EMS agencies with high rates of field termination of resuscitation and longer scene times also have high rates of survival

Berry, Christopher; Olaf, Mark; Kupas, Douglas F.; Berger, Andrea; Knörr, A

doi:10.1016/j.resuscitation.2021.09.039

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…The mean age amongst studies that reported age was 62.9 years. Six studies reported survival to hospital discharge, 6 , 29 , 30 , 31 , 32 , 33 three studies reported survival to 30 days. 7 , 34 , 35 Favourable neurological status on discharge was reported by six studies.…”

Section: Resultsmentioning

confidence: 99%

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Expedited transport versus continued on-scene resuscitation for refractory out-of-hospital cardiac arrest: A systematic review and meta-analysis

Burns,

Hsu,

Keech

et al. 2023

Resuscitation Plus

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Section: Resultsmentioning

confidence: 99%

“… 7 , 34 , 35 Favourable neurological status on discharge was reported by six studies. 6 , 7 , 29 , 30 , 32 , 33 …”

Section: Resultsmentioning

confidence: 99%

Expedited transport versus continued on-scene resuscitation for refractory out-of-hospital cardiac arrest: A systematic review and meta-analysis

Burns,

Hsu,

Keech

et al. 2023

Resuscitation Plus

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“…Potential between-patient clustering at the EMS agency level [28] will be accounted for using generalized estimating equations with an exchangeable correlation structure meaning that we will be estimating population-averaged treatment effects. [29]…”

Section: Clusteringmentioning

confidence: 99%

Statistical Analysis Plan: The Effect of Automated External Defibrillators for Cardiac Arrests in Private Homes An Observational Study

Andersen,

Holmberg,

Granfeldt

et al. 2023

Preprint

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This document describes the statistical analysis plan for the study “The Effect of Automated External Defibrillators for Cardiac Arrests in Private Homes”. This will be an observational study using prospectively collected data from the CARES registry in the United States. We will include patients with an out-of-hospital cardiac arrest in a private home. The exposure will be application of an AED and the primary outcome will be survival to hospital discharge. Assuming that there is no causal effect of AED application in those with a non-shockable rhythm, we will use a “difference-in-difference” approach to estimate the causal effect of AED application in those with a shockable rhythm.

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“…Implementation of emergency medical services is highly variable even among well-developed and resourced systems. After out-of-hospital cardiac arrest, survival to discharge varies among North American emergency medical services systems from 0% to 29% . In comparison, survival to hospital discharge in the trial by Bernard et al exceeded 40% .…”

mentioning

confidence: 96%

Early Oxygen Supplementation After Resuscitation From Cardiac Arrest

Elmer

Guyette

2022

JAMA

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Supplemental oxygen administration was first noted to correct signs and symptoms of hypoxic respiratory failure more than a century ago. 1,2 Since that time, oxygen has become one of the most widely administered therapeutic interventions in medicine. The prevention or reversal of hypoxia can be lifesaving, but excessive oxygen supplementation and resulting hyperoxia promotes resorption atelectasis and free radical formation leading to oxidative damage to tissues, endothelial dysfunction, and other deleterious effects. 3 The optimal dose of supplemental oxygen has been explored in several randomized clinical trials. A single-center trial that included 434 patients in a general intensive care unit (ICU) population and compared oxygen titration to a partial pressure of arterial oxygen (PaO 2 ) of 70 to 100 mm Hg (arterial oxygen saturation [SpO 2 ] of 94%-98%) vs titration to a PaO 2 up to 150 mm Hg (SpO 2 of 97%-100%) found that the lower oxygenation goals reduced mortality. 4 By contrast, subsequent multicenter trials that included general ICU patients (sample sizes of 965, 400, and 2928 patients), [5][6][7] as well as patients with acute respiratory distress syndrome (n = 205) 8 or myocardial infarction (n = 6629) 9 found no benefit from lower oxygen targets.It is uncertain whether data from ICU-based trials in other patient populations generalize to the out-of-hospital and emergency department treatment of patients resuscitated from cardiac arrest. The pathophysiological sequelae of pulselessness and cardiopulmonary resuscitation may increase susceptibility to and potential harm from both hypoxia and hyperoxia in a manner that changes rapidly in the minutes after return of spontaneous circulation (ROSC). Respiratory failure is a common antecedent cause of cardiac arrest, whereas aspiration, pulmonary contusions, atelectasis, and hypotension develop in most patients who are resuscitated and contribute to ventilation-perfusion mismatch and hypoxemia. [10][11][12] Even when SpO 2 and PaO 2 values are within normal range, perivascular edema in the brain can cause tissue hypoxia that may contribute to secondary brain injury after ROSC. 13,14 Conversely, reperfusion injury is a major contributor to organ dysfunction after ROSC that is worsened by hyperoxia. 15 Postarrest hyperoxia may also reduce cerebral blood flow and cardiac output by increasing vascular resistance. 16 In this issue of JAMA, Bernard et al 17 report a multicenter clinical trial that randomized adult patients with ROSC after out-of-hospital cardiac arrest and advanced airway placement to receive rapid reduction in supplemental oxygen delivery targeting an SpO 2 of 90% to 94% or high-flow supplemental oxygen targeting an SpO 2 of 98% to 100%. Paramedics randomized eligible patients and initiated the study interven-

show abstract

EMS agencies with high rates of field termination of resuscitation and longer scene times also have high rates of survival

Cited by 7 publications

References 30 publications

Expedited transport versus continued on-scene resuscitation for refractory out-of-hospital cardiac arrest: A systematic review and meta-analysis

Expedited transport versus continued on-scene resuscitation for refractory out-of-hospital cardiac arrest: A systematic review and meta-analysis

Statistical Analysis Plan: The Effect of Automated External Defibrillators for Cardiac Arrests in Private Homes An Observational Study

Early Oxygen Supplementation After Resuscitation From Cardiac Arrest

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