Description of Emergency Medical Services, treatment of cardiac arrest patients and cardiac arrest registries in Europe

Tjelmeland, Ingvild; Alm-Kruse, Kristin; Gräsner, Jan-Thorsten; Bein, Berthold; Bossaert, Leo; Böttiger, Bernd W.; Herlitz, Johan; Lefering, Rolf; Lilja, Gisela; Masterson, Siobhán; Perkins, Gavin D; Wnent, Jan; Akın, Şule; Alihodžić, Hajriz; Baert, Valentine; Blom, Marieke T.; Booth, Scott; Burkart, Roman; Bywater, Dave; Kamishi, Drilon; Baubin, Michael; Birkun, Alexei; Cebula, Grzegorz; Cimpoieşu, Diana; Christopher, Giordimaina; Clarens, Carlo; Correia, Vitor Hugo Gouveia; Höskuldsson, Hlynur; Ioannides, Marios; Krikščionaitienė, Asta; Leckey, Stephanie; Lippert, Freddy; Markota, Andrej; Mols, Pierre; Nagy, Enikő; Nikolao, Nikolaos; Rosell-Ortiz, Fernando; Raffay, Violetta; Salo, Ari; Semeraro, Federico; Trenkler, Stefan; Truhlář, Anatolij; Quinn, Martin

doi:10.1186/s13049-020-00798-7

Cited by 32 publications

(23 citation statements)

References 31 publications

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“…The feasibility of a CPR method (in space) is a fundamental component of the health system (crew). Although recent data show that, throughout Europe, there are important differences in Emergency Medical Service systems [18], it is well established that an early start on chest compressions (as soon as possible) is vitally important after cardiac arrest and is correlated with a higher probability of survival [10,19]. As a first approach, HS, ER, and RBH are independent of any resources (and initially superior to those methods that require the patient to be restrained).…”

Section: General Considerationsmentioning

confidence: 99%

Randomized Comparison of Two New Methods for Chest Compressions during CPR in Microgravity—A Manikin Study

Schmitz

Ahlbäck

DuCanto

et al. 2022

JCM

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Background: Although there have been no reported cardiac arrests in space to date, the risk of severe medical events occurring during long-duration spaceflights is a major concern. These critical events can endanger both the crew as well as the mission and include cardiac arrest, which would require cardiopulmonary resuscitation (CPR). Thus far, five methods to perform CPR in microgravity have been proposed. However, each method seems insufficient to some extent and not applicable at all locations in a spacecraft. The aim of the present study is to describe and gather data for two new CPR methods in microgravity. Materials and Methods: A randomized, controlled trial (RCT) compared two new methods for CPR in a free-floating underwater setting. Paramedics performed chest compressions on a manikin (Ambu Man, Ambu, Germany) using two new methods for a free-floating position in a parallel-group design. The first method (Schmitz–Hinkelbein method) is similar to conventional CPR on earth, with the patient in a supine position lying on the operator’s knees for stabilization. The second method (Cologne method) is similar to the first, but chest compressions are conducted with one elbow while the other hand stabilizes the head. The main outcome parameters included the total number of chest compressions (n) during 1 min of CPR (compression rate), the rate of correct chest compressions (%), and no-flow time (s). The study was registered on clinicaltrials.gov (NCT04354883). Results: Fifteen volunteers (age 31.0 ± 8.8 years, height 180.3 ± 7.5 cm, and weight 84.1 ± 13.2 kg) participated in this study. Compared to the Cologne method, the Schmitz–Hinkelbein method showed superiority in compression rates (100.5 ± 14.4 compressions/min), correct compression depth (65 ± 23%), and overall high rates of correct thoracic release after compression (66% high, 20% moderate, and 13% low). The Cologne method showed correct depth rates (28 ± 27%) but was associated with a lower mean compression rate (73.9 ± 25.5/min) and with lower rates of correct thoracic release (20% high, 7% moderate, and 73% low). Conclusions: Both methods are feasible without any equipment and could enable immediate CPR during cardiac arrest in microgravity, even in a single-helper scenario. The Schmitz–Hinkelbein method appears superior and could allow the delivery of high-quality CPR immediately after cardiac arrest with sufficient quality.

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Section: General Considerationsmentioning

confidence: 99%

Randomized Comparison of Two New Methods for Chest Compressions during CPR in Microgravity—A Manikin Study

Schmitz

Ahlbäck

DuCanto

et al. 2022

JCM

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“…Health insurance or the state covers healthcare in Germany. 13 Hospitals with an internal medicine department and an emergency department treat patients that survive to hospital admission. Recently a unique certification for cardiac-arrest centres was established.…”

Section: Healthcare In Germanymentioning

confidence: 99%

Importance of reporting survival as incidence: a cross-sectional comparative study on out-of-hospital cardiac arrest registry data from Germany and Norway

et al. 2022

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ObjectivesHealth registries are a unique source of information about current practice and can describe disease burden in a population. We aimed to understand similarities and differences in the German Resuscitation Registry (GRR) and the Norwegian Cardiac Arrest Registry (NorCAR) and compare incidence and survival for patients resuscitated after out-of-hospital cardiac arrest.DesignA cross-sectional comparative analysis reporting incidence and outcome on a population level.SettingWe included data from the cardiac arrest registries in Germany and Norway.ParticipantsPatients resuscitated between 1 January 2015 and 31 December 2019 were included, resulting in 29 222 cases from GRR and 16 406 cases from NorCAR. From GRR, only emergency medical services (EMS) reporting survival information for patients admitted to the hospital were included.Primary and secondary outcome measuresThis study focused on the EMS systems, the registries and the patients included in both registries. The results compare the total incidence, incidence of patients resuscitated by EMS, and the incidence of survival.ResultsWe found an incidence of 68 per 100 000 inhabitants in GRR and 63 in NorCAR. The incidence of patients treated by EMS was 67 in GRR and 53 in NorCAR. The incidence of patients arriving at a hospital was higher in GRR (24.3) than in NorCAR (15.1), but survival was similar (8 in GRR and 7.8 in NorCAR).ConclusionGRR is a voluntary registry, and in-hospital information is not reported for all cases. NorCAR has mandatory reporting from all EMS and hospitals. EMS in Germany starts treatment on more patients and bring a higher number to hospital, but we found no difference in the incidence of survival. This study has improved our knowledge of both registries and highlighted the importance of reporting survival as incidence when comparing registries.

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“…An overview of EMS set-up for OHCA response in Europe was recently published. 37 Furthermore, it is not known if a consistent definition of bystander was used across all participating countries. A recently published survey showed substantial differences in the interpretation of the term "bystander", even after the original definition had been presented to the participants.…”

Section: Limitationsmentioning

confidence: 99%

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

Wnent

Tjelmeland

Lefering³

et al. 2021

Resuscitation

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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 1.17À1.83). 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.

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Description of Emergency Medical Services, treatment of cardiac arrest patients and cardiac arrest registries in Europe

Cited by 32 publications

References 31 publications

Randomized Comparison of Two New Methods for Chest Compressions during CPR in Microgravity—A Manikin Study

Randomized Comparison of Two New Methods for Chest Compressions during CPR in Microgravity—A Manikin Study

Importance of reporting survival as incidence: a cross-sectional comparative study on out-of-hospital cardiac arrest registry data from Germany and Norway

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

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