Survival in Out-of-Hospital Cardiac Arrest After Standard Cardiopulmonary Resuscitation or Chest Compressions Only Before Arrival of Emergency Medical Services: Nationwide Study During Three Guideline Periods

Out-of-hospital cardiac arrest associated with venous thromboembolism-a Swedish population-based cohort study

BACKGROUND

Venous thromboembolism (VTE) is a common and preventable cardiovascular disease but is potentially fatal if it presents as pulmonary embolism. There are few population-based studies on out-of-hospital cardiac arrest (OHCA) associated with VTE.

OBJECTIVES

We aimed to investigate the prevalence and survival of VTE-associated OHCA in relation to sex, age, and presenting rhythm.

METHODS

This population-based cohort included all individuals over 15 years registered with a medical OHCA in Sweden 2008-2018. Data from national registers were used. Association with presenting rhythm, 30-day survival, and sex was estimated using adjusted multinomial and binary logistic regression for odds ratios (ORs) with 95% CI.

RESULTS

OHCA was associated with VTE in 852 (2.0%) of 41 813 individuals. The median age for VTE-associated OHCA was 69, compared to 73 for the entire cohort, with a higher female prevalence (45% vs 34%). Younger women had a proportionally higher incidence of VTE-associated OHCA than men of the same age. Pulseless electrical activity and asystole had adjusted ORs of 17.2 (95% CI, 11.3-26.0) and 9.59 (95% CI, 6.37-14.4) for VTE-associated OHCA compared with the entire cohort. The 30-day survival was substantially lower in the VTE group compared with the overall medical OHCA group, 2.0% vs 12%, adjusted OR 0.25 (95% CI, 0.13-0.47).

CONCLUSION

This nationwide study confirms that VTE-associated OHCA is uncommon and almost always fatal. Despite fewer women experiencing OHCA, a higher proportion had VTE-associated OHCA, especially younger women. Our findings highlight the need for better prevention and identification of VTE-associated OHCA, particularly in women.

The role of bystander CPR in out-of-hospital cardiac arrest: what the evidence tells us

Out-of-hospital cardiac arrest (OHCA) is a global public health problem. Lay bystanders witness almost half of OHCA, so early recognition is critical to allow immediate initiation of cardiopulmonary resuscitation (CPR) by the bystander. The present investigation aims to analyze the most recent scientific evidence of the effect of bystander CPR on survival after an OHCA. A systematic literature review was carried out at the "Web of Science," "Scopus," and "PubMed" databases, including publications from the last 20 years. After inclusion/exclusion criteria, 37 articles were identified. Results indicate that patients who receive CPR are more likely to survive than those who don't, and CPR is associated with a good quality of life post-OHCA. Emphasis should be placed on practicing chest compressions only when the bystander has not mastered the artificial ventilation technique. Finding an AED is the first step to using it in an OHCA situation. Correct use of an AED by laypeople is associated with nearly double the survival rate after an OHCA when compared to standard CPR. It is important to promote CPR and AED training to non-professionals, such as community residents and youth, as training is associated with higher success rates of effective CPR-AED. A mobile phone positioning system to recruit trained laypeople or text message alerts to send citizen volunteers as well as assistance through a mobile app appear to have significant advantages in practicing effective CPR. The benefits of bystander CPR outweigh the risk of injury to victims, highlighting the need to disseminate training to laypeople.

Are Saudi Radiological Sciences Students Prepared for Emergencies? Exploring Knowledge, and Attitudes Towards Basic Life Support and Cardiopulmonary Resuscitation

Purpose

This study aims to evaluate the preparedness of Saudi radiological sciences students for emergencies by assessing their awareness of cardiac arrest evaluation criteria, knowledge of Cardiopulmonary Resuscitation (CPR) and defibrillators, and attitudes towards performing CPR.

Methods

A cross-sectional descriptive study was conducted among students from the radiological sciences program at three Saudi universities. Using a well-established questionnaire, the study employed non-probability convenient sampling. Descriptive statistics were generated, and chi-square test examined associations between categorical variables and Basic Life Support (BLS) training status.

Results

Out of 367 students contacted, 261 participated (71.1% response rate). BLS training markedly enhances knowledge of the correct chest compression rate, with 50.9% of trained students demonstrating accurate understanding compared to 27.5% of untrained students (P < 0.0001). A significant correlation was found between BLS training and the ability to perform cardiac massage during cardiac arrest and respiratory standstill, with 44.1% of students demonstrating this knowledge (P < 0.0001). Notably, 80.8% of students without BLS training lacked knowledge of cardiac massage, compared to only 30.4% of those with training. Additionally, 30.6% of students were familiar with defibrillators, and 44.1% knew AED locations (P = 0.0007). Hesitation to perform CPR was mainly due to fear of mistakes (53.6%) and harm concerns (31.1%).

Conclusion

Our findings reveal significant gaps in knowledge, confidence, and preparedness for cardiac emergencies among Saudi radiological sciences students, with only 41.4% having completed BLS training. These results highlight the urgent need for comprehensive BLS education to.

Out-of-Hospital Cardiac Arrest Ambulance Delay Zones and AED Placement in a Southern Brazilian City

Out-of-hospital cardiac arrests (OHCAs) have high mortality rates, worsened by limited access to automated external defibrillators (AEDs). This study analyzed OHCA response times, identified areas with prolonged ambulance travel times, and proposed optimal AED locations in a medium-sized city in southern Brazil. Data from 278 non-traumatic OHCA cases (2019-2022) in patients over 18 years old, with ambulance response times under 20 min, were included. Spatial survival analysis assessed the probability of exceeding the recommended 5-min (300 s) ambulance response time. The maximal covering location problem identified 100 strategic AED sites within a 150-s reach for bystanders. AED and ambulance travel times were compared using the Wilcoxon test (p < 0.01). Defibrillation occurred in 89 cases (31.01%), and bystander CPR was performed in 149 cases (51.92%). Despite these efforts, 77% of patients died. The median ambulance response time was 11.63 min, exceeding 5 min in most cases, particularly at peak times like 11 a.m. AED placement in selected locations could cover 76% of OHCA occurrences, with a mean AED travel time of 320 s compared to 709 s for ambulances. Strategic AED placement could enhance early defibrillation and improve survival outcomes.

Bystander cardiopulmonary resuscitation and outcomes of mass cardiac arrests caused by a crowd crush

INTRODUCTION

A crowd crush can lead to respiratory arrest and result in multiple mass cardiac arrests (MCAs), which are often classified as Black Tag in disaster triage. Recently, many laypersons have been commonly trained in compression-only cardiopulmonary resuscitation (CPR) without ventilation support in various communities. This study aims to describe the characteristics of bystander CPR administered and the outcomes of MCAs during the Itaewon crowd crush incident.

METHODS

An observational study was conducted on the CPR characteristics of MCAs during the Halloween Festival in 2022, utilizing two databases: (1) MCAs registered in the Korea Out-of-Hospital Cardiac Arrest Registry (KOHCAR) and (2) MCAs uploaded on social media platforms (Instagram and YouTube), identified through relevant keyword searches. Video clips with a minimum streaming time of 10 s and a clear view of bystander CPR were analyzed. General demographic findings were analyzed using the KOHCAR, while the type of bystander CPR (compression-only CPR with or without rescue breathing) was compared using the social media data.

RESULTS

Of the 218 patients attended by EMS, 119 MCAs were registered in KOHCAR. The mean age of the victims was 24.5 years, with 10 (8.4%) being non-Korean. The median ambulance response time was 59 min. Among the victims, 22 (18.5%) received CPR (19 bybystanders, 2 by first responders, and 1 by a disaster medical assistant team), followed by EMS resuscitation, while 7 (5.9%) received CPR first by the EMS team. The remaining 90 victims (75.6%) were pronounced deceased by EMS providers. Three victims (2.5%) achieved return of spontaneous circulation (ROSC) in the field, and one (0.8%) survived to hospital discharge. From the social media database, 26 video clips containing CPR were identified (14 from 251 clips on Instagram and 12 from 187 on YouTube), excluding duplicates and non-CPR cases. In the 26 video clips containing CPR, a total of 228 bystander CPR cases were identified in the video clips. Of these, 217 (95.2%) involved compression-only CPR, while 11 cases (4.8%) included CPR with rescue breathing.

CONCLUSION

Most MCAs were pronounced deceased, likely due to their classification as Black Tag or delayed response times. Only a small percentage (4.8%) of bystander CPR cases included rescue breathing. An optimized resuscitation protocol for MCAs in crowd crush scenarios should be developed.

The association between the type of bystander and survival after an out-of-hospital cardiac arrest: A French nationwide study

Background

Early bystander interventions are associated with more favorable outcomes after out-of-hospital cardiac arrest (OHCA). The objective of the present study was to determine whether the type of bystander-patient relationship was associated with survival and neurological outcomes after OHCA in France.

Methods

We analyzed data registered in the French National Cardiac Arrest Registry (RéAC) between July 1st, 2011, and April 30th, 2023. The study population comprised bystander-attended cases of OHCA managed by the emergency medical services. Bystanders were categorized as family members, other laypersons, off-duty professional first responders, or off-duty healthcare professionals. The primary outcome was 30-day survival with a favorable neurological outcome (Cerebral Performance Category 1 or 2). The secondary outcomes included the bystander cardiopulmonary resuscitation (CPR) initiation rate, return of spontaneous circulation, and survival upon admission to the hospital. Our statistical analyses were based on bivariate and multivariable logistic regressions analyses.

Results

Among the 89,861 OHCA cases analyzed, family members constituted the largest group of bystanders (69.2%). Compared with non-family-member bystanders, family bystander status was associated with a lower CPR initiation rate, a longer no-flow time, and lower 30-day survival rates. Specifically, cases of OHCA with non-family-member bystanders were 32% more likely to survive with a CPC of 1-2 at day 30 than cases with family member bystanders. Medically trained bystander status (off-duty professional first responders and healthcare professionals) was associated with higher CPR initiation and 30-day survival rates, relative to nontrained laypersons.

Conclusions

Survival after an OHCA appears to be associated with the type of bystander. Although family members were the most common bystanders, they were less likely to initiate CPR and less likely to see the OHCA patient survive. Efforts to increase the post-OHCA survival rate should include targeted interventions (such as public education and training programs) that emphasize the importance of early CPR and automated external defibrillator use by family members.

A two-sample Mendelian randomization study on the relationship of body weight, body mass index, and waist circumference with cardiac arrest

BACKGROUND

This study aims to explore the causal relationship of body weight, body mass index (BMI), and waist circumference (WC) with the risk of cardiac arrest (CA) using two-sample Mendelian randomization (MR).

METHODS

Data were summarized using genome-wide association studies (GWAS). Two-sample MR analyses were performed using the inverse variance weighting (IVW) method, the weighted median method, and the MR-Egger analysis. Heterogeneity test and sensitivity analysis were performed using Cochran's Q test and the leave-one-out method, respectively. The Steiger test was used to detect reverse causality. Bayesian model-averaged MR was used to identify the most influential risk factors.

RESULTS

A total of 13 GWAS data were collected for BMI, body weight and WC. IVW analyses showed a positive correlation of body weight, BMI, and WC with CA (all OR>1 and P<0.05), with MR-Egger and weighted median methods confirming the IVW findings. No horizontal pleiotropy or heterogeneity was observed. Sensitivity analysis indicated that no single nucleotide polymorphism (SNP) caused significant changes in overall causality. Bayesian model-averaged MR was also used to rank causality based on marginal inclusion probability (MIP), and the corresponding model-averaged causal estimate (MACE) were confirmed, which indicated that WC (GWAS ID: ukb-b-9405) was the highest-ranked risk factor (MIP=0.119, MACE=0.011); its posterior probability was 0.057. A total of 14 sex-specific GWAS data on weight, BMI, and WC were analyzed in relationship with CA, and the MR results showed no significant effects of sex-specific factors.

CONCLUSION

Body weight, BMI, and WC are causally associated with an increased risk of CA, with WC identified as the most important risk factor.

Resuscitation Attempt and Outcomes in Patients With Asystole Out-of-Hospital Cardiac Arrest

Importance

Little is known about the epidemiology of out-of-hospital cardiac arrest (OHCA) in patients with asystole in countries where prehospital resuscitation is not withheld or terminated.

Objective

To investigate the secular trends in the patient outcomes and advanced life support (ALS) procedures and evaluate the association of ALS procedures with favorable outcomes among patients with OHCA and asystole.

Design, Setting, and Participants

This cohort study analyzed data from a nationwide prospective OHCA registry in Japan. OHCA occurred from June 1, 2014, to December 31, 2020. Adults with an initial rhythm of asystole and OHCA were included in the analysis, which was conducted between July 29, 2022, and August 24, 2024.

Exposures

Year of OHCA and prehospital ALS procedures (advanced airway management [AAM] and intravenous epinephrine administration).

Main Outcomes and Measures

Trends in prehospital and in-hospital ALS procedures and patient outcomes were described using the Jonckheere-Terpstra trend test for continuous variables and the Cochran-Armitage trend test for categorical variables. The primary outcome was a favorable neurological outcome at 30 days. The secondary outcomes included a favorable neurological outcome at 90 days and survival at 30 and 90 days. Associations between prehospital procedures and outcomes were analyzed using time-dependent propensity score and risk-set matching.

Results

Of 60 349 patients with OHCA, 35 843 (59.4%) presented with asystole (median age, 77 [IQR, 64-85] years; 20 573 [57.4%] men). Among these, 33 674 patients (93.9%) underwent ALS procedures, with 67 (0.2%) achieving a favorable neurological outcome at 30 days. No significant trends in the outcomes were noted, except for a decline in return of spontaneous circulation (424 of 1848 [22.9%] to 1178 of 5892 [20.0%]; P = .003). Neither AAM (odds ratio [OR], 1.27 [95% CI, 0.76-2.12]; P = .36) nor intravenous epinephrine administration (OR, 0.53 [95% CI, 0.24-1.13]; P = .10) was associated with a favorable neurological outcome at 30 days, although both were associated with survival at 30 days (ORs, 1.45 [95% CI, 1.21-1.74] and 1.81 [95% CI, 1.44-2.27], respectively; P < .001 for both).

Conclusions and Relevance

In this cohort study of patients with OHCA presenting with asystole, the proportion with a favorable neurological outcome at 30 days was substantially low, and no prehospital ALS procedure was associated with a favorable neurological outcome. These findings suggest that discussions regarding implementation of a termination of resuscitation rule for such patients are warranted.

The rural CPR outreach project: Medical students teach bystander CPR to secondary school students

INTRODUCTION

Prompt bystander cardiopulmonary resuscitation (CPR) can double the chance of cardiac arrest survival. Rural and remote communities experience longer emergency service wait times and have lower rates of bystander-CPR compared to their urban counterparts. Our study addresses this disparity.

METHODS

We designed a 1.5-h free hands-only CPR course tailored to secondary school students in rural and remote communities taught by medical students. We evaluated our course using pre-test and post-test surveys.

RESULTS

We taught over 300 secondary students in 5 days. Less than one-third of students had previously taken a CPR course. We found that brief CPR instruction taught by medical students was effective in both improving students' knowledge of CPR (t[528] = -26, P < 0.01) and perceived comfort in performing CPR (t[548] = -12, P < 0.01).

CONCLUSION

CPR courses taught by medical students are effective, low cost, and may help address regional health care disparities. Teaching CPR to rural/remote communities may have secondary benefits such as promoting health care careers to rural youth. We encourage other health professional programmes to consider engaging students in CPR outreach projects.

INTRODUCTION

Une réanimation cardio-pulmonaire rapide peut doubler les chances de survie en cas d'arrêt cardiaque. Les communautés rurales et éloignées connaissent des temps d'attente plus longs dans les services d'urgence et ont des taux plus faibles de RCP par rapport à leurs homologues urbains. Notre étude porte sur cette disparité.

MTHODES

Nous avons conçu un cours de RCP pratique et gratuit d'une heure et demie, adapté aux élèves du secondaire des communautés rurales et isolées et dispensé par des étudiants en médecine. Nous avons évalué notre cours à l'aide d'enquêtes pré-test et post-test.

RSULTATS

En 5 jours, nous avons enseigné à plus de 300 élèves du secondaire. Moins d'un tiers des élèves avaient déjà suivi un cours de RCP. Nous avons constaté qu'une brève formation à la RCP dispensée par des étudiants en médecine était efficace pour améliorer les connaissances des élèves en matière de RCP (t[528] = -26, P < 0,01) et la perception de leur aisance à pratiquer la RCP (t[548] = -12, P < 0,01).

CONCLUSION

Les cours de RCP dispensés par les étudiants en médecine sont efficaces, peu coûteux et peuvent contribuer à lutter contre les disparités régionales en matière de soins de santé. L'enseignement de la RCP aux communautés rurales/éloignées peut avoir des avantages secondaires tels que la promotion des carrières dans le domaine de la santé auprès des jeunes ruraux. Nous encourageons d'autres programmes professionnels de santé à envisager d'engager leurs étudiants dans des projets de sensibilisation à la RCP.

The Real Experience of Lay Responders Performing Cardiopulmonary Resuscitation: A Synthesis of Qualitative Evidence

Objectives

To synthesize qualitative evidence on the experience of lay responders performing cardiopulmonary resuscitation (CPR).

Methods

Qualitative evidence synthesis was performed using the Thomas and Harden method. The PubMed, Cochrane Library, Web of Science, OVID Medline, Embase, CINAHL, CNKI, and WanFang databases were systematically searched. The quality of the research was assessed by the Critical Assessment Skills Program Tool (CASP).

Results

A total of 5,610 studies were identified, and 9 studies were included in the analysis. Four analytical themes were generated: emotional ambivalence before CPR, psychological tolerance during CPR, perceived experience after CPR, and enhancing psychological resilience.

Conclusion

Lay responders face complicated psychological experience during CPR, which may be susceptible to psychological effects such as "loss aversion," "bystander effects" and "knowledge curse." In addition to the timely retraining of CPR, lay responders should be instructed to manage psychological distress and improve psychological resilience. More importantly, the psychological sequelae may be long-lasting, requiring ongoing psychological intervention and follow-up based on valuing transdisciplinarity across endeavours.

Standard cardiopulmonary resuscitation versus chest compressions only after out-of-hospital cardiac arrest: a protocol for a systematic review and meta-analysis

INTRODUCTION

The 2020 American Heart Association guidelines encourage lay rescuers to provide chest compression-only cardiopulmonary resuscitation to simplify the process and encourage cardiopulmonary resuscitation initiation. However, recent clinical trials had contradictory results about chest compression-only cardiopulmonary resuscitation. This study will aim to compare standard and chest compressions-only cardiopulmonary resuscitation after out-of-hospital cardiac arrest.

METHODS AND ANALYSIS

This study will retrieve only randomised and quasi-randomised controlled trials from the Cochrane Library, PubMed, Web of Science and Embase databases. Data on study design, participant characteristics, intervention details and outcomes will be extracted by a unified standard form. Primary outcomes to be assessed are hospital admission, discharge, and 30-day survival, and return of spontaneous circulation. The Grading of Recommendations, Assessment, Development and Evaluation framework will evaluate the quality of evidence. Cochrane's tool for assessing the risk of bias will evaluate risk deviation. If the I2 statistic is lower than 40%, the fixed-effects model will be used for meta-analysis. Otherwise, the random-effects model will be used. The search will be performed following the publication of this protocol (estimated to occur on 30 December 2024).

DISCUSSION

This study will evaluate the effect of chest compression-only cardiopulmonary resuscitation after out-of-hospital cardiac arrest and provide evidence for cardiopulmonary resuscitation guidelines.

ETHICS AND DISSEMINATION

No patient or public entity will be involved in this study. Therefore, the study does not need to be ethically reviewed. The results of the study will be disseminated through peer-reviewed journal publications and committee conferences.

PROSPERO REGISTRATION NUMBER

CRD42021295507.

Out-of-Hospital Cardiac Arrest in the Eye of the Beholder and Emergency Medical Service

Purpose

Out-of-hospital cardiac arrest (OHCA) remains a global healthcare problem, with low survival and bystander cardiopulmonary resuscitation (CPR) rates. This study aimed to identify event-related factors in OHCA and their impact on return of spontaneous circulation (ROSC) achievement and maintenance until hospital admission.

Patients and Methods

All data were collected from Utstein Resuscitation Registry Template for OHCA from The Institute of Emergency Medicine of Zagreb from January 2012 to August 2022. This cross-sectional research analyzed 2839 Utstein reports, including 2001 male, 836 female, and 8 subjects of unknown gender. The average age was 65.4 ± 16.2 years.

Results

The most frequent place of collapse was private residence, and 27% of collapses were unwitnessed. Dispatcher-provided CPR instructions were provided in 39.7% of cases until the arrival of the emergency service team, which showed a very strong effect on bystander-provided CPR, and were followed in 68.4% of cases, while non-instructed bystander CPR was provided in only 7.9% of cases. Bystander CPR is more likely to be provided in public places than in private residences, often with both compression and ventilation. Bystander CPR was also more likely to be provided to men. Cases with bystander CPR, and compressions with ventilation compared to compression only CPR, showed a significantly greater success in maintaining ROSC later in CPR, both with moderate effects.

Conclusion

Bystander CPR has been shown to have a significant role in achieving and maintaining ROSC until hospital admission. However, our results showed a location-dependent nature of bystanders' willingness to perform CPR as well as sex disparities in patients receiving CPR. With deficient education in basic life support in Croatia, dispatchers need to insist on and instruct bystander CPR performance.

Wolf creek XVII part 4: Amplifying lay-rescuer response

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.

Compression-Only or Standard Cardiopulmonary Resuscitation for Trained Laypersons in Out-of-Hospital Cardiac Arrest: A Nationwide Randomized Trial in Sweden

BACKGROUND

The ongoing TANGO2 (Telephone Assisted CPR. AN evaluation of efficacy amonGst cOmpression only and standard CPR) trial is designed to evaluate whether compression-only cardiopulmonary resuscitation (CPR) by trained laypersons is noninferior to standard CPR in adult out-of-hospital cardiac arrest. This pilot study assesses feasibility, safety, and intermediate clinical outcomes as part of the larger TANGO2 survival trial.

METHODS

Emergency medical dispatch calls of suspected out-of-hospital cardiac arrest were screened for inclusion at 18 dispatch centers in Sweden between January 1, 2017, and March 12, 2020. Inclusion criteria were witnessed event, bystander on the scene with previous CPR training, age above 18 years of age, and no signs of trauma, pregnancy, or intoxication. Cases were randomized 1:1 at the dispatch center to either instructions to perform compression-only CPR (intervention) or instructions to perform standard CPR (control). Feasibility included evaluation of inclusion, randomization, and adherence to protocol. Safety measures were time to emergency medical service dispatch CPR instructions, and to start of CPR, intermediate clinical outcome was defined as 1-day survival.

RESULTS

Of 11 838 calls of suspected out-of-hospital cardiac arrest screened for inclusion, 2168 were randomized and 1250 (57.7%) were out-of-hospital cardiac arrests treated by the emergency medical service. Of these, 640 were assigned to intervention and 610 to control. Crossover from intervention to control occurred in 16.3% and from control to intervention in 18.5%. The median time from emergency call to ambulance dispatch was 1 minute and 36 s (interquartile range, 1.1-2.2) in the intervention group and 1 minute and 30 s (interquartile range, 1.1-2.2) in the control group. Survival to 1 day was 28.6% versus 28.4% (P=0.984) for intervention and control, respectively.

CONCLUSIONS

In this national randomized pilot trial, compression-only CPR versus standard CPR by trained laypersons was feasible. No differences in safety measures or short-term survival were found between the 2 strategies. Efforts to reduce crossover are important and may strengthen the ongoing main trial that will assess differences in long-term survival.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT02401633.

Out-of-hospital cardiac arrest: Survival in children and young adults over 30 years, a nationwide registry-based cohort study

OBJECTIVES

We studied short-term (30-day) and long-term (up to ten-year) survival among children and young adults following out-of-hospital cardiac arrest (OHCA) in Sweden over the course of the past 30 years. We also studied the causes of OHCA in children and examined predictors of survival.

SETTING

This was a nationwide, registry-based cohort study, using the Swedish Registry of Cardiopulmonary Resuscitation. Our study comprised a cohort of 4,804 individuals aged 0 to 30 years who suffered OHCA between 1990 and 2020, in whom cardiopulmonary resuscitation (CPR) was initiated. We stratified the study cohort to distinct age groups and time periods.

RESULTS

We found an increase in 30-day survival from 7% to 20% over the span of 30 years. In those under 1 year of age, survival increased from 2% to 19%. Time to CPR decreased from 14 to 2 min. The 10-year survival was high among those who survived 30 days. The etiology of cardiac arrests exhibited significant variations across different age groups but remained relatively consistent over time. Causes linked to mental illness constituted a substantial percentage of these cases. Compared to the reference period (1990-1994), the odds of survival in 2015-2020 was 3.00 (95% CI: 1.43, 6.94; p = 0.006).

CONCLUSION

Survival rate after OHCA in children and young adults has increased three-fold over the past 30 years. Still overall mortality is high underscoring the need for continued efforts to mitigate risk factors and optimize survival.

Mortality after cardiac arrest in children less than 2 years: relevant factors

BACKGROUND

There are only scant studies of predicting outcomes of pediatric resuscitation due to lack of population-based data. This study aimed to determine variable factors that may impact the survival of resuscitated children aged under 24 months.

METHODS

This is a retrospective study of 66 children under 24 months. Cardiopulmonary resuscitation (CPR) with pediatric advanced life support guideline was performed uniformly for all children. Linear regression analysis with variable factors was conducted to determine impacts on mortality.

RESULT

Factors with statistically significant increases in mortality were the number of administered epinephrine (p value < 0.001), total CPR duration (p value < 0.001), in-hospital CPR duration of out-hospital cardiac arrest (p value < 0.001), and changes in cardiac rhythm (p value < 0.040). However, there is no statistically significant association between patient outcomes and remaining factors such as age, sex, underlying disease, etiology, time between last normal to CPR, initial CPR location, initial cardiac rhythm, venous access time, or inotropic usage.

CONCLUSION

More than 10 times of epinephrine administration and CPR duration longer than 30 minutes were associated with a higher mortality rate, while each epinephrine administration and prolonged CPR time increased mortality.

IMPACT STATEMENT

This study analyzed various factors influencing mortality after cardiac arrest in patients under 24 months. Increased number of administered epinephrine and prolonged cardiopulmonary resuscitation duration do not increase survival rate in patients under 24 months. In patients with electrocardiogram rhythm changes during CPR, mortality increased when the rhythm changed into asystole in comparison to no changes occurring in the rhythm.

Surgical mask-to-mouth ventilation as an alternative ventilation technique during CPR: A crossover randomized controlled trial

INTRODUCTION

Chest compression with rescue breathing improves outcomes in cardiac arrest. However, the efficacy of rescue breathing through surgical masks has not been investigated.

OBJECTIVE

We aimed to compare the tidal volume generated by mouth-to-mouth ventilation (MMV) with that generated by surgical mask-to-mouth ventilation (SMV), mouth-to-surgical mask ventilation (MSV), and surgical mask-to-surgical mask ventilation (SSV) in a manikin.

METHODS

A crossover randomized controlled trial was conducted in 42 medical personnel volunteers randomly assigned to perform four ventilation techniques: MMV (no protective equipment), SMV (participant wearing a mask), MSV (manikin wearing a mask), and SSV, (both participant and manikin wearing a mask). The average tidal volume and the proportion of adequate ventilation, evaluated using a manikin, were compared across different ventilation methods.

RESULTS

The average tidal volume of MMV (828 ± 278 ml) was significantly higher than those of the MSV (648 ± 250 ml, P < 0.001) and SSV (466 ± 301 ml, P < 0.001), but not SMV (744 ± 288 ml, P = 0.054). Adequate ventilation was achieved in 144/168 (85.7%) cases in the MMV group, a proportion significantly higher than in the SMV (77.4%, P = 0.02), MSV (66.7%, P < 0.001) and SSV (39.3%, P < 0.001) groups. The willingness to perform SMV was higher than that to perform MMV.

CONCLUSIONS

MMV resulted in a superior average tidal volume when compared to both MSV and SSV. However, SMV achieved a comparable average tidal volume to MMV.

Prehospital Predictors of Survival in Patients with Out-of-Hospital Cardiac Arrest

Background and Objectives: Despite advances in the treatment of heart diseases, the outcome of patients experiencing sudden cardiac arrest remains poor. The aim of our study was to determine the prehospital variables as predictors of survival outcomes in out-of-hospital cardiac arrest (OHCA) victims. Materials and Methods: This was a retrospective observational cohort study of OHCA cases. EMS protocols created in accordance with the Utstein style reporting for OHCA, first responder intervention reports, medical dispatch center dispatch protocols and hospital medical reports were all reviewed. Multivariate logistic regression was performed with the following variables: age, gender, witnessed status, location, bystander CPR, first rhythm, and etiology. Results: A total of 381 interventions with resuscitation attempts were analyzed. In more than half (55%) of them, bystander CPR was performed. Thirty percent of all patients achieved return of spontaneous circulation (ROSC), 22% of those achieved 30-day survival (7% of all OHCA victims), and 73% of those survived with Cerebral Performance Score 1 or 2. The logistic regression model of adjustment confirms that shockable initial rhythm was a predictor of ROSC [OR: 4.5 (95% CI: 2.5-8.1)] and 30-day survival [OR: 9.3 (95% CI: 2.9-29.2)]. Age was also associated (≤67 years) [OR: 3.9 (95% CI: 1.3-11.9)] with better survival. Conclusions: Elderly patients have a lower survival rate. The occurrence of bystander CPR in cardiac arrest remains alarmingly low. Shockable initial rhythm is associated with a better survival rate and neurological outcome compared with non-shockable rhythm.

Facilitating cardiopulmonary resuscitation training in high-risk areas of England: A study protocol

Introduction

Bystanders' interventions improve chances of survival from out-of-hospital cardiac arrest (OHCA) before Emergency Medical Services arrive. Some areas in England are of concern. These high-risk areas have a higher incidence of cardiac arrest combined with lower-than-average bystander CPR rates and are characterised by higher proportions of minority ethnic group residents and deprivation.Collaborating with people from the Black African and Caribbean and South Asian minority communities in deprived areas of England, we aim to develop and evaluate the implementation of theoretically informed intervention(s) to address factors contributing to lower bystander intervention rates.

Methods

The study is a collaborative realist enquiry, informed by the Theoretical Domains Framework and associated Behaviour Change Wheel. It consists of 1) a realist evidence synthesis to produce initial program theories developed from primary workshop data and published evidence. It will include identifying factors contributing to the issue and potential interventions to address them; 2) theoretically informed intervention development, using the initial program theories and behaviour change theory and 3) a realist mixed methods implementation evaluation with embedded feasibility.Public involvement (PPI) as study team and public advisory group members is key to this study.We will conduct realist evidence synthesis, qualitative and statistical analyses appropriate to the various methods used.

Dissemination

We will develop a dissemination plan and materials targeted to members of the public in high-risk areas as well as academic outputs. We will hold an event for participating community groups and stakeholders to share findings and seek advice on next steps.

Study registration

ISRCTN90350842. Registration date 28.03.2023. The study was registered after its start date.

Factors and Barriers on Cardiopulmonary Resuscitation and Automated External Defibrillator Willingness to Use among the Community: A 2016-2021 Systematic Review and Data Synthesis

Background

Bystander cardiopulmonary resuscitation (CPR) and using an automated external defibrillator (AED) can improve out-of-hospital cardiac arrest survival. However, bystander CPR and AED rates remained consistently low. The goal of this systematic review was to assess factors influencing community willingness to perform CPR and use an AED for out-of-hospital cardiac arrest survival (OHCA) victims, as well as its barriers.

Methods

The review processes (PROSPERO: CRD42021257851) were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review protocol; formulation of review questions; systematic search strategy based on identification, screening, and eligibility using established databases including Scopus, Web of Science, and Medline Complete via EBSCOhost; quality appraisal; and data extraction and analysis. There is identification of full-text journal articles that were published between 2016 and 2021 and written in English.

Results

Of the final 13 articles, there are six identified factors associated with willingness to perform CPR and use an AED, including socio-demographics, training, attitudes, perceived norms, self-efficacy, and legal obligation. Younger age, men, higher level of education, employed, married, having trained in CPR and AED in the previous 5 years, having received CPR education on four or more occasions, having a positive attitude and perception toward CPR and AED, having confidence to perform CPR and to apply an AED, and legal liability protection under emergency medical service law were reasons why one would be more likely to indicate a willingness to perform CPR and use an AED. The most reported barriers were fear of litigation and injuring a victim.

Conclusions

There is a need to empower all the contributing factors and reduce the barrier by emphasizing the importance of CPR and AEDs. The role played by all stakeholders should be strengthened to ensure the success of intervention programs, and indirectly, that can reduce morbidity and mortality among the community from OHCA.

State of the art post-cardiac arrest care: evolution and future of post cardiac arrest care

Out-of-hospital cardiac arrest is a leading cause of mortality. In the pre-hospital setting, bystander response with cardiopulmonary resuscitation and the use of publicly available automated external defibrillators have been associated with improved survival. Early in-hospital treatment still focuses on emergency coronary angiography for selected patients. For patients remaining comatose, temperature control to avoid fever is still recommended, but former hypothermic targets have been abandoned. For patients without spontaneous awakening, the use of a multimodal prognostication model is key. After discharge, follow-up with screening for cognitive and emotional disabilities is recommended. There has been an incredible evolution of research on cardiac arrest. Two decades ago, the largest trials include a few hundred patients. Today, undergoing studies are planning to include 10-20 times as many patients, with improved methodology. This article describes the evolution and perspectives for the future in post-cardiac arrest care.

Learning of Basic Life Support through the Flipped Classroom in Secondary Schoolchildren: A Quasi-Experimental Study with 12-Month Follow-Up

Background and Objectives: International institutions together with the World Health Organisation recommend the teaching of BLS in schools. Therefore, the objective of this research was to study the feasibility of teaching CPR and AED through the flipped classroom, exploring the medium- and long-term retention of knowledge and practical skills among high school students. Materials and Methods: The sample consisted of 260 secondary schoolchildren (137 in the experimental group (EG) and 123 in the control group (CG)) between 12 and 14 years old (M = 12.75 ± 1.02). Results: The data revealed that the EG obtained better post-course results in the correct position of the hands (p = 0.011), the depth of external cardiac compression (p > 0.001), and the mean time to apply an effective shock with the AED (p = 0.013). The CG obtained better results in compressions with complete chest re-expansion (p = 0.025). These differences disappeared at 6 months (p > 0.05) and 12 months (p > 0.05). Conclusions: A training program based on the flipped classroom is as effective and viable as traditional training, although more efficient since it is applied in less time, in the sequence of action in BLS, CPR skills, and the application of an effective shock with an AED.

Pre-Arrival Care of the Out-of-Hospital Cardiac Arrest Victim

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.

Outcomes after Clinical and Traumatic Out-of-Hospital Cardiac Arrest

BACKGROUND

Data on out-of-hospital cardiac arrest are still scarce, very varied, and indicate a poor prognosis for traumatic events.

OBJECTIVES

To describe the out-of-hospital/in-hospital survival, survival time, and neurological conditions of those treated by advanced life support units and submitted to cardiopulmonary resuscitation and compare the results of clinical and traumatic cardiac arrests.

METHODS

This is a cohort study carried out in three stages; in the first two, data were collected from the Mobile Emergency Care Service forms and medical records; then, the Brain Performance Category Scale was applied in the third stage. The sample consisted of resuscitated victims aged ≥18 years. Fisher's and log-rank tests were used to compare the causes, considering a significance level of 5%.

RESULTS

852 patients were analyzed; 20.66% were hospitalized, 4.23% survived until transfer or discharge, and 58.33% had a favorable outcome one year after arrest. There was an association between pre/in-hospital survival and the nature of the occurrence (p=0.026), but there was no difference between the survival curves (p=0.6).

CONCLUSIONS

Survival of hospitalization after out-of-hospital cardiac arrest was low; however, most who survived to be discharged achieved a favorable outcome after one year. The survival time of those hospitalized after clinical and traumatic events were similar, but pre-hospital survival was higher among trauma patients.

Impact of the COVID-19 pandemic on prehospital characteristics and outcomes of out-of-hospital cardiac arrest among the elderly in Japan: A nationwide study

Aim

To assess the impact of the 2020 coronavirus disease (COVID-19) pandemic on the prehospital characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in the elderly.

Methods

In this population-based nationwide observational study in Japan, 563,100 emergency medical service-unwitnessed OHCAs in elderly (≥65 years) patients involving any prehospital resuscitation efforts were analysed (144,756, 140,741, 140,610, and 136,993 cases in 2020, 2019, 2018, and 2017, respectively). The epidemiology, characteristics, and outcomes associated with OHCAs in elderly patients were compared between 3 years pre-pandemic (2017-2019) and the pandemic year (2020). The primary outcome was neurologically favourable one-month survival. The secondary outcomes were the rate of bystander cardiopulmonary resuscitation (CPR), defibrillation by a bystander, dispatcher-assisted (DA)-CPR attempts, and one-month survival.

Results

During the pandemic year, the rates of neurologically favourable 1-month survival (crude odds ratio, 95% confidence interval: 1.19, 1.14-1.25), bystander CPR (1.04, 1.03-1.06), and DA-CPR attempts (1.10, 1.08-1.11) increased, whereas the incidence of public access defibrillation (0.88, 0.83-0.93) decreased. Subgroup analyses based on interaction tests showed that the increased rate of neurologically favourable survival during the pandemic year was enhanced in OHCA at care facilities (1.51, 1.36-1.68) and diminished or abolished on state-of-emergency days (0.90, 0.74-1.09), in the mainly affected prefectures (1.08, 1.01-1.15), and in cases with shockable initial rhythms (1.03, 0.96-1.12).

Conclusions

The COVID-19 pandemic increased the bystander CPR rate in association with enhanced DA-CPR attempts and improved the outcomes of elderly patients with OHCAs.

Bystander basic life support and survival after out-of-hospital cardiac arrest: A propensity score matching analysis

INTRODUCTION AND OBJECTIVES

In out-of-hospital cardiac arrest, early recognition, calling for emergency medical assistance, and early cardiopulmonary resuscitation are acknowledged to be the three most important components in the chain of survival. However, bystander basic life support (BLS) initiation rates remain low. The objective of the present study was to evaluate the association between bystander BLS and survival after an out-of-hospital cardiac arrest (OHCA).

METHODS

We conducted a retrospective cohort study of all patients with OHCA with a medical etiology treated by a mobile intensive care unit (MICU) in France from July 2011 to September 2021, as recorded in the French National OHCA Registry (RéAC). Cases in which the bystander was an on-duty fire fighter, paramedic, or emergency physician were excluded. We assessed the characteristics of patients who received bystander BLS vs. those who did not. The two classes of patient were then matched 1:1, using a propensity score. Conditional logistic regression was then used to probe the putative association between bystander BLS and survival.

RESULTS

During the study, 52,303 patients were included; BLS was provided by a bystander in 29,412 of these cases (56.2%). The 30-day survival rates were 7.6% in the BLS group and 2.5% in the no-BLS group (p < 0.001). After matching, bystander BLS was associated with a greater 30-day survival rate (odds ratio (OR) [95% confidence interval (CI)] = 1.77 [1.58-1.98]). Bystander BLS was also associated with greater short-term survival (alive on hospital admission; OR [95%CI] = 1.29 [1.23-1.36]).

CONCLUSIONS

The provision of bystander BLS was associated with a 77% greater likelihood of 30-day survival after OHCA. Given than only one in two OHCA bystanders provides BLS, a greater focus on life saving training for laypeople is essential.

Short- and long-term survival after out-of-hospital cardiac arrest in Kaunas (Lithuania) from 2016 to 2018

BACKGROUND

No studies analysing out-of-hospital cardiac arrest (OHCA) epidemiology and outcomes in Lithuania were published in the last decade.

METHODS

We conducted a retrospective analysis of prospectively collected data. The incidence of OHCA and the demographics and outcomes of patients who were treated for OHCA between 1 and 2016 and 31 December 2018 at Kaunas Emergency Medical Service (EMS) were collected and are reported in accordance with the Utstein recommendations. Multivariable logistic regression analysis was used to identify predictors of survival to hospital discharge.

RESULTS

In total, 838 OHCA cases of EMS-treated cardiac arrest (CA) were reported (95.8 per 100.000 inhabitants). The median age was 71 (IQR 58-81) years of age, and 66.7% of patients were males. A total of 73.8% of OHCA cases occurred at home, 59.3% were witnessed by a bystander, and 54.5% received bystander cardiopulmonary resuscitation. The median EMS response time was 10 min. Cardiac aetiology was the leading cause of CA (78.8%). The initial rhythm was shockable in 27.6% of all cases. Return of spontaneous circulation at hospital transfer was evident in 24.9% of all cases. The survival to hospital discharge rate was 10.9%, and the 1-year survival rate was 6.9%. The survival to hospital discharge rate in the Utstein comparator group was 36.1%, and the 1-year survival rate was 27.2%. Five factors were associated with improved survival to hospital discharge: shockable rhythm, time from call to arrival at the patient less than 10 min, witnessed OHCA, age < 80 years, and male sex.

CONCLUSION

This is the first OHCA study from Lithuania examining OHCA epidemiology and outcomes over a three year period. Routine OHCA data collection and analysis will allow us to track the efficacy of service improvements and should become a standard practice in all Lithuanian regions.

TRIAL REGISTRATION

This research was registered in the clinicaltrials.gov database: Identifiers: NCT04784117, Unique Protocol ID: LITOHCA. Brief Title: Out-of-hospital Cardiac Arrest Epidemiology and Outcomes in Kaunas 2016-2021.

Feasibility of Mouth-to-Mouth Ventilation through FPP2 Respirator in BLS Training during COVID-19 Pandemic (MOVERESP Study): Simulation-Based Study

Background: Due to the COVID-19 pandemic, Basic Life Support (BLS) training has been limited to compression-only or bag–mask ventilation. The most breathable nanofiber respirators carry the technical possibility for inflation of the mannequin. The aim of this study was to assess the efficacy of mouth-to-mouth breathing through a FFP2 respirator during BLS. Methods: In the cross-over simulation-based study, the medical students performed BLS using a breathable nanofiber respirator for 2 min on three mannequins. The quantitative and qualitative efficacy of mouth-to-mouth ventilation through the respirator in BLS training was analyzed. The primary aim was the effectivity of mouth-to-mouth ventilation through a breathable respirator. The secondary aims were mean pause, longest pause, success in achieving the optimal breath volume, technique of ventilation, and incidence of adverse events. Results: In 104 students, effective breath was reached in 951 of 981 (96.9%) attempts in Adult BLS mannequin (Prestan), 822 of 906 (90.7%) in Resusci Anne, and 1777 of 1857 (95.7%) in Resusci Baby. In Resusci Anne and Resusci Baby, 28.9%/15.9% of visible chest rises were evaluated as low-, 33.0%/44.0% as optimal-, and 28.8%/35.8% as high-volume breaths. Conclusions: Mouth-to-mouth ventilation through a breathable respirator had an effectivity greater than 90%.

Are first responders first? The rally to the suspected out-of-hospital cardiac arrest

BACKGROUND

Time is the crucial factor in the "chain of survival" treatment concept for out-of-hospital cardiac arrest (OHCA). We aimed to measure different response time intervals by comparing emergency medical system (EMS), fire fighters and smartphone aided volunteer responders.

METHODS

In two large Swedish regions, volunteer responders were timed from the alert until they arrived at the scene of the suspected OHCA. The first arriving volunteer responders who tried to fetch an automated external defibrillator (AED-responder) and who ran to perform bystander cardiopulmonary resuscitation (CPR-responder) were compared to both the first arriving EMS and fire fighters. Three-time intervals were measured, from call to dispatch, the unit response time (from dispatch to arrival) and the total response time.

RESULTS

During 22 months, 2631 suspected OHCAs were included. The median time from call to dispatch was in minutes 1.8 (95% CI = 1.7-1.8) for EMS, 2.9 (95% CI = 2.8-3.0) for fire-fighters and 3.0 (95% CI = 2.9-3.1) for volunteer responders. The median unit response time was 8.3 (95% CI = 8.1-8.5) for EMS, 6.8 (95% CI = 6.7-6.9) for fire fighters and 6.0 (95% CI = 5.7-6.2) for AED-responders and 4.6 (95% CI = 4.5-4.8) for CPR-responders. The total response time was 10.4 (95% CI = 10.1-10.6) for EMS, 10.2 (95% CI = 9.9-10.4) for fire fighters, 9.6 (95% CI = 9.1-9.8) for AED-responders and 8.2 (95% CI = 8.0-8.3) for CPR-responders.

CONCLUSION

First arriving volunteer responders had the shortest unit response time when compared to both fire fighters and EMS, however this advantage was reduced by delays introduced at the dispatch center. Earlier automatic dispatch should be considered in further studies.

Trends in survival after cardiac arrest: a Swedish nationwide study over 30 years

AIMS

Trends in characteristics, management, and survival in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) were studied in the Swedish Cardiopulmonary Resuscitation Registry (SCRR).

METHODS AND RESULTS

The SCRR was used to study 106 296 cases of OHCA (1990-2020) and 30 032 cases of IHCA (2004-20) in whom resuscitation was attempted. In OHCA, survival increased from 5.7% in 1990 to 10.1% in 2011 and remained unchanged thereafter. Odds ratios [ORs, 95% confidence interval (CI)] for survival in 2017-20 vs. 1990-93 were 2.17 (1.93-2.43) overall, 2.36 (2.07-2.71) for men, and 1.67 (1.34-2.10) for women. Survival increased for all aetiologies, except trauma, suffocation, and drowning. OR for cardiac aetiology in 2017-20 vs. 1990-93 was 0.45 (0.42-0.48). Bystander cardiopulmonary resuscitation increased from 30.9% to 82.2%. Shockable rhythm decreased from 39.5% in 1990 to 17.4% in 2020. Use of targeted temperature management decreased from 42.1% (2010) to 18.2% (2020). In IHCA, OR for survival in 2017-20 vs. 2004-07 was 1.18 (1.06-1.31), showing a non-linear trend with probability of survival increasing by 46.6% during 2011-20. Myocardial ischaemia or infarction as aetiology decreased during 2004-20 from 67.4% to 28.3% [OR 0.30 (0.27-0.34)]. Shockable rhythm decreased from 37.4% to 23.0% [OR 0.57 (0.51-0.64)]. Approximately 90% of survivors (IHCA and OHCA) had no or mild neurological sequelae.

CONCLUSION

Survival increased 2.2-fold in OHCA during 1990-2020 but without any improvement in the final decade, and 1.2-fold in IHCA during 2004-20, with rapid improvement the last decade. Cardiac aetiology and shockable rhythms were halved. Neurological outcome has not improved.

Association between type of bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest: A machine learning study

Aim

In the event of an out of hospital cardiac arrest (OHCA) it is recommended for a sole untrained bystander to perform compression only CPR (CO-CPR). However, it remains unknown if CO-CPR is inferior to standard CPR (S-CPR), including both compressions and ventilation, in terms of survival. One could speculate that due to the current pandemic, bystanders may be more hesitant performing mouth-to-mouth ventilation. The aim of this study is to assess the association between type of bystander CPR and survival in OHCA.

Methods

This study included all patients with a bystander treated OHCA between year 2015–2019 in ages 18–100 using The Swedish Registry for Cardiopulmonary Resuscitation (SRCR). We compared CO-CPR to S-CPR in terms of 30-day survival using a propensity score approach based on machine learning adjusting for a large number of covariates.

Results

A total of 13,481 patients were included (5,293 with S-CPR and 8,188 with CO-CPR). The matched subgroup consisted of 2994 cases in each group.

Gradient boosting were the best models with regards to predictive accuracy (for type of bystander CPR) and covariate balance. The difference between S-CPR and CO-CPR in all 30 models computed on covariate adjustment and 1-to-1 matching were non-significant. In the 30 weighted models, three comparisons (S-CPR vs. CO-CPR) were significant in terms of improved survival; odds ratio for men was 1.21 (99% confidence interval (CI) 1.02–1.43; Average treatment effect (ATE)); for patients ≥73 years 1.57 (99% CI 1.17–2.12) for Average treatment effect on treated (ATT) and 1.63 (99% CI 1.18–2.25) for ATE. Remaining 27 models showed no differences. No significances remain after adjustment for multiple testing.

Conclusion

We found no significant differences between S-CPR and CO-CPR in terms of survival, supporting current recommendations for untrained bystanders regarding CO-CPR.

Association of ambient air pollution with risk of out of hospital cardiac arrest in the United States

Objective

We assessed the association of acute exposure to ambient air particulate matter < 2.5 μm (PM2.5) and Ozone with risk of out of hospital cardiac arrest (OHCA).

Methods

We used data from the Cardiac Arrest Registry to Enhance Survival (CARES), a prospective multicenter registry of patients with OHCA in the U.S. Environmental data was obtained from publicly available data and linked with each patient. A case-crossover design was used to estimate association of acute exposure to ambient air PM2.5 and Ozone with risk of OHCA. Case day was defined as the day of the OHCA, and control days were same days of the week from preceding two weeks.

Results

Of 187,047 patients with OHCA, mean age was 61.5 ± 19.9 years, 59.7 % were males and 47.1 % were of White race. Mean daily PM2.5 concentration on case day was 9.2 ± 4.9 μg/m3 and mean averaged 8-hour Ozone concentration was 36.9 ± 12.1 ppb. Each 5 μg/m3 increase in PM2.5 concentration (case day vs. control day) was not associated with risk of OHCA (OR 0.99 [95 % CI 0.998, 1.017] p = 0.72). In contrast, there was an association of exposure to Ozone with risk of OHCA with every 12 ppb increase in Ozone associated with a higher risk for OHCA on case day (OR 1.011 [95 % CI 1.003, 1.019] p = 0.01).

Conclusion

In the U.S., higher exposure to Ozone was associated with increased risk of OHCA.

Clinical characteristics and survival in patients with heart failure experiencing in hospital cardiac arrest

In patients with heart failure (HF) who suffered in-hospital cardiac arrest (IHCA), little is known about the characteristics, survival and neurological outcome. We used the Swedish Registry of Cardiopulmonary Resuscitation to study this, including patients aged ≥ 18 years suffering IHCA (2008–2019), categorised as HF alone, HF with acute myocardial infarction (AMI), AMI alone, or other. Odds ratios (OR) for 30-day survival, trends in 30-day survival, and the implication of HF phenotype was studied. 6378 patients had HF alone, 2111 had HF with AMI, 4210 had AMI alone. Crude 5-year survival was 9.6% for HF alone, 12.9% for HF with AMI and 34.6% for AMI alone. The 5-year survival was 7.9% for patients with HF and left ventricular ejection fraction (LVEF) ≥ 50%, 15.4% for LVEF < 40% and 12.3% for LVEF 40–49%. Compared with AMI alone, adjusted OR (95% CI) for 30-day survival was 0.66 (0.60–0.74) for HF alone, and 0.49 (0.43–0.57) for HF with AMI. OR for 30-day survival in 2017–2019 compared with 2008–2010 were 1.55 (1.24–1.93) for AMI alone, 1.37 (1.00–1.87) for HF with AMI and 1.30 (1.07–1.58) for HF alone. Survivors with HF had good neurological outcome in 92% of cases.

Cervical Vagus Nerve Stimulation Improves Neurologic Outcome After Cardiac Arrest in Mice by Attenuating Oxidative Stress and Excessive Autophagy

BACKGROUND

Cerebral ischemia and reperfusion (I/R) induces oxidative stress and activates autophagy, leading to brain injury and neurologic deficits. Cervical vagus nerve stimulation (VNS) increases cerebral blood flow (CBF). In this study, we investigate the effect of VNS-induced CBF increase on neurologic outcomes after cardiac arrest (CA).

MATERIALS AND METHODS

A total of 40 male C57Bl/6 mice were subjected to ten minutes of asphyxia CA and randomized to vagus nerve isolation (VNI) or VNS treatment group. Eight mice received sham surgery and VNI. Immediately after resuscitation, 20 minutes of electrical stimulation (1 mA, 1 ms, and 10 Hz) was started in the VNS group. Electrocardiogram, blood pressure, and CBF were monitored. Neurologic and histologic outcomes were evaluated at 72 hours. Oxidative stress and autophagy were assessed at 3 hours and 24 hours after CA.

RESULTS

Baseline characteristics were not different among groups. VNS mice had better behavioral performance (ie, open field, rotarod, and neurologic score) and less neuronal death (p < 0.05, vs VNI) in the hippocampus. CBF was significantly increased in VNS-treated mice at 20 minutes after return of spontaneous circulation (ROSC) (p < 0.05). Furthermore, levels of 8-hydroxy-2'-deoxyguanosine in the blood and autophagy-related proteins (ie, LC-3Ⅱ/Ⅰ, Beclin-1, and p62) in the brain were significantly decreased in VNS mice. Aconitase activity was also reduced, and the p-mTOR/mTOR ratio was increased in VNS mice.

CONCLUSIONS

Oxidative stress induced by global brain I/R following CA/ROSC leads to early excessive autophagy and impaired autophagic flux. VNS promoted CBF recovery, ameliorating these changes. Neurologic and histologic outcomes were also improved.

A spatiotemporal data mining study to identify high-risk neighborhoods for out-of-hospital cardiac arrest (OHCA) incidents

Out-of-hospital cardiac arrest (OHCA) is a worldwide health problem. The aim of the study is to utilize the territorial-wide OHCA data of Hong Kong in 2012-2015 to examine its spatiotemporal pattern and high-risk neighborhoods. Three techniques for spatiotemporal data mining (SaTScan's spatial scan statistic, Local Moran's I, and Getis Ord Gi*) were used to extract high-risk neighborhoods of OHCA occurrence and identify local clusters/hotspots. By capitalizing on the strengths of these methods, the results were then triangulated to reveal "truly" high-risk OHCA clusters. The final clusters for all ages and the elderly 65+ groups exhibited relatively similar patterns. All ages groups were mainly distributed in the urbanized neighborhoods throughout Kowloon. More diverse distribution primarily in less accessible areas was observed among the elderly group. All outcomes were further converted into an index for easy interpretation by the general public. Noticing the spatial mismatches between hospitals and ambulance depots (representing supplies) and high-risk neighborhoods (representing demands), this setback should be addressed along with public education and strategic ambulance deployment plan to shorten response time and improve OHCA survival rate. This study offers policymakers and EMS providers essential spatial evidence to assist with emergency healthcare planning and informed decision-making.

Dissemination of Chest Compression-Only Cardiopulmonary Resuscitation by Bystanders for Out-of-Hospital Cardiac Arrest in Students: A Nationwide Investigation in Japan

We aimed to investigate how the types of bystander-initiated cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) among students have changed recently. We also determined the association between two types of bystander-CPRs (i.e., chest compression-only CPR [CCCPR] and conventional CPR with rescue breathing [CCRB]) and survival after OHCA. From a nationwide registry of pediatric OHCAs occurring in school settings in Japan, the data of 253 non-traumatic OHCA patients (elementary, junior high, and high school/technical college students) receiving bystander-CPR between April 2008 and December 2017 were analyzed. Multivariable logistic regression analysis was conducted to assess the impact of different types of bystander-CPR on 30-day survival with favorable neurological outcomes. The proportion of patients receiving CCCPR increased from 25.0% during 2008–2009 to 55.3% during 2016–2017 (p for trend < 0.001). Overall, 53.2% (50/94) of patients receiving CCCPR and 46.5% (74/159) of those receiving CCRB survived for 30 days with favorable neurological outcomes. Multivariable analysis showed no significant difference in outcomes between the two groups (adjusted odds ratio: 1.23, 95% confidence interval: 0.67–2.28). In this setting, CCCPR is a common type of bystander-CPR for OHCA in students, and the effectiveness of CCCPR and CCRB on survival outcomes seems comparable.

Effect of large-scale disasters on bystander-initiated cardiopulmonary resuscitation in family-witnessed, friend-witnessed and colleague-witnessed out-of-hospital cardiac arrest: a retrospective analysis of prospectively collected, nationwide, population-based data

IMPORTANCE

The effect of large-scale disasters on bystander cardiopulmonary resuscitation (BCPR) performance is unknown.

OBJECTIVE

To investigate whether and how large-scale earthquake and tsunami as well as subsequent nuclear pollution influenced BCPR performance for out-of-hospital cardiac arrest (OHCA) witnessed by family and friends/colleagues.

DESIGN AND SETTING

Retrospective analysis of prospectively collected, nationwide, population-based data for OHCA cases.

PARTICIPANTS

From the nationwide OHCA registry recorded between 11 March 2010 and 1 March 2013, we extracted 74 684 family-witnessed and friend/colleague-witnessed OHCA cases without prehospital physician involvement.

EXPOSURE

Earthquake and tsunamis that were followed by nuclear pollution and largely affected the social life of citizens for at least 24 weeks.

MAIN OUTCOME AND MEASURE

Neurologically favourable outcome after 1 month, 1-month survival and BCPR.

METHODS

We analysed the 4-week average trend of BCPR rates in the years affected and before and after the disaster. We used univariate and multivariate logistic regression analyses to investigate whether these disasters affected BCPR and OHCA results.

RESULTS

Multivariable logistic regression for tsunami-affected prefectures revealed that the BCPR rate during the impact phase in 2011 was significantly lower than that in 2010/2012 (42.5% vs 48.2%; adjusted OR; 95% CI 0.82; 0.68 to 0.99). A lower level of bystander compliance with dispatcher-assisted CPR instructions (62.1% vs 69.5%, 0.72; 95% CI 0.57 to 0.92) in the presence of a preserved level of voluntary BCPR performance (23.6% vs 23.8%) was also observed. Both 1-month survival and neurologically favourable outcome rates during the impact phase in 2011 were significantly poorer than those in 2010/2012 (8.5% vs 10.7%, 0.72; 95% CI 0.52 to 0.99, 4.0% vs 5.2%, 0.62; 95% CI 0.38 to 0.98, respectively).

CONCLUSION AND RELEVANCE

A large-scale disaster with nuclear pollution influences BCPR performance and clinical outcomes of OHCA witnessed by family and friends/colleagues. Basic life-support training leading to voluntary-initiated BCPR might serve as preparedness for disaster and major accidents.

Cardiac arrest in special circumstances

PURPOSE OF REVIEW

European Resuscitation Council Guidelines for Cardiopulmonary Resuscitation prioritize treatments like chest compression and defibrillation, known to be highly effective for cardiac arrest from cardiac origin. This review highlights the need to modify this approach in special circumstances.

RECENT FINDINGS

Potentially reversible causes of cardiac arrest are clustered into four Hs and four Ts (Hypoxia, Hypovolaemia, Hyperkalaemia/other electrolyte disorders, Hypothermia, Thrombosis, Tamponade, Tension pneumothorax, Toxic agents). Point-of-care ultrasound has its role in identification of the cause and targeting treatment. Time-critical interventions may even prevent cardiac arrest if applied early. The extracorporeal CPR (eCPR) or mechanical CPR should be considered for bridging the period needed to reverse the precipitating cause(s). There is low quality of evidence available to guide the treatment in the majority of situations. Some topics (pulmonary embolism, eCPR, drowning, pregnancy and opioid toxicity) were included in recent ILCOR reviews and evidence updates but majority of recommendations is based on individual systematic reviews, scoping reviews, evidence updates and expert consensus.

SUMMARY

Cardiac arrests from reversible causes happen with lower incidence. Return of spontaneous circulation and neurologically intact survival can hardly be achieved without a modified approach focusing on immediate treatment of the underlying cause(s) of cardiac arrest.

The World Restart a Heart Initiative: how to save hundreds of thousands of lives worldwide

PURPOSE OF REVIEW

Sudden out-of-hospital cardiac arrest (OHCA) is still one of the top reasons for death in industrialized countries. Bystander resuscitation rates differ significantly across the world despite bystanders being easily able to save lives in this situation. In the 4 years since initiation of the International Liaison Committee on Resuscitation (ILCOR) World Restart a Heart (WRAH), the initiative helped educating millions of people and thus enabled them to save lives.

RECENT FINDINGS

WRAH Day has gained more and more reach, partners and impact over the years. It has the potential of saving hundreds of thousands of lives, changing legislation and inspiring research. During the last year, new strategies had to be developed because of the COVID-pandemic. The importance of educating laypeople is underlined in recent publications and international guidelines.

SUMMARY

The WRAH awareness campaign has reached 194 countries and more than 200 million people in the last years. The success of it could even be kept going in the pandemic due to social media and digital/virtual programmes. International guidelines recommend raising awareness and name ILCOR WRAH as a way to do it.

Dispatcher instructions for bystander cardiopulmonary resuscitation and neurologically intact survival after bystander-witnessed out-of-hospital cardiac arrests: a nationwide, population-based observational study

Background

The International Liaison Committee on Resuscitation recommends that dispatchers provide instructions to perform compression-only cardiopulmonary resuscitation (CPR) to callers responding to adults with out-of-hospital cardiac arrest (OHCA). This study aimed to determine the optimal dispatcher-assisted CPR (DA-CPR) instructions for OHCA.

Methods

We analysed the records of 24,947 adult patients (aged ≥ 18 years) who received bystander DA-CPR after bystander-witnessed OHCA. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database for a 2-year period (2016–2017). Patients were divided into compression-only DA-CPR (n = 22,778) and conventional DA-CPR (with a compression-to-ventilation ratio of 30:2, n = 2169) groups. The primary outcome measure was 1-month neurological intact survival, defined as a cerebral performance category score of 1–2 (CPC 1–2).

Results

The 1-month CPC 1–2 rate was significantly higher in the conventional DA-CPR group than in the compression-only DA-CPR group (before propensity score (PS) matching, 7.5% [162/2169] versus 5.8% [1309/22778], p < 0.01; after PS matching, 7.5% (162/2169) versus 5.7% (123/2169), p < 0.05). Compared with compression-only DA-CPR, conventional DA-CPR was associated with increased odds of 1-month CPC 1–2 (before PS matching, adjusted odds ratio 1.39, 95% confidence interval [CI] 1.14–1.70, p < 0.01; after PS matching, adjusted odds ratio 1.34, 95% CI 1.00–1.79, p < 0.05).

Conclusion

Within the limitations of this retrospective observational study, conventional DA-CPR with a compression-to-ventilation ratio of 30:2 was preferable to compression-only DA-CPR as an optimal DA-CPR instruction for coaching callers to perform bystander CPR for adult patients with bystander-witnessed OHCAs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-021-03825-w.

Inequalities in Income and Education are Associated with Survival Differences after Out-of-hospital Cardiac Arrest: A Nationwide Observational Study

Supplemental Digital Content is available in the text.

Background:

Despite the acknowledged importance of socioeconomic factors as regards cardiovascular disease onset and survival, the relationship between individual-level socioeconomic factors and survival after out-of-hospital cardiac arrest is not established. Our aim was to investigate whether socioeconomic variables are associated with 30-day survival after out-of-hospital cardiac arrest.

Methods:

We linked data from the Swedish Registry for Cardiopulmonary Resuscitation with individual-level data on socioeconomic factors (ie, educational level and disposable income) from Statistics Sweden. Confounding and mediating variables included demographic factors, comorbidity, and Utstein resuscitation variables. Outcome was 30-day survival. Multiple modified Poisson regression was used for the main analyses.

Results:

A total of 31 373 out-of-hospital cardiac arrests occurring in 2010 to 2017 were included. Crude 30-day survival rates by income quintiles were as follows: Q1 (low), 414/6277 (6.6%); Q2, 339/6276 (5.4%); Q3, 423/6275 (6.7%); Q4, 652/6273 (10.4%); and Q5 (high), 928/6272 (14.8%). In adjusted analysis, the chance of survival by income level followed a gradient-like increase, with a risk ratio of 1.86 (95% CI, 1.65–2.09) in the highest-income quintile versus the lowest. This association remained after adjusting for comorbidity, resuscitation factors, and initial rhythm. A higher educational level was associated with improved 30-day survival, with the risk ratio associated with postsecondary education ≥4 years being 1.51 (95% CI, 1.30–1.74). Survival disparities by income and educational level were observed in both men and women.

Conclusions:

In this nationwide observational study using individual-level socioeconomic data, higher income and higher educational level were associated with better 30-day survival after out-of-hospital cardiac arrest in both sexes.

Awareness and attitude about basic life support among medical school students in Jeddah University, 2019: A cross-sectional study

Objectives:

To measure the level of knowledge and awareness towards basic life support (BLS) among students in preclinical years at Jeddah University (JU), and to determine their willingness to participate in BLS training in the near future.

Subjects and Methods:

A cross-sectional study was conducted among first-, second-, and third-year medical students of JU. A 27-item questionnaire measured the level of awareness and knowledge about BLS, including: 1) basic Information (seven items); 2) rescue reflex (eight items); and 3) CPR technique and process (12 items). Demographic and academic data, experience and exposure to BLS, and attitude regarding BLS (six items) were analysed as factors of adequate knowledge.

Results:

One hundred and four male students participated and 65 (62.5%) of them were in the second academic year. The correct answers varied from 10.6% to 67.3%, with eight items having <30% correct answers; and seven items showed >50% correct answers. Mean (SD) and median (P75) overall knowledge scores were 37.86 (13.92) and 37.04 (44.44) out of 100, respectively. Twenty-four (23.11%) participants attended a training course in BLS and 13 (12.5%) have ever performed BLS, either voluntarily or not voluntarily, and 18 (17.3%) felt that their current knowledge was sufficient. Knowledge level showed no statistically significant association with any of the investigated factors.

Conclusion:

There is an urgent need to integrate BLS courses to medical students to enrich their knowledge and improve resuscitation skills and ensure implementation of correct resuscitation techniques.

Out-of-hospital cardiac arrests in the city of Cape Town, South Africa: a retrospective, descriptive analysis of prehospital patient records

OBJECTIVES

While prospective epidemiological data for out-of-hospital cardiac arrest (OHCA) exists in many high-income settings, there is a dearth of such data for the African continent. The aim of this study was to describe OHCA in the Cape Town metropole, South Africa.

DESIGN

Observational study with a retrospective descriptive design.

SETTING

Cape Town metropole, Western Cape province, South Africa.

PARTICIPANTS

All patients with OHCA for the period 1 January 2018-31 December 2018 were extracted from public and private emergency medical services (EMS) and described.

OUTCOME MEASURES

Description of patients with OHCA in terms of demographics, treatment and short-term outcome.

RESULTS

A total of 929 patients with OHCA received an EMS response in the Cape Town metropole, corresponding to an annual prevalence of 23.2 per 100 000 persons. Most patients were adult (n=885; 96.5%) and male (n=526; 56.6%) with a median (IQR) age of 63 (26) years. The majority of cardiac arrests occurred in private residences (n=740; 79.7%) and presented with asystole (n=322; 34.6%). EMS resuscitation was only attempted in 7.4% (n=69) of cases and return of spontaneous circulation (ROSC) occurred in 1.3% (n=13) of cases. Almost all patients (n=909; 97.8%) were declared dead on the scene.

CONCLUSION

To our knowledge, this was the largest study investigating OHCA ever undertaken in Africa. We found that while the incidence of OHCA in Cape Town was similar to the literature, resuscitation is attempted in very few patients and ROSC-rates are negligible. This may be as a consequence of protracted response times, poor patient prognosis or an underdeveloped and under-resourced Chain of Survival in low- to middle-income countries, like South Africa. The development of contextual guidelines given resources and disease burden is essential.

Analysis of the Status Quo and Influencing Factors of Community Residents' Awareness of Basic Life Support and Willingness to Attempt Rescue

Objective

This study aimed to investigate community residents’ awareness of basic life support (BLS) and their willingness to attempt rescue.

Methods

From October to December 2020, in the communities of Nantong City, a stratified three-stage random sampling method was adopted to select residents from 12 neighborhood committees over the age of 18 with whom to conduct a cross-sectional questionnaire survey. A self-designed questionnaire was adopted, the contents of which included the general situation of the respondent, knowledge, attitude, and behavior in relation to BLS; the Cronbach’s α coefficient of the questionnaire was 0.719.

Results

A total of 3000 questionnaires were distributed, of which 2812 were valid, with a valid response rate of 93.73%. Of the 2812 respondents, 41.18% had seen an automatic external defibrillator (AED), 48.83% had experience of’ cardiopulmonary resuscitation (CPR), and 25.07% of the respondents had experience of’ AEDs. When an accident occurred, 50.50% of residents were willing to attempt rescue, 70.80% were willing to attempt rescue under professional guidance, and 71.23% were willing to attempt rescue after learning BLS techniques. Of the residents who were unwilling to attempt rescue, 32.75% were worried about their lack of ability, 27.91% were concerned about legal issues, 14.01% feared infectious diseases, and 10.35% were unwilling to perform mouth-to-mouth artificial respiration. Age, occupation, education level, and whether they had participated in first aid training were the influencing factors.

Conclusion

Residents in Nantong have less knowledge of BLS, and their knowledge of CPR is better than that of AEDs. Residents have a strong willingness to learn BLS. Measures need to be taken to improve their understanding of BLS and their application skills. Residents have high levels of willingness to attempt rescue, but a certain percentage of residents have concerns. Interventions can be made to target the different reasons.

Association of Psychological Distress, Contextual Factors, and Individual Differences Among Citizen Responders

Background

Little is known about the psychological risks of dispatched citizen responders who have participated in resuscitation attempts.

Methods and Results

A cross‐sectional survey study was performed with 102 citizen responders who participated in a resuscitation attempt from July 23, 2018, to August 22, 2018, in the Capital Region of Denmark. Psychological distress, defined as symptoms of posttraumatic stress disorder, was assessed 3 weeks after the resuscitation attempt and measured with the Impact of Event Scale‐Revised. Perceived stress was measured with the Perceived Stress Scale. Individual differences were assessed as the personality traits of agreeableness, conscientiousness, extraversion, neuroticism, and openness to experience with the Big Five Inventory, general self‐efficacy, and coping mechanisms (Brief Coping Orientation to Problems Experienced Inventory). Associations between continuous variables were examined with the Pearson correlation. The associations between psychological distress levels and contextual factors and individual differences were analyzed in multivariable linear regression models to determine factors independently associated with psychological distress levels. The mean overall posttraumatic stress disorder score was 0.65 of 12; the mean perceived stress score was 7.61 of 40. The most common coping mechanisms were acceptance and emotional support. Low perceived stress was significantly associated with high general self‐efficacy, and high perceived stress was significantly associated with high scores on neuroticism and openness to experience. Non–healthcare professionals were less likely to report symptoms of posttraumatic stress disorder.

Conclusions

Citizen responders who participated in resuscitation reported low levels of psychological distress. Individual differences were significantly associated with levels of psychological distress and should be considered when engaging citizen responders in resuscitation.

Different forms of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world with an estimated number of 275 000 treated with resuscitation attempts by the Emergency Medical Services (EMS) in Europe each year. Overall survival rates remain low, and most studies indicate that around 1 out 10 will survive to 30 days. Amongst the strongest factors associated with survival in OHCA is first recorded rhythm amendable to defibrillation, early defibrillation and prompt initiation of cardiopulmonary resuscitation (CPR). Overall, CPR started prior to EMS arrival has repeatedly been shown to be associated with survival rates 2-3 times higher compared with no such initiation. The primary goal of CPR is to generate sufficient blood flow to vital organs, mainly the brain and heart, until restoration of spontaneous circulation can be achieved. Barriers to the initiation of CPR by bystanders in OHCA include fear of being incapable, causing harm, and transmission of infectious diseases. Partly due to these barriers, and low rates of CPR, the concept of CPR with compression only was proposed as a simpler form of resuscitation with the aim to be more widely accepted by the public in the 1990s. But how reliable is the evidence supporting this simpler form of CPR, and are the outcomes after CO-CPR comparable to standard CPR?

To ventilate or not to ventilate during bystander CPR - A EuReCa TWO analysis

BACKGROUND

Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR).

METHOD

In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed.

RESULTS

A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17-1.83).

CONCLUSION

In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both.