Presumed Cardiac Arrest Research Articles

Follow-up on volunteer responders dispatched for out-of-hospital cardiac arrests: Addressing the psychological and physical impact

IntroductionSmartphone technology is increasingly used to engage lay people as volunteer responders in resuscitation attempts. Attention has recently been drawn to how resuscitation attempts may impact bystanders. Attempting resuscitation in out-of-hospital cardiac arrests (OHCA) may be an overwhelming experience and, in some cases, difficult to cope with. We developed a volunteer responder follow-up program to systematically measure the psychological and physical impact on volunteer responders dispatched for OHCAs. Methods and ResultsThe nationwide Danish volunteer responder program dispatches volunteer responders for presumed cardiac arrests. 90 min after notification of a potential nearby cardiac arrest, all volunteer responders receive a survey, and are asked to self-report their mental state of mind after the event. The volunteer responders are also asked to disclose any physical injury they sustained in relation to the event. Volunteer responders who report severe mental effects are offered a defusing conversation by a trained nurse.Between 1 September 2017 and 31 December 2022, the Danish volunteer responder program has alerted 177,866 volunteer responders for 10,819 presumed cardiac arrest alerts. Of 177,866 alerted volunteers responders, 62,711 accepted the alarm. In the same period, 7,317 cancelled their registration.From January 2019 to 31 December 31 2022, a total of 535 volunteer responders were offered a defusing consultation. ConclusionThe Danish volunteer responder follow-up program is carried out to assess the psychological and physical risks of responding to a suspected OHCA. We suggest a survey-based method for systematic screening of volunteer responders that allow volunteer responders to report any physical injury or need of psychological follow-up. The person providing defusing should be a trained and experienced healthcare professional.

Readiness of Teachers of General Education Institutions to Perform Cardiopulmonary Resuscitation

RELEVANCE The problem of sudden cardiac arrest and sudden death among the students of educational institutions is highly relevant for the Russian Federation. In order to plan interventions aimed at improving effectiveness of management and reducing mortality from cardiac arrest in educational institutions, a clear understanding of level of readiness and motivation of teachers to provide help to a cardiac arrest victim is necessary. AIM OF STUDY To evaluate willingness of teachers of general education institutions to provide cardiopulmonary resuscitation (CPR) in cases of cardiac arrest, and to investigate factors and relationships that determine readiness of teachers to give help. MATERIAL AND METHODS In February–March 2021, an online questionnaire survey of teaching staff of general education institutions was conducted in the Republic of Crimea. As part of the survey, respondents were asked to evaluate their willingness to attempt CPR on a loved one, a stranger or a pupil on a five-point Likert scale, and to indicate potential barriers for performing CPR. The survey was voluntary and anonymous. RESULTS The questionnaire was completed by 5,921 teachers. Of all respondents, 9.2% were males, 31.6% — aged over 50 years, 32.3% — work in urban areas. The proportion of teachers who expressed absolute willingness to perform CPR on a loved one, a stranger or a pupil was 63.6% (n=3,766), 34.8% (2,058) and 41.0% (2,427), respectively. At the same time, 13.6% (804), 31.0% (1,836) and 30.6% (1,809), respectively, indicated that they would probably not or definitely not attempt CPR. A high readiness to perform resuscitation (4–5 points) was confirmed to be associated with previous CPR training (p<0.001) and with higher level of CPR knowledge (p≤0.006). The main barriers to providing resuscitation were “lack of CPR knowledge and skills” (indicated by 31.4–36.3% of the respondents depending on the type of presumed cardiac arrest victim) and “fear of causing harm to a victim” (49.2–51.4%). CONCLUSION Considerable portion of teachers of general education institutions demonstrate low level of readiness to provide life-saving help in case of cardiac arrest. Lack of CPR knowledge and skills constitute the main barrier to attempting resuscitation. In order to improve survival from cardiac arrest in educational institutions, comprehensive organisational interventions are required, which should primarily focus on ensuring full coverage of teachers with high-quality training and retraining in resuscitation.

Abstract 147: Volunteer Responders Often Provide Emotional Support To Relatives Of Out-of-hospital Cardiac Arrest Patients Even After Arrival Of The Emergency Medical Services

Introduction: Volunteer responders (VR) are dispatched to OHCA to fetch an AED and provide CPR. However, often more than one volunteer responder arrives, allowing additional responders to handle tasks beyond resuscitative efforts. We aimed to assess which tasks dispatched VR performed during resuscitation attempts and the proportion of VR providing emotional support to patient relatives. Method and Results: This was an observational study with prospectively collected data from Denmark's national volunteer responder cohort between April 2020 and May 2022. We included 18,489 VR who accepted an alarm and arrived at a presumed cardiac arrest. All VR who received an alarm received a survey 90 minutes after, which included questions regarding their handling of tasks (response rate 86.1%). Of 18,489 volunteers, 6,612 (35.8%) arrived before EMS. Among all VR who arrived at the cardiac arrest scene, 3,424 (18.5%) performed CPR, 1,851 (10.0%) attached an AED, and 3,447 (18.6%) provided support for relatives. In univariate logistic regression models, VR provision of CPR was significantly associated with being healthcare educated (OR: 1.76, 95% CI: 1.61-1.93), police or firefighter (OR: 3.28, 95% CI: 2.96-3.64). Further, odds for CPR provision increased with recent CPR course (OR: 2.48, 95% CI: 2.09-2.93). VR provision of CPR was significantly associated with an increasing number of VR arriving before EMS. Odds for the provision of CPR were doubled in cases where three or more VR arrived before EMS (OR:6.06, 95% CI: 5.29-6.94) compared to cases where one VR arrived (OR: 3.15, 95% CI: 2.70-3.69). When VR arrived after EMS, 14.9 % provided support for relatives (Fig 1). Conclusion: Volunteer responders’ engagement in OHCA is associated with educational background and the number of volunteers arriving before EMS. Provision of support for relatives is the most frequently handled task, even at arrival after the EMS.

Survival to hospital discharge is equivalent to 30-day survival as a primary survival outcome for out-of-hospital cardiac arrest studies

AimThe 2015 Utstein guidelines stated that 30-day survival could be used as an alternative to survival to hospital discharge (STHD) as the primary survival outcome in out-of-hospital cardiac arrest (OHCA) studies. We sought to ascertain the equivalence (concordance) of these two survival outcome measures. MethodsWe conducted a population-based retrospective cohort study of OHCA patients who were attended by St John Western Australia (SJ-WA) paramedics in Perth, WA between 1999 and 2018. OHCA patients were included if they received either an attempted resuscitation by SJ-WA or bystander defibrillation; were a resident of WA; and were transported to a hospital emergency department (ED). STHD was determined through hospital record review and 30-day survival via the WA Death Registry and cemetery registration data. ResultsThe study cohort comprised a total of 7953 OHCA patients, predominantly male (70%), with a median (IQR) age of 63 (46–77 years), a presumed cardiac arrest aetiology (78.9%), and the majority occurred in a private residence (66.8%). Survival rates were identical for STHD and 30-day survival, with both being (13.78%, 95% CI: 13.02–14.54%) (p = 0.99). The overall concordance between the two survival rates was 99.6%. There were only 30 (0.4%) discordant cases in total: 15 cases with STHD-yes but 30-day survival-no; and 15 cases with STHD-no but 30-day survival-yes. ConclusionWe found that STHD and 30-day survival were equivalent survival metrics in our OHCA Registry. However, given potential differences in health systems, we suggest that 30-day survival is likely to enable more reliable comparisons across jurisdictions.

Improving Care of Out-of-Hospital Cardiac Arrest: Next Steps.

> Humanity’s greatest advances are not in its discoveries—but in how those discoveries are applied. > > –Bill Gates Cardiac arrest is a common cause of death, afflicting >300 000 patients per year in the United States, with a case fatality rate of 95%.1 Many of these deaths may be prevented with improved resuscitation efforts. Considerable progress has been made in the last 5 years on how to improve survival from out-of-hospital cardiac arrest, but the opportunity to improve outcome remains largely unrealized. In recent years, the data have increased regarding who suffer cardiac arrest, where, how they are treated, and related outcomes. Several informative registries are found, in both the United States and other countries, with the most detailed major North American registry being in the National Institutes of Health-sponsored ROC program (Resuscitation Outcomes Consortium) and the most extensive being CARES (Cardiac Arrest Registry to Enhance Survival). Both registries have provided important insights, including that more than half of patients with cardiac arrest have underlying ischemic heart disease and more than three quarters of cardiac arrests occur in patients’ homes. An important analysis from ROC showed regional heterogeneity in survival of patients with presumed cardiac arrest with shockable rhythm, ranging from 8% in Alabama to 40% in Seattle, suggesting an opportunity to improve care by adapting best practices around the …

A text message alert system for trained volunteers improves out-of-hospital cardiac arrest survival

AimsThe survival rate of sudden out-of-hospital cardiac arrests (OHCAs) increases by early notification of Emergency Medical Systems (EMS) and early application of basic life support (BLS) techniques and defibrillation. A Text Message (TM) alert system for trained volunteers in the community was implemented in the Netherlands to reduce response times. The aim of this study was to assess if this system improves survival after OHCA. Methods and ResultsFrom April 2012 to April 2014 data on all 1546 emergency calls for OHCA in the Dutch province of Limburg were collected according to the Utstein template. On site resuscitation attempts for presumed cardiac arrest were made in 833 cases, of which the TM-alert system was activated in 422 cases. Two cardiopulmonary resuscitation (CPR) scenarios were compared: 1. TM-alert system was activated but no responders attended (n=131), and 2. TM-alert system was activated with attendance of ≥1 responder(s) (n=291). Survival to hospital discharge was 16.0% in scenario 1 and 27.1% in scenario 2 corresponding with OR=1.95 (95% CI 1.15–3.33; P=.014). After adjustment for potential confounders the odds ratio increased (OR=2.82; 95% CI 1.52–5.24; P=.001). Of the 100 survivors, 92% were discharged from the hospital to their home with no or limited neurological sequelae. ConclusionThe TM-alert system is effective in increasing survival to hospital discharge in OHCA victims and the degree of disability or dependence after survival is low.

Sudden Unexpected Death in North Carolina (SUDDEN): methodology review and screening results

ObjectivesThis paper describes the methodology for a prospective, community-based study of sudden unexpected death in Wake County, North Carolina.MethodsFrom 1 March to 29 June 2013, data of presumed cardiac arrest...

Part 5: Adult Basic Life Support

Part 8 : Advanced life support : 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

Emergency Communications with Limited-English-Proficiency Populations

Objective. We investigated 9-1-1 telecommunicators’ perceptions of communication difficulties with callers who have limited English proficiency (LEP) and the frequency and outcomes of specific communication behaviors. Methods. A survey was administered to 150 telecommunicators from four 9-1-1 call centers of a metropolitan area in the Pacific Northwest to assess their experience working with LEP callers. In addition, 172 9-1-1 recordings (86 of which were labeled by telecommunicators as having a “language barrier”) were abstracted for telecommunicators’ communication behaviors and care delivery outcomes. All recordings were for patients who were in presumed cardiac arrest (patient unconscious and not breathing). Additionally, computer-assisted dispatch (CAD) reports were abstracted to assess dispatch practices with regard to timing of basic life support (BLS) and advanced life support (ALS) dispatch. Results. One hundred twenty-three of the telecommunicators (82%%) filled out the survey. The majority (70%%) reported that they encounter LEP callers almost daily and most (78%%) of them reported that communication difficulties affect the medical care these callers receive. Additionally, the telecommunicators reported that calls with LEP callers are often (36%%) stressful. The number one strategy for communication with LEP callers reported by telecommunicators was the use of a telephone interpreter line known as the Language Line. However, the Language Line was utilized in only 13%% of LEP calls abstracted for this study. The analysis of 9-1-1 recordings suggests that the LEP callers received more repetition, rephrasing, and slowing of speech than the non-LEP callers. Although there was no difference in time from onset of call to dispatching BLS, there was a significant difference in simultaneous dispatching of BLS and ALS between the LEP calls (20%%) and non-LEP calls (38%%, p < 0.05). Conclusion. Our study shows that 9-1-1 telecommunicators believe language barriers with LEP callers negatively impact communication and care outcomes. More research needs to be conducted on “best practices” for phone-based emergency communication with LEP callers. Additionally, LEP communities need to better understand the 9-1-1 system and how to effectively communicate during emergencies.

How Sudden Is Sudden Cardiac Death?

Out-of-hospital sudden cardiac death (SCD) is a frequent cause of death. Survival rates remain low despite increasing efforts in medical care. Better understanding of the circumstances of SCD could be helpful in developing preventive measures and facilitating proper reactions to such a pending event. Information on cases of out-of-hospital SCD was collected in the Berlin, Germany, emergency medical system via a questionnaire. Bystander interviews were performed by the emergency physician on scene immediately after declaration of death or return of circulation. Of 5831 rescue missions, 406 involved patients with presumed cardiac arrest. Sixty-six percent had a known cardiac disease. In 72%, the arrest occurred at home, and in 67%, it occurred in the presence of an eyewitness. Information on symptoms immediately preceding the arrest was available in 80% (n = 323) of all 406 patients and in 274 of those with witnessed arrest. Symptoms were identical in the 2 groups. Typical angina was present for a median of 120 minutes in 25% of the 274 patients with witnessed arrest and in 33% with a symptom duration of less than 1 hour. SCD occurs most often at home in the presence of relatives and after a longer period of typical warning symptoms. Although the much-hailed use of public access defibrillation is supported by several studies, the present results raise the question of whether educational measures and targeted educational programs tailored for patients at risk and their relatives should have a higher priority.

Location of Cardiac Arrests in the Public Access Defibrillation Trial

Background. The Public Access Defibrillation (PAD) Trial found an overall doubling in the number of out-of-hospital cardiac arrest (CA) survivors when a lay responder team was equipped with an automated external defibrillator (AED), compared with cardiopulmonary resuscitation (CPR) alone. Objectives. To describe the types of facilities that participated in the trial andto report the incidence of CA andsurvival in these different types of facilities. Methods. In this post-hoc analysis of PAD Trial data, the physical characteristics of the participating facilities andthe numbers of presumed CAs, treatable CAs, andsurvivors are reported for each category of facilities. Results. There were 625 presumed CAs at 1,260 participating facilities. Just under half (n = 291) of the presumed CAs were classified as treatable CAs. Treatable CAs occurred at a rate of 2.9 per 1,000 person-years of exposure; rates were highest in fitness centers (5.1) andgolf courses (4.8) andlowest in office complexes (0.7) andhotels (0.7). Survival from treatable CA was highest in recreational complexes (0.5), public transportation sites (0.4), andfitness centers (0.4) andlowest in office complexes (0.1) andresidential facilities (0.0). Conclusions. During the PAD Trial, the exposure-adjusted rate of treatable CA was highest in fitness centers andgolf courses, but the incidence per facility was low to moderate. Survival from treatable cardiac arrest was highest in recreational complexes, public transportation facilities, andfitness centers.

CPR Without Mouth-to-Mouth Ventilation

A small body of animal and human research suggests, perhaps surprisingly, that mouth-to-mouth ventilation may not improve outcomes for patients who undergo cardiopulmonary resuscitation after out-of-hospital cardiac arrest. To test this theory, researchers in Seattle studied 520 episodes of presumed cardiac arrest in which bystanders (not trained …