Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest

Stiell, Ian G.; Wells, George A.; Field, Brian; Spaite, Daniel W.; Nesbitt, Lisa; Maio, Valerie J. De; Nichol, Graham; Cousineau, Donna; Blackburn, Josée; Munkley, Doug; Luinstra-Toohey, Lorraine; Campeau, Tony; Dagnone, Eugene; Lyver, Marion B

doi:10.1056/nejmoa040325

Cited by 770 publications

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“…4) Because tracheal intubation and adrenaline administration have been shown to affect the outcomes of OHCAs [16,[20][21][22][23], we analysed the effect of the project on the outcomes of OHCAs managed prior to hospital arrival without tracheal intubation or adrenalin administration. As shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…2). In this term, we had a larger number of OHCAs, and the interval between the call and the arrival on the scene was significantly prolonged, presumably due to unusually heavy snowfall in this winter.The use of ACLS, including tracheal intubation and adrenaline administration, has been shown to affect the outcome of OHCAs [16,[20][21][22][23]. We compared the outcomes between the two time periods for OHCAs managed prior to hospital arrival without prehospital ACLS procedures because the incidence of ACLS was higher after the project.…”

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confidence: 99%

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The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

et al. 2012

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(CQI) project for telephone-assisted cardiopulmonary resuscitation (telephone-CPR), which included instruction on chest-compression-only CPR, education on how to recognise out-of-hospital cardiac arrests (OHCAs) with agonal breathing, emesis and convulsion, recommendations for on-line or redialling instructions, and feedback from emergency physicians. This study aimed to investigate the effect of this project on the incidence of bystander CPR and the outcomes of OHCAs.Materials and Methods: The baseline data were prospectively collected on 4995 resuscitation-attempted OHCAs, which were recognised or witnessed by citizens rather than emergency medical technicians during the period of February 2004 to March 2010. The incidence of telephone-CPR and bystander CPR, as well as the outcomes of the OHCAs, were compared before and after the project.Results: The incidence of telephone-CPR and bystander CPR significantly increased after the project (from 42% to 62% and from 41% to 56%, respectively). The incidence of failed telephone-CPR due to human factors significantly decreased from 30% to 16%. The outcomes of OHCAs significantly improved after the projects. A multiple logistic regression analysis revealed that the CQI project is one of independent factors associated with one-year (1-Y) survival with favourable neurological outcomes (odds ratio = 1.81, 95% confidence interval = 1.20-2.76).Conclusions: The CQI project for telephone-CPR increased the incidence of bystander CPR and improved the outcome of OHCAs. A CQI project appeared to be essential to augment the effects of telephone-CPR.Keywords: Telephone-CPR; Continuous quality improvement; Cardiopulmonary resuscitation; Dispatcher; Emergency medical service; Out-of-hospital cardiac arrest INTRODUCTION Currently, medical control (MC) for the emergency medical service system (EMS) is active in Japan.However, MC, including education, is mainly targeted to emergency medical technicians (EMTs) and is rarely targeted to dispatchers in Japan. Since February 2004, the Ishikawa MC Council has requested that fire departments collect the reasons why dispatchers failed to provide telephone-assisted instruction on cardiopulmonary resuscitation (telephone-CPR). Telephone-CPR has been shown to increase the incidence of bystander CPR and is expected to improve the outcomes of out-of-hospital cardiac arrests (OHCAs) [1][2][3][4][5].There are no special qualifications or authorisations required for fire department staff to be dispatchers in Japan. Some dispatchers have no experience as EMTs. An educational program for dispatchers has not been established. In some fire departments, the actual condition of the OHCA patient, discovered by EMTs during a post-arrival interview, is not relayed back to the dispatchers.In March of 2007, the Ishikawa MC Council initiated the Continuous Quality Improvement (CQI) project for telephone-CPR. The project included the following: 1) a standardized manual for instruction on chest-compression-only CPR (CC-only CPR), 2) education on how to recognise OH...

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

et al. 2012

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“…A randomized control trial where patients either received advanced cardiac life support with intravenous drugs or ACLS without intravenous drugs demonstrated no difference in survival to hospital discharge. [37] Furthermore, another study[38] showed no difference in survival to hospital discharge after institution of ACLS training (consisting of the addition of endotracheal intubation and intravenous line administration of medications).…”

Section: Discussionmentioning

confidence: 99%

Epinephrine in out-of-hospital cardiac arrest:A critical review

Reardon¹,

Magee²

2013

World Journal of Emergency Medicine

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BACKGROUND:Epinephrine is recommended in advanced cardiac life support guidelines for use in adult cardiac arrest, and has been used in cardiopulmonary resuscitation since 1896. Yet, despite its long time use and incorporation into guidelines, epinephrine suffers from a paucity of evidence regarding its influence on survival. This critical review was conducted to address the knowledge deficit regarding epinephrine in out-of-hospital cardiac arrest and its effect on return of spontaneous circulation, survival to hospital discharge, and neurological performance.METHODS:The EMBASE and MEDLINE (through the Pubmed interface) databases, and the Cochrane library were searched with the key words “epinephrine”, “cardiac arrest” and variations of these terms. Original research studies concerning epinephrine use in adult, out-of-hospital cardiac arrest were selected for further review.RESULTS:The search yielded nine eligible studies based on inclusion criteria. This includes five prospective cohort studies, one retrospective cohort study, one survival analysis, one case control study, and one RCT. The evidence clearly establishes an association between epinephrine and increased return of spontaneous circulation, the data were conflicting concerning survival to hospital discharge and neurological outcome.CONCLUSIONS:The results of this review exhibit the paucity of evidence regarding the use of epinephrine in out of hospital cardiac arrest. There is currently insufficient evidence to support or reject its administration during resuscitation. Larger sample, placebo controlled, double blind, randomized control trials need to be performed to definitively establish the effect of epinephrine on both survival to hospital discharge and the neurological outcomes of treated patients.

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“…And the weakest link in the “chain of survival” was the rarity of bystander CPR. The incidence of bystander CPR was 32% in New York,11 21% in Detroit,12 15% in Ontario, Canada,13 28% in Japan,14 25% in Singapore,15 and 25% in the US CARES Registry in 200916 and 28.6% in 2012 8. Only approximately one in four patients with witnessed OHCA was receiving bystander CPR.…”

Section: Survival Of Primary Cardiac Arrests Was Unchanged For Decadesmentioning

confidence: 99%

Cardiocerebral and cardiopulmonary resuscitation – 2017 update

Ewy

2017

Acute Medicine & Surgery

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Sudden cardiac arrest is a major public health problem in the industrialized nations of the world. Yet, in spite of recurrent updates of the guidelines for cardiopulmonary resuscitation and emergency cardiac care, many areas have suboptimal survival rates. Cardiocerebral resuscitation, a non‐guidelines approach to therapy of primary cardiac arrest based on our animal research, was instituted in Tucson (AZ, USA) in 2002 and subsequently adopted in other areas of the USA. Survival rates of patients with primary cardiac arrest and a shockable rhythm significantly improved wherever it was adopted. Cardiocerebral resuscitation has three components: the community, the pre‐hospital, and the hospital. The community component emphasizes bystander recognition and chest compression only resuscitation. Its pre‐hospital or emergency medical services component emphasizes: (i) urgent initiation of 200 uninterrupted chest compressions before and after each indicated single defibrillation shock, (ii) delayed endotracheal intubation in favor of passive delivery of oxygen by a non‐rebreather mask, (iii) early adrenaline administration. The hospital component was added later. The national and international guidelines for cardiopulmonary resuscitation and emergency medical services are still not optimal, for several reasons, including the fact that they continue to recommend the same approach for two entirely different etiologies of cardiac arrest: primary cardiac arrest, often caused by ventricular fibrillation, where the arterial blood oxygenation is little changed at the time of the arrest, and secondary cardiac arrest from severe respiratory insufficiency, where the arterial blood is severely desaturated at the time of cardiac arrest. These different etiologies need different approaches to therapy.

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Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest

Cited by 770 publications

References 31 publications

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

Epinephrine in out-of-hospital cardiac arrest:A critical review

Cardiocerebral and cardiopulmonary resuscitation – 2017 update

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