Early Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest

Funada

2018

JAHA

BackgroundThe response time of emergency medical services (EMS) is an important determinant of survival after out‐of‐hospital cardiac arrest. We sought to identify upper limits of EMS response times and bystander interventions associated with neurologically intact survival.Methods and ResultsWe analyzed the records of 553 426 patients with out‐of‐hospital cardiac arrest in a Japanese registry between 2010 and 2014. The primary study end point was 1‐month neurologically intact survival (Cerebral Performance Category scale 1 or 2). Increased EMS response time was associated with significantly decreased adjusted odds of 1‐month neurologically intact survival (adjusted odds ratio [aOR] for each 1‐minute increase, 0.89; 95% confidence interval [CI], 0.89–0.90), although this relationship was modified by bystander interventions. The bystander interventions and the ranges of EMS response times that were associated with increased adjusted 1‐month neurologically intact survival were as follows: bystander defibrillation, from ≤2 minutes (aOR, 3.10 [95% CI, 1.25–7.31]) to 13 minutes (aOR, 5.55 [95% CI, 2.66–11.2]); bystander conventional cardiopulmonary resuscitation, from 3 minutes (aOR 1.48 [95% CI, 1.02–2.12]) to 11 minutes (aOR 2.41 [95% CI, 1.61–3.56]); and bystander chest‐compression‐only cardiopulmonary resuscitation, from ≤2 minutes (aOR 1.57 [95% CI, 1.01–2.25]) to 11 minutes (aOR 1.92 [95% CI, 1.45–2.56]). However, the increase in neurologically intact survival of those receiving bystander interventions became statistically insignificant compared with no bystander interventions when the EMS response time was outside these ranges.ConclusionsThe upper limits of the EMS response times associated with improved 1‐month neurologically intact survival were 13 minutes when bystanders provided defibrillation (typically with cardiopulmonary resuscitation) and 11 minutes when bystanders provided cardiopulmonary resuscitation without defibrillation.

Section: Introductionmentioning

confidence: 99%

Relationship Between Emergency Medical Services Response Time and Bystander Intervention in Patients With Out‐of‐Hospital Cardiac Arrest

Funada

2018

JAHA

“…In the prehospital phase of care, bystander CPR and public AED application can improve OHCA survival 18, 19, 20, 21, 22. We observed bystander CPR in excess of 40% among all rhythm arrests and approaching 60% in the Utstein subgroup, results that surpass other North American and Asian reports and that compare favorably to European experiences 23, 24, 25.…”

Section: Discussionmentioning

confidence: 45%

Multistate 5‐Year Initiative to Improve Care for Out‐of‐Hospital Cardiac Arrest: Primary Results From the HeartRescue Project

Diepen

Girotra

Abella

et al. 2017

JAHA

BackgroundThe HeartRescue Project is a multistate public health initiative focused on establishing statewide out‐of‐hospital cardiac arrest (OHCA) systems of care to improve case capture and OHCA care in the community, by emergency medical services (EMS), and at hospital level.Methods and ResultsFrom 2011 to 2015 in the 5 original HeartRescue states, all adults with EMS–treated OHCA due to a presumed cardiac cause were included. In an adult population of 32.8 million, a total of 64 988 OHCAs—including 10 046 patients with a bystander‐witnessed OHCA with a shockable rhythm—were treated by 330 EMS agencies. From 2011 to 2015, the case‐capture rate for all‐rhythm OHCA increased from an estimated 39.0% (n=6762) to 89.2% (n=16 103; P<0.001 for trend). Overall survival to hospital discharge was 11.4% for all rhythms and 34.0% in the subgroup with bystander‐witnessed OHCA with a shockable rhythm. We observed modest temporal increases in bystander cardiopulmonary resuscitation (41.8–43.5%, P<0.001 for trend) and bystander automated external defibrillator application (3.2–5.6%, P<0.001 for trend) in the all‐rhythm group, although there were no temporal changes in survival. There were marked all‐rhythm survival differences across the 5 states (8.0–16.1%, P<0.001) and across participating EMS agencies (2.7–26.5%, P<0.001).ConclusionsIn the initial 5 years, the HeartRescue Project developed a population‐based OHCA registry and improved statewide case‐capture rates and some processes of care, although there were no early temporal changes in survival. The observed survival variation across states and EMS systems presents a future challenge to elucidate the characteristics of high‐performing systems with the goal of improving OHCA care and survival.

“…(2,3) Ukoliko se mere osnovne životne podrške primene od strane svedoka odmah po nastanku kolapsa pacijenata, a do dolaska hitne službe, značajno se povećava stopa preživlja-vanja. (3,4) . Na povećanje stope preživljavanja utiču-e i sama uloga dispečera ukoliko uspešno vodi telefonski KPR.…”

Section: Uvodunclassified

EURECA 2015 Subotica: One year monitoring of patients with shockable rhythm

Budimski¹,

Momirovic-Stojkovic²,

Jakšić-Horvat³

2016

J. Resusc. Balc.

Metodologija rada:Prospektivni observacioni trial Evropskog Resuscitacionog saveta. Program organizovan od strane Resuscitacionog saveta Srbije a na osnovu ovlašćenja Evropskog resuscitacionog saveta. Saradnja sa Sekcijom urgentne medicine. U studiju su uključeni svi pacijenti -i odrasli i deca, koji su zatečeni mrtvi u vanbolničkim uslovima, a kod kojih je intervenisala hitna medicinska pomoć. Podaci su prikupljani tokom jednogodiš-njeg perioda (2015 godina). Popunjavanje ankete -lekara nakon izvršene intervencije na terenu. RezultatiŠokabilan inicijalni ritam je imalo 22 pacijenta (15.5/100.000). Dvadeset osoba muškog pola (14.1/100.000) i 4 žene (2.8/100.000). Tokom primene postupaka reanimacije u dva slučaja se ritam iz nešokabilnog prevodi u šokabilan. Prosečna starost pacijenata sa šokabilnim ritmom je 65.6 godina. Proseč-no vreme od prijema poziva u dispečerskom centru do primene DC šoka je 9.8 min. Dispečer je tri puta uspeo telefonski da vodi KPR uz navođenje laika o postupcima osnovne životne podrš-ke do dolaska lekarske ekipe. Ekipa je dva puta zatekla svedoka kako radi reanimaciju uz primenu "samo kompresije", dok je u jednom slučaju laik odustao od primene KPR i taj je pacijent imao ne šokabilan inicijalni ritam. Od ukupnog broja pacijenata sa šokabilnim ritmom, ROSC je postignut kod 11 (7.8/100.000) pacijenata i oni su sa opipljivim pulsom predati Odeljenju za prijem i zbrinjavanje urgentnih stanja Opšte bolnice Subotica. Iz bolnice je otpušteno 5 (3.5/100.000) pacijenata dok se za 4 (2.8/100.000) pacijenta zna da su živi i nakon 30 dana po otpustu.