Out-of-hospital Cardiac Arrest Cases Research Articles

Abstract 158: Exploring the Potential for Kidney Donation in Out-of-Hospital Cardiac Arrest Cases With No Chance of Survival

Introduction: The global kidney shortage can potentially be addressed through the implementation of the uncontrolled donation after circulatory death (uDCD) pathway. However, the current Termination-of-Resuscitation (TOR) rules, although effective in identifying futile resuscitation, do not consider the potential benefits of organ donation. Objective: This study aims to assess the potential pool of uDCD kidney donors among patients with resuscitation attempts by Emergency Medical Services (EMS) who meet TOR criteria. Methods: Retrospective analysis was conducted using data from the Paris Sudden Death Expertise Center (SDEC) registry spanning from 2011 to 2020. TOR criteria evaluation and identification of potential organ donors were performed using established selection criteria from previous protocols on TOR rules and uDCD. Incidence rates (per patient-years) were calculated using data from the National Institute of Statistics and Economic Studies. Results: Out of 19,976 cases of Out-of-Hospital-Cardiac Arrest (OHCA) with resuscitation attempts by EMS, 12,890 (64.5%) did not achieve sustained Return of Spontaneous Circulation (ROSC). Among patients with no successful ROSC, the annual number and incidence of patients with no chance of survival varied across different TOR rules, ranging from 626 to 1081 cases and from 8.14 to 10.04 per 100,000 patient-years. The proportion of OHCA patients meeting both TOR criteria and extended kidney criteria ranged from 67.8% to 73.6% of total cases of OHCA who did not achieve sustained ROSC. Conclusion: Our findings demonstrate that the implementation of a uDCD program, in cases where TOR rules indicate no chance of survival, has the potential to significantly increase the pool of potential organ donors.

Abstract 409: Burden of Overdose in Young Adult Cardiac Arrest Cases

Introduction: Overdose related out-of-hospital cardiac arrests (OHCA) are preventable devastating occurrences, often affecting young adults, leading to many years of productive life lost. The purpose of this study was to characterize overdose related OHCA over time and assess its excess burden in young adult cases in the state of Illinois. Methods: The Cardiac Arrest Registry to Enhance Survival (CARES) database was used. We excluded pediatric and trauma cases. Bivariate associations were assessed. Population attributable fractions (PAF) were also calculated. Results: During 2018 to 2022, a total of 23,637 non-traumatic adult OHCA cases were reported to CARES from Illinois (with a population catchment >40% in 2022). Of these, 8.2% (N=1,928) were overdose related. Overdose accounts for 9.5% of the OHCA in males, and 5.9% in females. By race and ethnicity, 9.6% of cases in Hispanics, 9.3% in Blacks and 7.3% in Whites are due to overdose. The number of overdose related OHCA peaked in 2020 (n=449); however, 2022 (n=432) contributed to the historically highest proportion of overdose related OHCA (8.5%). While the overall mean age for OHCA was 63.7 (SD=17) years with a peak at 60 years, the mean age for overdose cases was 44.7 (SD=13.5) with a peak at 50 years. While young adults (18-34-year-olds) have a lower likelihood of cardiac arrests accounting for only 6% of the total OHCA, they contribute 26% of the overdose OHCA. Young adult OHCA cases are nearly six times more likely to be overdose related (Relative Risk=5.5; 95% CI: 5.0 - 6.0) as compared to older cases. In terms of population impact, 21% of the overdose related OHCA are attributed to young adult cases (PAF=0.212). If young adults had the same risk of overdose-related OHCA as older cases, we would expect 408 fewer overdose-related OHCA, and the rate of overdose-related OHCA would drop from 8.2% to 6.4%. Similarly, for adults <40 years of age, 31% of the overdose related cardiac arrests are attributed to these young cases (PAF=0.309), and we would expect 596 fewer cases had the risk of overdose related OHCA been same as older cases. Conclusion: Overdose related OHCAs represent a significant burden in younger patients. Prevention strategies that reduce the burden of overdose related OHCA should be a public health priority.

Abstract 346: Deep Learning Approach for Predicting Good Neurological Outcome for Out-of-Hospital Cardiac Arrest Patients

Background: Cardiac arrest continues to pose a significant public health burden, with over 350,000 cases of out-of-hospital cardiac arrests (OHCA) occurring each year in the United States, and nearly 90% of them being fatal. The objective of this work was to develop a deep learning model that can accurately predict the Cerebral Performance Category (CPC) in adult OHCA cases. Methods: Adult OHCA cases at an urban academic emergency department were enrolled between 2018-2023. We evaluated data collected post return of spontaneous circulation (ROSC) at the first hour. Six different groups of data were tested for the prediction of CPC score: (1) Post-Rosc Vitals, (2) Pre-hospital & ED data points, and (3) Hospital Admission data points. The second group of exploratory research variables include: (4) ultrasound variables, (5) biomarkers and (6) Sex steroid hormones. The figure below illustrates the prediction framework for cardiac arrest patients, post ROSC, admitted to the hospital. Results: Of the total of 109 cases that were enrolled, 45% were female and 48% were Black. More than one-third (35%) were discharged alive but only 20% had a CPC of 1-2. While the base model with clinical and demographic variables had an AUC of 0.54, addition of subsequent variables improved the AUC substantially. The AUC improved to 0.59, 0.67 and 0.78 when hormones, ultrasound and biomarker variables were added, respectively, to the base model. However, the optimal model included all variables, resulting in a noteworthy AUC score of 0.861. Conclusion: Our findings emphasize the significance of incorporating novel variables to comprehensively evaluate the outcomes of cardiac arrest patients so that better prediction models can be developed, potentially aiding in modifying procedures and any necessary measures to shift the outcome in favor of preserving patients' lives after OHCA.

Evaluation of Telephone Cardiopulmonary Resuscitation Performance in Current Practice in Saudi Arabia.

Out-of-hospital cardiac arrest (OHCA) is a global health problem with a low survival rate. Telephone cardiopulmonary resuscitation (T-CPR) guidance by emergency medical services (EMS) dispatchers can improve CPR performance and, consequently, survival rates. Accordingly, the American Heart Association (AHA) has released performance standards for T-CPR in current practice to improve its quality. However, no study has examined T-CPR performance in Saudi Arabia. Therefore, this study aims to evaluate T-CPR performance in the Saudi Arabian EMS system. A retrospective observation of OHCA calls in current practice was conducted in Riyadh, Saudi Arabia. OHCA calls were reviewed to identify those that met the selection criteria. Variables collected included return of spontaneous circulation (ROSC), OHCA recognition rate, time from EMS call receipt to location acquisition, to OHCA recognition and to commencement of CPR. A total of 308 OHCA cases were reviewed, and 100 calls were included. ROSC was identified in 10% of the included calls. OHCA was correctly recognized in 62% of the calls. The time to OHCA identification and CPR performance from EMS call receipt were found to be 303 s and 367 s, respectively. T-CPR performance in Saudi Arabia is below AHA standards. However, this is similar to what has been reported in the literature. Avoiding any unnecessary call transfer during OHCA calls and prompt identification of callers' locations could improve T-CPR performance.

Predictors, Prevalence, and Clinical Outcomes of Out-of-Hospital Cardiac Arrests in Croatia: A Nationwide Study.

Out-of-hospital cardiac arrest (OHCA) remains a pivotal health challenge globally. In Croatia, there has been a knowledge gap regarding the prevalence, predictors, and outcomes of OHCA patients. This study aims to determine the prevalence, prediction, and outcomes of OHCA patients in Croatia. An extensive one-year analysis was performed on all OHCA treated by the Emergency Medical Service in Croatia, based on the Utstein recommendations. Data were extracted from Croatian Institute of Emergency Medicine databases, focusing on adult individuals who experienced sudden cardiac arrest in out-of-hospital settings in Croatia. From 7773 OHCA cases, 9.5% achieved spontaneous circulation pre-hospital. Optimal outcomes corresponded to EMS intervention within ≤13 min post-arrest onset AUC = 0.577 (95% CI: 0.56-0.59; p < 0.001) and female gender OR = 1.81 (95% CI: 1.49-2.19; p < 0.001). Northern Croatia witnessed lower success rates relative to the capital city Zagreb OR = 0.68 (95% CI: 0.50-0.93; p = 0.015). Early intervention by EMS, specifically within a 13-min period following the onset of a cardiac arrest, significantly enhances the probability of achieving successful OHCA outcomes. Gender differences and specific initial heart rhythms further influenced the likelihood of successful outcomes. Regional disparities, with reduced success rates in northern Croatia compared to the City of Zagreb, were evident.

Survey of resuscitation practices at emergency medical service agencies in the U.S

BackgroundSurvival for out-of-hospital cardiac arrest (OHCA) varies across emergency medical service (EMS) agencies. Yet, little is known about resuscitation response and quality improvement activities at EMS agencies. We describe herein a novel survey to EMS agencies in a U.S. registry for OHCA. MethodsUsing data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 577 EMS agencies with ≥10 OHCA cases annually between 2015 and 2019 that remained active in CARES. We administered a survey to EMS directors regarding agency characteristics, cardiac arrest response, relationships with first responders and dispatchers, quality improvement activities and perceived barriers in the community. ResultsOf eligible EMS agencies, 470 (81.5%) completed the survey. The high completion rate was likely due to frequent personalized emails and phone calls, liaising with CARES state coordinators to encourage survey response, and multiple periodic drawings of an automated external defibrillator during the survey period for participating EMS agencies. The survey examined rates of resuscitation training modalities; use of resuscitation equipment and devices in the field; frequency of simulation; non-EMS stakeholder response to OHCA (dispatchers, fire, police); quality improvement; and community factors affecting bystander response to OHCA. ConclusionsIn this study design paper on the RED-CASO survey, we provide summary data on EMS agency characteristics in the U.S. Upon linkage to CARES patient-level data, this survey will provide critical insights into ‘best practices’ at EMS agencies with the highest OHCA survival rates as well as provide insights into current disparities in outcomes.

A Motorcycle Paramedic Increases the Survival Rate of Patients after OHCA.

Background and Objectives: Despite advancements in modern medicine, the survival rate of patients after out-of-hospital cardiac arrest (OHCA) remains low. The proportion of OHCA patients who could be saved under ideal circumstances is unknown. A significant portion of patients experience cardiac arrest due to irreversible conditions. The survival of patients with reversible causes depends on the prompt initiation of basic life support (BLS) and early defibrillation. In order to increase the chances of survival, the motorcycle paramedic (MP) project was implemented in Ljubljana in 2003. The MP is equipped with an AED. In the case of OHCA with a shockable rhythm, he performs defibrillation before the arrival of the emergency medical team (EMT). The aim of this study was to evaluate whether the MP, by reducing response times to OHCA patients, increases the survival and outcome of these patients compared to the EMT. Materials and Methods: A retrospective analysis of OHCA cases within the area covered by Ljubljana Emergency Medical Service (EMS) was conducted for the period from January 2003 to December 2022. Instances where the MP arrived at the scene before the EMT were considered MP interventions and classified as the MP group; all other interventions were classified as the EMT group. Results: Between January 2003 and December 2022, the EMT performed resuscitation on 3352 patients. In 316 cases, the MP was simultaneously activated and arrived at the scene before the EMT. The response time in the MP group was shorter compared to the EMT group (7.7 ± 4.1 min vs. 9.9 ± 6.5 min, p < 0.001). In 16 patients, return of spontaneous circulation (ROSC) was achieved before the arrival of the EMT. The MP group had a higher ROSC rate, a larger proportion of patients were discharged from the hospital and there were more patients with a good neurological outcome compared to the EMT group (44.3% vs. 36.9%, p = 0.009; 18.7% vs. 13.0%, p = 0.005; 15.9% vs. 10.6%, p = 0.004, respectively). Conclusion: This study has demonstrated that the implementation of the MP into the EMS in Ljubljana has resulted in shorter response times, an increased survival rate and improved neurological outcome for OHCA patients.

Out-of-hospital cardiac arrest: assessing the problem status and identifying priority areas for improving the care provision. Data from the 2020-2022 Crimean registry

Aim. To study the regional epidemiological characteristics of out-of-hospital cardiac arrest (OHCA), the process and effectiveness of care for OHCA, and identify priority areas for improving the care provision.Material and methods. An analysis of the data from the "Crimean registry of cases of OHCA and cardiopulmonary resuscitation" was performed. The study used data from 2020 to 2022. The analytical sample consisted of all OHCA cases developed before the ambulance arrival, followed by cardiopulmonary resuscitation (CPR).Results. Of the 356 OHCA cases occurred before the ambulance arrival, followed by CPR (2020 — 141, 2021 — 103, 2022 — 112), in 65,2% of cases (n=232) cardiac arrest developed in men, in 64,0% (n=228) — in city residents, 70,2% (n=250) — in private houses or apartments. The mean age was 59 years (median 62 years). The cause of 89,6% of OHCA cases (n=319) was disease, 3,9% (n=14) — drowning, 2,8% (n=10) — trauma, 2,0% (n=7) — asphyxia, 1,1% (n=4) — toxicity, 0,6% (n=2) — electrical injury. In addition, 7,3% (n=26) of patients survived. Bystanders attempted CPR before ambulance arrived in 27,2% (n=97) of cases. In cases where CPR was performed by bystanders, ambulance specialists were 2,5 times more likely to register a potentially shockable rhythm on the primary electrocardiogram (19,6% and 7,7%, respectively; p=0,001), 2,2 times more often performed defibrillation (22,7% and 10,4%, respectively; p=0,003). When defibrillation was performed, the proportion of survivors was 3,9 times higher than without defibrillation (20,4% and 5,2%, respectively; p=0,001).Conclusion. Conducting CPR by OHCA bystanders increases the success rate of CPR performed by ambulance team. However, bystanders rarely provide first aid, which causes a high mortality rate. To reduce mortality in OHCA, the attention should be focused on the development, implementation and regulatory support of measures aimed at involving the population in providing first aid. This should include regular population training in CPR, widespread popularization of first aid, remote provision of CPR instructions by emergency dispatchers to untrained OHCA bystanders and ensuring the availability of automated external defibrillators.

Investigation of mortality rates and the factors affecting survival in out-of-hospital cardiac arrest patients

Background It is known that even if spontaneous circulation returns after cardiopulmonary resuscitation(CPR) in geriatric out-of-hospital cardiac arrests(OHCA), the overall one-year survival rate of these patients is very low. In our study, we aimed to investigate the factors affecting survival in OHCA cases. Methods OHCA patients over 18 years of age were examined in two different groups as 18–64 years old and over 65 years old. Demographic data, comorbidities, cardiac arrest rhythms and minutes, and the number of days they were hospitalized in the intensive care unit were recorded. Results The mean age was 65.9 ± 15.8 years and 39.9% (n = 110) of the patients were female. The number of intensive care unit stays was significantly higher in the over-65 age group (p = 0.011). The mortality rate and one-year survival rate were significantly lower in the over-65 age group (p < 0.001). Median CPR time was 21 min (IQR:14–32) in the entire patient population. The duration of CPR was 22 min (IQR:14–35) in patients with in-hospital mortality, and 15 min (IQR:13–25) in patients discharged from the hospital. In this comparison, the difference is statistically significant (p = 0.008). Conclusion In our study, it was determined that especially over 65 years of age, coronary artery disease, and post-arrest CPR duration were determinant and predictive factors in in-hospital and long-term survival.

Hospital-administered ECPR for out-of-hospital cardiac arrest: an observational cohort study

BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) is a treatment method for refractory out-of-hospital cardiac arrest (OHCA) requiring a complex chain of care.MethodsAll cases of OHCA between 1 January 2016 and 31 December...

Neurologic outcome and location of cardiac arrest in out-of-hospital cardiac arrest patients who underwent extracorporeal cardiopulmonary resuscitation: A multicentre retrospective cohort in Japan

AimWe examined the association between the location of cardiac arrest and outcomes of patients with out-of-hospital cardiac arrest (OHCA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR). MethodsThis was a secondary analysis of SAVE-J II, a multicentre retrospective registry with 36 participating institutions across Japan, which enrolled adult patients with OHCA who underwent ECPR. The outcomes of interest were favourable neurologic outcome at discharge. We compared the outcome between OHCA cases that occurred at residential and public locations, using a multilevel logistic regression model allowing for the random effect of each hospital. ResultsAmong 1,744 enrolled OHCAs, 809 and 935 occurred at residential (house: 603; apartment: 206) and public (street: 260; workplace: 210; others: 465) locations, respectively. The proportion of favourable neurologic outcomes was lower in OHCAs at residential locations than those at public locations (88/781 (11.3%) vs.131/891 (14.7%); adjusted odds ratio, 0.72 [95% confidence interval, 0.53–0.99]). However, subgroup analyses for patients with EMS aged <65 years call to hospital arrival within 30 minutes or during daytime revealed less difference between residential and public locations. ConclusionWhen cardiac arrests occurred at residential locations, lower proportions of favourable neurologic outcomes were exhibited among patients with OHCA who underwent ECPR. However, the event’s location may not affect the prognosis among appropriate and select cases when transported within a limited timeframe.

Prehospital Administration of Norepinephrine and Epinephrine for Shock after Resuscitation from Cardiac Arrest

Introduction Shock after resuscitation from out-of-hospital cardiac arrest (OHCA) is often treated with vasopressors. We examined whether infusion of epinephrine versus norepinephrine was associated with prehospital rearrest and neurologically favorable survival among OHCA patients. Methods This retrospective study included OHCA cases in Seattle, Washington from 2014-2021 who had return of spontaneous circulation (ROSC) followed by vasopressor infusion. Our primary exposure was infusion of epinephrine or norepinephrine. Our primary outcome was prehospital rearrest. Secondary outcomes included survival and neurologically favorable outcome (Cerebral Performance Category score of 1 or 2). We used multivariable logistic regression to test associations between exposures and outcomes adjusting for key covariates. Results Of 451 OHCA patients with ROSC followed by vasopressor infusion, 253 (56%) received norepinephrine and 198 (44%) received epinephrine infusions. Those who received epinephrine were older (median 66 [interquartile ranges {IQR} 53-79] vs 63 [IQR 47-75] years), but otherwise had similar baseline characteristics. Patients who received epinephrine were twice as likely to rearrest (55% vs 25%). After adjustment, the difference in rearrest rates between epinephrine and norepinephrine persisted (OR 3.28, 95%CI 2.25-5.08), and the odds of pulses at hospital arrival were lower in the epinephrine group (OR 0.52 95%CI 0.32-0.83). After adjustment, there was no difference in neurologically favorable survival, survival to hospital admission, or survival to discharge. Conclusion Patients who received epinephrine infusions after ROSC suffered prehospital rearrest more frequently than those who received norepinephrine. Survival and neurological status at hospital discharge were similar. Future trials should examine the optimal approach to hemodynamic management for post-OHCA shock.

Rural versus urban out-of-hospital cardiac arrest response, treatment and outcomes in the North East of England from 2018 to 2019.

Out-of-hospital cardiac arrest (OHCA) is a time-sensitive medical emergency. There is international evidence to suggest that rural regions experience worse OHCA outcomes, such as reduced survival rates. The aim of this study was to quantitatively review and compare the OHCA response, treatment and pre-hospital outcomes in a single-centre ambulance service over a 1-year period in urban and rural areas. This study used retrospective OHCA audit data from the North East Ambulance Service NHS Foundation Trust, from April 2018 to April 2019, comparing OHCA response, treatment and return of spontaneous circulation (ROSC) data in relation to urban or rural classification status, using the UK government urban-rural classification tool. A total of 1295 urban cases and 319 rural cases were compared. Bystander public-access defibrillator (PAD) use was higher in rural areas in comparison to urban areas (20/319 (6.3%) vs 47/1295 (3.6%); p = 0.03). The mean ambulance response time was slower in rural areas (10:43 minutes (n = 319) (SD ± 8.2) vs 07:35 minutes (n = 1295) (SD ± 7.1); p = < 0.01). Despite this, overall ROSC rates at hospital were similar between the groups, with no statistically significant difference (rural: 87/319 (27.3%) vs urban: 409/1295 (31.6%); p = 0.14).A further sub-group analysis of initially shockable OHCA cases showed slower ambulance response times in rural areas (10:45 minutes (n = 68) (SD ± 12.3) vs 07:55 minutes (n = 245) (SD ± 5.5); p = < 0.01) and that rural cases experienced lower ROSC at hospital rates (31/68 (45.6%) vs 151/245 (61.6%); p = 0.02). This report showed differences in OHCA response and outcomes between rural and urban settings. In the shockable OHCA sub-group analysis, rural areas had slower ambulance response times and lower ROSC rates. The longer ambulance response times in the rural shockable OHCA group could be a factor in the reduced ROSC rates. Linking hospital survival data should be used in future research to explore this area further.

Observational analysiS of out-of-hospital Cardiac Arrest occurRence and temporal variability patterns in subpopulation of southern POLand from 2006 to 2018: OSCAR-POL registry.

Temporal variability of out-of-hospital cardiac arrest (OHCA) occurrence was presented in previous studies, however, the data regarding long-term observation is scarce. The aim of this study was to investigate the temporal variability of OHCA occurrence during a long-time period and analyze the circadian pattern within particular timeframes. The retrospective analysis of 5058 OHCA cases was made covering the period from January 1st, 2006 to December 31st, 2018. Circadian, weekly, monthly and seasonal variabilities were investigated. The circadian variability of OHCA occurrence was assessed within particular years, seasons of the year, and days of the week. The highest OHCA incidence was observed between 08:00 and 08:59 and the lowest between 01:00 and 01:59 (7.1% vs. 1.6%, p < 0.001). After division into 6-h intervals, a significantly lower number of OHCA cases occurred between 00:00 and 05:59 (12.3%) in comparison to the highest number observed in between 06:00 and 11:59 (12.3% vs. 33.5%, p < 0.001). The highest OHCA occurrence was observed on Monday (14.9%), however, no weekly variability was found (p = 0.557). The highest OHCA occurrence was observed in the winter and lowest in the summer (27.4% vs. 22.8%, p < 0.001). Significant circadian variability was observed for every day of the week, every season and year during the observation period (p < 0.001). Circadian, monthly and seasonal variability of OHCA occurrence was confirmed in the long-term observation with no differences between particular days of the week. Significant circadian variability was observed within days of the week, seasons of the year, and particular years.

Effect of a national awareness campaign on ambulance attendances for chest pain and out-of-hospital cardiac arrest

AimAwareness of heart attack symptoms may enhance health-seeking behaviour and prevent premature deaths from out-of-hospital cardiac arrest (OHCA). We sought to investigate the impact of a national awareness campaign on emergency medical service (EMS) attendances for chest pain and OHCA. MethodsBetween January 2005 and December 2017, we included registry data for 97,860 EMS-attended OHCA cases from 3 Australian regions and dispatch data for 1,631,217 EMS attendances for chest pain across 5 Australian regions. Regions were exposed to between 11 and 28 months of television, radio, and print media activity. Multivariable negative binomial models were used to explore the effect of campaign activity on the monthly incidence of EMS attendances for chest pain and OHCA. ResultsMonths with campaign activity were associated with an 8.8% (IRR 1.09, 95% CI: 1.07, 1.11) increase in the incidence of EMS attendances for chest pain and a 5.6% (IRR 0.94, 95% CI: 0.92, 0.97) reduction in OHCA attendances. Larger intervention effects were associated with increasing months of campaign activity, increasing monthly media spending and media exposure in 2013. In stratified analyses of OHCA cases, the largest reduction in incidence during campaign months was observed for unwitnessed arrests (IRR 0.93, 95% CI: 0.90, 0.96), initial non-shockable arrests (IRR 0.93, 95% CI: 0.90, 0.97) and arrests occurring in private residences (IRR 0.95, 95% CI: 0.91, 0.98). ConclusionA national awareness campaign targeting knowledge of heart attack symptoms was associated with an increase in EMS use for chest pain and a reduction in OHCA incidence and may serve as an effective primary prevention strategy for OHCA.

Comparison of outcomes of out-of-hospital cardiac arrest patients: Emergency calls placed from mobile phones vs. landline phones

BackgroundUntil recently, calls to the emergency medical service (EMS) from landline phones, which display the caller’s exact location at the dispatch center, had been common. Since the use of mobile phones has become widespread, many emergency calls are now made from mobile phones. Differences in outcomes of out-of-hospital cardiac arrest (OHCA) patients for whom EMS was called from mobile versus landline phones has not yet been fully elucidated. MethodsWe performed a retrospective, population-based analysis in Kobe, Japan to examine whether EMS calls from mobiles improved the prognosis of OHCA patients over EMS calls placed from landlines. The primary outcome was favorable neurological outcome, defined as Cerebral Performance Category (CPC) scores of 1 or 2 at discharge. Secondary outcomes were survival at one-month, survival at discharge, and time durations between call and EMS activities. ResultsOf 4,231 OHCA cases, 2,194 cases (706 landline cases vs. 1,488 mobile cases) were included in this study. The percentages of favorable neurological outcomes were 0.7% (5/706) in the landline group and 3.8% (56/1,488) in the mobile group. Adjusted multivariable logistic regression revealed that favorable neurological outcomes (odds ratio [OR] 3.03, 95% confidence interval [CI] 1.12–8.17, p = 0.03) were better in the mobile group, while one-month survival (OR 1.30, 95% CI 0.80–2.14, p = 0.29) was not significantly different. Bystander CPR was more frequently administered in the mobile group (landlines 61.3% vs. mobiles 68.4%, p < 0.01). Time durations between call to EMS dispatch (184.5 [IQR 157–220 s] vs. 205 [IQR 174–248 s], p < 0.01) and EMS arrival (476.5 [IQR 377–599 s] vs. 491 [IQR 407.5–611.5 s], p < 0.01) were shorter in the landline group. ConclusionsAlthough the landline caller location display system seems effective for shorter times between EMS call and EMS arrival, mobile phone use was associated with better neurological outcomes.

Left-sided valvular heart disease and survival in out-of-hospital cardiac arrest: a nationwide registry-based study

Survival in left-sided valvular heart disease (VHD; aortic stenosis [AS], aortic regurgitation [AR], mitral stenosis [MS], mitral regurgitation [MR]) in out-of-hospital cardiac arrest (OHCA) is unknown. We studied all cases of OHCA in the Swedish Registry for Cardiopulmonary Resuscitation. All degrees of VHD, diagnosed prior to OHCA, were included. Association between VHD and survival was studied using logistic regression, gradient boosting and Cox regression. We studied time to cardiac arrest, comorbidities, survival, and cerebral performance category (CPC) score. We included 55,615 patients; 1948 with AS (3,5%), 384 AR (0,7%), 17 MS (0,03%), and 704 with MR (1,3%). Patients with MS were not described due to low case number. Time from VHD diagnosis to cardiac arrest was 3.7 years in AS, 4.5 years in AR and 4.1 years in MR. ROSC occurred in 28% with AS, 33% with AR, 36% with MR and 35% without VHD. Survival at 30 days was 5.2%, 10.4%, 9.2%, 11.4% in AS, AR, MR and without VHD, respectively. There were no survivors in people with AS presenting with asystole or PEA. CPC scores did not differ in those with VHD compared with no VHD. Odds ratio (OR) for MR and AR showed no difference in survival, while AS displayed OR 0.58 (95% CI 0.46–0.72), vs no VHD. AS is associated with halved survival in OHCA, while AR and MR do not affect survival. Survivors with AS have neurological outcomes comparable to patients without VHD.

The Minnesota first-responder AED project: Aiming to increase survival in out-of-hospital cardiac arrest

There are 350,000 out-of-hospital cardiac arrest (OHCA) cases annually in the United States of America. Using automated external defibrillators (AEDs) has increased survival in cardiac arrests (CA) with an initial shockable rhythm. Thus, guidelines recommend complete geographical coverage with AEDs. To fill in the gaps in Minnesota, the Center for Resuscitation Medicine at the University of Minnesota raised an $18.8 million grant from the Helmsley Charitable Trust to supply law enforcement first responders with AEDs and, thus, increase survival rates after OHCA by reducing the time to first shock. This report elaborates on the decision-making, fundraising, and logistic strategy required to reach statewide AED coverage. MethodsThe baseline need for AEDs was analyzed using a questionnaire sent out to state law enforcement agencies, state patrols, city and county agencies, and tribal agencies in 2021. Furthermore, OHCA cases of 2021 were reviewed. The combination of this information led to an action plan to equip and train all agencies throughout the state's eight regions with AEDs. ResultsThe electronic survey was initially sent out to 358 agencies. The initial response rate was 77% (n = 276). This resulted in a total need of 8300 AEDs to be deployed over three years (2022–2025). As of 2023, over 4769 AEDs have been distributed, covering 237 sites. ConclusionBy equipping first responders with AED systems, the Center for Resuscitation Medicine aims to shorten the gap in statewide AED coverage, thus increasing the chances of survival after OHCA.

Characteristics and Treatment Outcomes of Out-of-Hospital Cardiac Arrests Occurring in Public Places: A National Population-Based Observational Study.

Sudden cardiac arrest, particularly out-of-hospital cardiac arrest (OHCA), is a global public health concern. However, limited research exists on the epidemiology of OHCAs occurring in public places, trends and impact of bystander intervention, and influence of extraordinary circumstances. This study investigated the epidemiological factors, bystander characteristics, and outcomes of OHCAs that occurred in public places in South Korea from 2016 to 2021 and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic. A retrospective analysis was conducted using an Out-of-Hospital Cardiac Arrest Surveillance database, including 33,206 cases of OHCA that occurred in public places. Cases with do-not-resuscitate orders or insufficient data were excluded. A steady increase in bystander-performed cardiopulmonary resuscitation over the years and a constant decrease in bystander automated external defibrillator (AED) use were observed. Survival-to-discharge rates for OHCAs remained relatively steady until a marginal decrease was observed during the pandemic (pandemic, 13.1%; pre-pandemic, 14.4%). Factors affecting survival included the presence of a shockable rhythm, witnessed arrest, cardiac arrest due to disease, use of bystander AED, and period relative to the COVID-19 pandemic. These findings emphasize the critical role of bystanders in outcomes of OHCAs and inform public health strategies on better management of OHCAs in public places.

Documented Use of Emergency Medical Dispatch Protocols is Associated with Improved Survival in Out of Hospital Cardiac Arrest

Objective There are over 300,000 out-of-hospital cardiac arrests (OHCA) annually in the United States (US) and despite many scientific advances in the field, the survival rate remains low. We seek to determine if return of spontaneous circulation (ROSC) is higher when use of emergency medical dispatch (EMD) protocols is documented for OHCA calls compared to when no EMD protocol use is documented. We also seek identify care-related processes that differ in calls that use EMD protocols. Methods This is a retrospective cohort study of U.S. adults with OHCA prior to emergency medical services (EMS) arrival using 2019 National EMS Information System data. The primary exposure was EMD usage during EMS call. The primary outcome was prehospital ROSC, and secondary outcomes included automated external defibrillator (AED) use before EMS arrival, bystander CPR, and end-of-event EMS survival (survival to the end of the EMS care at transport destination). Multivariable logistic regression adjusted for age, sex, race/ethnicity, primary insurance, rurality, initial rhythm, arrest etiology, and witnessed arrest. Results Of the 96,269 OHCA cases included, EMD use was documented in 73%. Overall, 26% of subjects achieved ROSC in EMS care. EMD subjects were more likely to achieve ROSC (27.2% vs. 23.5%, uOR 1.22, 95%CI 1.18 − 1.26) even after adjusting for subject and arrest characteristics (aOR 1.13, 95%CI 1.08 − 1.17). EMD subjects also had higher end-of-event survival (19.1% vs. 16.4%, aOR 1.20, 95%CI 1.15 − 1.25). AED use before EMS arrival was more common in the EMD group (28.3% vs. 26.3% %diff 2.0, 95%CI 1.4 to 2.6), as was CPR before EMS arrival (63.8% vs. 55.1%, difference 8.6%, 95%CI 7.9 to 9.3%). Conclusions In this retrospective analysis, the rate of ROSC was higher in adult OHCA patients when EMD protocol use was reported compared to when it was not reported. The group with documented EMD use also experienced higher rates of bystander AED use, bystander CPR, and end-of-event survival.