Improved outcome for prehospital cardiopulmonary collapse with resuscitation by bystanders.

Copley, Donaldp .; Mantle, John A.; Rogers, W. J.; Russell, Renee; Rackley, Charlese .

doi:10.1161/01.cir.56.6.901

Cited by 162 publications

(13 citation statements)

References 30 publications

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“…Two patients died of an unknown etiology. A multivariate model generated from all admission variables, including call-to-shock time (a consistent predictor of outcome [2, 3, 4, 5, 6, 7, 8, 9, 10]), reveals that digoxin use (HR 3.02, 95% CI 1.80–5.06, p < 0.001), hypertension (HR 2.06, 95% CI 2.123–3.45, p = 0.006), and call-to-shock time (HR 1.18, 95% CI 1.01–1.38, p = 0.038) were multivariate predictors of long-term mortality (fig. 2).…”

Section: Resultsmentioning

confidence: 99%

“…This includes rapid access to emergency medical care, cardiopulmonary resuscitation, defibrillation and advanced care interventions [3]. Several studies have shown that rapid defibrillation after an OHCA in ventricular fibrillation (VF) is the single most important determinant of survival outcome [4, 5, 6, 7, 8, 9, 10]. Due to issues impeding the chain of survival, in most locations the survival rates range from 3 to 10% [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21].…”

Section: Introductionmentioning

confidence: 99%

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Admission Predictors of In-Hospital Mortality and Subsequent Long-Term Outcome in Survivors of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest: A Population-Based Study

Bunch¹,

West²,

Packer³

et al. 2004

Cardiology

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Background: Survival following out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation (VF) is poor and dependent on a rapid emergency response system. Improvements in emergent early response have resulted in a higher percentage of patients surviving to admission. However, the admission variables that predict both short- and long-term survival in a region with high discharge survival following OHCA require further study in order to identify survivors at subsequent highest risk. Methods: All patients with OHCA arrest in Olmsted County Minnesota between 1990 and 2000 who received defibrillation of VF by emergency services were included in the population-based study. Baseline patient admission characteristics in survivor and nonsurvivor groups were compared. Survivors to hospital discharge were prospectively followed to determine long-term survival. Results: Two hundred patients suffered a VF arrest. Of these patients, 145 (73%) survived to hospital admission (7 died within the emergency department) and 79 (40%) were subsequently discharged. Sixty-six (83%) were male, with an average age of 61.9 ± 15.9 years. Univariate predictors of in-hospital mortality included call-to-shock time (6.6 vs. 5.5 min, p = 0.002), a nonwitnessed arrest (75.4 vs. 92.4%, p = 0.008), in-field use of epinephrine (27.8 vs. 93.4%, p < 0.001), age (68.1 vs. 61.9 years, p = 0.017), hypertension (36.1 vs. 14.1%, p = 0.005), ejection fraction (32.4 vs. 42.4, p = 0.012), and use of digoxin (34.9 vs. 12.7%, p = 0.002). Of all these variables, hypertension [hazard ratio (HR) 4.0, 95% CI 1.1–14.1, p = 0.03], digoxin use (HR 4.5, 95% CI 1.3–15.6, p = 0.02), and epinephrine requirement (HR 62.0, 95% CI 15.1–254.8, p < 0.001) were multivariate predictors of in-hospital mortality. Nineteen patients (24%) had died prior to the survey follow-up. Five patients experienced a cardiac death, resulting in a 5-year expected cardiac survival of 92%. Multivariate variables predictive of long-term mortality include digoxin use (HR 3.02, 95% CI 1.80–5.06, p < 0.001), hypertension (HR 2.06, 95% CI 2.12–3.45, p = 0.006), and call-to-shock time (HR 1.18, 95% CI 1.01–1.38, p = 0.038). Conclusion: A combined police/fire/EMS defibrillation program has resulted in an increase of patients surviving to hospital admission after OHCA. This study confirms the need to decrease call-to-shock times, which influence both in-hospital and long-term mortality. This study also identifies the novel demographic variables of digoxin and hypertension, which were also independent risk factors of increased in-hospital and long-term mortality. Identification of these variables may provide utility in identifying those at high-risk of subsequent mortality after resuscitation.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Admission Predictors of In-Hospital Mortality and Subsequent Long-Term Outcome in Survivors of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest: A Population-Based Study

Bunch¹,

West²,

Packer³

et al. 2004

Cardiology

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“…On the other hand, pass-not yet passed decisions based on the standard format o f the A H A or the recording strip may be unnecessarily stringent concerning C P R performance procedures. For early activation o f the emergency medical service and rapid initiation of BLS, the effect on outcome is well demonstrated [2,3,[27][28][29], while evidence for the effect on survival of variability in performance of cardiac compression or ventilation is not substantial. Lund [2] demonstrated a negative effect on survival of gross omissions in C P R technique (e.g.…”

Section: Consistency In Ranking 4 Discussionmentioning

confidence: 99%

Evaluation of cardiopulmonary resuscitation skills of general practitioners using different scoring methods

Jansen¹,

Berden

Vleuten³

et al. 1997

Resuscitation

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In this study we evaluated the practical performance of 70 general practitioners in cardiopulmonary resuscitation (CPR) before and after instruction and compared checklist-based scores to mechanical recording scores in order to investigate which scoring method is preferable.Both checklist and recording strip-based scores showed significant improvement after instruction, but only 37% were judged proficient according to the American Heart Association standards (checklist scoring), and 47% according to the recording print-based scoring system, while raters judged 97% as satisfactory by general impression. Interrater reliability was highest for the recording print (0.97) and lower for the checklist (0.79), especially for CPR performance (0.56). Comparison of checklist and recording print showed that the checklist was specific but not very sensitive in identifying poor performance for cardiac compression rate, since observers overestimated performance. The correlation for CPR performance between checklist score and recording strip score was low (0,45), indicating that candidates were ranked differently, The correlation between diagnosis and performance score was low for checklist as well as recording print (0.22), indicating that the score on diagnosis was a poor predictor for the score on performance of CPR.These results support the use of the recording manikin as compared with the use of a checklist for formative evaluation of basic life support skills. However, as proficiency in diagnosis and performance in CPR are poorly correlated, assessment of diagnosis using a checklist must be included. Therefore we strongly recommend the combination of assessment by observers using a checklist for diagnostic procedures and the recording strip of the manikin for performance of CPR, as employed in most evaluation schemes.

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“…Many reports provide data to compare the survival rates of cardiac arrest victims who receive "early" CPR (defined here as CPR initiated by citizens or bystanders) with the survival rates of those who receive "late" CPR (that CPR initiated by emergency responders) (22,25,27,38,46,52,53,64,66,89,90,95,97,(101)(102)(103)112). "Early" usually differs from "late" CPR by about four minutes.…”

Section: The Early Cpr Linkmentioning

confidence: 99%

Emergency Medical Services and Sudden Cardiac Arrest: The

Cummins

1993

Annual Review of Public Health

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Improved outcome for prehospital cardiopulmonary collapse with resuscitation by bystanders.

Cited by 162 publications

References 30 publications

Admission Predictors of In-Hospital Mortality and Subsequent Long-Term Outcome in Survivors of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest: A Population-Based Study

Admission Predictors of In-Hospital Mortality and Subsequent Long-Term Outcome in Survivors of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest: A Population-Based Study

Evaluation of cardiopulmonary resuscitation skills of general practitioners using different scoring methods

Emergency Medical Services and Sudden Cardiac Arrest: The

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