Survival Of Cardiac Arrest Victims Research Articles

Factors influencing the intentions of nurses and respiratory therapists to use automated external defibrillators during in-hospital cardiac arrest: a qualitative interview study.

Nurses and respiratory therapists are seldom allowed to use automated external defibrillators (AED) during in-hospital cardiac arrest. This can result in significant time delays before defibrillation occurs and lower survival for cardiac arrest victims. We sought to identify barriers and facilitators to AED use by nurses and respiratory therapists. We conducted semi-structured qualitative interviews with a purposeful sample of nurses and respiratory therapists. We developed the interview guide based on the constructs of the theory of planned behaviour, which elicits salient attitudes, social influences, and control beliefs potentially influencing the intent to use an AED. Interviews were recorded, transcribed verbatim, and analysed until achieving data saturation. Two independent reviewers performed inductive analyses to identify emerging categories and themes, and ranked them by frequency of the number of participants stating the topic. Demographics for the 24 interviewees include mean age 40.5, 79.2% female, 87.5% performed cardiopulmonary resuscitation (CPR), 29.2% defibrillated a patient. Identified attitudes pertained to the timeliness of defibrillation, patient survival, simplicity of AED use, accuracy of rhythm recognition, and harm to self or others. Social influences consisted of physician and hospital administration support of AED use. Control beliefs included training on AED use, policy allowing AED use, familiarity with AED, and task burden during resuscitation. Most nurses and respiratory therapists intended to use an AED if permitted to do so by a medical directive. Successful implementation would require educational initiatives focusing on safety and efficacy of AEDs, support from physicians and hospital administrators, and additional training on AED use.

Mass CPR training

First responder training is key to the survival of cardiac arrest victims. Our objective was to analyze the effectiveness of method designed to teach basic life support (BLS) to a large number of school students on a single day.

Magnetically targeted drug delivery during cardiopulmonary resuscitation and the post-resuscitation period

Treatment with pharmacological agents is frequently required during cardiopulmonary resuscitation efforts and almost always during the post-resuscitation period. However, the lack of scientific evidence, the potent side effects and the association of resuscitation drugs with poor outcome act as a disincentive for their use. The use of magnetic nanoparticles in medicine has great potential. Magnetically targeted drug delivery may be an ideal method of pharmaceutical treatment during the resuscitation efforts and post-resuscitation period. In addition, there is evidence that magnetic nanotechnology may be used in the detection of post-cardiac arrest brain injury. In the light of poor survival of cardiac arrest victims, research in cardiopulmonary resuscitation should focus on this promising technology as soon as possible.

108: The Effect of Video Demonstration to Improve the Quality of Dispatcher-Assisted Chest Compression-Only Cardiopulmonary Resuscitation Amongst Middle-Age Persons

Bystander cardiopulmonary resuscitation (CPR) significantly improves survival of cardiac arrest victims. Dispatcher assistance increases bystander to do CPR but the quality of CPR remains unsatisfactory. This study was conducted to assess the effect of video demonstration performing CPR by non-trained middle-age person compared with traditional voice instructions in simulated cardiac arrest.

Interactive video instruction improves the quality of dispatcher-assisted chest compression-only cardiopulmonary resuscitation in simulated cardiac arrests*

Bystander cardiopulmonary resuscitation (CPR) significantly improves survival of cardiac arrest victims. Dispatch assistance increases bystander CPR, but the quality of dispatcher-assisted CPR remains unsatisfactory. This study was conducted to assess the effect of adding interactive video communication to dispatch instruction on the quality of bystander chest compressions in simulated cardiac arrests. A randomized controlled study with a scenario developed to simulate cardiac arrest in a public place. The victim was simulated by a mannequin and the cell phone for dispatch assistance was a video cell phone with both voice and video modes. Chest compression-only CPR instruction was used in the dispatch protocol. Ninety-six adults without CPR training within 5 years were recruited. The subjects were randomized to receive dispatch assistance on chest compression with either voice instruction alone (voice group, n = 53) or interactive voice and video demonstration and feedback (video group, n = 43) via a video cell phone. Performance of chest compression-only CPR throughout the scenario was videotaped. The quality of CPR was evaluated by reviewing the videos and mannequin reports. Chest compressions among the video group were faster (median rate 95.5 vs. 63.0 min-1, p < 0.01), deeper (median depth 36.0 vs. 25.0 mm, p < 0.01), and of more appropriate depth (20.0% vs. 0%, p < 0.01). The video group had more "hands-off" time (5.0 vs. 0 second, p < 0.01), longer time to first chest compression (145.0 vs. 116.0 seconds, p < 0.01) and total instruction time (150.0 vs. 121.0 seconds, p < 0.01). The addition of interactive video communication to dispatcher-assisted chest compression-only CPR initially delayed the commencement of chest compressions, but subsequently improved the depth and rate of compressions. The benefit was achieved mainly through real-time feedback.

A survey of attitudes and factors associated with successful cardiopulmonary resuscitation (CPR) knowledge transfer in an older population most likely to witness cardiac arrest: design and methodology.

BackgroundOverall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While bystander cardiopulmonary resuscitation (CPR) can increase survival for cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%). Most cardiac arrest victims are men in their sixties, they usually collapse in their own home (85%) and the event is witnessed 50% of the time. These statistics would appear to support a strategy of targeted CPR training for an older population that is most likely to witness a cardiac arrest event. However, interest in CPR training appears to decrease with advancing age. Behaviour surrounding CPR training and performance has never been studied using well validated behavioural theories.Methods/DesignThe overall goal of this study is to conduct a survey to better understand the behavioural factors influencing CPR training and performance in men and women 55 years of age and older. The study will proceed in three phases. In phase one, semi-structured qualitative interviews will be conducted and recorded to identify common categories and themes regarding seeking CPR training and providing CPR to a cardiac arrest victim. The themes identified in the first phase will be used in phase two to develop, pilot-test, and refine a survey instrument based upon the Theory of Planned Behaviour. In the third phase of the project, the final survey will be administered to a sample of the study population over the telephone. Analyses will include measures of sampling bias, reliability of the measures, construct validity, as well as multiple regression analyses to identify constructs and beliefs most salient to seniors' decisions about whether to attend CPR classes or perform CPR on a cardiac arrest victim.DiscussionThe results of this survey will provide valuable insight into factors influencing the interest in CPR training and performance among a targeted group of individuals most susceptible to witnessing a victim in cardiac arrest. The findings can then be applied to the design of trials of various interventions designed to promote attendance at CPR classes and improve CPR performance.Trial registrationClinicalTrials.gov NCT00665288

An evaluation of 9-1-1 calls to assess the effectiveness of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions: design and methodology

BackgroundCardiac arrest is the leading cause of mortality in Canada, and the overall survival rate for out-of-hospital cardiac arrest rarely exceeds 5%. Bystander cardiopulmonary resuscitation (CPR) has been shown to increase survival for cardiac arrest victims. However, bystander CPR rates remain low in Canada, rarely exceeding 15%, despite various attempts to improve them. Dispatch-assisted CPR instructions have the potential to improve rates of bystander CPR and many Canadian urban communities now offer instructions to callers reporting a victim in cardiac arrest. Dispatch-assisted CPR instructions are recommended by the International Guidelines on Emergency Cardiovascular Care, but their ability to improve cardiac arrest survival remains unclear.Methods/DesignThe overall goal of this study is to better understand the factors leading to successful dispatch-assisted CPR instructions and to ultimately save the lives of more cardiac arrest patients. The study will utilize a before-after, prospective cohort design to specifically: 1) Determine the ability of 9-1-1 dispatchers to correctly diagnose cardiac arrest; 2) Quantify the frequency and impact of perceived agonal breathing on cardiac arrest diagnosis; 3) Measure the frequency with which dispatch-assisted CPR instructions can be successfully completed; and 4) Measure the impact of dispatch-assisted CPR instructions on bystander CPR and survival rates.The study will be conducted in 19 urban communities in Ontario, Canada. All 9-1-1 calls occurring in the study communities reporting out-of-hospital cardiac arrest in victims 16 years of age or older for which resuscitation was attempted will be eligible. Information will be obtained from 9-1-1 call recordings, paramedic patient care reports, base hospital records, fire medical records and hospital medical records. Victim, caller and system characteristics will be measured in the study communities before the introduction of dispatch-assisted CPR instructions (before group), during the introduction (run-in phase), and following the introduction (after group).DiscussionThe study will obtain information essential to the development of clinical trials that will test a variety of educational approaches and delivery methods for telephone cardiopulmonary resuscitation instructions. This will be the first study in the world to clearly quantify the impact of dispatch-assisted CPR instructions on survival to hospital discharge for out-of-hospital cardiac arrest victims.Trial RegistrationClinicalTrials.gov NCT00664443

Automated external defibrillators (AED) in pre-hospital care (PHC) and public access to defibrillation: a real necessity

The aim of this work is discussing technical aspects and the use of AED in PHC services and to objectively present evidencesfavoring the effectiveness of the public access to defibrillation. As this is not a metanalysis, but a descriptive literature survey, we selectedarticles in MEDLINE’s database using the search words “cardiac arrest”, “cardiopulmonary resuscitation”, “public access defibrillation”and “out-of- hospital”. The articles were evaluated by analyzing methods and determination of limitations on the design. We found 156articles and 33 have been chosen that presented relevant conclusions of the main studies demonstrating that AEDs are effective for dailyuse and present a good correlation cost-benefit, have a strong impact in survival of cardiac arrest victims outside the hospital. Publicaccess to defibrillation and to PHC teams having AED equipment has a positive impact in the survival of victims of cardiac arrest; andprograms for qualification in cardiopulmonary resuscitation must be offered to professionals and the community.

Abstract 107: Community Public Access Defibrillation Sites: Compliance with American Heart Association Recommendations

Introduction The Public Access Defibrillation (PAD) Trial demonstrated improved survival of cardiac arrest victims when automated external defibrillators (AEDs) were combined with CPR by lay responders. These PAD sites incorporated American Heart Association (AHA) recommended elements of a PAD site and the volunteer responders received refresher CPR/AED training. It is unknown if typical community PAD sites maintain these elements after initial program development. The Johnson County Early Defibrillation Task Force (JCEDTF) in Johnson County, IA distributed AEDs throughout the county in 2002. CPR training was provided at program initiation. The purpose of this study was to evaluate the PAD sites 5 years later to assess compliance with AHA recommendations. Methods A 25 point scoring system was developed to assign numerical values to the components of a PAD site: planned and practiced response, links with local EMS, and training of rescuers. Surveys were mailed to all 39 PAD sites. Site visits with tours were conducted at each the site to confirm the survey. Sites were grouped into educational, community, or business sites. Results Thirty two surveys were returned (response rate 82%): 5 educational sites, 13 business and industrial sites and 14 community sites. The Table shows the percentage of points that each group achieved for the components of an AED program. No site had incorporated all the recommended elements: the best sites included only 2/3 of the recommendations. There was a statistical difference in CPR training, with business and industrial sites performing best. Community sites were particularly weak with CPR training. Conclusions PAD sites incorporate approximately half of the elements of an effective PAD program. Business and industrial sites perform slightly better than educational or community sites. CPR training and EMS links are the poorest areas of compliance. These results may indicate that the effectiveness of a PAD site may diminish with time. Table: Percentage of Achieved Points

Outcome of Out-of-Hospital Cardiorespiratory Arrest in Children

To analyze the characteristics and outcome of out-of-hospital cardiorespiratory arrest in children in Spain. Secondary analysis of data from a prospective, multicenter study analyzing cardiorespiratory arrest in children. Ninety-five children between 7 days and 16 years with cardiorespiratory arrest. Data were recorded according to the Utstein style. The outcome variables were the sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). Neurologic and general performance outcome was assessed by the Pediatric Cerebral Performance Category (PCPC) scale and the Pediatric Overall Performance Category (POPC) scale. Initial survival was 47.3% and 1-year survival was 26.4%. Mortality was higher in children younger than 1 year. Survival of patients with respiratory arrest (82.1%) was significantly higher than survival of cardiac arrest victims (14.4%). Patients who were initially resuscitated by laypersons or paramedics had higher survival (53.6%) than those who were initially resuscitated by doctors and/or nurses (15.2%) (P < 0.01). Mortality was higher in the patients who presented slow rhythms (asystole, severe bradycardia) or pulseless electrical activity than in those presenting ventricular fibrillation (P = 0.001). Multivariate logistic regression revealed that the best indicator of mortality was duration of cardiopulmonary resuscitation longer than 20 minutes. After 1 year, most survivors had normal or mild disability. Mortality of out-of-hospital cardiorespiratory arrest in children is high. When resuscitation is started soon by layperson or paramedics, survival is increased. Duration of resuscitation efforts is the best indicator of mortality. Most of survivors had good long-term neurologic outcome.