Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies

Berdowski, Jocelyn; Berg, Robert A.; Tijssen, Jan G.P.; Koster, Rudolph W.

doi:10.1016/j.resuscitation.2010.08.006

Cited by 1,703 publications

(1,197 citation statements)

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“…3,4 The chance of survival following OHCA depends on the "chain of survival" 5 concept as well as the steps taken in the first few minutes following the event. With better implementation of the links of this chain, cardiac arrest survival can be improved.…”

Section: Introductionmentioning

confidence: 99%

Real-time visual feedback during training improves laypersons’ CPR quality: a randomized controlled manikin study

Baldi

Cornara

Epis

et al. 2017

CJEM

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Objective: The chances of surviving an out-of-hospital cardiac arrest depend on early and high-quality cardiopulmonary resuscitation (CPR). Our aim is to verify whether the use of feedback devices during laypersons' CPR training improves chest compression quality. Methods: Laypersons totalling 450 participating in Basic Life Support and Automated External Defibrillation (BLS/ AED) courses were randomly divided into three groups: group No Feedback (NF) attended a course without any feedback, group Short Feedback (SF) a course with 1-minute training with real-time visual feedback, and group Long Feedback (LF) a course with 10-minute training with real-time visual feedback. At the end of each course, we recorded 1 minute of compression-only CPR. The primary end point was the difference in the percentage of compressions performed with correct depth. Results: There was a significant improvement in the percentage of compressions with correct depth in the groups receiving feedback compared to the other (NF v. LF, p = 0.022; NF v. SF, p = 0.005). This improvement was also present in the percentage of compressions with a complete chest recoil (71.7% in NF, 86.6% in SF, and 88.8% in LF; p < 0.001), compressions with the correct hand position (93.2% in NF, 98.2% in SF, and 99.3% in LF; p < 0.001), and in the Total CPR Score (79.4% in NF, 90.2% in SF, and 92.5% in LF; p < 0.001). There were no significant differences for all of the parameters between group SF and group LF. Conclusions: Real-time visual feedback improves laypersons' CPR quality, and we suggest its use in every BLS/AED course for laypersons because it can help achieve the goals emphasized by the International Liaison Committee on Resuscitation recommendations. RÉSUMÉObjectif: Les chances de survie à la suite d'un arrêt cardiaque survenu dans la collectivité dépend de la rapidité des manoeuvres de réanimation cardiorespiratoire (RCR) ainsi que de leur qualité. L'étude décrite ici visait à vérifier si l'utilisation de dispositifs de rétroaction durant la formation des profanes en la matière pouvait améliorer la qualité des compressions thoraciques. Méthode: Ont participé à des cours de réanimation de base et de défibrillation 450 profanes en la matière, divisés au hasard en trois groupes : le premier a suivi le cours sans rétroaction (SR) aucune; le deuxième a suivi le cours avec une brève rétroaction (BR), soit 1 minute de formation avec une rétroaction visuelle en temps réel; et le troisième a suivi le cours avec une longue rétroaction (LR), soit 10 minutes de formation avec une rétroaction visuelle en temps réel. À la fin de chacun des cours, il y a eu enregistrement des compressions seules durant 1 min. Le principal critère d'évaluation était les différences de pourcentage quant aux compressions réalisées à la bonne profondeur. Résultats: Une amélioration sensible du pourcentage des compressions réalisées à la bonne profondeur a été observée dans les groupes dans lesquels il y avait eu de la rétroaction comparativement à celui qui n'en avait pas reç...

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Section: Introductionmentioning

confidence: 99%

Real-time visual feedback during training improves laypersons’ CPR quality: a randomized controlled manikin study

Baldi

Cornara

Epis

et al. 2017

CJEM

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“…Estimates for survival to hospital discharge vary widely, both globally and regionally, with Canadian rates sitting between 4%–10%. [3] There is an ongoing discussion concerning interventions to improve survival rates. Some interventions have strong evidence such as prompt initiation of high quality CPR ( OR 1.23–5.01),[4] early defibrillation ( OR 2.56, 95% CI 1.41–4.64),[5,6] minimizing interruption in chest compressions ( OR 2.33–3.01),[7] and post resuscitation care inititatives.…”

Section: Introductionmentioning

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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“…Classification of etiology can be difficult to determine in some cases, and variable approaches to classification could produce bias, although investigations of etiology suggest that cardiac etiology accounts for the large majority of arrests in North America, and etiology is not associated with outcome 34. We acknowledge the variability in published OHCA incidence estimates; however, our case ascertainment rates were based on estimates developed through a systematic review of published literature 16, 35. Program implementation was deferred to local leadership, given the goals of large‐scale involvement and the quality‐improvement initiative, thus we cannot rigorously assess which of these programs provided the optimal delivery approach.…”

Section: Discussionmentioning

confidence: 99%

“…Trends in these variables were examined by calendar year using linear regression for continuous variables and the Mantel–Haenszel test of trend for categorical variables. We used US Census data and published estimates of North American adult EMS‐treated all‐rhythm (55 per 100 000 person‐years) and adult ventricular fibrillation (14 per 100 000 person‐years) OHCA incidence rates to calculate the extent of yearly case capture 16. Annual case‐capture rates were calculated as percentages based on the numbers of cases in the state‐based CARES registry (the numerator) divided by the expected number based on the estimated incidence in the participating states (the denominator).…”

Section: Methodsmentioning

confidence: 99%

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

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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.

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Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies

Cited by 1,703 publications

References 77 publications

Real-time visual feedback during training improves laypersons’ CPR quality: a randomized controlled manikin study

Real-time visual feedback during training improves laypersons’ CPR quality: a randomized controlled manikin study

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

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

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