Strategies to Improve Cardiac Arrest Survival

Graham, Robert; McCoy, Margaret A.; Schultz, Andrea M.; Directions, Future

doi:10.17226/21723

Cited by 32 publications

(20 citation statements)

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“…In our study, the value of 10.6% of bystander-initiated CPR in all patients with OHCA of any cause is even lower compared to the average value in European countries of 58% and the maximal observed value of 82.6% [3]. Many other studies also reported higher bystander CPR rates [2,[12][13][14][15]. In the 2019 AHA statistical report, 36.5%-44.5% of non-professionals in the United States initiated CPR [11].…”

Section: Discussioncontrasting

confidence: 63%

Initial Outcomes and Survival of Out-of-Hospital Cardiac Arrest: EuReCa Serbia Multicenter Cohort Study

Nikolovski¹,

Lazić²,

Fišer³

et al. 2021

Cureus

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IntroductionAlthough the global survival rate of patients after out-of-hospital cardiac arrest (OHCA) has increased in the previous years, there still remain significant multifactorial public health challenges with many important aspects influencing the overall survival rate of these patients. The objective of this article is to analyze basic epidemiological parameters of OHCA in Serbia and to evaluate the influence of pre-hospitalization factors on the survival of OHCA patients. MethodsData on OHCA within the EuReCa Serbia Registry was collected according to the EuReCa Study protocol during the period October 1, 2014 -December 31, 2019, and included basic demographic data of the patients, data related to OHCA prior to hospital arrival, as well as data regarding subsequent hospitalization. ResultsThe study included 6,266 EuReCa events (54% males), with a median age of 73 years [interquartile range (IQR) 63-82]. Cardiac arrest was witnessed in 3,111 out of 6,266 cases (49.6%), of which 2,725 cases (87.6%) were witnessed by bystanders and 286 cases (12.4%) by the emergency medical service (EMS) team. Resuscitation measures were attempted in 2,097 of 3,111 (67.4%) witnessed OHCA cases. Bystander cardiopulmonary resuscitation (CPR) was initiated in 288 cases within the bystander-witnessed group of 2,725 cases (10.6%). An initial shockable rhythm was detected in 323 out of 3,111 witnessed cases (10.4%). Any return of spontaneous circulation (ROSC) prior to hospital arrival was observed in 441 out of 2,097 cases where CPR was initiated (21.0%). Within the group of 2,097 events where CPR was initiated, in 287 cases the patient was transported to the hospital with ROSC (13.7%). An automated external defibrillator (AED) was used by bystanders in three cases. The collapse in locations other than the place of residence [p < 0.01; odds ratio (OR) 3.928], attempt to initiate CPR by a bystander (p < 0.01; OR 2.169), and presence of initial shockable rhythm (p = 0.01; OR 2.070) were observed as significant predictors of any ROSC in OHCA patients. Out of 287 patients hospitalized with ROSC, 54 (18.8%) were discharged alive. ConclusionCollapse outside of residence place, bystander CPR initiation, and initially detected shockable rhythm are important predictors of ROSC prior to hospital arrival and overall survival. Key factors of CPR-providing performance observed in this study were witnessing OHCA, CPR initiated by a bystander, presence of initial shockable rhythm, and any ROSC prior to hospital arrival.

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Section: Discussioncontrasting

confidence: 63%

Initial Outcomes and Survival of Out-of-Hospital Cardiac Arrest: EuReCa Serbia Multicenter Cohort Study

Nikolovski¹,

Lazić²,

Fišer³

et al. 2021

Cureus

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“…Early defibrillation with an automated external defibrillator (AED) can increase survival from an out-of-hospital cardiac arrest (OHCA) to >50%, 1,2 and is associated with improved long-term survival, and lower risks of anoxic brain damage and nursing home admission. 3 Half of patients are <65 years of age, 4 which poses a substantial public health burden and a considerable economic impact. 5 In recognition of the enormous unutilized potential for improving outcomes, the American Institute of Medicine, the American Heart Association and the European Resuscitation Council have specifically called for actions to improve early defibrillation during OHCAs.…”

Section: Introductionmentioning

confidence: 99%

“…5 In recognition of the enormous unutilized potential for improving outcomes, the American Institute of Medicine, the American Heart Association and the European Resuscitation Council have specifically called for actions to improve early defibrillation during OHCAs. 4,6,7 AEDs are often untraceable or inaccessible, and thus, difficult to locate when needed. [8][9][10][11] Furthermore, AEDs are substantially more likely to be used when registered and linked to emergency medical dispatch centres.…”

Section: Introductionmentioning

confidence: 99%

Automated external defibrillator accessibility is crucial for bystander defibrillation and survival: A registry-based study

et al. 2019

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Aims: Optimization of automated external defibrillator (AED) placement and accessibility are warranted. We examined the associations between AED accessibility, at the time of an out-of-hospital cardiac arrest (OHCA), bystander defibrillation, and 30-day survival, as well as AED coverage according to AED locations. Methods:In this registry-based study we identified all OHCAs registered by mobile emergency care units in Copenhagen, Denmark (2008.Information regarding registered AEDs (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) was retrieved from the nationwide Danish AED Network. We calculated AED coverage (AEDs located 200 m route distance from an OHCA) and, according to AED accessibility, the likelihoods of bystander defibrillation and 30-day survival.Results: Of 2500 OHCAs, 22.6% (n = 566) were covered by a registered AED. At the time of OHCA, <50% of these AEDs were accessible (n = 276).OHCAs covered by an accessible AED were nearly three times more likely to receive bystander defibrillation (accessible: 13.8% vs. inaccessible: 4.8%, p < 0.001) and twice as likely to achieve 30-day survival (accessible: 28.8% vs. inaccessible: 16.4%, p < 0.001). Among bystander-witnessed OHCAs with shockable heart rhythms (accessible vs. inaccessible AEDs), bystander defibrillation rates were 39.8% vs. 20.3% (p = 0.01) and 30-day survival rates were 72.7% vs. 44.1% (p < 0.001). Most OHCAs were covered by AEDs at offices (18.6%), schools (13.3%), and sports facilities (12.9%), each with a coverage loss >50%, due to limited AED accessibility. Conclusions:The chance of a bystander defibrillation was tripled, and 30-day survival nearly doubled, when the nearest AED was accessible, compared to inaccessible, at the time of OHCA, underscoring the importance of unhindered AED accessibility.

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“…Following prior literature, MACE was defined using billing codes for ST-elevation/non-ST-elevation myocardial infarction (STEMI/NSTEMI, ICD-9-CM 410.xx, ICD-10-CM I21.xx), cardiac arrest (ICD-9-CM 427.5, ICD-10-CM I46.x, I97.121), or all-cause in-hospital death. 2,[15][16][17]…”

Section: Discussionmentioning

confidence: 99%

Improving Identification of Patients at Low Risk for Major Cardiac Events After Noncardiac Surgery Using Intraoperative Data

Navathe¹,

Lei²,

Fleisher³

et al. 2020

Journal of Hospital Medicine

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BACKGROUND/OBJECTIVE: Risk-stratification tools for cardiac complications after noncardiac surgery based on preoperative risk factors are used to inform postoperative management. However, there is limited evidence on whether risk stratification can be improved by incorporating data collected intraoperatively, particularly for low-risk patients. METHODS: We conducted a retrospective cohort study of adults who underwent noncardiac surgery between 2014 and 2018 at four hospitals in the United States. Logistic regression with elastic net selection was used to classify in-hospital major adverse cardiovascular events (MACE) using preoperative and intraoperative data (“perioperative model”). We compared model performance to standard risk stratification tools and professional society guidelines that do not use intraoperative data. RESULTS: Of 72,909 patients, 558 (0.77%) experienced MACE. Those with MACE were older and less likely to be female. The perioperative model demonstrated an area under the receiver operating characteristic curve (AUC) of 0.88 (95% CI, 0.85-0.92). This was higher than the Lee Revised Cardiac Risk Index (RCRI) AUC of 0.79 (95% CI, 0.74-0.84; P < .001 for AUC comparison). There were more MACE complications in the top decile (n = 1,465) of the perioperative model’s predicted risk compared with that of the RCRI model (n = 58 vs 43). Additionally, the perioperative model identified 2,341 of 7,597 (31%) patients as low risk who did not experience MACE but were recommended to receive postoperative biomarker testing by a risk factor–based guideline algorithm. CONCLUSIONS: Addition of intraoperative data to preoperative data improved prediction of cardiovascular complication outcomes after noncardiac surgery and could potentially help reduce unnecessary postoperative testing.

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Strategies to Improve Cardiac Arrest Survival

Cited by 32 publications

References 0 publications

Initial Outcomes and Survival of Out-of-Hospital Cardiac Arrest: EuReCa Serbia Multicenter Cohort Study

Initial Outcomes and Survival of Out-of-Hospital Cardiac Arrest: EuReCa Serbia Multicenter Cohort Study

Automated external defibrillator accessibility is crucial for bystander defibrillation and survival: A registry-based study

Improving Identification of Patients at Low Risk for Major Cardiac Events After Noncardiac Surgery Using Intraoperative Data

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