Bystander Resuscitation Research Articles

Effects of the 2020 COVID-19 pandemic on outcomes of out-of-hospital cardiac arrest and bystander resuscitation efforts: a nationwide cohort study in Japan.

Background and importance There is limited knowledge about the nationwide impact of the 2020 COVID-19 pandemic in Japan on out-of -hospital cardiac arrest (OHCA) outcomes.Objectives The aim of this study was to investigate the impact of the 2020 COVID-19 pandemic on OHCA outcomes and bystander resuscitation efforts in Japan. Design Retrospective analysis of a nationwide population-based registry of OHCA cases. Settings and participants To conduct this study, we created a comprehensive database comprising 821 665 OHCA cases by combining and reconciling the OHCA database for 835 197 OHCA cases between 2017 and 2020 with another database, including location and time records. After applying exclusion and inclusion criteria, we analysed 751 617 cases.Outcome measures and analysis The primary outcome measure for this study was survival with neurologically favourable outcome (cerebral performance category 1 or 2). We compare OHCA characteristics and outcomes between prepandemic and pandemic years, and also investigated differences in factors associated with outcomes. Results We found that survival with neurologically favourable outcome and the rates of bystander cardiopulmonary resuscitation (CPR) slightly increased in the pandemic year [2.8% vs. 2.9%; crude odds ratio (OR), 1.07; 95% confidence interval (CI), 1.03-1.10; 54.1% vs. 55.3%, 1.05 (1.04-1.06), respectively], although the incidence of public access defibrillation (PAD) slightly decreased [1.8% vs. 1.6%, 0.89 (0.86-0.93)]. Calls for hospital selection by emergency medical service (EMS) increased during the pandemic. Subgroup analysis showed that the incidence of neurologically favourable outcome increased in 2020 for OHCA cases that occurred on nonstate of emergency days, in unaffected prefectures, with noncardiac cause, nonshockable initial rhythm, and during daytime hours. Conclusions During the 2020 COVID-19 pandemic in Japan, survival with neurologically favourable outcome of OHCA patients and bystander CPR rate did not negatively change, despite the decrement in PAD incidence. However, these effects varied with the state of emergency, region, and characteristics of OHCA, suggesting an imbalance between medical demand and supply, and raising concerns about the pandemic.

Abstract 295: Availability Of Automatic Defibrillators And Volunteer Responders For Out-of-hospital Cardiac Arrest In Denmark

Introduction: Public automatic defibrillators (AEDs) and bystander resuscitation (CPR) are critical for cardiac arrest survival. We examined how availability of AEDs and volunteer responders that can be summoned with an app have developed following many national initiatives to improve survival. Methods: All OHCA (Out-of-Hospital Cardiac Arrest) registered with coordinates within the Danish Cardiac Arrest Registry (2016-2020) were included. This study assessed coverage of 1) AEDs and 2) volunteer responders at 12 noon for home and public OHCAs. Coverage was defined as ≥ 1 AED and ≥ 4 volunteer responders within 200, 500, or 1,800 meters using straight line distance from the OHCA. Results: A total of 22,330 OHCAs were included. At 12 noon, 33,180 volunteer responders (572/100,000 inhabitants) and 22,418 AEDs (387/100,000 inhabitants) were available. More OHCA were covered with AEDs compared to volunteer responders for all distances. A significant difference was found in AED coverage in public compared to home arrests for all distances (p for difference at all distances <0.05). Opposite, no difference was found in volunteer responder coverage for home compared to public arrests at 1,800 and 500 meters (p for difference >0.05). Figure 1 illustrates AED and volunteer responder coverage for home and public arrest. Conclusion: Following the implementation of a national volunteer responder program and strategic placement of AEDs in Denmark, most historical OHCAs were covered by AEDs and volunteer responders within 1,800 meters. Although we have more volunteer responders per 100,000 inhabitants compared to AEDs, we found more than half (53%) of all OHCA were covered with AEDs within 200 meters whereas only 16% of all OHCAs were covered by volunteer responders within 200 meters. These findings indicate strategic AED placement in Denmark, but further efforts regarding volunteer responder recruitment are needed to increase coverage of the historical OHCA in Denmark.

Abstract 14870: Adrenomedullin in Patients With Out-of-Hospital Cardiac Arrest

Introduction: Adrenomedullin (ADM) is a free circulating peptide that regulates endothelial barrier function and vascular tone. Here, we sought to study the relationship of adrenomedullin in combination with lactate and the risk of death in patients with out-of-hospital cardiac arrest (OHCA) of non-traumatic origin. Methods: Mid-regional pro-ADM (MR-proADM) concentrations were measured in OHCA patients after successful ROSC on admission. The outcome of interest was all-cause death. Patients were characterized by quartiles (Q) of MR-proADM and lactate concentrations. Cox models were adjusted for age, sex, shockable rhythm, bystander resuscitation, and baseline eGFR. Results: A total of 232 patients were included in the present study (28% women, 67 years, SAPS II score 80). In total, 132 patients (56.9%) died, and 24 patients had an unfavorable neurologic outcome (i.e., a CPC score of 3-4). The median MR-proADM and lactate levels were 1.4 nmol/L (IQR 0.8 to 2.8 nmol/L) and 4.8 mmol/L (IQR 2.8 to 7.4 mmol/L), respectively. MR-proADM concentrations correlated weakly with lactate levels (r=0.23, P<0.001). High (Q4) versus low (Q1-Q3) MR-proADM concentration was associated with an increased rate of death at 28 days (45.4% vs. 75.9%; P<0.001; Fig A ). After multivariable adjustment (including baseline lactate levels), higher MR-proADM levels were significantly associated with an increased risk of death (Q4 vs. Q1-Q3: adjusted HR 1.84, 95% CI 1.21 to 2.77; adjusted HR for 1 unit increase in standardized biomarker 1.55, 95% CI 1.28 to 1.86). The combination of high MR-proADM and high lactate (Q4) concentration identified patients at particularly elevated risk (adjusted HR 3.99; 95% CI 1.67-9.56; Fig B ). Conclusions: Higher MR-proADM concentration are associated with an increased risk of death in patients with OHCA of non-traumatic origin. The combination of high MR-proADM and high lactate levels identifies patients at distinctly elevated risk.

Pediatric and adult Out-of-Hospital cardiac arrest incidence within and near public schools in British Columbia: Missed opportunities for Systematic AED deployment strategies

BackgroundSystematic automated external defibrillator(AED) placement in schools may improve pediatric out-of-hospital cardiac arrest(OHCA) survival. To estimate their utility, we identified school-located pediatric and adult OHCAs to estimate the potential utilization of school-located AEDs. Further, we identified all OHCAs within an AED-retrievable distance of the school by walking, biking, and driving. MethodsWe used prospectively collected data from the British Columbia(BC) Cardiac Arrest Registry(2013–2020), and geo-plotted all OHCAs and schools(n = 824) in BC. We identified adult and pediatric(age < 18 years) OHCAs occurring in schools, as well as nearby OHCAs for which a school-based externally-placed AED could be retrieved by a bystander prior to emergency medical system(EMS) arrival. ResultsOf 16,409 OHCAs overall in the study period, 28.6 % occurred during school hours. There were 301 pediatric OHCAs. 5(1.7 %) occurred in schools, of whom 2(40 %) survived to hospital discharge. Among both children and adults, 28(0.17 %) occurred in schools(0.0042/school/year), of whom 21(75 %) received bystander resuscitation, 4(14 %) had a bystander AED applied, and 14(50 %) survived to hospital discharge. For each AED, an average of 0.29 OHCAs/year(95 % CI 0.21–0.37), 0.93 OHCAs/year(95 % CI 0.69–1.56) and 1.69 OHCAs/year(95 % CI 1.21–2.89) would be within the potential retrieval distance of a school-located AED by pedestrian, cyclist and automobile retrieval, respectively, using the median EMS response times. ConclusionWhile school-located OHCAs were uncommon, outcomes were favourable. 11.1% to 60.9% of all OHCAs occur within an AED-retrievable distance to a school, depending on retrieval method. Accessible external school-located AEDs may improve OHCA outcomes of school children and in the surrounding community.

Impact of COVID-19 on out-of-hospital cardiac arrest: A registry-based cohort-study from the German Resuscitation Registry.

The global COVID-19 pandemic effects people and the health system. Some international studies reported an increasing number of out-of-hospital cardiac arrest (OHCA). Comparable studies regarding the impact of COVID-19 on incidence and outcome of OHCA are not yet available for Germany. This epidemiological study from the German Resuscitation Registry (GRR) compared a non-pandemic period (01.03.2018-28.02.2019) and a pandemic period (01.03.2020-28.02.2021) regarding the pandemic-related impact on OHCA care. A total of 18,799 cases were included. The incidence of OHCA (non-pandemic 117.9 vs. pandemic period 128.0/100,000 inhabitants) and of OHCA with resuscitation attempted increased (66.0 vs. 69.1/100,000). OHCA occurred predominantly and more often at home (62.8% vs. 66.5%, p<0.001). The first ECG rhythm was less often shockable (22.2% vs. 20.3%, p = 0.03). Fewer cases of OHCA were observed (58.6% vs. 55.6% p = 0.02). Both the bystander resuscitation rate and the proportion of telephone guided CPR remained stable (38.6% vs. 39.8%, p = 0.23; and 22.3% vs. 22.5%, p = 0.77). EMS arrival times increased (08:39 min vs. 09:08 min, p<0.001). Fewer patients reached a return of spontaneous circulation (ROSC) (45.4% vs. 40.9%, p<0.001), were admitted to hospital (50.2% vs. 45.0%, p<0.001), and discharged alive (13.9% vs. 10.2%, p<0.001). Survival after OHCA significantly decreased while the bystander resuscitation rate remained stable. However, longer EMS arrival times and fewer cases of witnessed OHCA may have contributed to poorer survival. Any change to EMS systems in the care of OHCA should be critically evaluated as it may mean a real loss of life-regardless of the pandemic situation.

Resuscitation simulation among people who are likely to witness opioid overdose: Experiences from the SOONER Trial.

The opioid crisis is a growing public health emergency and increasing resources are being directed towards overdose education. Simulation has emerged as a novel strategy for training overdose response, yet little is known about training non-clinicians in bystander resuscitation. Understanding the perspectives of individuals who are likely to experience or witness opioid overdose is critical to ensure that emergency response is effective. The Surviving Opioid Overdose with Naloxone Education and Resuscitation (SOONER) study evaluates the effectiveness of a novel naloxone education and distribution tool among people who are non-clinicians and likely to witness opioid overdose. Participants' resuscitation skills are evaluated using a realistic overdose simulation as the primary outcome of the trial. The purpose of our study is to describe the experience of participants with the simulation process in the SOONER study. We employed a semi-structured debriefing interview and a follow up qualitative interview to understand the experience of participants with simulation. A qualitative content analysis was performed using data from 21 participants who participated in the SOONER study. Our qualitative analysis identified 5 themes and 17 subthemes which described the experience of participants within the simulation process. These themes included realism, valuing practical experience, improving self-efficacy, gaining new perspective and bidirectional learning. Our analysis found that simulation was a positive and empowering experience for participants in the SOONER trial, most of whom are marginalized in society. Our study supports the notion that expanding simulation-based education to non-clinicians may offer an acceptable and effective way of supplementing current opioid overdose education strategies. Increasing the accessibility of simulation-based education may represent a paradigm shift whereby simulation is transformed from a primarily academic practice into a patient-based community resource.

Association between Mode of Transport and Patient Outcomes in the Emergency Department following Out-of-Hospital Cardiac Arrest: A Single-Center Retrospective Study

Background Out-of-hospital cardiac arrest (OHCA) remains a health problem worldwide, carrying a high mortality rate. Comparison of emergency department (ED) return of spontaneous circulation (ROSC) after OHCA in relation to emergency medical services (EMS) and non-EMS modes of transportation to the hospital was conducted to assess the impact points of the EMS system in Thailand. Methods This retrospective observational study enrolled all OHCA patients who visited the ED of Ramathibodi Hospital, a tertiary university hospital in Bangkok, between January 1, 2008, and May 31, 2020. Patients were differentiated into EMS and non-EMS groups according to mode of transportation to the ED. Patients’ characteristics and comorbidities, witnessed arrests, bystander chest compression, initial rhythm, and resuscitation treatment were documented. ED-sustained ROSC, ED survival, 30-day survival, and 30-day survival with good cerebral performance category (CPC) scores were monitored and recorded. Multivariate logistic analyses were performed to assess factors influencing clinical outcomes. Results A total of 339 patients were enrolled, 117 (34.51%) of whom were in the EMS transport group. There were no differences between the EMS and non-EMS groups in ED-sustained ROSC (adjusted odds ratio [aOR], 0.99; 95% confidence interval [CI], 0.58–1.70; P = 0.98), or ED survival (aOR, 0.99; 95% CI, 0.57–1.71; P = 0.97). There were also no differences in 30-day survival or 30-day survival with good CPC score between the two groups. Conclusions In our cohort data of OHCA, ED-sustained ROSC and ED survival outcomes were not superior in the EMS transportation group. Evidence to show that EMS transportation affected 30-day survival and 30-day good CPC score was also lacking. Thus, public promotion of Thailand’s EMS system is advocated with a simultaneous improvement of EMS response to enhance OHCA outcomes.

Inverse Association Between Bystander Use of Audiovisual Feedback From an Automated External Defibrillator and Return of Spontaneous Circulation.

BackgroundTreatment with an automated external defibrillator (AED) improves outcome in out‐of‐hospital cardiac arrest (OHCA). Audiovisual feedback from an AED may assist bystanders achieve higher quality cardiopulmonary resuscitation. However, the association between audiovisual feedback and clinical outcomes is not well assessed in real‐life OHCA. The aim of this study was to assess the association between audiovisual feedback from an AED used in bystander resuscitation with rates of return of spontaneous circulation (ROSC) and 30‐day survival in a real‐life cohort of patients with OHCA.Methods and ResultsWe included 325 patients treated with bystander AED use before arrival of emergency medical services during 2016 to 2019 from the Capital Region of Denmark. Patients were divided into a “feedback” and a “nonfeedback” group, depending on presence of audiovisual feedback from the AED. Audiovisual feedback was defined as voice prompts with continuous feedback to ongoing resuscitation. Rates of ROSC upon hospital admission and 30‐day survival were assessed, and univariate and multivariable models were applied to decide the association to audiovisual feedback. Multivariable models were adjusted for sex, age, primary heart rhythm, and location of OHCA. A total of 155 (48%) patients had a bystander AED applied with audiovisual feedback and 170 (52%) without audiovisual feedback. A lower rate of ROSC was found in the feedback group compared with the nonfeedback group (33% [n=51] versus 45% [n=76]; P=0.03). No association was observed between AV feedback and 30‐day survival (feedback=27% [n=42] and nonfeedback=31% [n=53]; P=0.49). In the unadjusted logistic regression model, audiovisual feedback was associated with a decreased chance of ROSC (odds ratio, 0.61; 95% CI, 0.38–0.95; P=0.03), which remained significant after adjusted analysis (odds ratio, 0.53; 95% CI, 0.29–0.97; P=0.04), whereas we found no significant association between audiovisual feedback and 30‐day survival in the unadjusted and adjusted analyses.ConclusionsAudiovisual feedback from an AED used by bystanders was associated with a lower chance of ROSC at hospital admission, but we found no significant difference in 30‐day survival. Focus on early and correct bystander cardiopulmonary resuscitation and AED use remain key for OHCA survival.

Urban-Rural Differences in Cardiac Arrest Outcomes: A Retrospective Population-Based Cohort Study

BackgroundApproximately 10% of people who suffer an out-of-hospital cardiac arrest (OHCA) treated by paramedics survive to hospital discharge. Survival differs by up to 19.2% between urban centres and rural areas. Our goal was to investigate the differences in OHCA survival between urban centres and rural areas. MethodsThis was a retrospective cohort study of OHCA patients treated by Nova Scotia Emergency Medical Services (EMS) in 2017. Cases of traumatic, expected, and noncardiac OHCA were excluded. Data were collected from the Emergency Health Service electronic patient care record system and the discharge abstract database. Geographic information system analysis classified cases as being in urban centres (population > 1000 people) or rural areas, using 2016 Canadian Census boundaries. The primary outcome was survival to hospital discharge. Multivariable logistic regression covariates were age, sex, bystander resuscitation, whether the arrest was witnessed, public location, and preceding symptoms. ResultsA total of 510 OHCAs treated by Nova Scotia Emergency Medical Services were included for analysis. A total of 12% (n = 62) survived to discharge. Patients with OHCAs in urban centres were 107% more likely to survive than those with OHCAs in rural areas (adjusted odds ratio = 2.1; 95% confidence interval = 1.1 to 3.8; P = 0.028). OHCAs in urban centres had a significantly shorter mean time to defibrillation of shockable rhythm (11.2 minutes ± 6.2) vs those in rural areas (17.5 minutes ± 17.3). ConclusionsNova Scotia has an urban vs rural disparity in OHCA care that is also seen in densely populated OHCA centres. Survival is improved in urban centres. Further improvements in overall survival, especially in rural areas, may arise from community engagement in OHCA recognition and optimized healthcare delivery.

Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study

BackgroundPre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country.MethodsWe performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital.ResultsOf 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively).ConclusionIn this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.

Abstract 9382: Outcomes After Traumatic Out-of-Hospital Cardiac Arrest in Vietnam: A Multicenter Prospective Cohort Study

Introduction: Pre-hospital services are not well developed in Vietnam, especially the immature of a trauma system of care. The prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. This study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. Hypothesis: Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Methods: We performed a multicenter prospective observational study of consecutive patients (&gt;16 years) presenting with traumatic OHCA to 3 central hospitals in Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients with traumatic OHCA and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. Results: Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 26.1% (29/111) of the patients were taken by the emergency medical services (EMS), 90% (27/30) received pre-hospital advanced airway, and 54.7% (29/53) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P&gt;0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P=0.649; respectively). Conclusion: Improvements are needed in the EMS in Vietnam, such as increasing bystander first-aid and developing a trauma system of care, as well as developing a standard emergency first-aid program for both healthcare personnel and the community.

The McGill World Restart a Heart 2020 Campaign: a student-led, patient-engaged, large-scale online simulation program

Abstract Background Cardiac arrest is a leading cause of death, with the majority of cases occurring in homes or public places. Up to 55% are witnessed by family members, colleagues or friends, yet most victims don't receive cardiopulmonary resuscitation (CPR), which can triple the odds of survival. Mortality therefore remains high at over 90%. Enhancing bystander CPR skills is a crucial public health investment. Objective Engage the Canadian and global community in a thought-provoking and immersive experience to explore cardiac arrests, destigmatize bystander CPR, and enhance resuscitation knowledge and skills. Partner with patients, leverage innovative technologies, and social media, to develop a digital scalable simulation/educational exercise. Methods Interprofessional healthcare students from the Faculty coordinated a University World Restart a Heart (WRAH) 2020 Campaign as part of a global initiative. Amplified by social media influencers, the Campaign team produced a bilingual digital Campaign with succinct and high-impact videos including survivor and non-survivor family perspectives, digital live events, a patient education guide for families of cardiac arrest patients, and an open access eModule. Our Steering Committee comprised University leadership, intensive and emergency care physicians, a cardiac arrest survivor, and the communications team from the Faculty, Centre for Simulation and Interactive Learning, and University Health Centre. Results The Campaign garnered an international audience with over 74,636 impressions across social media platforms (Facebook, Instagram, and Twitter), 42,600 views of Campaign videos, and 1,500 views of hour-long webinars. Campaign ambassadors had a combined viewership of over 500,000 followers, and included astronaut physicians, Olympic athletes, adult and pediatric cardiac arrest survivors, and social media influencers. The Campaign launched an innovative bystander resuscitation eModule that delivers scalable screen-based simulation. The patient education guide, in collaboration with the University Health Centre's Patient Education Office, focuses on the chain of survival and expectations for acute management, hospitalization and recovery. Conclusion Tens of thousands of individuals reached through the University WRAH 2020 Campaign are now empowered to initiate CPR, which may help reduce the morbidity and mortality of cardiac arrests. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The McGill Fund.

How senior paramedics decide to cease resuscitation in pulseless electrical activity out of hospital cardiac arrest: a mixed methods study

BackgroundEvidenced-based guidelines on when to cease resuscitation for pulseless electrical activity are limited and support for paramedics typically defaults to the senior clinician. Senior clinicians include paramedics employed to work beyond the scope of clinical guidelines as there may be a point at which it is reasonable to cease resuscitation. To support these decisions, one ambulance service has applied a locally derived cessation of resuscitation checklist. This study aimed to describe the patient, clinical and system factors and examine senior clinician experiences when ceasing resuscitation for pulseless electrical activity.Design and methodsAn explanatory sequential mixed method study was conducted in one ambulance service in the South West of England. A consecutive sample of checklist data for adult pulseless electrical activity were retrieved from 1st December 2015 to 31st December 2018. Unexpected results which required exploration were identified and developed into semi-structured interview questions. A purposive sample of senior clinicians who ceased resuscitation and applied the checklist were interviewed. Content framework analysis was applied to the qualitative findings.ResultsSenior clinicians ceased resuscitation for 50 patients in the presence of factors known to optimise survival: Witnessed cardiac arrest (n = 37, 74%), bystander resuscitation (n = 30, 60%), defibrillation (n = 22, 44%), return of spontaneous circulation (n = 8, 16%). Significant association was found between witnessed cardiac arrest and bystander resuscitation (p = .00). Six senior clinicians were interviewed, and analysis resulted in four themes: defining resuscitation futility, the impact of ceasing resuscitation, conflicting views and clinical decision tools. In the local context, senior clinicians applied their clinical judgement to balance survivability. Multiple factors were considered as the decision to cease resuscitation was not always clear. Senior clinicians deviated from the checklist when the patient was perceived as non-survivable.ConclusionSenior clinicians applied clinical judgement to assess patients as non-survivable or when continued resuscitation was considered harmful with no patient benefit. Senior clinicians perceived pre-existing factors with duration of resuscitation and clinical factors known to optimise patient survival. Future practice could look beyond a set criteria in which to cease resuscitation, however, it would be helpful to investigate the value or threshold of factors associated with patient outcome.

The World Restart a Heart Initiative: how to save hundreds of thousands of lives worldwide

Sudden out-of-hospital cardiac arrest (OHCA) is still one of the top reasons for death in industrialized countries. Bystander resuscitation rates differ significantly across the world despite bystanders being easily able to save lives in this situation. In the 4 years since initiation of the International Liaison Committee on Resuscitation (ILCOR) World Restart a Heart (WRAH), the initiative helped educating millions of people and thus enabled them to save lives. WRAH Day has gained more and more reach, partners and impact over the years. It has the potential of saving hundreds of thousands of lives, changing legislation and inspiring research. During the last year, new strategies had to be developed because of the COVID-pandemic. The importance of educating laypeople is underlined in recent publications and international guidelines. The WRAH awareness campaign has reached 194 countries and more than 200 million people in the last years. The success of it could even be kept going in the pandemic due to social media and digital/virtual programmes. International guidelines recommend raising awareness and name ILCOR WRAH as a way to do it.

Modern Technologies and Approaches to Organization of Theoretical and Practical Basic Resuscitation Training for the Lay Public

Out-of-hospital cardiac arrest (OHCA) is a serious social and economic problem, and control over it is highly dependent from the overall performance of the system of public first aid and resuscitation training. Coverage of the population with theoretical and practical training in basic cardiopulmonary resuscitation (CPR) is significantly limited in the Russian Federation, and the quality of training is generally low. Based on the analysis of international scientific literature and current international guidelines, this review is delineating modern organizational approaches and technologies of resuscitation training that help to enhance the efficiency and increase the accessibility of CPR training for lay people. In particular, the paper discusses methods of resuscitation training utilizing distant learning technologies, technical means for CPR skills training using feedback and virtual reality technologies, target audience and retraining intervals. Guided by the results of analysis of the cumulative experience, the directions for optimization of the resuscitation training system in Russia are proposed, that offer a perspective to improve coverage of the population with basic CPR training, increase the rates of bystander resuscitation and decrease mortality from OHCA.

Towards individualised treatment of out-of-hospital cardiac arrest patients: an update on technical innovations in the prehospital chain of survival.

Out-of-hospital cardiac arrest (OHCA) is a major healthcare problem, with approximately 200 weekly cases in the Netherlands. Its critical, time-dependent nature makes it a unique medical situation, of which outcomes strongly rely on infrastructural factors and on-scene care by emergency medical services (EMS). Survival to hospital discharge is poor, although it has substantially improved, to roughly 25% over the last years. Recognised key factors, such as bystander resuscitation and automated external defibrillator use at the scene, have been markedly optimised with the introduction of technological innovations. In an era with ubiquitous smartphone use, the Dutch digital text message alert platform HartslagNu (www.hartslagnu.nl) increasingly contributes to timely care for OHCA victims. Guidelines emphasise the role of cardiac arrest recognition and early high-quality bystander resuscitation, which calls for education and improved registration at HartslagNu. As for EMS care, new technological developments with future potential are the selective use of mechanical chest compression devices and extracorporeal life support. As a future innovation, ‘smart’ defibrillators are under investigation, guiding resuscitative interventions based on ventricular fibrillation waveform characteristics. Taken together, optimisation of available prehospital technologies is crucial to further improve OHCA outcomes, with particular focus on more available trained volunteers in the first phase and additional research on advanced EMS care in the second phase.

Epidemiological characteristics and factors associated with out-of-hospital cardiac arrest attended by bystanders before ambulance arrival.

The aim of this study is to analyze the characteristics of out-of-hospital cardiac arrests based on whether patients received bystander resuscitation before ambulance arrival, and to describe the factors associated with resuscita-tion attempts by bystanders. A retrospective observational study was performed. Clinical data from cardiac arrest patients in the Basque Country (Spain) were collected over a period of five years. Epidemiological characteristics compared resuscitation started by bystanders with resuscitation carried out by ambulance caregivers. The relation between no resuscitation started by bystander and different exposure factors was explored by multiple logistic regression analysis. We analyzed 3,278 cardiac arrests. Of them, 61.9?% were not attended by bystanders and this was associated with the absence of instructions from Emergency Centre (OR: 6.25, 95%CI: 5.15-7.58, p?<?0.001), home location (OR: 2.94, 95%CI: 2.48-3.48, p?<?0.001), unwitnessed cardiac arrest (OR: 1.56, 95%CI 1.28-1.89, p?<?0.001), victims of 65 years or older (OR: 1.48, 95%CI: 1.26-1.74, p?<?0.001) and suburban locations (OR: 1.29, 95%CI: 1.04-1.62, p?=?0.023). There are differences in cardiac arrests depending on whether they have been resuscitated by bystanders. These characteristics may influence the bystander's decision to initiate resuscitation maneuvers (or not) and evolution.

Coronary angiography findings in patients with shock-resistant ventricular fibrillation cardiac arrest

IntroductionShock-resistant ventricular fibrillation (VF) poses a therapeutic challenge during out-of-hospital cardiac arrest (OHCA). For these patients, new treatment strategies are under active investigation, yet underlying trigger(s) and substrate(s) have been poorly characterised, and evidence on coronary angiography (CAG) data is often limited to studies without a control group. MethodsIn our OHCA-registry, we studied CAG-findings in OHCA-patients with VF who underwent CAG after hospital arrival. We compared baseline demographics, arrest characteristics, CAG-findings and outcomes between patients with VF that was shock-resistant (defined as >3 shocks) or not shock-resistant (≤3 shocks). ResultsBaseline demographics, arrest location, bystander resuscitation and AED-use did not differ between 105 patients with and 196 patients without shock-resistant VF. Shock-resistant VF-patients required more shocks, with higher proportions endotracheal intubation, mechanical CPR, amiodaron and epinephrine. In both groups, significant coronary artery disease (≥1 stenosis >70%) was highly prevalent (78% vs. 77%, p = 0.76). Acute coronary occlusions (ACOs) were more prevalent in shock-resistant VF-patients (41% vs. 26%, p = 0.006). Chronic total occlusions did not differ between groups (29% vs. 33%, p = 0.47). There was an association between increasing numbers of shocks and a higher likelihood of ACO. Shock-resistant VF-patients had lower proportions 24-h survival (75% vs. 93%, p < 0.001) and survival to discharge (61% vs. 78%, p = 0.002). ConclusionIn this cohort of OHCA-patients with VF and CAG after transport, acute coronary occlusions were more prevalent in patients with shock-resistant VF compared to VF that was not shock-resistant, and their clinical outcome was worse. Confirmative studies are warranted for this potentially reversible therapeutic target.

Relationship between markers of inflammation and hemodynamic stress and death in patients with out-of-hospital cardiac arrest

Biomarkers that reflect hemodynamic stress, inflammation, extracellular matrix remodeling, angiogenesis, and endothelial dysfunction may improve risk stratification and add valuable pathobiological insight in patients with out-of-hospital cardiac arrest (OHCA). In total, 120 patients with OHCA who survived at least 48 h after return of spontaneous circulation were consecutively included in the present analysis. Concentrations of 30 biomarkers were measured simultaneously using a multi-panel biomarker assay. Cox regression models were adjusted for age, sex, estimated glomerular filtration rate, lactate concentration, bystander resuscitation, initial cardiac rhythm, and type of targeted temperature management. Overall, 57 patients (47.5%) had a favorable neurological outcome (Cerebral Performance Category ≤ 2) at 30 days, while palliative care was initiated in 49 patients (40.8%), and 52 patients (43.3%) died. After correction for multiple testing with Bonferroni-Holm, 8 biomarkers (including Angiopoietin-2, Procalcitonin, Resistin, IL-4Rα, MMP-8, TNFα, Renin, and IL-1α) were significantly associated with all-cause death. After multivariable adjustment, only angiopoietin-2 (Adjusted (Adj) hazard ratio (HR) per 1-unit increase in standardized biomarker concentrations 1.52 (95% CI 1.16–1.99)) and renin (Adj HR 1.32 (95% CI 1.06–1.65) remained independently associated with an increased risk of death. The discriminatory performance indicated good performance for angiopoietin-2 (area under the curve (AUC): 0.75 (95% CI 0.66–0.75) and was significantly higher (P = 0.011) as compared with renin (AUC: 0.60, 95% CI 0.50–0.60). In conclusion, angiopoietin-2 was significantly associated with all-cause mortality in patients with OHCA who survived the first 48 h and may prove to be useful for risk stratification of these patients.

Does age still matter? An age-group comparison of self-efficacy, initial interest and performance when learning bystander resuscitation in secondary schools

Does age still matter? An age-group comparison of self-efficacy, initial interest and performance when learning bystander resuscitation in secondary schools