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Oliveira NC, Oliveira H, Silva TLC, Boné M, Bonito J. THE ROLE OF BYSTANDER CPR IN OUT-OF-HOSPITAL CARDIAC ARREST: WHAT THE EVIDENCE TELLS US. Hellenic J Cardiol 2024:S1109-9666(24)00201-X. [PMID: 39277169 DOI: 10.1016/j.hjc.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/26/2024] [Accepted: 09/06/2024] [Indexed: 09/17/2024] Open
Abstract
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 "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 alert 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 lay people.
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Affiliation(s)
- Natália C Oliveira
- Full professor. Postgraduate program in health promotion. Adventist University of Sao Paulo - SP, Brasil
| | - Hugo Oliveira
- PhD research fellow. Center for Research in Education and Psychology of the University of Evora.
| | - Thamires L C Silva
- PhD research fellow. Postgraduate program in nursing and health. University of Guarulhos, Guarulhos - SP, Brasil.
| | - Maria Boné
- Assistant professor. School of Education of the Polytechnic Institute of Beja, Portugal.
| | - Jorge Bonito
- Full professor. Center for Research in Education and Psychology of the University of Évora, Portugal. Research Center on Didactics and Technology in the Education of Trainers of University of Aveiro, Portugal.
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Armour R, Grunau B, Iammarino S, Buxton J, Kinniburgh B, Burgess H, Sedgemore KO, Choisil P, Nielsen S, Ross L. Performance of the Medical Priority Dispatch System® in Identifying Patients Requiring Chest Compressions at Overdose Prevention Services: A Retrospective Cohort Study. PREHOSP EMERG CARE 2024:1-8. [PMID: 38407219 DOI: 10.1080/10903127.2024.2319150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND AIMS The Medical Priority Dispatch System (MPDS)® is used to triage 9-1-1 calls according to acuity, with certain coding receiving telecommunicator cardiopulmonary resuscitation (T-CPR) for suspected out-of-hospital cardiac arrest (OHCA). However, this may be challenging for those with drug poisoning emergencies, who may resemble OHCA. We sought to examine the performance of the system to correctly identify cases requiring T-CPR, specifically at overdose prevention services (OPS). METHODS This retrospective cohort study included patients attended by the provincial emergency medical system (EMS) (May 1, 2019-January 31, 2023). We calculated the diagnostic performance of MPDS® assessment of whether the case required T-CPR instructions against the gold standard of whether the patient was found pulseless on EMS clinician arrival. We compared performance among subgroups, specifically OPS vs other locations and drug poisoning-classified cases vs other case classifications. RESULTS Comparing OPS to other locations, the sensitivity of MPDS® was similar (66.7% vs 62.4%, p = 0.4), with lower specificity (87.3% vs 98.1%, p < 0.01) and positive predictive value (0.3% vs 35.7%, p < 0.01) and higher negative predictive value (99.9% vs 99.4%, p < 0.01). The negative likelihood ratio of MPDS® was 0.381 at OPS locations, compared with 0.383 at other locations, while the positive likelihood ratio was 5.24, compared with 32.36. In patients with drug poisoning emergencies, compared with other 9-1-1 events, MPDS® had higher sensitivity (83.6% vs 60.6%, p < 0.01) but lower specificity (77.6% vs 98.9%, p < 0.01) and positive predictive value (10.5% vs 48.5%, p < 0.01), and similar negative predictive value (99.33% vs 99.35%, p = 0.03). The negative likelihood ratio of MPDS® was 0.212 in drug poisoning emergencies compared with 0.398 for all other presentations, and the positive likelihood ratio was 3.73 compared with 57.88. DISCUSSION AND CONCLUSIONS The ability of MPDS® to correctly identify patients needing telecommunicator cardiopulmonary resuscitation instructions differed between OPS settings and other locations, frequently recommending T-CPR for patients not suffering OHCA at an OPS. Different strategies developed in collaboration with people who use substances are required to better tailor dispatch instructions prior to EMS arrival to avoid delays in life-saving interventions.
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Affiliation(s)
- Richard Armour
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
- British Columbia Resuscitation Research Collaborative, Vancouver, British Columbia, Canada
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Brian Grunau
- British Columbia Resuscitation Research Collaborative, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
| | - Sammy Iammarino
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane Buxton
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brooke Kinniburgh
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Heather Burgess
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Kali-Olt Sedgemore
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Paul Choisil
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Linda Ross
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
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3
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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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Zicari RV, Brusseau J, Blomberg SN, Christensen HC, Coffee M, Ganapini MB, Gerke S, Gilbert TK, Hickman E, Hildt E, Holm S, Kühne U, Madai VI, Osika W, Spezzatti A, Schnebel E, Tithi JJ, Vetter D, Westerlund M, Wurth R, Amann J, Antun V, Beretta V, Bruneault F, Campano E, Düdder B, Gallucci A, Goffi E, Haase CB, Hagendorff T, Kringen P, Möslein F, Ottenheimer D, Ozols M, Palazzani L, Petrin M, Tafur K, Tørresen J, Volland H, Kararigas G. On Assessing Trustworthy AI in Healthcare. Machine Learning as a Supportive Tool to Recognize Cardiac Arrest in Emergency Calls. FRONTIERS IN HUMAN DYNAMICS 2021. [DOI: 10.3389/fhumd.2021.673104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Artificial Intelligence (AI) has the potential to greatly improve the delivery of healthcare and other services that advance population health and wellbeing. However, the use of AI in healthcare also brings potential risks that may cause unintended harm. To guide future developments in AI, the High-Level Expert Group on AI set up by the European Commission (EC), recently published ethics guidelines for what it terms “trustworthy” AI. These guidelines are aimed at a variety of stakeholders, especially guiding practitioners toward more ethical and more robust applications of AI. In line with efforts of the EC, AI ethics scholarship focuses increasingly on converting abstract principles into actionable recommendations. However, the interpretation, relevance, and implementation of trustworthy AI depend on the domain and the context in which the AI system is used. The main contribution of this paper is to demonstrate how to use the general AI HLEG trustworthy AI guidelines in practice in the healthcare domain. To this end, we present a best practice of assessing the use of machine learning as a supportive tool to recognize cardiac arrest in emergency calls. The AI system under assessment is currently in use in the city of Copenhagen in Denmark. The assessment is accomplished by an independent team composed of philosophers, policy makers, social scientists, technical, legal, and medical experts. By leveraging an interdisciplinary team, we aim to expose the complex trade-offs and the necessity for such thorough human review when tackling socio-technical applications of AI in healthcare. For the assessment, we use a process to assess trustworthy AI, called 1Z-Inspection® to identify specific challenges and potential ethical trade-offs when we consider AI in practice.
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdóttir H, Perkins GD. [Basic life support]. Notf Rett Med 2021; 24:386-405. [PMID: 34093079 PMCID: PMC8170637 DOI: 10.1007/s10049-021-00885-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), cardiopulmonary resuscitation (CPR) quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M. Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italien
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Mailand, Italien
- Department of Pathophysiology and Transplantation, University of Milan, Mailand, Italien
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finnland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moskau, Russland
| | - Koenraad G. Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerpen, Belgien
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nikosia, Zypern
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- West Midlands Ambulance Service, DY5 1LX Brierly Hill, West Midlands Großbritannien
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Hildigunnur Svavarsdóttir
- Akureyri Hospital, Akureyri, Island
- Institute of Health Science Research, University of Akureyri, Akureyri, Island
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- University Hospitals Birmingham, B9 5SS Birmingham, Großbritannien
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6
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdottir H, Perkins GD. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation 2021; 161:98-114. [PMID: 33773835 DOI: 10.1016/j.resuscitation.2021.02.009] [Citation(s) in RCA: 243] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), CPR quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italy
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; West Midlands Ambulance Service and Midlands Air Ambulance, Brierly Hill, West Midlands DY5 1LX, United Kingdom
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hildigunnur Svavarsdottir
- Akureyri Hospital, Akureyri, Iceland; Institute of Health Science Research, University of Akureyri, Akureyri, Iceland
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; University Hospitals Birmingham, Birmingham B9 5SS, United Kingdom
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7
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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: 73] [Impact Index Per Article: 18.3] [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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8
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Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, Lavonas EJ, Magid DJ. Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S337-S357. [DOI: 10.1161/cir.0000000000000918] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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9
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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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10
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Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM, Arafeh J, Benoit JL, Chase M, Fernandez A, de Paiva EF, Fischberg BL, Flores GE, Fromm P, Gazmuri R, Gibson BC, Hoadley T, Hsu CH, Issa M, Kessler A, Link MS, Magid DJ, Marrill K, Nicholson T, Ornato JP, Pacheco G, Parr M, Pawar R, Jaxton J, Perman SM, Pribble J, Robinett D, Rolston D, Sasson C, Satyapriya SV, Sharkey T, Soar J, Torman D, Von Schweinitz B, Uzendu A, Zelop CM, Magid DJ. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S366-S468. [DOI: 10.1161/cir.0000000000000916] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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11
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Fukushima H, Bolstad F. Telephone CPR: Current Status, Challenges, and Future Perspectives. Open Access Emerg Med 2020; 12:193-200. [PMID: 32982493 PMCID: PMC7490094 DOI: 10.2147/oaem.s259700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/12/2020] [Indexed: 12/16/2022] Open
Abstract
With each successive update of the cardiopulmonary resuscitation (CPR) guidelines, the role of dispatchers in sudden cardiac arrest (CA) has grown. Dispatchers instruct callers in how to perform CPR until the arrival of emergency medical service (EMS) professionals. This is widely known as telephone CPR (TCPR) or dispatch-assisted CPR (DACPR). Studies have shown the efficacy of TCPR in increasing the survival rate of sudden CA. The TCPR process, however, is challenging and needs to be constantly evaluated and refined in order to improve the survival rate of sudden CA victims throughout the world. In this review article, the current status, challenges, and future perspectives of TCPR are discussed with a view to providing a research foundation from which to launch further studies into the effective role of dispatchers in sudden CA.
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Affiliation(s)
- Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan
| | - Francesco Bolstad
- Department of Clinical English, Nara Medical University, Kashihara City, Nara, Japan
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12
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Asai H, Fukushima H, Bolstad F, Okuchi K. Quality of dispatch-assisted cardiopulmonary resuscitation by lay rescuers following a standard protocol in Japan: an observational simulation study. Acute Med Surg 2017; 5:133-139. [PMID: 29657724 PMCID: PMC5891109 DOI: 10.1002/ams2.315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/10/2017] [Indexed: 02/04/2023] Open
Abstract
Aim Bystander cardiopulmonary resuscitation (CPR) is essential for improving the outcomes of sudden cardiac arrest patients. It has been reported that dispatch-assisted CPR (DACPR) accounts for more than half of the incidence of CPR undertaken by bystanders. Its quality, however, can be suboptimal. We aimed to measure the quality of DACPR using a simulation study. Methods We recruited laypersons at a shopping mall and measured the quality of CPR carried out in our simulation. Dispatchers provided instruction in accordance with the standard DACPR protocol in Japan. Results Twenty-three laypersons (13 with CPR training experience within the past 2 years and 10 with no training experience) participated in this study. The median chest compression rate and depth were 106/min and 33 mm, respectively. The median time interval from placing the 119 call to the start of chest compressions was 119 s. No significant difference was found between the groups with and without training experience. However, subjects with training experience more frequently placed their hands correctly on the manikin (84.6% versus 40.0%; P = 0.026). Twelve participants (52.2%, seven in trained and five in untrained group) interrupted chest compressions for 3-18 s, because dispatchers asked if the patient started breathing or moving. Conclusion This current simulation study showed that the quality of DACPR carried out by lay rescuers can be less than optimal in terms of depth, hand placement, and minimization of pauses. Further studies are required to explore better DACPR instruction methods to help lay rescuers perform CPR with optimal quality.
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Affiliation(s)
- Hideki Asai
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara Nara Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara Nara Japan
| | - Francesco Bolstad
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara Nara Japan.,Department of Clinical English Nara Medical University Kashihara Nara Japan
| | - Kazuo Okuchi
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara Nara Japan
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13
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2017; 20:3-24. [PMID: 32214897 PMCID: PMC7087749 DOI: 10.1007/s10049-017-0328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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Travers AH, Perkins GD, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C. Part 3: Adult Basic Life Support and Automated External Defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2016; 132:S51-83. [PMID: 26472859 DOI: 10.1161/cir.0000000000000272] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review comprises the most extensive literature search and evidence evaluation to date on the most important international BLS interventions, diagnostics, and prognostic factors for cardiac arrest victims. It reemphasizes that the critical lifesaving steps of BLS are (1) prevention, (2) immediate recognition and activation of the emergency response system, (3) early high-quality CPR, and (4) rapid defibrillation for shockable rhythms. Highlights in prevention indicate the rational and judicious deployment of search-and-rescue operations in drowning victims and the importance of education on opioid-associated emergencies. Other 2015 highlights in recognition and activation include the critical role of dispatcher recognition and dispatch-assisted chest compressions, which has been demonstrated in multiple international jurisdictions with consistent improvements in cardiac arrest survival. Similar to the 2010 ILCOR BLS treatment recommendations, the importance of high quality was reemphasized across all measures of CPR quality: rate, depth, recoil, and minimal chest compression pauses, with a universal understanding that we all should be providing chest compressions to all victims of cardiac arrest. This review continued to focus on the interface of BLS sequencing and ensuring high-quality CPR with other important BLS interventions, such as ventilation and defibrillation. In addition, this consensus statement highlights the importance of EMS systems, which employ bundles of care focusing on providing high-quality chest compressions while extricating the patient from the scene to the next level of care. Highlights in defibrillation indicate the global importance of increasing the number of sites with public-access defibrillation programs. Whereas the 2010 ILCOR Consensus on Science provided important direction for the “what” in resuscitation (ie, what to do), the 2015 consensus has begun with the GRADE methodology to provide direction for the quality of resuscitation. We hope that resuscitation councils and other stakeholders will be able to translate this body of knowledge of international consensus statements to build their own effective resuscitation guidelines.
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Schoolchildren as BLS instructors for relatives and friends: Impact on attitude towards bystander CPR. Resuscitation 2015; 85:1769-74. [PMID: 25447432 DOI: 10.1016/j.resuscitation.2014.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/06/2014] [Accepted: 10/15/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We investigated the impact of Cardio-Pulmonary Resuscitation (CPR) instruction by children on the attitude of people to perform bystander CPR. METHODS In 2012, children from primary and secondary school (age span 11–13 years) received a free individual CPR training package containing an inexpensive manikin and a training video. After a CPR training session by their class teacher, they were invited to teach their relatives and friends. After the training, the trainees of the children were invited to participate in a web survey, containing a test and questions about prior CPR training and about their attitude towards bystander CPR (BCPR) before and after the training. We measured the impact on the attitude to perform BCPR and the theoretical knowledge transfer by the children. RESULTS A total of 4012 training packages were distributed to 72 schools of which 55 class teachers subscribed their students (n = 822) for the training programme for relatives and friends. After a validation procedure, 874 trainees of 290 children were included in the study. In comparison to trainees of secondary schoolchildren, trainees of primary schoolchildren scored better for the test as well as for a positive change of attitude towards future BCPR (P < 0.001). For every child-instructor 1.7 people changed their attitude towards BCPR positively. CONCLUSIONS Instructing schoolchildren to teach their relatives and friends in Basic Life Support (BLS) led to a more positive attitude towards BCPR. The results were more positive with trainees from primary schoolchildren than with trainees from secondary schoolchildren.
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2015; 18:748-769. [PMID: 32214896 PMCID: PMC7088113 DOI: 10.1007/s10049-015-0081-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015; 95:81-99. [PMID: 26477420 DOI: 10.1016/j.resuscitation.2015.07.015] [Citation(s) in RCA: 722] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Besnier E, Damm C, Jardel B, Veber B, Compere V, Dureuil B. Dispatcher-assisted cardiopulmonary resuscitation protocol improves diagnosis and resuscitation recommendations for out-of-hospital cardiac arrest. Emerg Med Australas 2015; 27:590-596. [DOI: 10.1111/1742-6723.12493] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Emmanuel Besnier
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
| | - Cedric Damm
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
| | - Benoit Jardel
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
| | - Benoit Veber
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
| | - Vincent Compere
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
| | - Bertrand Dureuil
- Department of Anaesthesiology and Intensive Care; Rouen University Hospital; Rouen Cedex France
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Perkins GD, Travers AH, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C, Bierens JJ, Bourdon E, Brugger H, Buick JE, Charette ML, Chung SP, Couper K, Daya MR, Drennan IR, Gräsner JT, Idris AH, Lerner EB, Lockhat H, Løfgren B, McQueen C, Monsieurs KG, Mpotos N, Orkin AM, Quan L, Raffay V, Reynolds JC, Ristagno G, Scapigliati A, Vadeboncoeur TF, Wenzel V, Yeung J. Part 3: Adult basic life support and automated external defibrillation. Resuscitation 2015; 95:e43-69. [DOI: 10.1016/j.resuscitation.2015.07.041] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fukushima H, Imanishi M, Iwami T, Kitaoka H, Asai H, Seki T, Kawai Y, Norimoto K, Urisono Y, Nishio K, Okuchi K. Implementation of a dispatch-instruction protocol for cardiopulmonary resuscitation according to various abnormal breathing patterns: a population-based study. Scand J Trauma Resusc Emerg Med 2015; 23:64. [PMID: 26382582 PMCID: PMC4573300 DOI: 10.1186/s13049-015-0145-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 09/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We modified the dispatch protocol for cardiopulmonary resuscitation (CPR) using results of a retrospective analysis that identified descriptions by laypersons of possible patterns of agonal respiration. The purpose of this study was to assess the effectiveness of this modified protocol by comparing the frequency of dispatch instructions for CPR and bystander CPR before and after protocol implementation. We also identified descriptions of abnormal breathing patterns among 'Not in cardiac arrest (CA)' unresponsive cases. METHODS This study was conducted prospectively using the population-based registry of out-of-hospital cardiac arrests (OHCAs). For 8 months we implemented this modified protocol in cooperation with 4 fire departments that cover regions with a total population of 840,000. RESULTS There were 478 and 427 OHCAs before and after implementation, respectively. Among them, 69 and 71 layperson-witnessed OHCAs for pre- and post-implementation, respectively, were analyzed. Dispatchers provided CPR instructions more frequently after protocol implementation than before (55/71 [77.5 %] vs. 41/69 [59.4 %], p < 0.05). Based on breathing patterns described by emergency callers, dispatchers assessed 143 'Not in CA' unresponsive cases and provided CPR instruction for 45 cases. Sensitivity and specificity of this protocol was 93 % and 50 %, respectively. CONCLUSIONS This modified protocol based on abnormal breathing described by laypersons significantly increased CPR instructions. Considering high sensitivity and low specificity for abnormal breathing to identify CA and the low risk of chest compression for 'Not in CA' cases, our study suggested that dispatchers can provide CPR instruction assertively and safely for those unresponsive individuals with various abnormal breathing patterns.
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Affiliation(s)
- Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan.
| | - Masami Imanishi
- Nara Saiseikai Gose Hospital, Mimuro, 20, Gose City, Nara, 639-2306, Japan.
| | - Taku Iwami
- Kyoto University Health Service, Yoshida-honmachi, sakyo-ku, Kyoto, 606-8501, Japan.
| | - Hironori Kitaoka
- Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan.
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan.
| | - Tadahiko Seki
- Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan.
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan.
| | - Kazunobu Norimoto
- Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan.
| | - Yasuyuki Urisono
- Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan.
| | - Kenji Nishio
- Department of General Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan.
| | - Kazuo Okuchi
- Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan.
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Fukushima H, Imanishi M, Iwami T, Seki T, Kawai Y, Norimoto K, Urisono Y, Hata M, Nishio K, Saeki K, Kurumatani N, Okuchi K. Abnormal breathing of sudden cardiac arrest victims described by laypersons and its association with emergency medical service dispatcher-assisted cardiopulmonary resuscitation instruction. Emerg Med J 2014; 32:314-7. [PMID: 24401986 PMCID: PMC4392227 DOI: 10.1136/emermed-2013-203112] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Current guidelines for cardiopulmonary resuscitation (CPR) emphasise that emergency medical service (EMS) dispatchers should identify sudden cardiac arrest (CA) with abnormal breathing and assist lay rescuers performing CPR. However, lay rescuers description of abnormal breathing may be inconsistent, and it is unclear how EMS dispatchers provide instruction for CPR based on the breathing status of the CA victims described by laypersons. Methods and results To investigate the incidence of abnormal breathing and the association between the EMS dispatcher-assisted CPR instruction and layperson CPR, we retrospectively analysed 283 witnessed CA cases whose information regarding breathing status of CA victims was available from population-based prospective cohort data. In 169 cases (59.7%), laypersons described that the CA victims were breathing in various ways, and that the victims were ‘not breathing’ in 114 cases (40.3%). Victims described as breathing in various ways were provided EMS dispatch-instruction for CPR less frequently than victims described as ‘not breathing’ (27.8% (47/169) vs 84.2% (96/114); p<0.001). Multivariate logistic regression showed that EMS dispatch-instruction for CPR was associated significantly with layperson CPR (adjusted OR, 11.0; 95% CI, 5.72 to 21.2). Conclusions This population-based study indicates that 60% of CA victims showed agonal respiration, which was described as breathing in various ways at the time of EMS call. Although EMS dispatch-instruction was associated significantly with an increase in layperson CPR, abnormal breathing was associated with a much lower rate of CPR instruction and, in turn, was related to a much lower rate of bystander CPR.
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Affiliation(s)
- Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Masami Imanishi
- Department of Neurosurgery, Nara Saiseikai Gose Hospital, Gose, Nara, Japan
| | - Taku Iwami
- Department of Health Service, Kyoto University Health Service, Kyoto, Kyoto, Japan
| | - Tadahiko Seki
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Kazunobu Norimoto
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuyuki Urisono
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Michiaki Hata
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Kenji Nishio
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Keigo Saeki
- Department of Community Health and Epidemiology, Nara Medical University, Kashihara, Nara, Japan
| | - Norio Kurumatani
- Department of Community Health and Epidemiology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazuo Okuchi
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
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Quality of CPR performed by trained bystanders with optimized pre-arrival instructions. Resuscitation 2013; 85:124-30. [PMID: 24096105 DOI: 10.1016/j.resuscitation.2013.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/26/2013] [Accepted: 09/20/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Telephone-CPR (T-CPR) can increase initiation of bystander CPR. We wanted to study if quality oriented continuous T-CPR would improve CPR performance vs. standard T-CPR. METHOD Ninety-five trained rescuers aged 22-69 were randomized to standard T-CPR or experimental continuous T-CPR (comprises continuous instructions, questions and encouragement). They were instructed to perform 10 min of chest compressions-only on a manikin, which recorded CPR performance in a small, confined kitchen. Three video-cameras captured algorithm time data, CPR technique and communication. Demography and training experience were captured during debriefing. RESULTS Participants receiving continuous T-CPR delivered significantly more chest compressions (median 1000 vs. 870 compressions, p=0.014) and compressed more frequently to a compression rate between 90 and 120 min(-1) (median 87% vs. 60% of compressions, p<0.001), compared to those receiving standard T-CPR. This also resulted in less time without compressions after CPR had started (median 12s vs. 64 s, p<0.001), but longer time interval from initiating contact with dispatcher to first chest compression (median 144 s vs. 84 s, p<0.001). There was no difference in chest compression depth (mean 47 mm vs. 48 mm, p = 0.90) or in demography, education and previous CPR training between the groups. CONCLUSION In our simulated scenario with CPR trained lay rescuers, experimental continuous T-CPR gave better chest compression rate and less hands-off time during CPR, but resulted in delayed time to first chest compression compared to standard T-CPR instructions.
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Hopper K, Epstein SE, Fletcher DJ, Boller M. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 3: Basic life support. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S26-43. [DOI: 10.1111/j.1476-4431.2012.00753.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kate Hopper
- School of Veterinary Medicine; Department of Veterinary Surgical and Radiological Sciences; University of California at Davis; Davis; CA
| | - Steven E. Epstein
- School of Veterinary Medicine; Department of Veterinary Surgical and Radiological Sciences; University of California at Davis; Davis; CA
| | - Daniel J. Fletcher
- College of Veterinary Medicine; Department of Clinical Sciences; Cornell University; Ithaca; NY
| | - Manuel Boller
- Department of Clinical Studies; School of Veterinary Medicine; and the Department of Emergency Medicine; School of Medicine; Center for Resuscitation Science University of Pennsylvania; Philadelphia; PA
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Lerner EB, Rea TD, Bobrow BJ, Acker JE, Berg RA, Brooks SC, Cone DC, Gay M, Gent LM, Mears G, Nadkarni VM, O'Connor RE, Potts J, Sayre MR, Swor RA, Travers AH. Emergency medical service dispatch cardiopulmonary resuscitation prearrival instructions to improve survival from out-of-hospital cardiac arrest: a scientific statement from the American Heart Association. Circulation 2012; 125:648-55. [PMID: 22230482 DOI: 10.1161/cir.0b013e31823ee5fc] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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The consequences of noncompliance with guidelines for withholding or terminating resuscitation in traumatic cardiac arrest patients. ACTA ACUST UNITED AC 2011; 71:997-1002. [PMID: 21986740 DOI: 10.1097/ta.0b013e3182318269] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The validity of current guidelines regarding resuscitation of patients in traumatic cardiopulmonary arrest (TCPA) and the ability of emergency medical services (EMS) to appropriately apply them have been called into question. The purpose of this study is to demonstrate the consequences of violating the current published guidelines and whether EMS personnel were able to accurately identify patients in TCPA. METHODS We conducted a retrospective review of our Level I trauma center's database that identified 294 patients over an 8-year period (January 1, 2003, to December 31, 2010) who suffered prehospital TCPA and met criteria for the withholding or termination of resuscitation based on current guidelines. Patient demographics, prehospital/emergency department physiology, survival, neurologic outcome, and hospital charges were analyzed. RESULTS One of 294 patients (0.3%) survived to reach hospital discharge with a Glasgow Coma Scale score of 6. The total costs incurred for these 294 patients meeting criteria for withholding or termination of resuscitation were $3,852,446.65. One hundred seventeen (39.8%) patients were evaluated by more than one EMS team. There was 100% agreement on the presence (15 of 15) or absence (102 of 102) of a pulse between the EMS teams. CONCLUSIONS Our data support the current guidelines regarding the withholding or termination of resuscitation of patients in prehospital TCPA and represent the largest series to date on this topic. EMS personnel were able to accurately determine traumatic cardiac arrest in the field in this series. Violation of the current guidelines resulted in six patients being resuscitated to a neurologically devastated state. No loss of neurologically intact survivors would have resulted had strict adherence to the guidelines been maintained.
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