Improved outcome for patients with a cardiac arrest by supervision of the emergency medical services system
ABSTRACT Background: The outcome for patients with an out-of-hospital cardiac arrest can only be improved through optimal pre-hospital therapy by the emergency medical services (EMS) system. So far it is not clear if physician supervision of the EMS system is necessary for an optimal result.Methods: In a retrospective and prospective case series we describe the changes in outcome for patients with an out-of-hospital cardiac arrest after the implementation of limited physician supervision of the EMS system. We also analysed the factors that were responsible for these changes.Results: We studied 479 consecutive patients with an out-of-hospital cardiac arrest. In the pre-intervention period, the survival rate for patients with an out-of-hospital cardiac arrest was 13%. This increased to 21.6% when physician supervision was implemented (p = 0.013). This increase in survival coincided with an improvement in pre-hospital advanced cardiac life support with an increase in the number of patients who arrived with a stable cardiac rhythm in the emergency department (p < 0.001).Conclusions: Limited physician supervision of an EMS system in a non-metropolitan area may improve the outcome for patients with an out-of-hospital cardiac arrest.
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ABSTRACT: There is a lack of high-quality information about the effectiveness of resuscitation interventions and international differences in structure, process and outcome after out-of-hospital cardiac arrest and cardiopulmonary resuscitation because data are not collected uniformly. An internet-based international registry could make such evaluations possible, and enable the conduct of large randomized controlled trials of resuscitation therapies. A prospective international cohort study was performed that included 571 infants, children and adults (a) who experienced cardiac arrest requiring chest compressions or external defibrillation, (b) outside the hospital in the study communities and (c) upon whom resuscitation was attempted by EMS personnel. Cardiac arrest was defined as lack of responsiveness, breathing or movement in individuals for whom the EMS system is activated for whom an arrest record is completed. All data were collated via a secure and confidential web-based method by using automated forms processing software with appropriate variable range checks, logic checks and skip rules. Median number of missing responses for each variable was 0 (interquartile range 0, 0). Twenty-seven percent of the patients had a first recorded rhythm of ventricular fibrillation or ventricular tachycardia, 60% had a witnessed arrest, and 34% received bystander CPR. Mean time from call to arrival on scene was 7.1+/-5.1 min. Six percent of the patients survived to hospital discharge. The resuscitation process was highly variable across centers, and survival and neurological outcome were also significantly and independently different across centers. This study shows that it is possible to collect data prospectively describing the structure, process and outcome associated with cardiac arrest in multiple international sites via the internet. Therefore, it is feasible to conduct adequately powered randomized trials of resuscitation therapies in international settings.Resuscitation 07/2005; 65(3):265-77. DOI:10.1016/j.resuscitation.2004.12.019 · 3.96 Impact Factor
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ABSTRACT: To assess the frequency with which paramedic skills were used in out of hospital cardiac arrest and the effect of tracheal intubation on outcome. Retrospective analysis of ambulance service reports and hospital records. Scottish Ambulance Service and hospitals admitting acute patients throughout Scotland. A total of 8651 out of hospital resuscitation attempts were recorded and tracheal intubation was attempted in 3427 (39.6%) arrests. One hundred and thirty six patients (3.7%) were intubated and 476 (9.1%) of the patients who were not intubated survived to hospital discharge (p < 0.001). Among the patients who were defibrillated the proportion intubated was highest in the patients who received the greatest number of shocks (p < 0.01). Among subjects receiving similar numbers of shocks survival rates were lower for intubated patients (p < 0.01). Patients with unwitnessed arrests were most frequently intubated and survival rates were lowest in this group. Patients who are intubated seem to have lower survival rates. This may however reflect the difficulty of the resuscitation attempt rather than the effects of intubation. The use of basic life support skills rapidly after cardiac arrest is associated with the best survival rates.Heart (British Cardiac Society) 10/1997; 78(4):399-402. DOI:10.1136/hrt.78.4.399 · 6.02 Impact Factor
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ABSTRACT: There is no evidence showing an impact from any advanced cardiac life support (ACLS) medications on patient survival following cardiac arrest. One potential reason for a lack of such benefit may be medication timing. We formed the hypothesis that medications are given late after rescuer arrival, limiting any benefit. We performed a meta-analysis to determine the time from emergency medical services (EMS) dispatch to first medication administration, regardless of route, during out-of-hospital cardiac arrest (OOHCA). Then, the mean time and ranges of reported study medication delivery in clinical trials where medication was the experimental intervention was determined. We conducted a comprehensive literature review between January 1990 and August 2005 in MEDLINE using the following MeSH headings: cardiopulmonary resuscitation, cardiac arrest, heart arrest, EMS, EMT, ambulance, and the names of all ACLS medications. We reviewed the abstracts of 632 studies and full manuscripts of 248 published papers. We eliminated the following articles from further analysis: non-peer reviewed; all without human primary data (includes review articles, guidelines or consensus manuscripts, editorials, or simulation studies); animal data; case reports. We used no language restriction. From this search, our independent reviewers found 17 papers that contained information on time to medication administration. We analyzed reporting of drug delivery time to 7617 patients in 32 different emergency medical services systems. Time to first medication delivery by any route was a mean of 17.7 min (range 10.0-25.0; 95% CI around mean 10.6, 24.8). Time to intravenous experimental medication administration was a mean of 19.4 min (range 13.3-25.0; 95% CI around mean 12.8, 25.9). Medications are given late during out-of-hospital cardiac arrest, even in cohorts where drug delivery is a key study intervention.Resuscitation 09/2006; 70(2):201-6. DOI:10.1016/j.resuscitation.2005.12.006 · 3.96 Impact Factor