Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and Outcome

Nichol, Graham; Thomas, E. G.; Callaway, Clifton W.; Hedges, Jerris R.; Powell, Judy; Aufderheide, Tom P.; Rea, Tom; Lowe, Robert A.; Brown, Todd B.; Dreyer, John; Davis, Daniel G.; Idris, Ahamed H.; Stiell, Ian G.

doi:10.1001/jama.300.12.1423

Cited by 1,771 publications

(1,204 citation statements)

References 48 publications

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“…Using the method described by Elmer et al,26 we estimated the potential impact of addressing 3 of the identified themes that have been studied previously in out‐of‐hospital cardiac arrest (OHCA): telecommunicator CPR, improved neuroprognostication, and optimizing postarrest care (Table 3). Nationally, there are ≈167 000 emergency medical service–treated OHCAs in the United States, with a survival rate of ≈12% 1, 27. In systems in which telecommunicator CPR is optimized, all rhythm survival from OHCA is ≈37% 28.…”

Section: Discussionmentioning

confidence: 99%

Delphi Analysis of Science Gaps in the 2015 American Heart Association Cardiac Arrest Guidelines

Panchal

Cash

Crowe

et al. 2018

JAHA

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BackgroundCurrent cardiac arrest guidelines have limited high‐quality scientific evidence to support recommendations for care. The quality of scientific evidence on which guidelines are based may correlate with improved patient outcomes and meaningful survival. We sought to develop a prioritized list of knowledge gaps in resuscitation to assist researchers, policy makers, and funding agencies in their decision‐making process.Methods and ResultsA 4‐stage modified Delphi method was used with a panel of cardiac arrest experts. Experts addressed the prompt: “What are the top 3 gaps in knowledge involving cardiac arrest care that should be research priorities for National Institutes of Health/American Heart Association funding to have the greatest impact on public health?” Knowledge gaps were identified in the initial round, rated in a second round, and rank ordered in the third round, and they underwent final review and consensus (final round). The outcome was 10 knowledge gaps, with prioritization of the top 3 gaps. A total of 61 gaps, with 19 distinct themes, were identified by participants. The 10 knowledge gaps most likely to affect public health identified by the expert panel included, in order, the following: telecommunicator cardiopulmonary resuscitation, hemodynamic monitoring for goal‐directed resuscitation, reasons why bystanders fail to respond, optimization of postarrest care, out‐of‐hospital cardiac arrest identification and response, individualizing resuscitation strategies, predicting patients at risk, tools for neuroprognostication, optimal airway management, and optimizing educational strategies.ConclusionsTen priorities for cardiac arrest research were identified, but consensus was not reached on the prioritized top 3. Future research should address these gaps to potentially improve resuscitation guideline evidence quality.

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Section: Discussionmentioning

confidence: 99%

Delphi Analysis of Science Gaps in the 2015 American Heart Association Cardiac Arrest Guidelines

Panchal

Cash

Crowe

et al. 2018

JAHA

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“…Many studies, including a prospective, randomized trial, have shown that public access defibrillation (PAD) programs improve the rate of survival among patients with an OHCA. As a result of these findings, PAD programs have been introduced in many areas 8, 10, 11, 12, 17, 18…”

Section: Introductionmentioning

confidence: 99%

“…Long‐term survival can increase as much as 2 to 3 times if a bystander/first responder also uses an automated external defibrillator (AED) before emergency medical service (EMS) arrival 2, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Many studies, including a prospective, randomized trial, have shown that public access defibrillation (PAD) programs improve the rate of survival among patients with an OHCA.…”

Section: Introductionmentioning

confidence: 99%

Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America

Gianotto‐Oliveira

Gonzalez

Vianna

et al. 2015

JAHA

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BackgroundTargeted automated external defibrillator (AED) programs have improved survival rates among patients who have an out‐of‐hospital cardiac arrest (OHCA) in US airports, as well as European and Japanese railways. The Sao Paulo (Brazil) Metro subway carries 4.5 million people per day. A targeted AED program was begun in the Sao Paulo Metro with the objective to improve survival from cardiac arrest.Methods and ResultsA prospective, longitudinal, observational study of all cardiac arrests in the Sao Paulo Metro was performed from September 2006 through November 2012. This study focused on cardiac arrest by ventricular arrhythmias, and the primary endpoint was survival to hospital discharge with minimal neurological impairment. A total of 62 patients had an initial cardiac rhythm of ventricular fibrillation. Because no data on cardiac arrest treatment or outcomes existed before beginning this project, the first 16 months of the implementation was used as the initial experience and compared with the subsequent 5 years of full operation. Return of spontaneous circulation was not different between the initial 16 months and the subsequent 5 years (6 of 8 [75%] vs. 39 of 54 [72%]; P=0.88). However, survival to discharge was significantly different once the full program was instituted (0 of 8 vs. 23 of 54 [43%]; P=0.001).ConclusionsImplementation of a targeted AED program in the Sao Paulo Metro subway system saved lives. A short interval between arrest and defibrillation was key for good long‐term, neurologically intact survival. These results support strategic expansion of targeted AED programs in other large Latin American cities.

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“…Out‐of‐hospital cardiac arrests are reported as having a poor outcome 1, 2, 3, 4. Early defibrillation improves the survival of victims of sudden cardiac arrest 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16.…”

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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Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and Outcome

Cited by 1,771 publications

References 48 publications

Delphi Analysis of Science Gaps in the 2015 American Heart Association Cardiac Arrest Guidelines

Delphi Analysis of Science Gaps in the 2015 American Heart Association Cardiac Arrest Guidelines

Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America

Diagnostic Accuracy of Commercially Available Automated External Defibrillators

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