ersbøll AK, Gregers MCT. Increased bystander intervention when volunteer responders attend out-of-hospital cardiac arrest. Front Cardiovasc Med 2022; 9:1030843. [DOI: 10.3389/fcvm.2022.1030843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
AimThe primary aim was to investigate the association between alarm acceptance compared to no-acceptance by volunteer responders, bystander intervention, and survival in out-of-hospital cardiac arrest.Materials and methodsThis retrospective observational study included all suspected out-of-hospital cardiac arrests (OHCAs) with activation of volunteer responders in the Capital Region of Denmark (1 November 2018 to 14 May 2019), the Central Denmark Region (1 November 2018 to 31 December 2020), and the Northern Denmark Region (14 February 2020 to 31 December 2020). All OHCAs unwitnessed by Emergency Medical Services (EMS) were analyzed on the basis on alarm acceptance and arrival before EMS. The primary outcomes were bystander cardio-pulmonary resuscitation (CPR), bystander defibrillation and secondary outcome was 30-day survival. A questionnaire sent to all volunteer responders was used with respect to their arrival status.ResultsWe identified 1,877 OHCAs with volunteer responder activation eligible for inclusion and 1,725 (91.9%) of these had at least one volunteer responder accepting the alarm (accepted). Of these, 1,355 (79%) reported arrival status whereof 883 (65%) arrived before EMS. When volunteer responders accepted the alarm and arrived before EMS, we found increased proportions and adjusted odds ratio for bystander CPR {94 vs. 83%, 4.31 [95% CI (2.43–7.67)] and bystander defibrillation [13 vs. 9%, 3.16 (1.60–6.25)]} compared to cases where no volunteer responders accepted the alarm.ConclusionWe observed a fourfold increased odds ratio for bystander CPR and a threefold increased odds ratio for bystander defibrillation when volunteer responders accepted the alarm and arrived before EMS.
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16
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Modesti PA, Casolo G, Olivotto I, Pellegrino A. Sudden death in young athletes: Is it preventable? Eur J Intern Med 2022; 104:13-20. [PMID: 35718646 DOI: 10.1016/j.ejim.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 01/09/2023]
Abstract
Sudden death in young athletes is a rare but always dramatic condition. Unlike all other rare diseases, the estimate of its real incidence is made complex not only because of the uncertain number of correctly identified cases (numerator) but also because of the uncertain estimation of the real number of the reference population, the athletes (denominator). New elements of complexity are also emerging with regard to prevention. The current two pillars of prevention are pre-participation screening (proactive strategy) and promoting use / access to the automated external defibrillator (reactive strategy). The standardization of procedures implemented over the past two decades for pre-participation screening can now allow us to assess the impact of this approach. The result is complex to evaluate. While screening may allow the identification of conditions potentially associated with SDA, and therefore the adoption of specific treatments, in about 0.4% of screened subjects, a single study investigated the yield in terms of mortality showing a positive predictive value of 4.7% with 25% sensitivity. Conversely, the reactive strategy appears considerably effective, due to the widespread use of the automated external defibrillators in sports facilities, calling for a homogeneous implementation worldwide. On a broader perspective, the vast attention devoted to SDA prevention in the world of sports represents a major driver for transfer of a reactive prevention strategy to the general population.
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Affiliation(s)
- Pietro Amedeo Modesti
- Sport Medicine Unit, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy.
| | - Giancarlo Casolo
- Cardiology Department, Ospedale Versilia, Lido di Camaiore, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessio Pellegrino
- Sport Medicine Unit, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy
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17
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Lee D, Stiepak JK, Pommerenke C, Poloczek S, Grittner U, Prugger C. Public Access Defibrillators and Socioeconomic Factors on the Small—Scale Spatial Level in Berlin. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:393-399. [PMID: 35477511 PMCID: PMC9492911 DOI: 10.3238/arztebl.m2022.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/05/2021] [Accepted: 03/30/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The use of a public access defibrillator (PAD) increases the probability of surviving an out-of-hospital cardiac arrest (OHCA). No strategies exist, however, for the optimal distribution of PADs in an urban area in order to meet existing needs and ensure equal access for all potential users. It thus seems likely that the accessibility of PADs on the spatial level varies widely as a function of living circumstances. METHODS This cross-sectional study is based on registry data concerning PAD (2022, n = 776) and OHCA (2018-2020, n = 4051), along with data on socioeconomic factors on the spatial level in Berlin (12 districts and 137 subdistricts). Associations of socioeconomic factors with the number of PADs per 10 000 inhabitants and the PAD coverage rate of sites of previous OHCAs were investigated. RESULTS The median number of PADs per 10 000 inhabitants ranged from 0.46 to 2.67 at the district level, and only five districts had a median PAD coverage rate of sites of previous OHCAs above 0%, after aggregation of the analyses at the subdistrict level. Subdistricts with a more favorable economic status and a greater income disparity had a higher PAD density. Socially disadvantaged subdistricts had no association with PAD density. CONCLUSION There are large deficits in the distribution of PADs at the small-scale spatial level in Berlin with respect to the goals of meeting existing needs and ensuring equal access for all potential users. The findings presented here will be of importance for the planning of future PAD programs so that the distributional efficiency and fairness of PAD in urban areas can be improved.
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Affiliation(s)
- Dokyeong Lee
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin,*Institut für Public Health, Charité – Universitätsmedizin Berlin Charitéplatz 1, 10117 Berlin
| | - Jan-Karl Stiepak
- Emergency Medical Services Medical Director, Berlin: Jan-Karl Stiepak
| | - Christopher Pommerenke
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Stefan Poloczek
- Fire department of Berlin, Berlin: Jan-Karl Stiepak, Christopher Pommerenke,Emergency Medical Services Medical Director, Berlin: Jan-Karl Stiepak
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin,Berlin Institute of Health, Charité – Universitätsmedizin Berlin
| | - Christof Prugger
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
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18
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Management Decisions: The Effectiveness and Size of the Emergency Medical Team. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073753. [PMID: 35409435 PMCID: PMC8997948 DOI: 10.3390/ijerph19073753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023]
Abstract
In Poland, often for economic reasons, the staffing of medical rescue teams is limited to the legally required minimum. This gives rise to problems related to the effectiveness and efficiency of medical rescue teams. A literature review did not find any sources addressing the issue of the verification of the effectiveness of paramedic teams depending on the personnel composition of units. The aim of the study was to analyze the effectiveness of resuscitation depending on the size of the medical rescue team, comparing the work of two- and three-person teams. In total, 100 two-person teams and an analogous number of three-person units were studied. Statistical analyses were performed using the IBM SPSS Statistics 24 package. The results showed that the assessment of the condition of the victim as well as the ability to assess the heart rhythm and monitor the condition during advanced measures were more effective in three-person teams; three-person teams also used oxygen more frequently during advanced life support (ALS). Most of the elements influenced the quality of resuscitation and it can be unequivocally stated that the work of three rescuers is more efficient and definitely more effective.
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19
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Stærk M, Lauridsen KG, Krogh K, Løfgren B. Distribution and use of automated external defibrillators and their effect on return of spontaneous circulation in Danish hospitals. Resusc Plus 2022; 9:100211. [PMID: 35199074 PMCID: PMC8842076 DOI: 10.1016/j.resplu.2022.100211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Automated external defibrillators (AEDs) increase survival after out-of-hospital cardiac arrest. However, the effect of AEDs for in-hospital cardiac arrest (IHCA) remains uncertain. This study aims to describe the distribution and use of AEDs in Danish hospitals and investigate whether early rhythm analysis is associated with return of spontaneous circulation (ROSC). Methods All Danish public hospitals with a cardiac arrest team were included and sent a questionnaire on the in-hospital distribution of AEDs and manual defibrillators. Further, we collected data on IHCAs including rhythm analysis, device type, cardiac arrest team arrival, and ROSC from the national database on IHCA (DANARREST). Results Of 46 hospitals, 93% had AEDs and 93% had manual defibrillators. AEDs were often placed in wards or non-clinical areas, whereas manual defibrillators were often placed in areas with high-risk patients. We identified 3,204 IHCAs. AEDs were used in 13% of IHCAs. After adjustment for confounders, chance of ROSC was higher if the first rhythm analysis was performed before the arrival of the cardiac arrest team (RR: 1.28 (95% CI: 1.12–1.46)). The relative risk of ROSC was 1.09 (0.84–1.41) when analyzing with an AED before cardiac arrest team arrival and 1.19 (1.00–1.41) when using a manual defibrillator. However, there was no significant effect modification for AED vs manual defibrillator (p = 0.26). Conclusion AEDs are widely distributed in Danish hospitals but less commonly used for IHCAs compared to manual defibrillators. Rhythm analysis before arrival of the cardiac arrest team was associated with ROSC without significant effect modification of device type.
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Affiliation(s)
- Mathilde Stærk
- Department of Medicine, Randers Regional Hospital, Denmark
- Education and Research, Randers Regional Hospital, Denmark
| | - Kasper G. Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Emergency Department, Randers Regional Hospital, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Denmark
| | - Bo Løfgren
- Department of Medicine, Randers Regional Hospital, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Corresponding author at: Department of Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark.
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20
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Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation. Circulation 2022; 145:e776-e801. [PMID: 35164535 DOI: 10.1161/cir.0000000000001013] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
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21
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Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation. Resuscitation 2022; 172:204-228. [PMID: 35181376 DOI: 10.1016/j.resuscitation.2021.11.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
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22
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Affiliation(s)
- Remy Stieglis
- Department of Cardiology Amsterdam University Medical Center, Location AMC Amsterdam the Netherlands
| | - Rudolph W. Koster
- Department of Cardiology Amsterdam University Medical Center, Location AMC Amsterdam the Netherlands
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23
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Francis M, Buckley T, Tofler AR, Tofler GH. Masters Age Football And Cardiovascular Risk (MAFACARI). Intern Med J 2021; 52:369-378. [PMID: 34894042 DOI: 10.1111/imj.15660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Football (soccer) is popular among those of Masters age (≥35 years). Although regular exercise improves health, strenuous exercise causes a transient increase in cardiac risk. AIM The aim of this survey of Masters Age Footballers was to gain insight into cardiac risk factors, symptoms, and knowledge, attitudes and beliefs about myocardial infarction (MI), and support for prevention. METHODS A web-based survey using REDCap was completed by 153 amateur Masters footballers from A grade competition (n=24), B or lower grade (n=95) or social games (n=34) in Sydney, Australia. RESULTS Participants were aged 49.3±7.5 years and primarily male (92.2%), Caucasian (88.9%) and university educated (75.2%). Risk factors included hypercholesterolaemia (37.3%), hypertension (19.6%), smoker (7.8%), overweight (40.5%) or obese (13.1%). One fifth (21.6%) reported ≥1 potential cardiac symptom during activity in the prior year, for which one quarter (24.2%) sought medical attention. Knowledge of typical MI symptoms was high (>80%) but lower (<40%) for less typical symptoms. Half (49.6%) were unconfident to recognise MI in themselves. Half (49.0%) would remain on the field for 5-10 minutes with chest pain. Only 39.9% were aware that warning signs may precede MI by days. They overestimated survival from cardiac arrest (43%). Participants supported training in automatic external defibrillators (AED) and CPR (84%), AEDs at games (85%) and cardiac education (>70%). CONCLUSIONS Cardiac risk factors are common In Masters footballers, with one in five experiencing possible cardiac symptoms in the prior year. While gaps exist in knowledge and optimal responses, strong support exists for preventive measures. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matthew Francis
- Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Australia
| | - Thomas Buckley
- Royal North Shore Hospital, Sydney, Australia.,Sydney Nursing School, University of Sydney, Australia
| | | | - Geoffrey H Tofler
- Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Australia
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24
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Bolijn R, Sieben CHAM, Kunst AE, Blom M, Tan HL, van Valkengoed IGM. Sex differences in incidence of out-of-hospital cardiac arrest across ethnic and socioeconomic groups: A population-based cohort study in the Netherlands. Int J Cardiol 2021; 343:156-161. [PMID: 34509532 DOI: 10.1016/j.ijcard.2021.09.007] [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] [Received: 03/29/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Insight into the occurrence of out-of-hospital cardiac arrest (OHCA) within general populations may help to target prevention strategies. Case registries suggest that there may be substantial differences in emergency medical service (EMS)-attended OHCA incidence between men and women, but relative sex differences across ethnic groups and socioeconomic (SES) groups have not been studied. We investigated sex differences in OHCA incidence, overall and across these subgroups. METHODS We performed a retrospective population-based cohort study, combining individual-level data on ethnicity and income (as SES measure) from Statistics Netherlands of all men and women aged ≥25 years living in one study region in the Netherlands on 01-01-2009 (n = 1,688,285) with prospectively collected EMS-attended OHCA cases (n = 5676) from the ARREST registry until 31-12-2015. We calculated age-standardised incidence rates of OHCA. Sex differences were assessed with Cox proportional hazards regression analyses, adjusted for age, ethnicity and income, in the overall population, and across ethnic and SES groups. RESULTS The age-standardised incidence rate of OHCA was lower in women than in men (30.9 versus 87.3 per 100,000 person-years), corresponding with a hazard ratio (HR) of 0.33 (95% confidence interval [CI] 0.31-0.35). These sex differences in hazard for OHCA existed in all income quintiles (HR range: 0.30-0.35) and ethnic groups (HR range: 0.19-0.40), except among Moroccans (HR 0.89, 95% CI 0.51-1.57). CONCLUSION Women have a substantial, yet lower OHCA incidence rate than men. The magnitude of these sex differences did not vary across social strata.
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Affiliation(s)
- Renee Bolijn
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Cenne H A M Sieben
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anton E Kunst
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marieke Blom
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hanno L Tan
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Irene G M van Valkengoed
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
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Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Tijssen JGP, Zwinderman AH, Blom MT, Koster RW. Alert system-supported lay defibrillation and basic life-support for cardiac arrest at home. Eur Heart J 2021; 43:1465-1474. [PMID: 34791171 PMCID: PMC9009403 DOI: 10.1093/eurheartj/ehab802] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/17/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Aims Automated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home. Methods and results In residential areas, 785 AEDs were placed and 5735 volunteer responders were recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient. We analysed survival (primary outcome) and neurologically favourable survival to discharge, time to first defibrillation shock, and cardiopulmonary resuscitation (CPR) before Emergency Medical Service (EMS) arrival of patients in residences found with ventricular fibrillation (VF), before and after introduction of this text-message alert system. Survival from OHCAs in residences increased from 26% to 39% {adjusted relative risk (RR) 1.5 [95% confidence interval (CI): 1.03–2.0]}. RR for neurologically favourable survival was 1.4 (95% CI: 0.99–2.0). No CPR before ambulance arrival decreased from 22% to 9% (RR: 0.5, 95% CI: 0.3–0.7). Text-message-responders with AED administered shocks to 16% of all patients in VF in residences, while defibrillation by EMS decreased from 73% to 39% in residences (P < 0.001). Defibrillation by first responders in residences increased from 22 to 40% (P < 0.001). Use of public AEDs in residences remained unchanged (6% and 5%) (P = 0.81). Time from emergency call to defibrillation decreased from median 11.7 to 9.3 min; mean difference –2.6 (95% CI: –3.5 to –1.6). Conclusion Introducing volunteer responders directed to AEDs, dispatched by text-message was associated with significantly reduced time to first defibrillation, increased bystander CPR and increased overall survival for OHCA patients in residences found with VF.
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Affiliation(s)
- Remy Stieglis
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | - Jolande A Zijlstra
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | | | | | | | - Jan G P Tijssen
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | | | - Marieke T Blom
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | - Rudolph W Koster
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
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Longer retrieval distances to the automated external defibrillator reduces survival after out-of-hospital cardiac arrest. Resuscitation 2021; 170:44-52. [PMID: 34767901 DOI: 10.1016/j.resuscitation.2021.11.001] [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: 09/17/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate and compare survival after out-of-hospital (OHCA), where an automated external defibrillator (AED) was used, in densely, moderately and thinly populated areas. Also, to evaluate the association between AED retrieval distance and survival after OHCA. METHODS From 2014 to 2018, AEDs used during OHCA in the region of Southern Denmark were systematically collected. OHCAs were included if the OHCA address was known. OHCAs at nursing homes were excluded. To evaluate population density, a map with 1000 × 1000 meter grid cells was used with each cell color-graded according to the number of inhabitants. Densely, moderately and thinly populated areas were defined as ≥200 inhabitants, 20-199 inhabitants and 0-19 inhabitants per km2, respectively. Primary outcome was 30-day survival. RESULTS A total of 423 cases of OHCA were included, of which 207 (49%) occurred in densely populated areas, while 78 (18%) and 138 (33%) occurred in moderately and thinly populated areas, respectively. AED retrieval distances were: densely populated 105 m (IQR 5-450), moderately populated 220 m (IQR 5-450) and thinly populated 350 m (IQR 5-1500) (P < 0.001). Thirty-day survival was 40%, 31% and 34%, respectively (P = 0.3). In a multivariable regression analysis, mortality increased with 10% per 100 m an AED was placed further away from the site of OHCA. CONCLUSION Survival after OHCA, where an AED was used, did not seem to differ in thinly, moderately and densely populated areas. The length of the AED retrieval distance, however, was correlated with reduced survival after adjusting for other potentially explanatory variables.
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Peng CQ, Lawson KD, Heffernan M, McDonnell G, Liew D, Lybrand S, Pearson SA, Cutler H, Kritharides L, Trieu K, Huynh Q, Usherwood T, Occhipinti JA. Gazing through time and beyond the health sector: Insights from a system dynamics model of cardiovascular disease in Australia. PLoS One 2021; 16:e0257760. [PMID: 34591888 PMCID: PMC8483334 DOI: 10.1371/journal.pone.0257760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To construct a whole-of-system model to inform strategies that reduce the burden of cardiovascular disease (CVD) in Australia. METHODS A system dynamics model was developed with a multidisciplinary modelling consortium. The model population comprised Australians aged 40 years and over, and the scope encompassed acute and chronic CVD as well as primary and secondary prevention. Health outcomes were CVD-related deaths and hospitalisations, and economic outcomes were the net benefit from both the healthcare system and societal perspectives. The eight strategies broadly included creating social and physical environments supportive of a healthy lifestyle, increasing the use of preventive treatments, and improving systems response to acute CVD events. The effects of strategies were estimated as relative differences to the business-as-usual between 2019-2039. Probabilistic sensitivity analysis produced uncertainty intervals of interquartile ranges (IQR). FINDINGS The greatest reduction in CVD-related deaths was seen in strategies that improve systems response to acute CVD events (8.9%, IQR: 7.7-10.2%), yet they resulted in an increase in CVD-related hospitalisations due to future recurrent admissions (1.6%, IQR: 0.1-2.3%). This flow-on effect highlighted the importance of addressing underlying CVD risks. On the other hand, strategies targeting the broad environment that supports a healthy lifestyle were effective in reducing both hospitalisations (7.1%; IQR: 5.0-9.5%) and deaths (8.1% reduction; IQR: 7.1-8.9%). They also produced an economic net benefit of AU$43.3 billion (IQR: 37.7-48.7) using a societal perspective, largely driven by productivity gains. Overall, strategic planning to reduce the burden of CVD should consider the varying effects of strategies over time and beyond the health sector.
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Affiliation(s)
- Cindy Q. Peng
- Decision Analytics, The SAX Institute, Sydney, Australia
- * E-mail:
| | - Kenny D. Lawson
- Adjunct, Western Sydney University, Sydney, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Mark Heffernan
- Adjunct, Western Sydney University, Sydney, Australia
- Dynamic Operations, Sydney, Australia
| | | | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Sydney, Australia
| | - Leonard Kritharides
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Jo-An Occhipinti
- Decision Analytics, The SAX Institute, Sydney, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
- Computer Simulation & Advanced Research Technology (CSART), Sydney, Australia
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Matinrad N, Reuter-Oppermann M. A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services. CENTRAL EUROPEAN JOURNAL OF OPERATIONS RESEARCH 2021; 30:251-302. [PMID: 34566490 PMCID: PMC8449697 DOI: 10.1007/s10100-021-00769-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 05/31/2023]
Abstract
Emergency services worldwide face increasing cost pressure that potentially limits their existing resources. In many countries, emergency services also face the issues of staff shortage-creating extra challenges and constraints, especially during crisis times such as the COVID-19 pandemic-as well as long distances to sparsely populated areas resulting in longer response times. To overcome these issues and potentially reduce consequences of daily (medical) emergencies, several countries, such as Sweden, Germany, and the Netherlands, have started initiatives using new types of human resources as well as equipment, which have not been part of the existing emergency systems before. These resources are employed in response to medical emergency cases if they can arrive earlier than emergency medical services (EMS). A good number of studies have investigated the use of these new types of resources in EMS systems, from medical, technical, and logistical perspectives as their study domains. Several review papers in the literature exist that focus on one or several of these new types of resources. However, to the best of our knowledge, no review paper that comprehensively considers all new types of resources in emergency medical response systems exists. We try to fill this gap by presenting a broad literature review of the studies focused on the different new types of resources, which are used prior to the arrival of EMS. Our objective is to present an application-based and methodological overview of these papers, to provide insights to this important field and to bring it to the attention of researchers as well as emergency managers and administrators.
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Affiliation(s)
- Niki Matinrad
- Department of Science and Technology, Linköping University, Norrköping, 60174 Sweden
| | - Melanie Reuter-Oppermann
- Information Systems - Software and Digital Business Group, Technical University of Darmstadt, 64289 Darmstadt, Germany
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Chernov N, Bezverkhii A. Research study on the efficiency of a defibrillating biphasic pulse of various durations based on mathematical modeling and simulation of a cardiomyocyte. CARDIOMETRY 2021. [DOI: 10.18137/cardiometry.2021.18.4449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The paper presents the results of our research study on the impact of different durations of a biphasic rectangular pulse on the efficiency of the defibrillating action based on modeling and simulation of a cardiomyocyte in the framework of Cell Electrophysiology Simulation Environment. We used Luo-Rudy Mammalian Ventricular Model II (dynamic) as the mathematical model of the biochemical processes, which occur both on the surface and inside a cardiomyocyte in a guinea pig. An analysis of the obtained results allowed us to determine the optimal time of the defibrillating pulse. It has been shown that a pulse of 4 ms duration has the highest efficiency. The research has been carried out directly based on the mathematical model and simulation of the cardiomyocyte that makes it possible to minimize errors which may occur in experiments on animals
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Krzyżanowski K, Ślęzak D, Dąbrowski S, Żuratyński P, Mędrzycka-Dąbrowska W, Buca P, Jastrzębski P, Robakowska M. Comparative Analysis of the Effectiveness of Performing Advanced Resuscitation Procedures Undertaken by Two- and Three- Person Basic Medical Rescue Teams in Adults under Simulated Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094834. [PMID: 33946551 PMCID: PMC8124675 DOI: 10.3390/ijerph18094834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
(1) Objective: Paramedics as a profession are a pillar of the State Medical Rescue system. The basic difference between a specialist and a basic team is the composition of members. The aim of the study was to benchmark the effectiveness of performing advanced resuscitation procedures undertaken by two- and three-person basic emergency medical teams in adults under simulated conditions. (2) Design: The research was observational. 200 two- and three-people basic emergency medical teams were analyzed during advanced resuscitation procedures, ALS (Advanced Life Support) in adults under simulated conditions. (3) Method: The study was carried out among professionally active and certified paramedics. It lasted over two years. The study took place under simulated conditions using prepared scenarios. (4) Results: In total, 463 people took part in the study. The analysis of the survey results indicates that the efficiency of three-person teams is superior to the activities performed by two-person teams. Three-person teams were quicker to perform rescue actions than two-person teams. The two-person teams were much quicker to assess the condition of victims than the three-person teams. The three-person teams were more likely to check an open airway. The three-person teams were more efficient in assessing the heart rhythm and current condition of victims. It was demonstrated that three-person teams were more effective during electrotherapy. The analysis demonstrated that three-person teams were significantly faster and more efficient in chest compressions. Three-person teams were less likely to use emergency airway techniques than two-person teams. The results indicate that three-person teams administered the first dose of adrenaline significantly faster than two-person teams. For the “call for help”, the three-person teams were found to be more effective. (5) Conclusion: Paramedics in three-person teams work more effectively, make a proper assessment of heart rhythm and monitor when taking advanced actions. The quality of ventilation and BLS in both groups studied is insufficient. Numerous errors have been observed in two-person teams during pharmacotherapy.
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Affiliation(s)
- Kamil Krzyżanowski
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (K.K.); (S.D.); (P.Ż.)
| | - Daniel Ślęzak
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (K.K.); (S.D.); (P.Ż.)
- Correspondence:
| | - Sebastian Dąbrowski
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (K.K.); (S.D.); (P.Ż.)
| | - Przemysław Żuratyński
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (K.K.); (S.D.); (P.Ż.)
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology and Intensive Care Nursing, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Institute of Nursing and Midwifery, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
| | - Paulina Buca
- Division of Hyperbaric Medicine & Maritime Rescue—National Centre for Hyperbaric Medicine, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Powstania Styczniowego 9b, 81-519 Gdynia, Poland;
| | - Paweł Jastrzębski
- Departament of Emergency Medicine, Faculty of Health Science, University of Warmia and Mazury, Żołnierska 18, 10-561 Olsztyn, Poland;
| | - Marlena Robakowska
- Division of Public Health and Social Medicine, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Tuwima 15, 80-210 Gdańsk, Poland;
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Abstract
The European Resuscitation Council (ERC) has produced these Systems Saving Lives guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include chain of survival, measuring performance of resuscitation, social media and smartphones apps for engaging community, European Restart a Heart Day, World Restart a Heart, KIDS SAVE LIVES campaign, lower-resource setting, European Resuscitation Academy and Global Resuscitation Alliance, early warning scores, rapid response systems, and medical emergency team, cardiac arrest centres and role of dispatcher.
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Oving I, de Graaf C, Masterson S, Koster RW, Zwinderman AH, Stieglis R, AliHodzic H, Baldi E, Betz S, Cimpoesu D, Folke F, Rupp D, Semeraro F, Truhlar A, Tan HL, Blom MT. European first responder systems and differences in return of spontaneous circulation and survival after out-of-hospital cardiac arrest: A study of registry cohorts. THE LANCET REGIONAL HEALTH. EUROPE 2021; 1:100004. [PMID: 35104306 PMCID: PMC8454711 DOI: 10.1016/j.lanepe.2020.100004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND In Europe, survival-rates after out-of-hospital cardiac arrest (OHCA) vary widely between regions. Whether a system dispatching First Responders (FRs; main FR-types: firefighters, police officers, citizen-responders) is present or not may be associated with survival-rates. This study aimed to assess the association between having a dispatched FR-system and rates of return of spontaneous circulation (ROSC) and survival across Europe. METHODS Results of an inventory of dispatched FR-systems for OHCA in Europe were combined with aggregate ROSC and survival data from the EuReCa-TWO study and additionally collected data. Regression analysis (weighted on number of patients included per region) was performed to study the association between having a dispatched FR-system and ROSC and survival-rates to hospital discharge in the total population and in patients with shockable initial rhythm, witnessed OHCA and bystander cardiopulmonary resuscitation (CPR; Utstein comparator group). For regions without a dispatched FR-system, the theoretical survival-rate if a dispatched FR-system would have existed was estimated. FINDINGS We included 27 European regions. There were 15,859 OHCAs in the total group and 2,326 OHCAs in the Utstein comparator group. Aggregate ROSC and survival-rates were significantly higher in regions with an FR-system compared to regions without (ROSC: 36% [95%CI 35%-37%] vs. 24% [95%CI 23%-25%]; P<0.001; survival in total population [N=15.859]: 13% [95%CI 12%-15%] vs. 5% [95%CI 4%-6%]; P<0.001; survival in Utstein comparator group [N=2326]: 33% [95%CI 30%-36%] vs. 18% [95%CI 16%-20%]; P<0.001), and in regions with more than one FR-type compared to regions with only one FR-type. All main FR-types were associated with higher survival-rates (all P<0.050). INTERPRETATION European regions with dispatched FRs showed higher ROSC and survival-rates than regions without. FUNDING This project/work has received funding from the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381 (IO, HLT and MTB) and the European Union's COST programme under acronym PARQ, registered under grant agreement No CA19137 (IO, DC, HLT, MTB). HLT and MTB were supported by a grant from the Netherlands CardioVascular Research Initiative, Dutch Heart Foundation, Dutch Federation of University Medical Centres, Netherlands Organization for Health Research and Development, Royal Netherlands Academy of Sciences - CVON2017-15 RESCUED (HLT), and CVON2018-30 Predict2 (HLT and MTB).
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Affiliation(s)
- Iris Oving
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Corina de Graaf
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Siobhan Masterson
- Department of General Practice, National University of Ireland Galway and National Ambulance Service, Dublin, Ireland
| | - Rudolph W. Koster
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiologic Biostatics, Academic Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Remy Stieglis
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Hajriz AliHodzic
- Emergency Medical Service, Public Institution Health Centre 'Dr. Mustafa Šehović' Tuzla and Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Susanne Betz
- Department of Emergency Medicine, University Hospital Giessen and Marburg, Marburg, Germany
| | - Diana Cimpoesu
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Dennis Rupp
- Emergency Medical Services Mittelhessen, German Red Cross, Marburg, Germany
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy
| | - Anatolij Truhlar
- Emergency Medical Services of the Hradec Kralove Region and Department of Anaesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Corresponding author.
| | - Marieke T. Blom
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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de Graaf C, Beesems SG, Oud S, Stickney RE, Piraino DW, Chapman FW, Koster RW. Analyzing the heart rhythm during chest compressions: Performance and clinical value of a new AED algorithm. Resuscitation 2021; 162:320-328. [PMID: 33460749 DOI: 10.1016/j.resuscitation.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/26/2020] [Accepted: 01/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Automated external defibrillators (AED) prompt the rescuer to stop chest compressions (CC) for ECG analysis during out-of-hospital cardiac arrest (OHCA). We assessed the diagnostic accuracy and clinical benefit of a new AED algorithm (cprINSIGHT), which analyzes ECG and impedance signals during CC, allowing rhythm analysis with ongoing chest compressions. METHODS Amsterdam Police and Fire Fighters used a conventional AED in 2016-2017 (control) and an AED with cprINSIGHT in 2018-2019 (intervention). In the intervention AED, cprINSIGHT was activated after the first (conventional) analysis. This algorithm classified the rhythm as "shockable" (S) and "non-shockable" (NS), or "pause needed". Sensitivity for S, specificity for NS with 90% lower confidence limit (LCL), chest compression fractions (CCF) and pre-shock pause were compared between control and intervention cases accounting for multiple observations per patient. RESULTS Data from 465 control and 425 intervention cases were analyzed. cprINSIGHT reached a decision during CC in 70% of analyses. Sensitivity of the intervention AED was 96%, (LCL 93%) and specificity was 98% (LCL 97%), both not significantly different from control. Intervention cases had a shorter median pre-shock pause compared to control cases (8 s vs 22 s, p < 0.001) and higher median CCF (86% vs 80%, P < 0.001). CONCLUSION AEDs with cprINSIGHT analyzed the ECG during chest compressions in 70% of analyses with 96% sensitivity and 98% specificity when it made a S or a NS decision. Compared to conventional AEDs, cprINSIGHT leads to a significantly shorter pre-shock pause and a significant increase in CCF.
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Affiliation(s)
- Corina de Graaf
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Stefanie G Beesems
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sharon Oud
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | | | | | - Rudolph W Koster
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Blom MT, Oving I, Berdowski J, van Valkengoed IGM, Bardai A, Tan HL. Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest. Eur Heart J 2020; 40:3824-3834. [PMID: 31112998 PMCID: PMC6911168 DOI: 10.1093/eurheartj/ehz297] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/15/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022] Open
Abstract
Aims Previous studies on sex differences in out-of-hospital cardiac arrest (OHCA) had limited scope and yielded conflicting results. We aimed to provide a comprehensive overall view on sex differences in care utilization, and outcome of OHCA. Methods and results We performed a population-based cohort-study, analysing all emergency medical service (EMS) treated resuscitation attempts in one province of the Netherlands (2006–2012). We calculated odds ratios (ORs) for the association of sex and chance of a resuscitation attempt by EMS, shockable initial rhythm (SIR), and in-hospital treatment using logistic regression analysis. Additionally, we provided an overview of sex differences in overall survival and survival at successive stages of care, in the entire study population and in patients with SIR. We identified 5717 EMS-treated OHCAs (28.0% female). Women with OHCA were less likely than men to receive a resuscitation attempt by a bystander (67.9% vs. 72.7%; P < 0.001), even when OHCA was witnessed (69.2% vs. 73.9%; P < 0.001). Women who were resuscitated had lower odds than men for overall survival to hospital discharge [OR 0.57; 95% confidence interval (CI) 0.48–0.67; 12.5% vs. 20.1%; P < 0.001], survival from OHCA to hospital admission (OR 0.88; 95% CI 0.78–0.99; 33.6% vs. 36.6%; P = 0.033), and survival from hospital admission to discharge (OR 0.49, 95% CI 0.40–0.60; 33.1% vs. 51.7%). This was explained by a lower rate of SIR in women (33.7% vs. 52.7%; P < 0.001). After adjustment for resuscitation parameters, female sex remained independently associated with lower SIR rate. Conclusion In case of OHCA, women are less often resuscitated by bystanders than men. When resuscitation is attempted, women have lower survival rates at each successive stage of care. These sex gaps are likely explained by lower rate of SIR in women, which can only partly be explained by resuscitation characteristics. ![]()
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Affiliation(s)
- Marieke T Blom
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Iris Oving
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Jocelyn Berdowski
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Irene G M van Valkengoed
- Department of Public Health, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Abdenasser Bardai
- Department of Clinical Genetics, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
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Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A35-A79. [PMID: 33098921 PMCID: PMC7576327 DOI: 10.1016/j.resuscitation.2020.09.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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37
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Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, Bigham BL, Hirsch KG, Hoover AV, Kurz MC, Levy A, Lin Y, Magid DJ, Mahgoub M, Peberdy MA, Rodriguez AJ, Sasson C, Lavonas EJ. Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S580-S604. [PMID: 33081524 DOI: 10.1161/cir.0000000000000899] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Survival after cardiac arrest requires an integrated system of people, training, equipment, and organizations working together to achieve a common goal. Part 7 of the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, with an emphasis on elements that are relevant to a broad range of resuscitation situations. Previous systems of care guidelines have identified a Chain of Survival, beginning with prevention and early identification of cardiac arrest and proceeding through resuscitation to post-cardiac arrest care. This concept is reinforced by the addition of recovery as an important stage in cardiac arrest survival. Debriefing and other quality improvement strategies were previously mentioned and are now emphasized. Specific to out-of-hospital cardiac arrest, this Part contains recommendations about community initiatives to promote cardiac arrest recognition, cardiopulmonary resuscitation, public access defibrillation, mobile phone technologies to summon first responders, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about the recognition and stabilization of hospital patients at risk for developing cardiac arrest. This Part also includes recommendations about clinical debriefing, transport to specialized cardiac arrest centers, organ donation, and performance measurement across the continuum of resuscitation situations.
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38
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Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castrén M, Chung SP, Considine J, Couper K, Escalante R, Hatanaka T, Hung KK, Kudenchuk P, Lim SH, Nishiyama C, Ristagno G, Semeraro F, Smith CM, Smyth MA, Vaillancourt C, Nolan JP, Hazinski MF, Morley PT, Svavarsdóttir H, Raffay V, Kuzovlev A, Grasner JT, Dee R, Smith M, Rajendran K. Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S41-S91. [DOI: 10.1161/cir.0000000000000892] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This2020 International Consensus on Cardiopulmonary Resuscitation(CPR)and Emergency Cardiovascular Care Science With Treatment Recommendationson basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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39
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de Almeida J, Gonçalves F, Gonçalves L. External Automated Defibrillator-Assisted Diagnosis of Patient After Bringing Him Back to Life. JAMA Intern Med 2020; 180:1378-1379. [PMID: 32804220 DOI: 10.1001/jamainternmed.2020.2549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- José de Almeida
- Department of Cardiology, Coimbra University Hospital, Coimbra, Portugal
| | | | - Lino Gonçalves
- Department of Cardiology, Coimbra University Hospital, Coimbra, Portugal
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40
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Sun CLF, Karlsson L, Morrison LJ, Brooks SC, Folke F, Chan TCY. Effect of Optimized Versus Guidelines-Based Automated External Defibrillator Placement on Out-of-Hospital Cardiac Arrest Coverage: An In Silico Trial. J Am Heart Assoc 2020; 9:e016701. [PMID: 32814479 PMCID: PMC7660789 DOI: 10.1161/jaha.120.016701] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Mathematical optimization of automated external defibrillator (AED) placement may improve AED accessibility and out‐of‐hospital cardiac arrest (OHCA) outcomes compared with American Heart Association (AHA) and European Resuscitation Council (ERC) placement guidelines. We conducted an in silico trial (simulated prospective cohort study) comparing mathematically optimized placements with placements derived from current AHA and ERC guidelines, which recommend placement in locations where OHCAs are usually witnessed. Methods and Results We identified all public OHCAs of presumed cardiac cause from 2008 to 2016 in Copenhagen, Denmark. For the control, we computationally simulated placing 24/7‐accessible AEDs at every unique, public, witnessed OHCA location at monthly intervals over the study period. The intervention consisted of an equal number of simulated AEDs placements, deployed monthly, at mathematically optimized locations, using a model that analyzed historical OHCAs before that month. For each approach, we calculated the number of OHCAs in the study period that occurred within a 100‐m route distance based on Copenhagen’s road network of an available AED after it was placed (“OHCA coverage”). Estimated impact on bystander defibrillation and 30‐day survival was calculated by multivariate logistic regression. The control scenario involved 393 AEDs at historical, public, witnessed OHCA locations, covering 15.8% of the 653 public OHCAs from 2008 to 2016. The optimized locations provided significantly higher coverage (24.2%; P<0.001). Estimated bystander defibrillation and 30‐day survival rates increased from 15.6% to 18.2% (P<0.05) and from 32.6% to 34.0% (P<0.05), respectively. As a baseline, the 1573 real AEDs in Copenhagen covered 14.4% of the OHCAs. Conclusions Mathematical optimization can significantly improve OHCA coverage and estimated clinical outcomes compared with a guidelines‐based approach to AED placement.
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Affiliation(s)
- Christopher L F Sun
- Sloan School of Management Massachusetts Institute of Technology Cambridge MA.,Healthcare Systems Engineering Massachusetts General Hospital Boston MA
| | - Lena Karlsson
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Copenhagen Denmark.,Copenhagen Emergency Medical Services University of Copenhagen Denmark
| | - Laurie J Morrison
- Division of Emergency Medicine Department of Medicine University of Toronto Canada.,Rescu Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Canada
| | - Steven C Brooks
- Rescu Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Canada.,Departments of Emergency Medicine and Public Health Sciences Queen's University Kingston Canada
| | - Fredrik Folke
- Healthcare Systems Engineering Massachusetts General Hospital Boston MA.,Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Copenhagen Denmark
| | - Timothy C Y Chan
- Rescu Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Canada.,Department of Mechanical and Industrial Engineering University of Toronto Canada
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41
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Savastano S, Baldi E, Compagnoni S, Fracchia R, Ristagno G, Grieco N. The automated external defibrillator, an underused simple life-saving device: a review of the literature. A joint document from the Italian Resuscitation Council (IRC) and Associazione Italiana di Aritmologia e Cardiostimolazione (AIAC). J Cardiovasc Med (Hagerstown) 2020; 21:733-739. [PMID: 32740425 DOI: 10.2459/jcm.0000000000001047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
: The role of early defibrillation has been well established as a pivotal ring of the chain of survival since the nineties. In the following years, the scientific evidences about the beneficial role of early defibrillation have grown, and most of all, it has been demonstrated that the main determinant of survival is the time of defibrillation more than the type of rescuer. Early lay defibrillation was shown to be more effective than delayed defibrillation by healthcare providers. Moreover, because of the ease of use of automated external defibrillators (AEDs), it has been shown that also untrained lay rescuers can safely use an AED leading the guidelines to encourage early defibrillation by untrained lay bystanders. Although strong evidence has demonstrated that an increase in AED use leads to an increase in out-of-hospital cardiac arrest (OHCA) survival, the rate of defibrillation by laypeople is quite variable worldwide and very low in some realities. Our review of the literature about lay defibrillation highlights that the AED is a life-saving device as simple and well tolerated as underused.
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Affiliation(s)
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo.,Department of Molecular Medicine, Section of Cardiology, University of Pavia
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo.,Department of Molecular Medicine, Section of Cardiology, University of Pavia
| | - Rosa Fracchia
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo
| | - Giuseppe Ristagno
- Department of Medical and Surgical Physiopathology and Transplantation, University of Milan
| | - Niccolò Grieco
- First Cardiology Department - Cath Lab and Intensive Cardiac Care, Niguarda Hospital, Milan, Italy
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42
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Ming Ng W, De Souza CR, Pek PP, Shahidah N, Ng YY, Arulanandam S, White AE, Leong BSH, Ong MEH. myResponder Smartphone Application to Crowdsource Basic Life Support for Out-of-Hospital Cardiac Arrest: The Singapore Experience. PREHOSP EMERG CARE 2020; 25:388-396. [PMID: 32497484 DOI: 10.1080/10903127.2020.1777233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The Singapore myResponder is a novel smartphone application developed by the Singapore Civil Defence Force (SCDF) that notifies volunteer first responders of a suspected out-of-hospital cardiac arrest (OHCA) case and locations of Automated External Defibrillators (AED) in the vicinity so that they can assist with resuscitation. We aimed to examine the performance of this application, challenges encountered, and future directions. Methods: We analyzed data from the myResponder app since its launch from April 2015 to July 2019. The number of installations, registered community first responders, suspected OHCA cases, notifications sent by the app, percentage of responders who accepted activation and arrived at scene were reviewed. A subgroup of taxi driving responders (within a 1.5-kilometer response radius) carrying an AED under a subsequent pilot program was also analyzed. Results: By July 2019, 46,689 responders were registered in the myResponder app. There were a total of 19,189 cases created for suspected OHCA, with a median of 358 cases per month (IQR 330-430), in which 10,073 responders accepted activation from myResponder and 4,955 arrived on-scene. A total of 135,599 notifications were sent for these cases, with a median of 7.1 notifications per case (IQR 4.3-8.7). In 2019, the percentages of responders who accepted notification and arrived on scene were 45.8% and 24.1%, respectively. 43% (1110/2581) of responders arrived before EMS crew. Conclusion: The myResponder mobile application is a feasible smart technology solution to improve community response to OHCA, and to increase bystander CPR and AED use. Future directions include increasing the number of active responders, improving response rates, app performance, and better data capture for quality improvement.
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43
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Krammel M, Lobmeyr E, Sulzgruber P, Winnisch M, Weidenauer D, Poppe M, Datler P, Zeiner S, Keferboeck M, Eichelter J, Hamp T, Uray T, Schnaubelt S, Nuernberger A. The impact of a high-quality basic life support police-based first responder system on outcome after out-of-hospital cardiac arrest. PLoS One 2020; 15:e0233966. [PMID: 32484818 PMCID: PMC7266310 DOI: 10.1371/journal.pone.0233966] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Laypersons' efforts to initiate basic life support (BLS) in witnessed Out-of-Hospital Cardiac Arrest (OHCA) remain comparably low within western society. Therefore, in order to shorten no-flow times in cardiac arrest, several police-based first responder systems equipped with automated external defibrillators (Pol-AED) were established in urban areas, which subsequently allow early BLS and AED administration by police officers. However, data on the quality of BLS and AED use in such a system and its impact on patient outcome remain scarce and inconclusive. METHODS A total of 85 Pol-AED cases were randomly assigned to a gender, age and first rhythm matched non-Pol-AED control group (n = 170) in a 1:2 ratio. Data on quality of BLS were extracted via trans-thoracic impedance tracings of used AED devices. RESULTS Comparing Pol-AED cases and the control group, we observed a similar compression rate per minute (p = 0.677) and compression ratio (p = 0.651), mirroring an overall high quality of BLS administered by police officers. Time to the first shock was significantly shorter in Pol-AED cases (6 minutes [IQR: 2-10] vs. 12 minutes [IQR: 8-17]; p<0.001). While Pol-AED was not associated with increased sustained return of spontaneous circulation (p = 0.564), a strong and independent impact on survival until hospital discharge (adj. OR: 1.85 [95%CI: 1.06-3.23; p = 0.030]) and a borderline significance for the association with favorable neurological outcome (adj. OR: 1.58 [95%CI: 0.96-2.89; p = 0.052) were observed. CONCLUSION We were able to demonstrate an early start and a high quality of BLS and AED use in Pol-AED assessed OHCA cases. Moreover, the presence of Pol-AED care was associated with better patient survival and borderline significance for favorable neurological outcome.
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Affiliation(s)
- Mario Krammel
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.,PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Emergency Medical Service, Vienna, Austria
| | - Elisabeth Lobmeyr
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Markus Winnisch
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - David Weidenauer
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Philip Datler
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian Zeiner
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Keferboeck
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Emergency Medical Service, Vienna, Austria
| | - Thomas Hamp
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.,PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Thomas Uray
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian Schnaubelt
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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The contribution of comorbidity and medication use to poor outcome from out-of-hospital cardiac arrest at home locations. Resuscitation 2020; 151:119-126. [DOI: 10.1016/j.resuscitation.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/26/2020] [Accepted: 03/18/2020] [Indexed: 12/21/2022]
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45
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Liaw SY, Chew KS, Zulkarnain A, Wong SSL, Singmamae N, Kaushal DN, Chan HC. Improving perception and confidence towards bystander cardiopulmonary resuscitation and public access automated external defibrillator program: how does training program help? Int J Emerg Med 2020; 13:13. [PMID: 32183687 PMCID: PMC7079341 DOI: 10.1186/s12245-020-00271-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In conjunction with an automated external defibrillator (AED) placement program at various locations within a public university in Malaysia, a series of structured training programs were conducted. The objectives of this study is to (1) evaluate the effectiveness of a structured training program in improving the perception of the importance of AED and cardiopulmonary resuscitation (CPR), (2) evaluate the confidence of the employees in using an AED and performing bystander CPR, (3) identify the fears and concerns of these employees in using AED and performing CPR, and (4) determine the perception of these employees towards the strategy of the AEDs placed at various locations within the university. METHODS In this single-center observational study, a validated questionnaire aimed to assess the university employees' attitude and confidence in handling AED and performing CPR before (pre-test) and immediately after (post-test) the training program was conducted. RESULTS A total of 184 participants participated in this study. Using the Wilcoxon signed-rank test, the training programs appeared to have improved the perception that "using AED is important for unresponsive victims" (z = 4.32, p < 0.001) and that "AED practice drills should be performed on a regular basis" (z = - 2.41, p = 0.02) as well as increased the confidence to perform CPR (z = - 8.56, p < 0.001), use AED (z = - 8.93, p < 0.001), identify victims with no signs of life (z = - 7.88, p < 0.001), and the willingness to perform CPR and AED without hesitancy (z = - 8.91, p < 0.001). Fears and concerns on performing CPR and using AED also appeared to have been significantly reduced, and the perception on placement strategies of these AEDs was generally positive. CONCLUSION Using the theory of planned behavior as the explanatory framework, training programs appear to be helpful in improving the perception and the confidence of the participants towards performing CPR and using AED through the promotion of positive attitude, positive societal expectation, and a positive sense of empowerment. But whether this positive effect will translate into actual CPR performance and AED application in a real cardiac arrest is yet to be seen.
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Affiliation(s)
- Siew Yee Liaw
- Emergency Medicine and Trauma Department, Sarawak General Hospital, Jalan Hospital, Sarawak, 93586, Malaysia.,Faculty of Medicine, Universiti of Malaya, Jalan Universiti, Kuala Lumpur, 50603, Malaysia
| | - Keng Sheng Chew
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Jalan Datuk Mohammad Musa, 94300, Kota Samarahan, Sarawak, Malaysia.
| | - Ahmad Zulkarnain
- Faculty of Medicine, Universiti of Malaya, Jalan Universiti, Kuala Lumpur, 50603, Malaysia
| | - Shirly Siew Ling Wong
- Faculty of Economics & Business, Universiti Malaysia Sarawak, Jalan Datuk Mohammad Musa, Kota Samarahan, 94300, Sarawak, Malaysia
| | - Nariman Singmamae
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Jalan Datuk Mohammad Musa, 94300, Kota Samarahan, Sarawak, Malaysia
| | - Dev Nath Kaushal
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Jalan Datuk Mohammad Musa, 94300, Kota Samarahan, Sarawak, Malaysia
| | - Hiang Chuan Chan
- Emergency Medicine and Trauma Department, Sarawak General Hospital, Jalan Hospital, Sarawak, 93586, Malaysia
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Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Koster RW. AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest. Resuscitation 2020; 150:170-177. [PMID: 32045663 DOI: 10.1016/j.resuscitation.2020.01.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND For out-of-hospital cardiac arrest (OHCA) in residential areas, a dispatcher driven alert-system using text messages (TM-system) directing local rescuers (TM-responders) to OHCA patients was implemented and the desired density of automated external defibrillators (AEDs) or TM-responders investigated. METHODS We included OHCA cases with the TM-system activated in residential areas between 2010-2017. For each case, densities/km2 of activated AEDs and TM-responders within a 1000 m circle were calculated. Time intervals between 112-call and first defibrillation were calculated. RESULTS In total, 813 patients (45%) had a shockable initial rhythm. In 17% a TM-system AED delivered the first shock. With increasing AED density, the median time to shock decreased from 10:59 to 08:17 min. (p < 0.001) and shocks <6 min increased from 6% to 12% (p = 0.024). Increasing density of TM-responders was associated with a decrease in median time to shock from 10:59 to 08:20 min. (p < 0.001) and increase of shocks <6 min from 6% to 13% (p = 0.005). Increasing density of AEDs and TM-responders resulted in a decline of ambulance first defibrillation by 19% (p = 0.016) and 22% (p = 0.001), respectively. First responder AED defibrillation did not change significantly. Densities of >2 AEDs/km2 did not result in further decrease of time to first shock but >10 TM-responders/km2 resulted in more defibrillations <6 min. CONCLUSION With increasing AED and TM-responder density within a TM-system, time to defibrillation in residential areas decreased. AED and TM-responders only competed with ambulances, not with first responders. The recommended density of AEDs and TM-responders for earliest defibrillation is 2 AEDs/km2 and >10 TM-responders/km2.
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Affiliation(s)
- Remy Stieglis
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands.
| | - Jolande A Zijlstra
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands
| | - Frank Riedijk
- Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands
| | - Martin Smeekes
- Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands
| | | | - Rudolph W Koster
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands
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Homma PCM, de Graaf C, Tan HL, Hulleman M, Koster RW, Beesems SG, Blom MT. Transfer of essential AED information to treating hospital (TREAT). Resuscitation 2020; 149:47-52. [PMID: 32045664 DOI: 10.1016/j.resuscitation.2020.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/17/2020] [Accepted: 01/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Defibrillation in out-of-hospital cardiac arrest (OHCA) is increasingly performed by using an Automated External Defibrillator (AED). Therefore presence of a shockable rhythm is recurrently only documented by the AED. However, AED-information is rarely available to the treating physician. PURPOSE To determine (1) how often a shockable rhythm was recorded only in the AED; (2) if so, how often information that a shockable rhythm had been present reached the physician. METHODS Data on OHCA patients with (presumed) cardiac cause with an AED connected in the years 2012-2014 (Study period 1) and 2016 (Study period 2) in the Amsterdam Resuscitation Study (ARREST) database were collected. We determined how often only the AED had defibrillated. In these patients, we retrospectively analyzed EMS run sheets and hospital discharge letters to determine if a shockable rhythm and/or AED use was correctly noted. In Study period 2, we prospectively contacted the physicians to study whether AED defibrillation was known. RESULTS In Study period 1, of 2840 OHCA CPR attempts with (presumed) cardiac cause, 1521 (54%) patients had a shockable rhythm, with 356 patients (13%) receiving AED defibrillation only. Of these patients, 11 hospital discharge letters (4%) contained no information about a shockable rhythm. In Study period 2, 125/1128 patients (11%) received AED defibrillation only; of these, in two cases the shockable rhythm was unknown by the physician. CONCLUSION In 11-13% of OHCAs, a shockable rhythm is only seen on the AED-ECG. Adequate transfer to the physician of vital AED-information is essential but not always accomplished.
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Affiliation(s)
- Paulien C M Homma
- Amsterdam UMC, Academic Medical Center, Heart Center, Department of Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Corina de Graaf
- Amsterdam UMC, Academic Medical Center, Heart Center, Department of Cardiology, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Hanno L Tan
- Amsterdam UMC, Academic Medical Center, Heart Center, Department of Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Michiel Hulleman
- Amsterdam UMC, Academic Medical Center, Heart Center, Department of Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rudolph W Koster
- Amsterdam UMC, Academic Medical Center, Heart Center, Department of Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Stefanie G Beesems
- Amsterdam UMC, Academic Medical Center, Heart Center, Department of Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marieke T Blom
- Amsterdam UMC, Academic Medical Center, Heart Center, Department of Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
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Sin R, Vodehnalova I, Ralbovska DC, Struncova D, Cechurova L. Out-of-hospital cardiac arrest in the Pilsen Region in 2018. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:43-50. [PMID: 31974532 DOI: 10.5507/bp.2019.064] [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: 10/03/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
AIMS To acquire epidemiological data on pre-hospital cardiac arrest incidents occurring in the Pilsen Region of the Czech Republic in 2018, and the results of subsequent cardiopulmonary resuscitation Methods. A prospective observational study of the survival rate of out-of-hospital cardiac arrest (OHCA) in patients undergoing CPR carried out by emergency medical service personnel. The observed time period was from January 1st, 2018 until December 31st, 2018. The data were acquired from patients' records in paper and electronic forms. RESULTS In the monitored period 707 patients with signs of cardiac arrest were recorded in the Pilsen Region with an incidence rate of 128.9 per 100,000 inhabitants. Emergency medical units performed CPR in 484 cases. The incidence rate of pre-hospital CPR was 88.2 cases per 100,000 inhabitants. Spontaneous blood circulation was temporarily or permanently restored in 276 patients (57.0%), 203 (41.9%) patients were transferred to a hospital, and there were 61 (12.6%) cases of survival with Cerebral Performance Category (CPC) score of 1 or 2. The first monitored rhythm was a shockable in 134 (27.7%) cases. In this sub-group ROSC was achieved in 94 (70.1%) cases and 58 (43.3%) of those were subsequently transferred to a hospital. A good CPC result was achieved in 41 (30.6%) patients of this sub group. CONCLUSION The study has provided valuable epidemiological data on OHCA and prehospital CPR in the area of the Pilsen Region in 2018. The collected data, compared to international results, show a higher survival rate with good neurological score in 12.6% of cases.
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Affiliation(s)
- Robin Sin
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic.,Department of Infectious Diseases and Travel Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Czech Republic
| | - Ivana Vodehnalova
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic
| | - Denisa Charlotte Ralbovska
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic.,Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Denisa Struncova
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic
| | - Lenka Cechurova
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic
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Sarkisian L, Mickley H, Schakow H, Gerke O, Jørgensen G, Larsen ML, Henriksen FL. Global positioning system alerted volunteer first responders arrive before emergency medical services in more than four out of five emergency calls. Resuscitation 2020; 152:170-176. [PMID: 31923531 DOI: 10.1016/j.resuscitation.2019.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/21/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
Abstract
AIM To evaluate response rates for volunteer first responders (VFRs) activated by use of a smartphone GPS-tracking system and to compare response times of VFRs with those of emergency medical services (EMS). Furthermore, to evaluate 30-day-survival after out-of-hospital cardiac arrest (OHCA) on a rural island. METHODS Since 2012 a GPS-tracking system has been used on a rural island to activate VFRs during all emergency calls requesting an EMS. When activated, three VFRs were recruited and given distinct roles, including collection of the nearest automatic external defibrillator (AED). We retrospectively investigated EMS response data from April 2012 to December 2017. These were matched with VFR response times from the GPS-tracking system. The 30-day survival in OHCA patients was also assessed. RESULTS In 2266 of 2662 emergency calls (85%) at least one VFR arrived to the site before EMS. Median response times for VFRs (n = 2662) was 4:46 min:sec (IQR 3:16-6:52) compared with 10:13 min:sec (6:14-13:41) for EMS (p < 0.0001). A total of 17 OHCAs took place in public locations and 65 in residential areas. Thirty-day survival in these were 24% and 15%, respectively. CONCLUSION Use of a smartphone GPS-tracking system to dispatch VFRs ensures that in more than four of five cases, a VFR arrives to the site before EMS. Response times for VFRs were also found to be lower than EMS response times. Finally, the 30-day survival of OHCA patients in a rural area, based on these results, surpass our expectations.
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Affiliation(s)
- Laura Sarkisian
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, Odense C, 5000, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Hans Mickley
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, Odense C, 5000, Denmark.
| | - Henrik Schakow
- Emergency Medical Services, Region of Southern Denmark, Damhaven 12, Vejle, 7100, Denmark.
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, J.B. Winsløws Vej 4, Odense C, 5000, Denmark.
| | - Gitte Jørgensen
- Emergency Medical Services, Region of Southern Denmark, Damhaven 12, Vejle, 7100, Denmark.
| | - Mogens Lytken Larsen
- Department of Clinical Medicine, Aalborg University Hospital, Søndre Skovvej 15, Aalborg, 9000, Denmark.
| | - Finn Lund Henriksen
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, Odense C, 5000, Denmark.
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Bickel T, Gunasekaran P, Murtaza G, Gopinathannair R, Gunda S, Lakkireddy D. Sudden Cardiac Death in Famous Athletes, Lessons Learned, Heterogeneity in Expert Recommendations and Pitfalls of Contemporary Screening Strategies. J Atr Fibrillation 2019; 12:2193. [PMID: 32435342 DOI: 10.4022/jafib.2193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/11/2019] [Accepted: 10/12/2019] [Indexed: 01/02/2023]
Abstract
Sudden cardiac death (SCD) in competitive athletes, though relatively uncommon, invariably leads to controversy. Specific limitations of an extensive screening process include lack of robust evidence to support prevention of SCD, poor cost-effectiveness and uncertain downstream implications of a positive screening test. An emerging body of evidence points to enhanced neurologically intact survival to hospital discharge when automated external defibrillators (AEDs) are used in a timely manner following sudden cardiac arrest (SCA). A viable alternative to an expansive screening process could be a robust secondary prevention system comprising of improvements in AED availability, stringent enforcement of CPR training in athletes and trainers to provide timely and effective resuscitation to reduce death following SCA. This strategy could widen the window to diagnose and treat the underlying etiology and prevent recurrence of SCA while also offering financial feasibility. Restricting athletes from competitive sports is a difficult decision for physicians owing to a lack of well-defined cutoffs for acceptable and prohibitive risk from pathology predisposing to SCD, especially in the absence of a protective medico-legal framework. In this review, we highlight a few cases that generated intense scrutiny by the public, media and medical professionals about the efficacy, feasibility and pitfalls of the existing screening process to diagnose cardiovascular pathology predisposing to SCD. Furthermore, contrasting approaches to screening, diagnosis and downstream workup protocols between the European Society of Cardiology and the American Heart Association are analyzed.
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Affiliation(s)
- Trenton Bickel
- Division of Cardiovascular Disease, University of Kansas Hospital and Medical Center, Kansas City, Kansas
| | - Prasad Gunasekaran
- Division of Cardiovascular Disease, University of Kansas Hospital and Medical Center, Kansas City, Kansas
| | - Ghulam Murtaza
- The Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
| | - Rakesh Gopinathannair
- The Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
| | - Sampath Gunda
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
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