Out-of-hospital Cardiac Arrest Victims Research Articles

Cardiopulmonary Resuscitation Training and Automatic External Defibrillators Deployment: Strengthening Community Response to Cardiac Arrest

The most effective strategy to save the life of a victim of out-of-hospital cardiac arrest (OHCA) is to provide aid as early as possible. To achieve this objective, widespread dissemination of knowledge on basic life support and defibrillation (BLSD) in the general population is necessary. In recent years, evidence has been emerging supporting the effectiveness of public-access defibrillation (PAD) programs; the diffusion of automatic external defibrillators (AEDs) and the knowledge of their correct use among lay rescuers are associated with a higher survival rate and better neurological outcomes among OHCA victims. This study aims to implement and monitor a BLSD training program involving an entire city in Italy. Since 2016, a PAD program has been implemented in Busca (CN), a small town in the northwest of Italy. The project was divided into three phases: (1) the diffusion of AEDs in the most-frequented places in the city; (2) BLSD training aimed at reaching the most significant possible number of citizens; (3) the training of all schoolchildren in the basics of first aid. The retention of the concepts learned was assessed via a multiple-choice questionnaire proposed months after the training events. From 2016 to 2023, 42 BLSD courses were held, which trained 1302 adults (12.8% of citizens) with a female/male ratio of 0.9 and a median age of 46 (range: 32–59 years). The participants in the courses were volunteers from associations (59%), athletes (16%), ordinary citizens (13%), school staff (10%), and municipal employees (2%). At the start of the project in 2016, the first 11 AEDs were positioned. To date, the municipal area can count on 25 always-available defibrillators to reach each area within 4 minutes. Furthermore, 1500 school pupils were trained. The retention of the learned notions was excellent. After training, 92% of adult participants and 90% of the schoolchildren reported being willing to provide help in the event of cardiac arrest. The project combined the widespread diffusion of AEDs with a significant number of citizens able to use them, effectively providing cardiopulmonary resuscitation. This project ensured that an entire community shared the goal of saving the lives of people affected by OHCA.

Public access defibrillation programs: Progetto Vita, current legal aspects and challenges for the future

Out-of-hospital cardiac arrest (OHCA) represents a significant healthcare issue that is often underestimated. OHCA predominantly affects the general population, with staggering numbers: 400 000 cases annually in Europe and 350 000 in the United States, contributing to 50% of cardiovascular-related deaths. The vast majority of OHCA cases begin with a shockable rhythm, making effective treatment possible through early defibrillation, even by non-medical personnel using automated external defibrillators (AEDs). Despite the availability of such devices, survival from OHCA remains below 10%, with no substantial improvements over the last 25 years. Public access defibrillation programs, which reduce response times with AEDs, have demonstrated a significant increase in survival chances for OHCA victims. Particularly, the "Progetto Vita" in Piacenza is an emblematic example of early defibrillation in Europe, tripling survival rates in OHCA patients treated by laypersons compared to patients treated with the traditional system. This experience contributed to the approval of Law 116, dated August 4, 2021, in Italy, aimed at promoting the distribution and use of AEDs in sports facilities, public venues, transportation, and public services. The law also emphasizes that AEDs can be used without the need for specific training, thus promoting wider usage. In this article, we will briefly examine the epidemiology of OHCA and delve into the organizational model of the "Progetto Vita", which aligns with the principles of Law 116/2021. The goal is to provide some insights into organizational aspects that could facilitate the nationwide expansion of early defibrillation programs in the near future.

The Public's Perception of Bystander CPR Legality in the UAE: A Cross-Sectional Study

Background: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of mortality worldwide. Performance of an early, effective bystander cardiopulmonary resuscitation (BCPR) increases the likelihood of survival among OHCA victims. The frequency of BCPR performance on OHCA victims and the overall survival rate has been reported to be low in the UAE. Identifying factors that influence bystanders' response is essential to develop interventional strategies that effectively reduce rates of OHCA mortality in the UAE. This study aims to assess the public's knowledge, attitudes, and practices towards BCPR. Methods: This was a cross-sectional study conducted between April and June of 2023. Data was collected from 588 adults in the UAE using non-probability convenience and snowballing sampling methods. The research tool used was a 41-items structured questionnaire, assessing knowledge of OHCA detection, CPR execution, as well as perception towards mandatory CPR training and willingness to learn and perform CPR. Data entry and analysis was performed using Google Sheets and Statistical Package for Social Sciences (SPSS) version 26. Results: Of the 588 participants enrolled, a total of 509 entries were eligible for analysis. Of eligible participants, 17.9% and 80.9% were found to be completely and partially aware of identifying a cardiac arrest, respectively. In addition, 89.6% correctly identified that chest compressions and rescue breaths are part of CPR. However, only 14.9% of the sample were aware of the legality of performing BCPR in the UAE. Fear of causing harm (45.2%) and legal consequences (44.8%) were the most common reasons why people hesitate to perform BCPR. Conclusion: This study provided an in-depth insight into the public's perception of BCPR and its legality. UAE residents are not aware enough and are willing to learn CPR. Addressing the significant lack of awareness regarding CPR legality can reduce reluctance among the public towards performing life-saving measures.

Effects of the COVID-19 Pandemic on the Frequency of Bystander Intervention in Out-of-Hospital Cardiac Arrests.

Rapid administration of cardiopulmonary resuscitation (CPR) can significantly increase patient survival following an out-of-hospital cardiac arrest (OHCA). Through this study, we aimed to determine if the onset of the coronavirus disease 2019 (COVID-19) pandemic affected the likelihood of OHCAvictims receiving bystander-initiated CPR prior to EMS arrival. We used data collected by the National Emergency Medical Services Information System (NEMSIS) for years 2019 and 2020. Data was filtered to include only cases of OHCA where the status of bystander CPR was listed. We used a chi-squareanalysis to compare frequencies of patients receiving both bystander CPR and standard EMS interventions versus patients receiving only standard EMS interventions for the years before and during the COVID-19 pandemic declaration (2019 and 2020, respectively). Of the 577,011 cases that met our inclusion criteria, 228,259 occurred in 2019 and 348,752 occurred in 2020. The frequency of OHCA cases that reported bystander-initiated CPR prior to EMS arrival significantly decreased from 2019 to 2020 (53.7% vs. 52.5%, P<.001). Bystanders are often the first to administer CPR following a cardiac arrest. It was found that the likelihood of an OHCA victim receiving bystander CPR decreased from 2019 to 2020.

Abstract 421: Automated External Defibrillator Implementation Gaps in Three Non-Urban U.S. Communities

Introduction: Automated external defibrillators (AEDs) represent a crucial component of bystander response to out-of-hospital cardiac arrest (OHCA), yet epidemiologic evidence suggests that AEDs are deployed by laypersons in less than 5% of OHCA events in the US. The reasons for low utilization remain poorly characterized, especially in rural/suburban environments. We hypothesized that in these non-urban environments, layperson AED use is mostly in commercial or public locations despite most arrests occuring in private residences. Methods: We conducted an analysis of EMS-treated atraumatic OHCA events from 3 non-urban US regions (Cumberland County, PA; Jackson, TN; Forsyth County, GA), abstracted from EMS patient care reports. Data included Utstein reporting elements, arrest location type, and response intervals as calculated by dispatch and EMS arrival times. We excluded events in skilled nursing facilities and prisons. CPR and AED delivery by laypersons was measured. Results: Between 12/8/17-12/31/21, we identified 1542 adult OHCA patients with median age 66.5 y (IQR 22.5), 37% female, 18% had initial shockable rhythms, and 75% occurred in private residences. Return of spontaneous circulation was obtained in 19% of cases. Bystander CPR was performed in 23% and AEDs were deployed by laypersons in 3%. Laypersons applied AEDs in 12% of OHCA in commercial locations, 6% of OHCA in public, and 3% of OHCA in private residences. EMS response times were 4% less than 4 min, 48% 4-9 min, and 48% &gt;9 min; prevalence of AED use was indistinguishable between time intervals of EMS response. 16% OHCA victims still had initial shockable rhythms even among the &gt;9 min EMS response cases; of these, 1% received AED use from laypersons. Conclusion: In three non-urban US regions, most arrests occurred in private residences while AED use was much more likely in public or commercial locales, suggesting an important gap in AED deployment. Even in cases with prolonged response times, many patients had shockable rhythms, suggesting an important opportunity for earlier AED deployment. Future work will test whether placement of AEDs in residential areas using trained volunteer responders in these same communities will improve OHCA response and survival outcomes.

Abstract 262: Mediating Factors Between Community Race/Ethnicity and Initial Shockable Rhythm

Background: Initial shockable rhythm is an important predictor of favorable out-of-hospital cardiac arrest (OHCA) outcomes. While patients from minoritized communities suffer from lower rates of initial shockable rhythm, the reason for this disparity is not known. Hypothesis: OHCA characteristics contribute to disparities in initial shockable rhythm. Methods: We performed a retrospective study of the 2014-2021 Texas Cardiac Arrest Registry to Enhance Survival, including adult, non-traumatic OHCAs. Linked to census tract data, we stratified OHCAs based on having a majority of a race/ethnicity: &gt;50% White, &gt;50% Black, and &gt;50% Hispanic/Latino. To evaluate if initial shockable rhythm impacts outcome disparities, we compared logistic regression models between race and OHCA outcomes: 1) unadjusted, 2) adjusted for bystander CPR (bCPR), and 3) adjusted for initial rhythm. Using structural equation modeling, we then performed a mediation analysis between race/ethnicity, OHCA characteristics, and shockable rhythm, reporting the mediations proportions. Results: We included 39,596 OHCAs, 16,702 White, 5,461 Black, and 17,433 Hispanic. The rate of shockable rhythm was 19.0% for White, 14.3% for Black, and 14.6% for Hispanic. Odds of favorable neurologic outcome were lower for Black (OR 0.5, 95% CI 0.4-0.6) and Hispanic (OR 0.6, 95% CI 0.6-0.7). While adjusting for bCPR did not change these odds, adjusting for shockable rhythm increased odds for Black (OR 0.6, 95% CI 0.5-0.7) and Hispanic (OR 0.7, 95% CI 0.6-0.8). On mediation analysis, the proportion of initial shockable rhythm mediated for Black census tract were: age&gt;65 (-7.3%), male gender (6.8%), public location (6.9%), healthcare facility location (-17.2%), bystander witnessed (19.2%), bCPR (4.3%), and bystander AED (6.4%). The proportion mediated for Hispanic census tract were: age&gt;65 (-4.8%), male gender (0.5%), public location (-4.0%), healthcare location (-13.5%), bystander witnessed (20.8%), bCPR (8.7%), and bystander AED (6.2%). Conclusion: Bystander witnessed arrest was the most significant mediator of shockable rhythm for OHCA in Black and Hispanic communities, while bCPR was a modest mediator of shockable rhythm for Hispanic OHCA victims.

Prehospital Predictors of Survival in Patients with Out-of-Hospital Cardiac Arrest.

Background and Objectives: Despite advances in the treatment of heart diseases, the outcome of patients experiencing sudden cardiac arrest remains poor. The aim of our study was to determine the prehospital variables as predictors of survival outcomes in out-of-hospital cardiac arrest (OHCA) victims. Materials and Methods: This was a retrospective observational cohort study of OHCA cases. EMS protocols created in accordance with the Utstein style reporting for OHCA, first responder intervention reports, medical dispatch center dispatch protocols and hospital medical reports were all reviewed. Multivariate logistic regression was performed with the following variables: age, gender, witnessed status, location, bystander CPR, first rhythm, and etiology. Results: A total of 381 interventions with resuscitation attempts were analyzed. In more than half (55%) of them, bystander CPR was performed. Thirty percent of all patients achieved return of spontaneous circulation (ROSC), 22% of those achieved 30-day survival (7% of all OHCA victims), and 73% of those survived with Cerebral Performance Score 1 or 2. The logistic regression model of adjustment confirms that shockable initial rhythm was a predictor of ROSC [OR: 4.5 (95% CI: 2.5-8.1)] and 30-day survival [OR: 9.3 (95% CI: 2.9-29.2)]. Age was also associated (≤67 years) [OR: 3.9 (95% CI: 1.3-11.9)] with better survival. Conclusions: Elderly patients have a lower survival rate. The occurrence of bystander CPR in cardiac arrest remains alarmingly low. Shockable initial rhythm is associated with a better survival rate and neurological outcome compared with non-shockable rhythm.

Kesediaan Siswa Sekolah sebagai Bystander Resusitasi Jantung Paru (RJP) di Kabupaten Jember

Background: Out-of-hospital cardiac arrest (OHCA) is a global health problem with a high incidence and mortality rate as well as survival rates. The willingness of the community as a bystander to perform CPR on victims of OHCA is an important factor in increasing the survival rate. Purpose: To identify the student’s willingness as bystanders Cardio Pulmonary Resuscitation (CPR) in Jember Regency. Methods: This research is a quantitative research with a cross-sectional approach in the form of analytical descriptive. The number of respondents was 245 students of class VIII SMP Negeri in Jember Regency using simple random sampling. Result: The results showed that the majority of school students were willing to do CPR as bystanders as much as 66.1%. The unavailability of school students as bystanders for Cardio Pulmonary Resuscitation (CPR) was influenced by experience and training, respectively, as much as 100% of the total 158 students who answered not willing. Conclusion: This study shows that the majority of students in SMP N Jember Regency are not willing to be CPR bystanders, so training or learning with appropriate methods is needed to increase the number of CPR bystanders who are willing to help victims of OHCA. Key words: bystander, CPR, students

Sodium-glucose cotransporter-2 inhibitors compared with glucagon-like-peptide-1 receptor agonists and out-of-hospital cardiac arrest in type 2 diabetes: a nationwide nested case-control study.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are antidiabetic drugs that have beneficial direct effects on the myocardium by impacting cardiac ion channels and exchangers that control cardiac electrophysiology. We investigated the relationship between SGLT-2is in comparison to glucagon-like peptide-1 receptor agonists (GLP-1as) and out-of-hospital cardiac arrest (OHCA) in individuals with type 2 diabetes. Using data from Danish registries, we conducted a nationwide nested case-control study in a cohort of individuals with type 2 diabetes between 2013 and 2019. Cases were defined as OHCA victims from presumed cardiac causes and each case was randomly matched with five controls without OHCA based on age, sex, and index-date (OHCA date). Conditional logistic regression models were used to estimate the adjusted odds ratios (ORs) with 95% confidence interval (95% CI) of OHCA comparing SGLT-2i use with GLP-1as (reference). The study population consisted of 3 618 OHCA cases and 18 090 matched controls. SGLT-2i was used by 91 cases and 593 controls, and was associated with reduced odds of OHCA compared with use of GLP-1a after controlling for the relevant confounders (adjusted OR 0.76 [95% CI:0.58-0.99]). The adjusted OR of OHCA associated with SGLT-2i use did not vary significantly by sex (p-value interaction: 0.461), pre-existing cardiac disease (p-value interaction: 0.762), heart failure (p-value interaction: 0.891), diabetes duration (p-value interaction: 0.101) and chronic kidney disease (p-value interaction: 0.894). Use of SGLT-2i is associated with a reduced risk of OHCA compared with use of GLP-1a in type 2 diabetes.

The interaction effect of bystander cardiopulmonary resuscitation (CPR) and dispatcher CPR on outcomes after out-of-hospital cardiac arrest

This study aimed to evaluate the effects of bystander cardiopulmonary resuscitation (CPR) and dispatcher-assisted CPR (DA-CPR) on outcomes after out-of-hospital cardiac arrest (OHCA). We conducted a prospective observational study using the Korean Cardiac Arrest Research Consortium registry database and enrolled adults aged > 20 years who sustained OHCA. The study population comprised 13,864 patients from October 1, 2015, to June 30, 2021. All enrolled patients were transported to the emergency room and resuscitated by the emergency medical personnel. Patients with terminal illnesses, pregnancy, “do not resuscitate” cards, and insufficient recorded information were excluded. Good neurologic outcomes were noted in 6.5%, 9.9%, and 9.6% of patients in the “no bystander”, “standard bystander”, and “compression-only bystander” CPR groups, respectively, and differed significantly (p < 0.001). Survival to discharge differed significantly (p < 0.001) between groups at 10.8%, 13.1%, and 13.2%, respectively. In a multivariable model, the interaction between “compression-only” and DA-CPR showed a positive effect on good neurological outcomes and survival to discharge with an odds ratio of 1.93 (Confidence interval, CI 1.28–2.91, p = 0.002) and 1.74 (CI 1.24–2.44, p = 0.001), respectively. In conclusion, the interaction between compression-only CPR and DA-CPR is significantly associated with good neurological and survival outcomes after OHCA. Education for bystanders and dispatchers should adhere to the current guidelines to improve outcomes among OHCA victims.

Smartwatch based automatic detection of out-of-hospital cardiac arrest: Study rationale and protocol of the HEART-SAFE project

Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality. Immediate detection and treatment are of paramount importance for survival and good quality of life. The first link in the ‘chain of survival’ after OHCA – the early recognition and alerting of emergency medical services – is at the same time the weakest link as it entirely depends on witnesses. About one half of OHCA cases are unwitnessed, and victims of unwitnessed OHCA have virtually no chance of survival with good neurologic outcome. Also in case of a witnessed cardiac arrest, alerting of emergency medical services is often delayed for several minutes. Therefore, a technological solution to automatically detect cardiac arrests and to instantly trigger an emergency response has the potential to save thousands of lives per year and to greatly improve neurologic recovery and quality of life in survivors.The HEART-SAFE consortium, consisting of two academic centres and three companies in the Netherlands, collaborates to develop and implement a technical solution to reliably detect OHCA based on sensor signals derived from commercially available smartwatches using artificial intelligence. In this manuscript, we describe the rationale, the envisioned solution, as well as a protocol outline of the work packages involved in the development of the technology.

Abstract 206: Easily Created Prediction Model Using Deep Learning For Termination Of Resuscitation (tor) In Out Of Hospital Cardiac Arrest (ohca) Cases: The All-japan Utstein Registry Experience.

Background: Correct identification of futile prehospital resuscitation in out-of-hospital cardiac arrest (OHCA) may reduce unnecessary transports. Reliable prediction variables are needed for 'termination of resuscitation' (TOR) rules in OHCA. However, making such prediction models requires a large number of samples and time-consuming statistical analysis. Deep learning (DL), a form of artificial intelligence (AI), is attractive for building such prediction models. We made a TOR prediction model using a DL software, Prediction One (Sony Network Communications Inc., Tokyo, Japan). The purpose of this study was to evaluate the efficacy of this predictive model using general purpose AI compared to the Universal TOR rule for out - of hospital cardiac arrest. Methods: A retrospective, population-based review of OHCA victims without prehospital ROSC from January 1, 2010 to December 31, 2017 in the All-Japan Utstein Registry. We divided half (2010-2014) as a training dataset and half (2015-2017) as an external validation dataset. Prediction one made the prediction model using the training dataset with internal cross-validation. We used both the created model and the Universal TOR rule to predict outcomes using the external validation set. Results: 989,929 OHCA cases, 18 years of age or older, were registered in the All-Japan Utstein Registry and 575,346 cases were of presumed cardiac origin. Of these, 354,356 cases were used as the training dataset and 220,990 cases were used as the external validation dataset. The model made by Prediction One using 11 variables had AUC of 0.969 and F value of 0.969, and its AUC for the validation cohort was 0.964 (95%CI 0.963-0.966) with 99.3% accuracy. The model made by Prediction One using three variables of universal TOR rule had AUC of 0.948 and F value 0.967, and its AUC for the validation cohort was 0.939 (95%CI 0.936-0.942) with 99.1% accuracy. Conclusions: The accuracy of prediction models using Prediction One was good. More research into the utility of using AI for TOR prediction is required.

Out-of-hospital cardiac arrests in the city of Cape Town metropole of the Western Cape province of South Africa: a spatio-temporal analysis.

The incidence of out-of-hospital cardiac arrest (OHCA) is expected to increase in sub-Saharan Africa along with the incidence of cardiovascular disease. In low-resource settings (LRS), OHCA carries a negligible survival rate. Interventions to improve OHCA survival might not be cost effective for many LRS, and therefore need to be targeted to areas of high incidence. The aim of this study was to describe the temporal and geographic distribution of OHCA in the City of Cape Town, South Africa, and their proximity to percutaneous coronary intervention (PCI) resources. In this retrospective study, OHCA data between 1 January and 31 December 2018 were extracted from public and one private emergency medical services in the Western Cape. For temporal analysis, distribution of OHCA according to time of day, day of the week and month of the year were subjected to chi-squared testing. For geospatial analysis, cluster and outlier, and hotspot analyses were performed. Proximity analysis was employed to determine the driving time from OHCA location to the closest PCI-capable facility. A total of 929 patients with OHCA received an emergency medical services response in the City of Cape Town, corresponding to an annual prevalence of 23.2 per 100 000 persons. The distribution of OHCA incidence was not explained by month of the year (p = 0.08) or day of the week (p = 0.67). A statistically significant variation in OHCA incidence was explained by time of day (p < 0.01) with 30% (n = 279) of all OHCAs occurring from 05:00 to 09:59. Geospatial analysis yielded a large area of hotspots (99% confidence interval) over the centre of the metropole, Cape Flats and southern suburbs. The median (interquartile range) driving time from the incident to the closest PCI-capable facility was 10:22 (08:05) minutes. Incidents of OHCA occurred predominantly at home during the mid-morning, with hotspots around the city centre and residential suburbs of Cape Town. While the incidents occurred close to PCI-capable facilities, some areas remained underserved and access to PCI for OHCA victims may be impossible due to socio-economic factors. With an increase in OHCA incidence expected, it is essential that contextual, cost-effective management interventions be developed and implemented.

ОКАЗАНИЕ ДОГОСПИТАЛЬНОЙ ПОМОЩИ ПРИ ОСТАНОВКЕ СЕРДЦА: О СОВРЕМЕННОМ СОСТОЯНИИ ПРОБЛЕМЫ В РОССИЙСКОЙ ФЕДЕРАЦИИ

According to the international data, out-of-hospital cardiac arrest (OHCA) constitutes a serious global-scale problem that demands continuous and heightened attention of the public health authorities. While this problem generally remains underinvestigated in Russia, some domestic studies suggest a high OHCA incidence and a low probability of survival of OHCA victims. In order to reasonably choose strategies to decrease mortality in OHCA, a clear understanding of the present epidemiological situation and the specifics of performance of the existing prehospital care system is required. This article presents a generalised analysis of the scientific evidence on the problem of OHCA in Russia. In particular, the paper discusses epidemiological features of OHCA in the general population, characteristics of efficiency of prehospital care in OHCA, defects in organisation of first aid and emergency medical care provision in cardiac arrest, and reveals key factors which are responsible for the high mortality in OHCA. Results of the analysis may be utilised by healthcare authorities when planning organisational measures aimed at increasing efficiency of the prehospital care in OHCA and decreasing mortality of the population in the Russian Federation.

The Effect of CPR Multimedia Learning to Willingness of Nursing Students On Conducting CPR

Introduction: Incidence of out-of-hospital cardiac arrest (OHCA) varies worldwide as does the survival rate. The willingness of bystander on performing CPR on OHCA victims is an important factor in improving survival rate. Objective: To analyze the effect of CPR multimedia learning to willingness of nursing students on conducting CPR. Methods: This research was a quasy experimental study with randomized subject, pretest-posttest without control group design. The number of respondents were 36 students of 6th semester of nursing student using purposive sampling technique. The data was collected using a willingness questionnaire. Location of this study was in STIKES dr. Soebandi Jember. Ethical approval has been obtained from the Health Research Ethics Committee at STIKES dr. Soebandi Jember. Results: The results showed that there were score differences of nursing students' willingness to perform CPR between before and after CPR multimedia learning (p=0.000). In the early stages before the CPR multimedia learning (pretest), the average respondent's willingness to reach 9.68 (4-5 questions answered yes) with the lowest score 8 and the highest score 14. After the CPR multimedia learning (posttest), the average respondent's willingness reached 14.13 (7-8 questions answered yes) with the lowest score of 12 and the highest score of 16. Conclusion: This study shows that CPR multimedia learning can increase the willingness of nursing students on conducting CPR.

Impact of gender on survival of out-of-hospital cardiac arrest presenting with refractory ventricular arrhythmias and role of coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Clinical presentation and outcome of out-of-hospital cardiac arrest (OHCA) presenting with shockable rhythm may vary between males and females. Very limited data exist on gender-related differences in OHCAs with refractory ventricular arrhythmias (VA) and, in particular, on distribution and prevalence of coronary artery disease (CAD). Purpose The aim of this study was to characterize gender-related outcome, prevalence and severity of CAD in OHCA victims presenting with shockable rhythm and refractory VA. Methods All OHCAs presenting with shockable rhythm occurred between 2015 and 2019 in the province of Pavia (Italy) and in the Canton Ticino (Switzerland) were included. Results Out of 3592 OHCAs, 685 presented with shockable rhythm and, of them, 212 had a refractory VA. Overall, male gender was independently associated with a lower probability of survival both at hospital admission and at 30-days (OR 0.63, 95% CI 0.58-0.67, p &amp;lt;0.001 and OR 0.82 95% CI 0.74-0.91, p &amp;lt;0.001, respectively) and presented with a more severe CAD. Male gender was 5-times more frequently associated with OHCA presenting with refractory VA. Despite of a more favourable OHCA presentation (i.e. more often OHCA witnessed, public place occurrence and CPR initiated by bystander) male patients with refractory VA had a lower likelihood of survival (OR 0.25, 95% CI 0.21-0.30). A higher prevalence (81%) of CAD was observed in OHCAs presenting with refractory VA but not a higher number of diseased vessels. Conclusions Male gender is more frequently associated with refractory VA, lower probability of survival and higher prevalence and severity of CAD. CAD severity, however, does not significantly affect refractory VA presentation.

Addressing the Helper's and Victim's Gender Is Crucial in Schoolchildren Resuscitation Training-A Prospective, Educative Interventional Trial.

Background: A victim’s gender is a known factor that influences the willingness of adult bystanders to perform cardiopulmonary resuscitation (CPR) if an out-of-hospital cardiac arrest (OHCA) occurs. This study aims to identify whether gender characteristics of OHCA victims are also relevant to schoolchildren, who are the key target group of CPR trainings worldwide. Methods: A prospective, educative intervention study was performed in schoolchildren (5th–7th grade). Schoolchildren’s willingness to perform CPR was assessed by means of questionnaires before (t0) and after (t1) standardized CPR training. Participants were asked how determined they were to perform CPR in male and female OHCA victims on a 5-point Likert scale (not being determined to being very determined). A data analysis was performed according to the gender characteristics of schoolchildren. Results: Overall, 342 schoolchildren aged 10–15 years were included, and 166 male (MG) and 176 female (FG) schoolchildren served as a comparison group. Before (t0) and after (t1) the intervention, females showed a significantly higher general willingness to perform CPR than males (t0: 97.1% vs. 89.0%; p < 0.003 and t1: 95.7% vs. 98.9%; p = 0.038). The general willingness to perform CPR after training had a stronger increase in males (8.0% vs. 2.3%; p = 0.017). In the case that the OHCA victim was female, male schoolchildren were less willing to perform CPR than females at baseline (MG: n = 101;60.8% vs. FG: n = 147;84.5%; p < 0.001) and after training (MG: n = 97;58.4% vs. FG: n = 138;79.3%; p < 0.001). At t1, CPR willingness for female victims was improved in males (MG: n = 36;21.7% vs. FG: n = 19;10.9%; p = 0.006). Conclusions: The gender characteristics of OHCA victims, as well as schoolchildren themselves, have a relevant impact on the willingness to perform CPR. Training concepts should effectively motivate male schoolchildren to reduce preexisting inhibitions, especially towards female OHCA patients. Trial registration: This study was registered at the German Clinical Trials Register (Registration number: DRKS00017707) on 2 August 2019.

Race and ethnicity disparities in post-arrest care in Texas

IntroductionPost-arrest care is essential to the chain of survival after out-of-hospital cardiac arrest (OHCA). Sparse literature evaluates disparities in post-arrest care. We sought to measure post-arrest care disparities using a statewide OHCA registry. MethodsWe evaluated 2014–2020 data in the Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) and included adult OHCAs surviving to hospital admission. We stratified subjects by race/ethnicity. Outcomes were targeted temperature management (TTM), percutaneous intervention (PCI), early withdrawal of life-sustaining therapies (WLST), survival to discharge, and survival with cerebral performance category (CPC) of 1–2 (considered favorable). We used both multivariable and mixed-effects, logistic regression models to evaluate the association between race/ethnicity and outcomes, adjusting for confounders. We modeled receiving hospital as a random intercept for the mixed-models analysis. ResultsWe included 8,363 OHCAs; 3,916 White, 2,251 Black, 2,196 Hispanic/Latino. On multivariable analysis, Black patients had a lower PCI (aOR 0.4, 95% CI 0.3–0.5) and survival with good CPC (aOR 0.6, 95% CI 0.6–0.7). Hispanic/Latino patients had lower TTM (aOR 0.8, 95% CI 0.7–0.9), PCI (aOR 0.6, 95% CI 0.5–0.8), survival (aOR 0.8, 95% CI 0.7–0.9), and survival with good CPC (aOR 0.7, 95% CI 0.6–0.7). However, after adjusting for clustering by receiving hospital, most of the post-arrest care relationships were negated, and Black patients actually had a higher rate of TTM (aOR 1.2, 95% CI 1.1–1.3). ConclusionsMinority OHCA victims experienced disparities in post-arrest care and outcomes. However, adjusting for receiving hospital random-effect largely diminished these findings. Inter-hospital, post-arrest care disparities may exist.

Does the position of the body impact the return of spontaneous circulation and hospital survival in sudden cardiac arrest patients?

Introduction: Out-of-hospital cardiac arrest (OHCA) is a big medical problem. Material and methods: The aim of this study was to assess the occurrence of sitting position in victims of OHCA at the arrival of Emergency Medical Services (EMS) and examine whether maintaining a supine position until ambulance arrival impacts the return of spontaneous circulation (ROSC) and survival until hospital admission and discharge. The documentation of patients in the OHCA registry of part of Silesian Voivodeship 1–06.2018 was accessed and yielded 634 cases for analysis. Results: The sitting position was found in 41 (6.5%) patients. These patients were more frequently female: 46.3% vs 30.6%, and older: 74.0 (57.9–82.0) vs 67.7 (54.9–75.8) and less frequently received cardiopulmonary resuscitation (CPR) from bystanders: 7.3% vs 63.6%, while ROSC was found with similar frequency: 34.2% vs 34.1%, survival until hospital admission in ROSC subgroups was lower in those in a sitting position than in a lying position: 50% vs 75.5%. None patients who were found in the sitting position survived until hospital discharge, while 33 (6.1%) patients out of those found in the lying positions survived. The univariable analysis showed that the sitting position was associated with female sex, older age, previously implanted implantable cardioverter-defibrillator (ICD) before OHCA. The multivariable logistic revealed that the sitting position was independently associated with chest pain and the presence of ICD. Conclusions: Patients found in a sitting position at the arrival of EMS constituted 6.5% of patients with OHCA in whom resuscitation attempts were undertaken and were at higher risk of unfavorable outcomes.

Prone Dispatch-Directed CPR in Out-of-Hospital Cardiac Arrest: Two Successful Cases

Historically, dispatch-directed cardiopulmonary resuscitation (CPR) protocols only allow chest compression instructions to be delivered for patients able to be placed in the traditional supine position. For patients who are unable to be positioned supine, the telecommunicator and caller have no option except to continue attempts to position supine, which may result in delayed or no chest compressions being delivered prior to emergency medical services arrival. Any delay or lack of bystander chest compressions may result in worsening clinical outcomes of out-of-hospital cardiac arrest (OHCA) victims. We present the first two cases, to the best of our knowledge, of successfully delivered, bystander-administered, prone CPR instructions by a trained telecommunicator for two OHCA victims unable to be positioned supine.