Improving Survival From Sudden Cardiac Arrest

Marenco, John P.; Wang, Paul J.; Link, Mark S.; Homoud, Munther K.; Estes, N.A. Mark

doi:10.1001/jama.285.9.1193

Cited by 247 publications

(26 citation statements)

References 92 publications

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“…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

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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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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

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“…AEDs have an audiovisual prompt, which provides instructions, and have timing systems, which guide chest compression rate. These factors may improve CPR quality and benefit all patients with OHCA regardless of the initial rhythm type 4, 49. Few studies have investigated the effects of such prompt and real‐time feedback functions on the actual CPR.…”

Section: Issues Concerning Pad That Needs To Be Addressedmentioning

confidence: 99%

“…Early defibrillation of shockable rhythms can improve patient outcomes. The use of automated external defibrillators (AEDs) in pre‐hospital settings is a strategy to reduce the time interval until defibrillation 4. PAD use by bystanders or first responders can more effectively reduce this time interval and improve patient outcomes than the use of AED by emergency medical services (EMS) personnel 5, 6, 7, 8.…”

Section: Introductionmentioning

confidence: 99%

Effective deployment of public‐access automated external defibrillators to improve out‐of‐hospital cardiac arrest outcomes

Nakahara

Sakamoto

2017

J of Gen and Family Med

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Out‐of‐hospital cardiac arrest (OHCA) is a major health concern in Japan and other developed countries with aging populations. Improvements in OHCA outcomes require streamlining the chain of survival. Deployment of public‐access automated external defibrillators (PADs) and defibrillation by bystanders is one strategy that may streamline the chain by reducing the time to defibrillation in individuals with shockable rhythms. Although the effectiveness of PAD programs in increasing survival to discharge has been reported, there have been criticisms and concerns about the small population impact, cost‐effectiveness, and potential negative impact on those with nonshockable rhythms. This article reviews relevant literature regarding the effectiveness and concerns regarding PAD for OHCA.

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“…Early defibrillation improves the survival of victims of sudden cardiac arrest 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. However, it is often difficult to shorten the time from the cardiac arrest to the defibrillation utilizing the emergency medical service.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Commercially Available Automated External Defibrillators

Nishiyama

Negishi

et al. 2015

JAHA

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BackgroundAlthough automated external defibrillators (AEDs) have contributed to a better survival of out‐of‐hospital cardiac arrests, there have been reports of their malfunctioning. We investigated the diagnostic accuracy of commercially available AEDs using surface ECGs of ventricular fibrillation (VF), ventricular tachycardia (VT), and supraventricular tachycardia (SVT).Methods and ResultsECGs(VF 31, VT 48, SVT 97) were stored during electrophysiological studies and transmitted to 4 AEDs, the LifePak CR Plus (CR Plus), HeartStart FR3 (FR3), and CardioLife AED‐2150 (CL2150) and ‐9231 (CL9231), through the pad electrode cables. For VF, the CL2150 and CL9231 advised shocks in all cases, and the CR Plus and FR3 advised shocks in all but one VF case. For VTs faster than 180 bpm, the ratios for advising shocks were 79%, 36%, 89%, and 96% for the CR Plus, FR3, CL2150, and CL9231, respectively. The FR3 and CR Plus did not advise shocks for narrow QRS SVTs, whereas the CL9231 tended to treat high‐rate tachycardias faster than 180 bpm even with narrow QRS complexes. The characteristics of the shock advice for the FR3 differed from that for the CL9231 (kappa coefficient [κ]=0.479, P<0.001), and the CR Plus and CL2150 had characteristics somewhere between the 2 former AEDs (κ=0.818, P<0.001).ConclusionsCommercially available AEDs diagnosed VF almost always correctly. For VT and SVT diagnoses, a discrepancy was evident among the 4 investigated AEDs. The differences in the arrhythmia diagnosis algorithms for differentiating SVT from VT were thought to account for these differences.

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Improving Survival From Sudden Cardiac Arrest

Cited by 247 publications

References 92 publications

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

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

Effective deployment of public‐access automated external defibrillators to improve out‐of‐hospital cardiac arrest outcomes

Diagnostic Accuracy of Commercially Available Automated External Defibrillators

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