Continuous Improvements in “Chain of Survival” Increased Survival After Out-of-Hospital Cardiac Arrests

Iwami, Taku; Nichol, Graham; Hiraide, Atsushi; Hayashi, Yasuyuki; Nishiuchi, Tatsuya; Kajino, Kentaro; Morita, Hiroshi; Yukioka, Hidekazu; Ikeuchi, Hisashi; Sugimoto, Hisashi; Nonogi, Hiroshi; Kawamura, Takashi

doi:10.1161/circulationaha.108.802058

Cited by 319 publications

(203 citation statements)

References 42 publications

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“…These reforms likely led to a more rapidly initiated chain of survival that would have contributed to our documented increase in the percentage of defibrillated patients (Table 2) and earlier CPR. This may have contributed to our overall improved bystander‐witnessed survival, survival to hospital admission, and overall survival, as documented in other studies 17, 18, 19…”

Section: Discussionsupporting

confidence: 68%

Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

May

Zhang

Foley

et al. 2018

JAHA

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BackgroundIn 2002, the out‐of‐hospital cardiac arrest (OHCA) survival rate in Detroit was the lowest in the nation. Concerted efforts sought to improve the city's chain of survival with a focus on emergency medical services (EMS). This study assesses the impact on OHCA survival rates and describe factors associated with survival.Methods and ResultsData for non‐traumatic OHCA cases in Detroit from 2014 to 2016 were extracted from CARES (Cardiac Arrest Registry to Enhance Survival). Chi‐squared tests, non‐parametric tests, and a multivariable logistic regression analysis were employed to examine the associations between overall survival and its covariates. A total of 2359 non‐traumatic OHCA cases were examined. The overall survival rate increased from 3.7% in 2014 to 5.4% in 2015, and 6.4% in 2016 (P<0.01), reflecting a 73% improvement in survival over the 3‐year period. EMS median on‐scene time decreased over the study period, while the rate at which EMS initiated cardiopulmonary resuscitation and applied an automated external defibrillator (AED) greatly increased (P<0.001). The factors significantly associated with survival were female sex (odds ratio=1.70, P<0.05), a public setting (odds ratio=2.31, P<0.01), an EMS witness (odds ratio=6.18, P<0.01), and the presence of an initial shockable rhythm (odds ratio=1.88, P<0.05).ConclusionsFrom 2014 to 2016, the overall survival rate for OHCA patients in Detroit, MI significantly improved. Our results suggest that an improved chain of survival may explain this progress. This study is an example of how OHCA data analysis and EMS improvement can improve end OHCA outcomes in a resource‐limited urban setting.

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Section: Discussionsupporting

confidence: 68%

Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

May

Zhang

Foley

et al. 2018

JAHA

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“…Detailed characteristics of the EMS system in Osaka Prefecture have been described elsewhere 15, 16. Briefly, in Osaka, there are 34 fire stations with emergency dispatch centers operating a 24‐hour EMS system.…”

Section: Methodsmentioning

confidence: 99%

Exercise‐Related Out‐of‐Hospital Cardiac Arrest Among the General Population in the Era of Public‐Access Defibrillation: A Population‐Based Observation in Japan

Kiyohara

Nishiyama

Nishiuchi

et al. 2017

JAHA

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BackgroundExercise can trigger sudden cardiac arrest. Early initiation of cardiopulmonary resuscitation and automated external defibrillator use by laypersons could maximize the survival rate following exercise‐related out‐of‐hospital cardiac arrest (OHCA).Methods and Results OHCA data between 2005 and 2012 were obtained from a prospective population‐based OHCA registry in Osaka Prefecture. Patients with OHCA of presumed cardiac origin and occurring before emergency medical service personnel arrival were included. The incidence trends of exercise‐related OHCA over the 8‐year study period were assessed. Among patients with bystander‐witnessed, exercise‐related OHCA, the trends in the initiation of bystander cardiopulmonary resuscitation, public‐access defibrillation, and outcome were evaluated. The primary outcome was 1‐month survival with favorable neurological outcome, defined as cerebral performance category 1 or 2. During the study period, 0.7% of OHCAs of cardiac origin (222/31 030) were exercise related. The incidence of exercise‐related OHCA increased from 1.8 (per million population per year) in 2005 to 4.3 in 2012. Of these, 83.8% (186/222) were witnessed by bystanders. Among the patients with bystander‐witnessed, exercise‐related OHCA, the proportion that received bystander cardiopulmonary resuscitation (50.0% in 2005 and 86.2% in 2012) and public‐access defibrillation (7.1% in 2005 and 62.1% in 2012) significantly increased during the study period. Furthermore, the rate of 1‐month survival with favorable neurological outcome among these patients significantly improved (from 28.6% in 2005 to 58.6% in 2012).ConclusionsThe incidence rate of exercise‐related OHCA was low in the study population. The increase in bystander cardiopulmonary resuscitation and public‐access defibrillation rates were associated with improved outcome among patients with bystander‐witnessed, exercise‐related OHCA.

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“…For victims of sudden cardiac arrest (CA), bystander cardiopulmonary resuscitation (CPR) is a critical intervention for survival to hospital discharge 1, 2. The frequency of bystander CPR, however, still remains low, ranging from approximately 30% to 40% 2, 3.…”

Section: Introductionmentioning

confidence: 99%

Performance review of regional emergency medical service pre‐arrival cardiopulmonary resuscitation with or without dispatcher instruction: a population‐based observational study

Fukushima

Kawai

Asai

et al. 2017

Acute Medicine & Surgery

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BackgroundTo investigate variations in emergency medical service (EMS) pre‐arrival cardiopulmonary resuscitation (CPR), including both bystander CPR without dispatch assistance and dispatch‐assisted CPR (DACPR).MethodsWe carried out an observational study by implementing EMS pre‐arrival CPR reports in three fire agencies. We included adult, non‐traumatic, and non‐EMS witnessed out‐of‐hospital cardiac arrests. This reporting system comprised the dispatch instruction process and bystander CPR quality based on evaluations by EMS crews who arrived on the scene. Bystander CPR was categorized as “ongoing CPR” if the bystander was performing CPR when the EMS reached the patient's side and “good‐quality CPR” if the CPR was performed proficiently. We compared the frequencies of ongoing and good‐quality CPR in the bystander CPR already started without dispatch assistance (CPR in progress) group and DACPR group.ResultsOf 688 out‐of‐hospital cardiac arrests, CPR was already started in 150 cases (CPR in progress group). Dispatcher CPR instruction was provided in 368 cases. Among these, callers started chest compressions in 162 cases (DACPR group). Ongoing CPR was performed in 220 cases and was more frequent in the DACPR group (128/162 [79.0%] versus 92/150 [61.3%], P < 0.001). Good‐quality CPR was more frequent in the CPR in progress group, but the difference was not statistically significant (36/92 [39.1%] versus 42/128 [29.0%], P = 0.888).ConclusionsOngoing CPR and good‐quality CPR were not frequent in EMS pre‐arrival CPR. Detailed analysis of dispatch instructions and bystander CPR can contribute to improvement in EMS pre‐arrival CPR.

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Continuous Improvements in “Chain of Survival” Increased Survival After Out-of-Hospital Cardiac Arrests

Cited by 319 publications

References 42 publications

Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

Exercise‐Related Out‐of‐Hospital Cardiac Arrest Among the General Population in the Era of Public‐Access Defibrillation: A Population‐Based Observation in Japan

Performance review of regional emergency medical service pre‐arrival cardiopulmonary resuscitation with or without dispatcher instruction: a population‐based observational study

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