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Factors Associated with Quality of Bystander CPR: the Presence of Multiple Rescuers and Bystander-initiated CPR without Instruction
Abstract
Aims
To identify the factors associated with good-quality bystander cardiopulmonary resuscitation (BCPR).
Methods
Data were prospectively collected from 553 out-of-hospital cardiac arrests (OHCAs) managed with BCPR in the absence of emergency medical technicians (EMT) during 2012. The quality of BCPR was evaluated by EMTs at the scene and was assessed according to the standard recommendations for chest compressions, including proper hand positions, rates and depths.
Results
Good-quality BCPR was more frequently confirmed in OHCAs that occurred in the central/urban region (56.3% [251/446] vs. 39.3% [42/107], p = 0.0015), had multiple rescuers (31.8% [142/446] vs. 11.2% [12/107], p < 0.0001) and received bystander-initiated BCPR (22.0% [98/446] vs.5.6% [6/107], p < 0.0001). Good-quality BCPR was less frequently performed by family members (46.9% [209/446] vs. 67.3% [72/107], p = 0.0001), elderly bystanders (13.5% [60/446] vs. 28.0% [30/107], p = 0.0005) and in at-home OHCAs (51.1% [228/446] vs. 72.9% [78/107], p < 0.0001). BCPR duration was significantly longer in the good-quality group (median, 8 vs.6 min, p = 0.0015). Multiple logistic regression analysis indicated that multiple rescuers (odds ratio = 2.8, 95% CI: 1.5–5.6), bystander-initiated BCPR (2.7, 1.1–7.3), non-elderly bystanders (1.9, 1.1–3.2), occurrence in the central region (2.1, 1.3–3.3) and duration of BCPR (1.1, 1.0-1.1) were associated with good-quality BCPR. Moreover, good-quality BCPR was initiated earlier after recognition/witness of cardiac arrest compared with poor-quality BCPR (3 vs. 4 min, p = 0.0052). The rate of neurologically favourable survival at one year was 2.7% and 0% in the good-quality and poor-quality groups, respectively (p = 0.1357).
Conclusions
The presence of multiple rescuers and bystander-initiated CPR are predominantly associated with good-quality BCPR
... ey classified bystander CPR into two categories "high-quality" and "low-quality." Bystander CPR quality was judged to be "high" when the hand positions were appropriate and compression rates of at least 100/min and compression depths of at least 5 cm were ensured [11]. We compared CPR-related factors and outcomes according to bystander CPR quality. ...
... Assessment of simulated CPR could not reflect the situation of a real population [15,16]. Takei et al. evaluated bystanders in a single area [11]. However, we determined the quality status of CPR and the bystander factors related to high-quality CPR in a large multiregional study. ...
... When EMTs evaluated CPR performance of the bystanders on the scene, high-quality CPR accounted for only 6%, which was very low compared to that in a populationbased study in Japan using the same measurement method (80.7%) [11]. ...
Bystander cardiopulmonary dresuscitation (CPR) improves the survival and neurological outcomes of sudden cardiac arrest patients. The rate of bystander CPR is increasing; however, its performance quality has not been evaluated in detail. In this study, emergency medical technicians (EMTs) in the field evaluated bystander CPR quality, and we aimed to investigate the association between bystander information and CPR quality. This retrospective cohort study was based on data included in the Smart Advanced Life Support (SALS) registry between January 2016 and December 2017. We included patients older than 18 years who experienced an out-of-hospital cardiac arrest (OHCA) due to medical causes. Bystander CPR quality was judged to be “high” when the hand positions were appropriate and when compression rates of at least 100/min and compression depths of at least 5 cm were achieved. Among 6,769 eligible patients, 3,799 (58.7%) received bystander CPR, and 6% of bystanders performed high-quality CPR. After adjustment, the occurrence of cardiac arrest at home (adjusted odds ratio (aOR), 95% confidence interval (CI); 0.42, 0.27–0.64), witnessed cardiac arrest (1.45, 1.03–2.06), and younger bystander age all showed associations with one another. High-quality CPR led to a 4.29-fold increase in the chance of neurological recovery. In particular, high-quality CPR in patients aged 60 years showed a significant association compared with other age groups (7.61, 1.41–41.04). The main factor affecting CPR quality in this study was the age of the bystander, and older bystanders found it more difficult to maintain CPR quality. To improve the quality of bystander CPR, training among older bystanders should be the focus.
... Less than a third of all bystanders start cardiac resuscitation on their own (Takei et al., 2014). Two elements can explained this phenomenon (Dobbie et al., 2018;Malta Hansen et al., 2017): ...
... The more he/she feels that the situation is unstable, the more he/she will continue to guide very strictly. In line with literature (Takei et al., 2014), our results showed that few bystanders started resuscitation alone (2 out of 16). However we did not witness a "bystander effect" (Fischer et al., 2011), all participants performed cardiac massage even though their emergency training was old (in CoRe Paper -Community Engagement Proceedings of the ISCRAM Asia Pacific Conference 2022 ...
Out-of-hospital cardiac arrest (OHCA) and choking are two emergencies where the rapid action of a bystander can increase the victim's chances of survival. Few bystanders act because they are not aware of their role as the first link in the chain of survival. Working on collaboration among a local chain of survival and using applications to improve communication and provide tutorials of actions to perform can be used to overcome this issue. We investigate these elements in the context of the Geneva Chain of Survival using simulations. The results show that an optimal collaboration means a lead's handover between the intervening parties. Collaboration can be degraded by problems of communication, panic 1 , and confusion. Applications constitute a valuable addition to enhance the dispatcher's awareness and to help guide the CPR while not extending the intervention time. Finally, the debriefing that follows enables the acquisition of competencies through experiential learning that relies on emotions.
... In a real situation of cardiac arrest, Park et al. (2020) determined that people older than the age of 60 years perform CPR at a lower quality. Takei et al. (2014) confirmed that older eyewitnesses are less likely to perform CPR in reality. One possible reason is that a smaller proportion of older adults received FA training (Dobbie et al., 2018), which is a proven incentive to provide FA (Bakke et al., 2015;Tanigawa et al., 2011). ...
... Comparable with our research, the other studies ascertain different levels of psychophysical abilities to perform some of the FA measures (CPR). Mannequin studies on 19 older adult laypersons (with a median age of 78 years) performing CPR have shown disappointing results, with very low CPR quality and poor skill retention (Dorph et al., 2003), which is also confirmed by some others (Park et al., 2020;Takei et al., 2014). In contrast, Neset et al. (2010) determined that laypersons aged 50 to 76 years are capable of performing 10 minutes of CPR with satisfactory quality. ...
Relevant organizations emphasize the importance of first aid (FA) for older adults due to the increased risk of injuries and sudden illnesses in old age. Even though FA training guidelines have been developed, no program for an FA course adapted for the older adults has been formally adopted in Europe. This study’s objective is to identify older adults’ needs, beliefs, desires, advantages, and possible limitations in connection with FA. This qualitative study used semistructured interviews with 22 laypersons and retired health professionals older than 60 years old. The qualitative content analysis indicated that the major themes elicited by the older adults are motivation to participate in the FA training, older adults’ specific features as a resource or obstacle for participating in FA training, general suggestions, and content suggestions for FA training. Older adults are very differently motivated to participate in FA training due to the heterogeneity of their psychophysical abilities. They need and want to obtain additional knowledge from the field of FA and health protection for which any psychophysical limitations are not as relevant as when learning cardiopulmonary resuscitation. They want to learn how to recognize emergency situations and more about calling emergency services with the use of modern technology. In addition to cardiopulmonary resuscitation without rescue breaths, they also want to learn about topics related to the treatment of injuries. Those who had practiced FA in their work–life think that they can be a good source to transfer their knowledge to persons from their generation. While planning an FA training course, it has to be taken into consideration that older adults want a short course, adjusted to their varied psychophysical abilities. Due to the wide array of contents they want to learn, it would be reasonable to prepare a selection of different programs for short training courses.
... 14 Most OHCAs occur at home and are less likely to receive bystander CPR, which results in lower survival outcomes than those that occur in public places. [15][16][17] During OHCA cases occurring in private settings, middle-aged housewives and elderly people are most likely to be initial witnesses of the cardiac arrest and activate emergency medical services (EMS). However, most CPR education programs do not consider the characteristics of this home bystander population. ...
... 29,30 Moreover, most of the home bystanders are elderly and females who likely have less opportunities to receive CPR training program. 16 One study conducted in Korea showed that for OHCA cases occurring in private settings, only bystander CPR with dispatcher assistance showed improvement in patients' neurologic outcomes. 31 The HEROS training program was developed to increase compliance with the DA-CPR protocol offered in Korea and provide high-quality bystander CPR with confidence, focusing on middle-aged housewives and elderly people. ...
Introduction:
A new dispatcher-assisted basic life support training program, called "Home Education and Resuscitation Outcome Study (HEROS)" was developed with a goal to provide high-quality dispatcher-assisted cardiopulmonary resuscitation (CPR) training, with a focus on untrained home bystanders. This study aimed to determine whether the HEROS program is associated with improved quality in CPR performance during training and willingness to provide bystander CPR compared with other basic life support programs without dispatcher-assisted CPR (non-HEROS).
Methods:
This clustered randomized trial was conducted in 3 district health centers in Seoul. Intervention group was trained with the HEROS program and control group was trained with non-HEROS program. The primary outcome was overall CPR quality, measured as total CPR score. Secondary outcomes were other CPR quality parameters including average compression depth and rate, percentages of adequate depth, and acceptable release. Tertiary outcomes were posttraining survey results. Difference in difference analysis was performed to analyze the outcomes.
Results:
Among total 1929 trainees, 907 (47.0%) were trained with HEROS program. Compared with the non-HEROS group, the HEROS group showed higher-quality CPR performances and better maintenance of their CPR quality throughout the course (total scores of 84% vs. 80% for first session and 72% vs. 67% for last session; difference in difference of 12.2 vs. 13.2). Other individual CPR parameters also showed significantly higher quality in the HEROS group. The posttraining survey showed that both groups were highly willing to perform bystander CPR (91.4% in the HEROS vs. 92.3% in the non-HEROS) with only 3.4% of respondents in the HEROS group were not willing to volunteer compared with 6.2% in the non-HEROS group (P < 0.01).
Conclusions:
The HEROS training program helped trainees perform high-quality CPR throughout the course and enhanced their willingness to provide bystander CPR.
... A previous report showed that the 30-day survival after OHCA was significant when bystander CPR was performed within 12 [ 1 5 5 _ T D $ D I F F ] min after a sudden collapse [15]. In addition, a report from Japan indicated that laypersons who initiated CPR without DI were in many cases well-trained rescuers [16]. Thus, the effective performance time of bystander CPR would be influenced by its quality, which is related to the bystanders' need for DI. ...
... In our area, the dispatch center does not help rescuers once they have started CPR. As noted previously, bystanders who performed CPR without DI may have effective CPR training [16] so that they would be able to perform higher quality CPR than untrained or poorly trained rescuers. ...
Background We evaluated the association between survival and bystander cardiopulmonary resuscitation (CPR) with or without dispatcher instructions (DI) considering the time from emergency call receipt by the dispatch center to emergency medical services (EMS) personnel’s contact with the patient (i.e. time to EMS arrival).
Methods This prospective study conducted in Osaka City, Japan, from 2009 to 2015 included patients with medical cause-related out-of-hospital cardiac arrest who were ≥18 years old. The primary outcome was one-month favorable neurological survival. Using multiple logistic regression models, the adjusted odds ratios (AOR) of independent and DI-dependent CPR for the primary outcome were compared with no CPR. Adjustments were made for patients’ age, sex, activities of daily living before the cardiac arrest, year of cardiac arrest, location, presence or absence of witnesses, etiology of cardiac arrest, and the time from EMS contact with the patient to patient’s arrival at the hospital. The effective estimated “time to EMS arrival” was also calculated.
Results For analyses 10,925 individuals were eligible. Independent CPR had a significantly higher one-month favorable neurological survival than no CPR whereas there was no significant difference between DI-dependent CPR and no CPR (AOR, 1.90 [1.47–2.46] and 1.16 [0.91–1.47], respectively). The estimated “time to EMS arrival” for a one-month favorable neurological survival after independent CPR was ≤13 min.
Conclusions Bystander CPR that did not need DI was associated with significantly higher one-month favorable neurological survival than no CPR, with an effective estimated “time to EMS arrival” of ≤13 min.
... A total of 30 relatives of patients waited near intensive coronary care unit and in cardiology ward were approached to participate in the study [9,10]. Most of the participants belonged to the non medical profession (97%). ...
... In pre-test majority samples (53%) had fair knowledge whereas in post test most (90%) of the study participants had good knowledge [10]. Similarly in pre-test majority (57%) had moderate and (53%) had favourable attitude towards CPR in post-test. ...
... 3,9 Research involving college students demonstrated that using an unfamiliar AED model 6 month after CPR with AED training, prolonged the time to shock delivery. 7 In addition, other factors such as age 10,11 prior participation in CPR training 12 and psychophysical abilities 13 affect the quality of CPR performance. Vincent et al. 14 in a narrative review of the literature, reported that rescuers experience high levels of stress, noting some correlation between higher stress levels and lower resuscitation performance. ...
Objective
This study examined the impact of prior familiarity with automated external defibrillator (AED) models on the time of defibrillation and the emotional experiences of laypersons.
Methods
We conducted a randomized cross over simulation study with 123 participants to assess their reactions to both familiar and unfamiliar AED models. The time to first defibrillation was measured using three different AED training models, two of which were previously unknown to the participants. Additionally, semi-structured interviews were held with the participants to gather further insights.
Results
Participants took longer to initiate defibrillation with unfamiliar (M = 34 s) AEDs compared to familiar (M = 27 s) ones. This delay was accompanied by feelings of confusion, nervousness, and anxiety. Factors such as the design of the AED covers, electrodes, and buttons were identified as sources of confusion. Nonetheless, clear instructions and similarities between devices helped facilitate their use.
Conclusion
The findings suggest that AED design and familiarity with different AED designs may affect performance by laypersons. To improve user confidence, it would be useful to familiarize users with a variety of AED models as part of training initiatives. Understanding the impact of AED familiarity on rescuer’s response can guide CPR training strategies and improve outcomes for OHCA. As more AED models become available to the public, the user-friendliness of AEDs may also be improved. It is beneficial for AED manufacturers to consider the results of research when developing new models.
... A previous study reported that BCPR quality can increase by trained laypersons who are more active in providing SBCPR, and SBCPR provides better CPR quality than DACPR. SBCPR could reduce no-flow time by initiating chest compressions faster [31][32][33]. However, the BCPR quality may deteriorate owing to decreased aggressiveness of bystanders due to psychological fear of infection. ...
Bystander cardiopulmonary resuscitation (BCPR) is a significant factor in the chain of survival; however, various potential barriers are observed. We aimed to identify the impact of the coronavirus disease 2019 (COVID-19) pandemic on BCPR. This retrospective observational study used Daegu out-of-hospital cardiac arrest (OHCA) registry data of patients aged over 18 years with cardiac etiology in Daegu, Korea from 18 February 2019 to 17 February 2021. We divided BCPR into self-led (SBCPR) and dispatcher-assisted BCPR (DACPR). To determine changes in the effect of BCPR on OHCA outcomes from the COVID-19 pandemic, we performed multivariable logistic regression analyses by BCPR type. Furthermore, we performed the Wald test to identify differences in logistic regression analysis results between the two periods. A total of 1680 OHCAs were included (before-pandemic, 804; during pandemic, 876). The BCPR rate was not different between the two periods (DACPR, 43.9% vs. 42.0%; SBCPR, 18.7% vs. 18.4; p = 0.643). SBCPR showed effectiveness for OHCA outcomes before the pandemic (adjusted odds ratio (aOR), 2.59; 95% confidence interval (CI), 1.09-6.18 for survival to hospital discharge; aOR, 2.58; 95% CI, 1.03-6.46 for favorable neurological outcomes); however, it disappeared after the pandemic (aOR, 1.88; 95% CI, 0.88-4.00 for survival to hospital discharge; aOR, 1.67; 95% CI, 0.69-4.05 for favorable neurological outcomes). However, no statistical difference was observed in the Wald test (survival to hospital discharge, p = 0.586; favorable neurologic outcomes, p = 0.504). A decreasing trend in the effect of SBCPR on OHCA outcomes was observed during the COVID-19 pandemic; however, no statistically significant difference was observed compared with that before the pandemic. Keywords Bystander cardiopulmonary resuscitation; COVID-19; Outcomes; Out-of-hospital cardiac arrest; Pandemic
... Similarly, Park et al. evaluated chest compression quality through subjective observations by EMTs to investigate factors linked to high-quality bystander CPR. 23 This study also revealed no variation in CPR quality based on bystander sex and highlighted bystander age as the primary factor influencing CPR quality. One study from Korea highlighted the effectiveness of CPR performed by bystanders of different sexes on OHCA patient outcomes in the clinical setting; however, this study was biased due to the differences in previous CPR education between males and females, with the majority of males receiving CPR training in the military. ...
Background
The impact of the sex of bystanders who initiate cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patients has not been fully elucidated. This study aims to investigate the association between the sex of bystanders who perform CPR and the clinical outcomes of OHCA patients in real-world clinical settings.
Methods
We conducted a retrospective, observational study using data from the Okayama City Fire Department in Japan. Patients were categorized based on bystanders’ sex. Our primary outcomes were return of spontaneous circulation (ROSC). Our secondary outcome was 30-day survival and 30-day favorable neurological outcome, defined as Cerebral Performance Category score of 1 or 2. Multivariable logistic regression analysis was used to examine the association between these groups and outcomes.
Results
The study included 3,209 patients with a comparable distribution of male (1,540 patients: 48.0%) and female bystanders (1,669 patients: 52.0%) between the groups. Overall, 221 (6.9%) ROSC at hospital arrival, 226 (7.0%) patients had 30-day survival, and 121 (3.8%) patients had 30-day favorable neurological outcomes. Bystander sex (female as reference) did not contribute to ROSC at hospital arrival (adjusted OR [aOR] 1.11, 95% CI: 0.76–1.61), 30-day survival (aOR 1.23, 95% CI: 0.83–1.82), or 30-day favorable neurological outcomes (aOR 0.66, 95% CI: 0.34–1.27). Basic life support education experience was a bystander factor positively associated with ROSC. Patient factors positively associated with ROSC were initial shockable rhythm and witness of cardiac arrest.
Conclusion
There were no differences in ROSC, 30-day survival, or 30-day neurological outcomes in OHCA patients based on bystander sex.
... Accordingly, Leary et al. [48] confirmed that women and the older people perform shallower chest compressions on average. Similar findings were also confirmed by other researchers [49][50][51][52]. Nonetheless, we found that older people with preserved physical performance were able to effectively perform CPR on the Resusci Anne device for one minute. ...
Background
Older people need to acquire knowledge and skills at first aid (FA) training tailored to them. Our research aimed to evaluate an FA training programme adapted for older people. We assumed that satisfaction with FA training, as well as knowledge of FA, would be higher among older people who received training according to an adapted programme compared to those who received training according to the existing programme for the general public.
Methods
We trained older people according to the existing FA programme for the general public and according to a new FA training programme adapted for older people. The new training program is shorter and focuses on FA contents that are more relevant for older people. We evaluated participants with a general assessment questionnaire (consisting of items regarding satisfaction, comprehensibility, length, and physical difficulty), a test on theoretical FA knowledge, and a test on practical cardiopulmonary resuscitation (CPR) knowledge. To ensure the homogeneity of the groups and to verify the impact on the results of the test of practical CPR knowledge, we also tested the participants regarding their psychophysical capabilities.
Results
A total of 120 people completed the free FA training sessions. The general assessment questionnaire score of participants who were trained based on the new FA training program was 19.3 (out of 20), which was statistically significantly (p < 0.05) higher than that of those trained based on the old program (general assessment score of 17.1). Participants who were trained based on the new program scored an average of 8.6 points on the theoretical FA knowledge test, while those who were trained based on the old program scored an average of 7.1 points, which was statistically significantly (p < 0.05) lower. In both programs, the same average scores (7.5 out of 10 points) on the practical CPR knowledge test was achieved. However, participants who participated in the FA course adapted for the older people gained practical CPR knowledge in a shorter time. Older people with a greater psychophysical capacity were more successful in performing CPR, regardless of which FA training programme they received.
Conclusions
The effectiveness of FA training is greater if older people are trained in accordance with a targeted programme adapted to the psychophysical limitations of the older people.
... First, we could not account for factors such as the quality of the bystander CPR, which may have affected our findings. Previous studies have shown that there is a positive correlation between the number of bystanders and the quality of basic life support [25][26][27][28] ; however, in cases where OHCA occurs in residential locations, the number of witnesses is usually limited to family members, which may have limited the quality of BLS and affected the proportions of favourable neurologic outcomes. Second, since our study is retrospective and observational in nature, it is subject to potential biases and confounding factors; therefore, our findings should be interpreted with caution. ...
Aim
We 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).
Methods
This 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.
Results
Among 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.
Conclusion
When 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.
... Lower compression depth than recommended is frequently observed in DA-CPR, 12,13 and spontaneous CPR was reported to be of higher quality than DA-CPR. 14 Although the differences in the beneficial effects of DA-PCR and spontaneous CPR on the neurological outcomes of OHCA are still inconclusive, some reports have indicated better neurological outcomes in patients who underwent spontaneous CPR compared with DA-CPR. 15,16 Therefore, the effectiveness of spontaneous CPR possibly masked the effectiveness of CPR instructions. ...
Aim
To determine whether dispatcher‐provided cardiopulmonary resuscitation (CPR) instructions improve the outcomes of out‐of‐hospital cardiac arrest (OHCA).
Methods
Cases registered in the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest (JAAM‐OHCA) Registry between June 2014 and December 2019 were included. Cases in which the dispatcher provided CPR instructions to the bystander were included in the “Instructions” group”, and cases without CPR instructions were included in the “No Instructions” group. The primary outcome was the proportion of patients with a favorable neurological outcome, defined as a Glasgow–Pittsburgh cerebral performance category scale of 1 to 2 at 1 month after OHCA.
Results
Overall, 51,199 patients with OHCA were registered in the JAAM‐OHCA Registry during the study period. Of these, 33,745 were eligible for the study, with 16,509 in the Instructions group and 17,236 in the No Instructions group. The proportion of patients with a favorable neurological outcome at 1 month after OHCA was inferior in the Instructions group than in the No Instructions group (2.3% versus 3.0%, p < 0.001). After adjustment for patient background characteristics, no association was found between CPR instructions provided by a dispatcher and favorable neurological outcomes at 1 month after OHCA (adjusted odds ratio, 1.000; 95% confidence interval, 0.869–1.151, p = 0.996).
Conclusion
The present study found no clear clinical benefit of dispatcher‐provided CPR instructions on the neurological outcomes of cases with OHCA.
... Another limitation is the small study population. Furthermore, the lay rescuers participating in this study were younger and proportionally more male than in cases of real OHCA [35]. It can be expected that younger rescuers are physically fitter and have a quicker response time. ...
Background:
Telephone-Cardiopulmonary Resuscitation (T-CPR) significantly increases rate of bystander resuscitation and improves patient outcomes after out-of-hospital cardiac arrest (OHCA). Nevertheless, securing correct execution of instructions remains a difficulty. ERC Guidelines 2021 recommend standardised instructions with continuous evaluation. Yet, there are no explicit recommendations on a standardised wording of T-CPR in the German language. We investigated, whether a modified wording regarding check for breathing in a German T-CPR protocol improved performance of T-CPR.
Methods:
A simulation study with 48 OHCA scenarios was conducted. In a non-randomised trial study lay rescuers were instructed using the real-life-CPR protocol of the regional dispatch centre and as the intervention a modified T-CPR protocol, including specific check for breathing (head tilt-chin lift instructions). Resuscitation parameters were assessed with a manikin and video recordings.
Results:
Check for breathing was performed by 64.3% (n = 14) of the lay rescuers with original wording and by 92.6% (n = 27) in the group with modified wording (p = 0.035). In the original wording group the head tilt-chin manoeuvre was executed by 0.0% of the lay rescuers compared to 70.3% in the group with modified wording (p < 0.001). The average duration of check for breathing was 1 ± 1 s in the original wording group and 4 ± 2 s in the group with modified wording (p < 0.001). Other instructions (e.g. check for consciousness and removal of clothing) were well performed and did not differ significantly between groups. Quality of chest compression did not differ significantly between groups, with the exception of mean chest compression depth, which was slightly deeper in the modified wording group.
Conclusion:
Correct check for breathing seems to be a problem for lay rescuers, which can be decreased by describing the assessment in more detail. Hence, T-CPR protocols should provide standardised explicit instructions on how to perform airway assessment. Each protocol should be evaluated for practicability.
... Persons who are trained in CPR have demonstrated an understanding of the core principles behind the recognition and initial resuscitation of persons who are or may be in cardiac arrest; the quality of CPR by the trained is likely superior to a person given instructions over the phone (T-CPR). [19][20][21] As observed in our study, short call to scene times were associated with survival and may be attributed to the performance of high-quality CPR compared to a possibly untrained person performing CPR for the first time with telephone instruction. There is likely a temporal component of delay associated with those having to rely on T-CPR to prompt the initiation of compressions/early defibrillation and automatic external defibrillator use. ...
Aim of the Study
While out-of-hospital cardiac arrest (OHCA) is associated with poor survival, early bystander CPR (B-CPR) and telephone CPR (T-CPR) improves survival from OHCA. American Heart Association (AHA) Scientific Statements outline recommendations for T-CPR. We assessed these recommendations and hypothesized that meeting performance standards is associated with increased likelihood of survival. Additional variables were analyzed to identify future performance measurements.
Methods
We conducted a retrospective cohort study of non-traumatic, adult, OHCA using the Singapore Pan-Asian Resuscitation Outcomes Study. The primary outcome was likelihood of survival; secondary outcomes were pre-hospital Return of Spontaneous Circulation (ROSC) and B-CPR.
Results
From 2012-2016, 2,574 arrests met inclusion criteria. Mean age was 68±15; of 2,574, 1,125 (44%) received T-CPR with 5% (135/2574) survival. T-CPR cases that met the Lerner et al. performance metrics analyzed, demonstrated no statistically significant association with survival. Cases which met the Kurz et al. criteria, “Time for Dispatch to Recognize Need for CPR” and “Time to First Compression,” had adjusted odds ratios of survival of 1.01 (95% CI:1.00, 1.02; p=<0.01) and 0.99 (95% CI:0.99, 0.99; p=<0.01), respectively. Identified barriers to CPR decreased the odds of T-CPR and B-CPR being performed. Patients with prehospital ROSC had higher odds of B-CPR being performed. EMS response time < 8 minutes was associated with increased survival among patients receiving T-CPR.
Conclusion
AHA scientific statements on T-CPR programs serve as ideal starting points for increasing the quality of T-CPR systems and patient outcomes. More work is needed to identify other system performance measures.
... In real situations of cardiac arrest, Park et al. [40] found that people over 60 years of age performed lower quality CPR. Notably, Takei and colleagues [41] confirmed that, in reality, older eyewitnesses are less likely to perform CPR. The reasons and sources of acquiring FA knowledge in other medical situations could also be explored in more detail. ...
Background
In the event of a sudden illness or injury, elderly individuals are often dependent on self-help and mutual assistance from partners. With poor access to medical services during natural and other disasters, the importance of first aid knowledge of elderly individuals increases even more. We assessed the opinions of different generations of Slovenian population regarding the importance of knowing the basic first aid measures. In addition, we aimed to examine the knowledge of first aid in the most common emergencies that threaten elderly people’s health and lives, focusing on the knowledge of elderly.
Methods
A structured questionnaire was conducted with a representative Slovenian adult population ( n = 1079). Statistically significant differences in average ratings of the importance of first aid knowledge were compared among different age groups with one-way ANOVA followed by a post hoc test. Significant differences in percentages of correct answers in particular cases of health conditions between different age groups were determined using the χ 2 test followed by post hoc tests.
Results
Slovenes are well aware of the importance of first aid knowledge and feel personally responsible for acquiring this knowledge. The general opinion is that older retirees need less first aid knowledge than individuals in younger populations. We found a high level of knowledge about symptoms and first aid measures for some of the most common health conditions that occur in old age. The level of knowledge in the group of the oldest respondents was comparable with that of younger age groups. However, their recognition of health conditions was also somewhat worse, especially when recognising the symptoms and signs of hypoglycaemia and heart attack. Most of the tested knowledge did not depend on a person’s age but on the time since that person was last educated in first aid.
Conclusions
The knowledge of people older than 80 years is somewhat poorer than that in the younger population, mainly because too much time has passed since they were last educated in first aid. Public awareness of first aid needs to be increased and appropriate guidelines should be given with a focus on the elderly population.
... On account of complex procedures in resuscitation, the engagement of multiple rescuers is indispensable to guarantee high-quality CPR for patients with OHCA. It has been revealed that the presence of multiple bystanders is an independent factor positively correlated with high-performance CPR (6). Notably, 43.1% of OHCA rescue events are with multiple bystanders on the scene, which enables the implementation of the resuscitation procedures by teams of responders instead of isolated rescuers (7). ...
Objective
To design an innovative team-based cardiopulmonary resuscitation (CPR) educational plan for multiple bystanders and evaluate whether it was associated with better teamwork and higher quality of resuscitation.
Methods
The team-based CPR plan defined the process for a three-person team, emphasize task allocation, leadership, and closed-loop communication. Participants qualified for single-rescuer CPR skills were randomized into teams of 3. The teamwork performance and CPR operation skills were evaluated in one simulated cardiac arrest scenario before and after training on the team-based CPR plan. The primary outcomes were measured by the Team Emergency Assessment Measure (TEAM) scale and chest compression fraction (CCF).
Results
Forty-three teams were included in the analysis. The team-based CPR plan significantly improved the team performance (global rating 6.7 ± 1.3 vs. 9.0 ± 0.7, corrected p < 0.001 after Bonferroni's correction). After implementing the team-based CPR plan, CCF increased [median 59 (IQR 48–69) vs. 64 (IQR 57–71%)%, corrected p = 0.002], while hands-off time decreased [median 233.2 (IQR 181.0–264.0) vs. 207 (IQR 174–222.9) s, corrected p = 0.02]. We found the average compression depth was significantly improved through the team-based CPR training [median 5.1 (IQR 4.7–5.6) vs. 5.3 (IQR 4.9–5.5) cm, p = 0.03] but no more significantly after applying the Bonferroni's correction (corrected p = 0.35). The compression depths were significantly improved by collaborating and exchanging the role of compression among the participants after the 6th min.
Conclusion
The team-based CPR plan is feasible for improving bystanders teamwork performance and effective for improving resuscitation quality in prearrival care. We suggest a wide application of the team-based CPR plan in the educational program for better resuscitation performance in real rescue events.
... 72 Έχει παρατηρηθεί ότι οι συγγενείς των θυμάτων συνήθως δεν εφαρμόζουν καλής ποιότητας ΚΑΡΠΑ, ιδίως όταν είναι ηλικιωμένοι και η ΚΑ συμβαίνει στο σπίτι τους. 73 Επιπρόσθετα, οι ηλικιωμένοι συνήθως δεν επιλέγουν να ακολουθήσουν προγράμματα εκπαίδευσης που να σχετίζονται με τη διαχείριση της ΚΑ. 20,74 Η αποτελεσματικότητα όμως της ΚΑΡΠΑ και τα ποσοστά επιβίωσης εξαρτώνται από τις δεξιότητες και την ικανότητα του παρευρισκόμενου να ακολουθεί τις οδηγίες. 75 Επομένως, η εκπαίδευση των πολιτών στην αντιμετώπιση της ΚΑ είναι υψίστης σημασίας για την ενίσχυση της επιβίωσης. ...
E-health services have a variety of applications in the case of both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest
(IHCA). Every aspect of telemedicine belongs to the field of e-health services. Several technological means are applied in OHCA,
including the use of smartphones with focused applications, video services, and drones. Health care professionals can derive a variety
of benefits from telemedicine services, including an electronic form of early warning system, telemetry, telemedicine consultation,
for treating cardiac arrest. The education and training of both health professionals and citizens are crucial for the optimal exploitation of these new technologies. E-health services promote participation and accessibility for all, enhance the role and performance of health professionals, and ultimately improve the quality of health care provision.
... Therefore, these factors potentially associated with BCPR quality might affect the quality of the study results. 35 Fourth, no comparative analysis was performed with the results of other disasters. Fifth, since this study is based on one disaster that occurred in Japan, it is unclear whether the results will apply to other disasters as well. ...
Importance:
The effect of large-scale disasters on bystander cardiopulmonary resuscitation (BCPR) performance is unknown.
Objective:
To investigate whether and how large-scale earthquake and tsunami as well as subsequent nuclear pollution influenced BCPR performance for out-of-hospital cardiac arrest (OHCA) witnessed by family and friends/colleagues.
Design and setting:
Retrospective analysis of prospectively collected, nationwide, population-based data for OHCA cases.
Participants:
From the nationwide OHCA registry recorded between 11 March 2010 and 1 March 2013, we extracted 74 684 family-witnessed and friend/colleague-witnessed OHCA cases without prehospital physician involvement.
Exposure:
Earthquake and tsunamis that were followed by nuclear pollution and largely affected the social life of citizens for at least 24 weeks.
Main outcome and measure:
Neurologically favourable outcome after 1 month, 1-month survival and BCPR.
Methods:
We analysed the 4-week average trend of BCPR rates in the years affected and before and after the disaster. We used univariate and multivariate logistic regression analyses to investigate whether these disasters affected BCPR and OHCA results.
Results:
Multivariable logistic regression for tsunami-affected prefectures revealed that the BCPR rate during the impact phase in 2011 was significantly lower than that in 2010/2012 (42.5% vs 48.2%; adjusted OR; 95% CI 0.82; 0.68 to 0.99). A lower level of bystander compliance with dispatcher-assisted CPR instructions (62.1% vs 69.5%, 0.72; 95% CI 0.57 to 0.92) in the presence of a preserved level of voluntary BCPR performance (23.6% vs 23.8%) was also observed. Both 1-month survival and neurologically favourable outcome rates during the impact phase in 2011 were significantly poorer than those in 2010/2012 (8.5% vs 10.7%, 0.72; 95% CI 0.52 to 0.99, 4.0% vs 5.2%, 0.62; 95% CI 0.38 to 0.98, respectively).
Conclusion and relevance:
A large-scale disaster with nuclear pollution influences BCPR performance and clinical outcomes of OHCA witnessed by family and friends/colleagues. Basic life-support training leading to voluntary-initiated BCPR might serve as preparedness for disaster and major accidents.
... Moreover, nursing homes are likely to have multiple and more physically capable rescuers than an older spouse in a private residence, and these factors are independent predictors of good-quality bystander CPR. 26 Fourth, we observed a significantly higher rate of shock delivery using public-access AEDs in the nursing home group relative to the private residence group. Public-access AED deployment in nursing homes combined with the involvement of rescuers who were aware and trained in AED use may partly explain our results. ...
Objective:
To investigate the characteristics and outcomes of patients who experienced cardiac arrest in nursing homes compared with those in private residences and determine prognostic factors for survival.
Design:
This was a retrospective study that analyzed data from an Utstein-style registry of the Tokyo Fire Department.
Setting and participants:
We identified patients age ≥65 years who experienced cardiac arrest in a nursing home or private residence from the population-based registry of out-of-hospital cardiac arrests in Tokyo, Japan, from 2014 to 2018.
Methods:
Patients were grouped into the nursing home or the private residence groups according to their cardiac arrest location. We compared the characteristics and outcomes between the 2 groups and determined prognostic factors for survival in the nursing home group. The primary outcome was 1-month survival after cardiac arrest.
Results:
In total, 37,550 patient records (nursing home group = 6271; private residence group = 31,279) were analyzed. Patients in the nursing home group were significantly older and more often had witnessed arrest, bystander cardiopulmonary resuscitation (CPR), and shock delivery using an automated external defibrillator. The 1-month survival rate was significantly higher in the nursing home group (2.6% vs 1.8%, P < .001). In the best scenario (daytime emergency call, witnessed cardiac arrest, bystander CPR provided), the 1-month survival rate after cardiac arrest in the nursing home group was 8.0% (95% confidence interval 6.4-9.9%), while none survived if they had neither witness nor bystander CPR.
Conclusions and implications:
Survival outcome was significantly better in the nursing home group than in the private residence group and was well stratified by 3 prognostic factors: emergency call timing, witnessed status, and bystander CPR provision. Our results suggest that a decision to withhold vigorous treatment solely based on nursing home residential status is not justified, while termination of resuscitation may be determined by considering significant prognostic factors.
... In a real situation of cardiac arrest, Park et al. [51] found that people over 60 perform CPR at a lower quality. Notably, Takei and colleagues [52] confirmed that older eyewitnesses are less likely to perform CPR in reality. The reasons for and sources of acquiring FA knowledge considering other opportunities and possibilities (i.e. in the mass media, at the family doctor) were also not explored in more detail in the present study. ...
We aimed to determine the needs and opportunities of older lay people to obtain first aid skills. We determined the level of theoretical knowledge of performing first aid with a structured questionnaire, performed on the sample of 842 adult inhabitants of Slovenia. The method of sampling was balanced by using a system of sampling weights in order to correct deviations in the structure of the sample to the level of the population structure. We also checked their attitude regarding the renewal of first aid knowledge. The level of self-assessment of first aid knowledge and actual theoretical knowledge of proper first aid measures typically decreased with age. The percentage of those who had attended first aid courses at any time was statistically significantly lower among respondents over the age of 60; 38% of elderly respondents thought they needed to renew their first aid knowledge, and 44% would attend a suitable first aid course. None of the 29 European Red Cross and Red Crescent Societies member states that responded have a developed a formally adopted first aid program to train the elderly. A tailored first aid training program for the elderly could be one of the many steps that should be taken to ensure adequate health care for the elderly population.
... In a real situation of cardiac arrest, Park et al. [50] found that people over 60 perform CPR at a lower quality. Takei and colleagues [51] con rmed that older eyewitnesses are less likely to perform CPR in reality. In addition, our research's limitation is also that the questionnaire was focused to be made on a representative sample of all the population of Slovenia, but not on a representative sample of the elderly, although the total number of respondents older than 60 was not small (n = 402). ...
Background: The vulnerability of the elderly population increases with natural and other disasters. Consequent social isolation affects their health. Health problems, which can lead to emergencies, can be an even greater burden during times of social isolation. Early identification and action in terms of first aid for the most common emergencies that threaten an individual’s health or life affect these conditions. We aimed to examine the knowledge of first aid in the most common emergencies that threaten elderly people’s health and life among a Slovenian population, focusing on the elderly people’s knowledge.
Methods: A cross-sectional population-based survey was conducted on 1079 respondents. Data were collected with a structured questionnaire. Statistically significant differences in average ratings among different age groups were determined with one-way ANOVA followed by a post hoc test. Significant differences between the categories of age groups were determined using the χ2 square test followed by appropriate post hoc testing for multiple comparisons. By regression analysis (Spearman’s rho and Pearson Correlation), we determined the correlations.
Results: Our survey results indicated that Slovenes are aware of the importance of first aid knowledge and feel personally responsible for acquiring and developing this knowledge. The most surprising finding of our research is the high level of knowledge of recognising some of the most common conditions that occur in old age and taking action in response to them. Simultaneously, most of the knowledge tested does not depend on the person’s age or the time since that person was last educated in first aid. Nevertheless, out of all age groups, those older than 80 stand out. The respondents’ general opinion is that the elderly over 80 years of age need less first aid knowledge. Furthermore, their first aid knowledge is also somewhat worse, especially when recognising sudden illness.
Conclusions: Older than 80 are the most vulnerable psycho physically and socially, especially in natural and other disasters such as a pandemic. In the same time, their disaster preparedness from a first aid perspective is poor. There is a need to raise awareness and provide guidance on emergency preparedness to older people.
... It remains uncertain if the inevitable degeneration of shockable rhythm could be slowed even more using a different CPR strategy by increasing the proportion of lay person able to provide CPR. 30,31 Limitations The observational nature of the present study is its main limitation. The NFT and BLFT needed to be approximated (using the delays from elapsed time from call dispatch to first rhythm) because the precise delay before the initiation of CPR was not recorded. ...
Aims
For out-of-hospital cardiac arrest (OHCA) patients, the influence of the delay before the initiation of resuscitation, termed the no-flow time (NFT), and duration of bystander-only resuscitation low-flow time (BLFT) on the type of electrical rhythm observed has not been well described. The objective of this study is to determine the relationship between NFT, BLFT and the likelihood of a shockable rhythm over time.
Methods
Using a North American prospective registry (2005-2015; mostly urban settings), we selected adult (18 years and over) patients who experienced a witnessed OHCA from a suspected cardiac etiology. Patients with an emergency medical services witnessed OHCA were only included in sensitivity analyses. The association between the NFT, BLFT and the presence of a shockable rhythm was evaluated using a multivariable logistic regression adjusting for the registry version, age, sex, and public location.
Results
A total of 229,632 patients were logged in the registry, 50,957 of whom were included. Of these, 17,704 (34.7%) had an initial shockable rhythm. After the first minute, a significant decrease over time in the occurrence of shockable rhythm is observed but is slower when bystander cardiopulmonary resuscitation (CPR) is provided (each supplemental minute of BLFT: adjusted odds ratio=0.95, 95%CI=0.94-0.95; each supplemental minute of NFT: adjusted odds ratio=0.91, 95%CI=0.90-0.91]).
Conclusions
In this large observational study, we were able to demonstrate that longer NFT were associated with lower odds of shockable presenting rhythms. Bystander CPR significantly mitigates the degradation of shockable rhythms over time, strengthening the need to improve bystander CPR rates around the world.
... Studies comparing DA-assisted CPR and bystander initiated CPR prior to the call have found no significant difference in survival between the two groups [13,26]. However, Takei et al. showed significantly more good quality CPR compared to low quality CPR (OR 2.67) in bystander-initiated CPR prior to the call to the EMDC [27]. It is fair to assume that bystanders who start CPR without instructions are at least willing to perform CPR. ...
Background
The European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPR prior ), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPR prior ).
Methods
Baseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPR prior and CPR prior and data collection continued until 200 cases were collected in the NO-CPR prior -group.
Results
NO-CPR prior OHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPR prior comprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances.
Conclusions
We observed variations in OHCA recognition in 71–96% and dispatcher assisted-CPR were provided in 50–80% in NO-CPR prior calls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.
... 4,31 Moreover, multiple physically capable rescuers are more likely to be present in a busy railroad station, and this factor is an independent predictor of good-quality bystander CPR. 32 Finally, we observed a relatively high rate of public-access AED use for cardiac arrest with ventricular fibrillation. A systematic review of barriers to public-access defibrillation revealed that public-access AED use is reduced because of unawareness and unwillingness to use AEDs among bystanders, ignorance of AED locations, and delayed access. ...
Aim
To investigate the effectiveness of public-access automated external defibrillators (AEDs) at Tokyo railroad stations.
Methods
We analysed data from a population-based registry of out-of-hospital cardiac arrests in Tokyo, Japan (2014–2018). We identified patients aged ≥18 years who experienced bystander-witnessed cardiac arrest due to ventricular fibrillation of presumed cardiac origin at railroad stations. The primary outcome was survival at 1 month after cardiac arrest with favourable neurological outcomes (cerebral performance category 1–2).
Results
Among 280 eligible patients who had bystander-witnessed cardiac arrest and received defibrillation at railroad stations, 245 patients (87.5%) received defibrillation using public-access AEDs and 35 patients (12.5%) received defibrillation administered by emergency medical services (EMS). Favourable neurological outcomes at 1 month after cardiac arrest were significantly more common in the group that received defibrillation using public-access AEDs (50.2% vs. 8.6%; adjusted odds ratio: 11.2, 95% confidence interval: 1.43–88.4) than in the group that received defibrillation by EMS. Over a 5-year period, favourable neurological outcomes at 1 month after cardiac arrest of 101.9 cases (95% confidence interval: 74.5–129.4) were calculated to be solely attributable to public-access AED use. The incremental cost-effectiveness ratio to gain one favourable neurological outcome obtained from public-access AEDs at railroad stations was lower than that obtained from nationwide deployment (48.5 vs. 2133.4 AED units).
Conclusion
Deploying public-access AEDs at Tokyo railroad stations presented significant benefits and cost-effectiveness. Thus, it may be prudent to prioritise metropolitan railroad stations in public-access defibrillation programs.
... Secondly, bystanders' backgrounds such as age, bystander-patient relationship and training experience and locations of OHCA were not included in the analysis because of lack of these data in unwitnessed cases. Therefore, these factors, which are associated with BCPR quality [17,19], might affect the study results. Thirdly, the time of collapse or intervals from this time point was unavailable in unwitnessed cases and was not included in the multiple regression analyses. ...
Objectives: This study aimed to analyse the effects of rescue breath and chest compression combinations in bystander cardiopulmonary resuscitation (BCPR) with and without dispatch-assisted CPR (DA) on the outcomes between unwitnessed and bystander-witnessed out-of-hospital cardiac arrest (OHCA).
Design and Settings: This retrospective study analysed the prospectively collected data of 212,003 unwitnessed and 117,920 bystander-witnessed OHCA cases between 2014 and 2016 in Japan, with BCPR classification based on two clinical components (DA provision [with or without DA] and combination of breaths and compressions [standard or compression-only]).
Main outcome measures: Neurologically favourable outcome at 1 month
Results: In univariate analysis, unwitnessed cases had no significant association of BCPR with the overall neurologically favourable outcome (provided vs not provided, 0.65% [686/106,152] vs 0.66% [694/105,851]) compared with bystander-witnessed cases (5.6% [3,538/62,814] vs 3.5% [1,911/55,106]). After BCPR classification by two clinical components, the outcome of unwitnessed cases was improved by standard BCPR with DA (0.88% [69/7,807], adjusted OR; 95% CI, 1.38; 1.05–1.81) and compression-only (1.04% [161/15,497], 1.49;1.23–1.80) and standard (1.18% [41/3,463], 1.71; 1.21–2.43) BCPR without DA, but not by compression-only BCPR with DA (0.52% [415/79,385], 0.88; 0.76–1.01). According to multivariable logistic regression analysis focusing on the two clinical components only in cases with BCPR, neurologically favourable outcomes were worse in DA provision (0.76; 0.60–0.97) but better in standard BCPR, (1.27; 1.01–1.60) without significant interaction (P = 0.16), in unwitnessed cases. In bystander-witnessed cases, DA provision was associated with better outcomes (1.27; 1.01–1.60), with significant interaction (P = 0.03).
Conclusions: Compared with no BCPR, compression-only BCPR with DA does not improve the neurologically favourable outcomes, and standard BCPR without DA is ideal in unwitnessed OHCA cases. Education on standard CPR and chest compression-only CPR as an option should be maintained because numerous OHCA cases are not witnessed by bystanders.
... We observed that 60% of OHCA had ≥2 rescuers on scene, similar to prior reports. 23 Multiple rescuers were most common during unassisted CPR (82%), followed by TCPR (52%), and least common when no CPR was performed (44%). Multiple rescuers were associated with higher quality CPR performance in a dose-dependent manner such that average fraction and rate increased as the number of rescuers increased from 1, to 2, to ≥3 bystanders. ...
Background
Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out‐of‐hospital cardiac arrest. We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator CPR (TCPR).
Methods and Results
We investigated non‐traumatic out‐of‐hospital cardiac arrest occurring in a large metropolitan emergency medical system during a 6‐month period. Information about bystander care was ascertained through review of the 9‐1‐1 recordings in addition to emergency medical system and hospital records to determine bystander CPR status (none versus TCPR versus unassisted), the number of bystanders on‐scene, and CPR performance metrics of compression fraction and compression rate. Of the 428 eligible out‐of‐hospital cardiac arrest, 76.4% received bystander CPR including 43.7% unassisted CPR and 56.3% TCPR; 35.2% had one bystander, 33.3% had 2 bystanders, and 31.5% had ≥3 bystanders. Overall compression fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (fraction=52%, rate=87 per minute for TCPR versus fraction=69%, rate=102 for unassisted CPR, P <0.05 for each comparison) and the number of bystanders (fraction=55%, rate=87 per minute for 1 bystander, fraction=59%, rate=89 for 2 bystanders, fraction=65%, rate=97 for ≥3 bystanders, test for trend P <0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an automated external defibrillator (8.0%).
Conclusions
Bystander CPR quality as gauged by compression fraction and rate approached guideline goals though performance depended upon the type of CPR and number of bystanders.
... Of these, early bystander interventions, particularly cardiopulmonary resuscitation (CPR) with early defibrillation, can have the greatest potential impact on outcome. 1 Rapid recognition of cardiac arrest by the emergency medical dispatcher followed by instructing the caller to promptly perform CPR and retrieve an automated external defibrillator are essential steps. [2][3][4][5] Such guidance is contingent on prompt recognition of OHCA by the dispatcher. In 2018, the overall rate of CPR by bystanders was 77% in Denmark, 6 which corresponded to the rate of dispatcher-recognized OHCA at the Copenhagen Emergency Medical Services (EMS). ...
Importance
Emergency medical dispatchers fail to identify approximately 25% of cases of out-of-hospital cardiac arrest (OHCA), resulting in lost opportunities to save lives by initiating cardiopulmonary resuscitation.
Objective
To examine how a machine learning model trained to identify OHCA and alert dispatchers during emergency calls affected OHCA recognition and response.
Design, Setting, and Participants
This double-masked, 2-group, randomized clinical trial analyzed all calls to emergency number 112 (equivalent to 911) in Denmark. Calls were processed by a machine learning model using speech recognition software. The machine learning model assessed ongoing calls, and calls in which the model identified OHCA were randomized. The trial was performed at Copenhagen Emergency Medical Services, Denmark, between September 1, 2018, and December 31, 2019.
Intervention
Dispatchers in the intervention group were alerted when the machine learning model identified out-of-hospital cardiac arrest, and those in the control group followed normal protocols without alert.
Main Outcomes and Measures
The primary end point was the rate of dispatcher recognition of subsequently confirmed OHCA.
Results
A total of 169 049 emergency calls were examined, of which the machine learning model identified 5242 as suspected OHCA. Calls were randomized to control (2661 [50.8%]) or intervention (2581 [49.2%]) groups. Of these, 336 (12.6%) and 318 (12.3%), respectively, had confirmed OHCA. The mean (SD) age among of these 654 patients was 70 (16.1) years, and 419 of 627 patients (67.8%) with known gender were men. Dispatchers in the intervention group recognized 296 confirmed OHCA cases (93.1%) with machine learning assistance compared with 304 confirmed OHCA cases (90.5%) using standard protocols without machine learning assistance (P = .15). Machine learning alerts alone had a significantly higher sensitivity than dispatchers without alerts for confirmed OHCA (85.0% vs 77.5%; P < .001) but lower specificity (97.4% vs 99.6%; P < .001) and positive predictive value (17.8% vs 55.8%; P < .001).
Conclusions and Relevance
This randomized clinical trial did not find any significant improvement in dispatchers’ ability to recognize cardiac arrest when supported by machine learning even though artificial intelligence did surpass human recognition.
Trial Registration
ClinicalTrials.gov Identifier: NCT04219306
... The quality of BCPR and bystander-initiated resuscitation efforts for BLS are affected by the number of rescuers involved in providing BLS. 29 There may be fewer rescuers during times other than school hours on school days at school, likely reducing the survival outcome. For BLS education at school, in addition to the ability to voluntarily perform high-quality CPR as the only rescuer, taking measures to increase the proportion of BCPR by training 30 and learning to recognise cardiac arrest early are important. ...
Objective
To investigate the association of school hours with outcomes of schoolchildren with out-of-hospital cardiac arrest (OHCA).
Methods
From the 2005–2014 nationwide databases, we extracted the data for 1660 schoolchildren (6–17 years) with bystander-witnessed OHCA. Univariate analyses followed by propensity-matching procedures and stepwise logistic regression analyses were applied. School hours were defined as 08:00 to 18:00.
Results
The neurologically favourable 1-month survival rate during school hours was better than that during non-school hours only on school days: 18.4% and 10.5%, respectively. During school hours on school days, patients with OHCA more frequently received bystander cardiopulmonary resuscitation (CPR) and public access defibrillation (PAD), and had a shockable initial rhythm and presumed cardiac aetiology. The neurologically favourable 1-month survival rate did not significantly differ between school hours on school days and all other times of day after propensity score matching: 16.4% vs 16.1% (unadjusted OR 1.02; 95% CI 0.69 to 1.51). Stepwise logistic regression analysis during school hours on school days revealed that shockable initial rhythm (adjusted OR 2.44; 95% CI 1.12 to 5.42), PAD (adjusted OR 3.32; 95% CI 1.23 to 9.10), non-exogenous causes (adjusted OR 5.88; 95% CI 1.85 to 20.0) and a shorter emergency medical service (EMS) response time (adjusted OR 1.15; 95% CI 1.02 to 1.32) and witness-to-first CPR interval (adjusted OR 1.08; 95% CI 1.01 to 1.15) were major factors associated with an improved neurologically favourable 1-month survival rate.
Conclusions
School hours are not an independent factor associated with improved outcomes of OHCA in schoolchildren. The time delays in CPR and EMS arrival were independently associated with poor outcomes during school hours on school days.
... 7 Minerva anestesiologica 743 ka and co-workers who showed that bystander cPr was initiated to a lesser extent by family members, compared with friends, colleagues or others, 25 implying longer no-flow times. In addition, takei and co-workers demonstrated that the quality of cPr differed depending on where the oHca occurred and whether the lay-rescuer was related to the victim or not, 26 which might translate to a lower quality of cPr, due to fatigue or lack of training. Poor outcomes amongst those arresting at place of residence is indeed a problem that demands further attention and the present findings highlight the need to improve early interventions prior to eMs arrival. ...
Background:
The majority of out-of-hospital cardiac arrests (OHCAs) occur at place of residence, which is associated with worse outcomes in unselected prehospital populations. Our aim was to investigate whether location of arrest was associated with outcome in a selected group of initial survivors admitted to intensive care.
Methods:
This is a post-hoc analysis of the Targeted Temperature Management After Cardiac Arrest (TTM) trial, a multicenter controlled trial, randomizing 950 OHCA patients to an intervention of 33 °C or 36 °C. The location of cardiac arrest was defined as place of residence versus public place or other. The outcome measures were mortality and neurological outcome, as defined by the Cerebral Performance Category Scale, at 180 days.
Results:
Approximately half of 938 included patients arrested at place of residence (53%). Location groups did not differ with respect to age (P=0.11) or witnessed arrests (P=0.48) but bystander CPR was less common (P=0.02) at place of residence. OHCA at place of residence was associated with higher 180-day mortality (55% vs. 38%, P<0.001) and worse neurological outcome (61% vs. 43%, P<0.001) compared with a public place or other. After adjusting for known confounders, OHCA at place of residence remained an independent predictor of mortality (P=0.007).
Conclusions:
Half of all initial survivors after OHCA admitted to intensive care had an arrest at place of residence which was independently associated with poor outcomes. Actions to improve outcomes after OHCA at place of residence should be addressed in future trials.
... We generally do not know what quality of CPR participants will perform during resuscitation, but we know that good-quality bystander CPR is positively reflected in survival. [41][42][43][44] It is possible to make training for laypeople more relevant and effective by focusing on the most important learning objectives, prioritising practical training, training people to work in teams with dispatchers, using objective feedback to stimulate good performance, and documenting the results for quality improvement and cultivating a culture of excellence. QCPR Classroom can provide objective feedback on the quality and quantity of CPR. ...
Objectives
‘Quality Cardiopulmonary Resuscitation (QCPR) Classroom’ was recently introduced to provide higher-quality Cardiopulmonary Resuscitation (CPR) training. This study aimed to examine whether novel QCPR Classroom training can lead to higher chest-compression quality than standard CPR training.
Design
A cluster randomised controlled trial was conducted to compare standard CPR training (control) and QCPR Classroom (intervention).
Setting
Layperson CPR training in Japan.
Participants
Six hundred forty-two people aged over 15 years were recruited from among CPR trainees.
Interventions
CPR performance data were registered without feedback on instrumented Little Anne prototypes for 1 min pretraining and post-training. A large classroom was used in which QCPR Classroom participants could see their CPR performance on a big screen at the front; the control group only received instructor’s subjective feedback.
Primary and secondary outcome measures
The primary outcomes were compression depth (mm), rate (compressions per minute (cpm)), percentage of adequate depth (%) and recoil (%). Survey scores were a secondary outcome. The survey included participants’ confidence regarding CPR parameters and ease of understanding instructor feedback.
Results
In total, 259 and 238 people in the control and QCPR Classroom groups, respectively, were eligible for analysis. After training, the mean compression depth and rate were 56.1±9.8 mm and 119.2±7.3 cpm in the control group and 59.5±7.9 mm and 116.8±5.5 cpm in the QCPR Classroom group. The QCPR Classroom group showed significantly more adequate depth than the control group (p=0.001). There were 39.0% (95% CI 33.8 to 44.2; p<0.0001) and 20.0% improvements (95% CI 15.4 to 24.7; P<0.0001) in the QCPR Classroom and control groups, respectively. The difference in adequate recoil between pretraining and post-training was 2.7% (95% CI −1.7 to 7.1; pre 64.2±36.5% vs post 66.9%±34.6%; p=0.23) and 22.6% in the control and QCPR Classroom groups (95% CI 17.8 to 27.3; pre 64.8±37.5% vs post 87.4%±22.9%; p<0.0001), respectively.
Conclusions
QCPR Classroom helped students achieve high-quality CPR training, especially for proper compression depth and full recoil. For good educational achievement, a novel QCPR Classroom with a metronome sound is recommended.
... Furthermore, previous studies on CPR have identified certain rescuer attributes associated with the provision of high-quality CPR, such as working in a healthcare profession, recent CPR certification, and male gender. [10][11][12] Information regarding whether DA is beneficial in specific rescuer subgroups is sparse. Identifying who benefits from DA can help to determine who should receive it. ...
Aims:
The introduction of dispatcher assistance (DA) services has led to increased bystander cardiopulmonary resuscitation (CPR) participation rates. However, the extent to which DA improves CPR quality remains unclear. This study aimed to evaluate the efficacy of DA in improving CPR quality among healthcare professionals and laypersons within a multi-ethnic Southeast Asian population.
Methods:
A parallel, randomised controlled, open label trial was performed. Four hundred and twelve participants were recruited via convenience sampling in a public location. In a simulated cardiac-arrest scenario, the participants were randomised to perform CPR with DA over the phone (DA+) or CPR without DA (DA-). The ratio of participant assignment to DA+ and DA- was 1:1. The primary outcomes were CPR compression depth, compression rate, no-flow time, complete release of pressure between compressions, and hand location. The assessment involved CPR manikins and human assessors.
Results:
A larger proportion of participants in DA + achieved the correct compression rate (34.3% vs 18.1%, p < 0.001). There was no difference in the other primary outcomes. A subgroup analysis revealed that healthcare professionals in DA+ had a higher proportion of correct hand location compared to those in DA- (82.1% vs. 53.5%, p < 0.05). There was no significant difference in CPR quality among laypersons with valid CPR certification regardless of whether they received DA.
Conclusion:
DA should be provided to laypersons without valid CPR certification, as well as healthcare professionals. The identification of gaps in the current DA protocol highlights areas where specific changes can be made to improve CPR quality.
... Focus could be on evaluating the CPR quality by giving the bystanders feedback. High-quality CPR remains essential to improving outcomes [23,24]. The existing feedback on compression technique includes voice prompts, metronomes, visual dials, numerical displays, waveforms, verbal prompts, and visual alarms. ...
... Istraživanje [6] ukazuje da i pored loše edukovanosti laika na započinjanje KPR-a, postoji motivacija za sticanje znanja i veština za BLS kao i za praćenje uputstva dispečera. Istraživanje [7] zaključuje da se u urbanim sredinama postiže bolji odgovor laika uz dobre kompresije i ukoliko je prisutno više spasilaca, dok je KPR znatno slabijeg kvaliteta ukoliko se sprovodi od strane članova porodice, starijih osoba kao i kada se KPR sprovodi kod kuće. U Poljskoj, rezultati analize započinjanja KPR od strane svedoka u ruralnim i urbanim sredinama, ukazuje da su svedoci koji su prisustvovali kolapsu iz ruralnih sredina, u znatnoj meri prihvatali započinjanje mera resuscitacije kao i instrukcije od strane dispečera, od laika koji su bili svedoci srčanoj zastoja u urbanim sredinama [8]. ...
Aims: Determining the influence of laypersons who witnessed cardiac arrest related to the outcome of the out-of-hospital cardiac arrest treated by the emergency medical services for the period covered by the study. Methodology: Cardiac arrest data’s has been collected by the unified questionnaire of EuReCa-Serbia study, as a part of a prospective study of an observational trail of the European Resuscitation Council registered Clinical Trial NCT02236819 and approved by the US healthcare authorities. The data’s from the Serbian cardiac arrest registry has been analyzed in period of 1st of October 2014 until 1st of August 2017 from www.eureca.rs application. Collected data’s were processed by the statistical program of SPSS. Results: In period of 1.10.2017. - 1.08.2017. it has been 3153 out-ofhospital cardiac arrests (OHCA). CPR is attempted at 1385 patients. OHCA was witnessed in 993/1385 (72%) cases. Witnessed cardiac arrest was most happened in private residences 785/993 (79%), on the streets 76/993 (8%), in public places 40/993 (4%) and at place of work 20/993 (2%). CPR by laymen is attempted in 123/993 (12%) cases, full sequence CPR in 62/123 (50%), and chest compression only (CCO) in 61/123 (50%). Laymen at private residences started CPR in 94/993 (9.4%) cases. The youngest patient resuscitated by a layperson was younger than 1 year old and the oldest one had 89 years. Dispatcher assisted CPR was registered in 68/993 (6%) cases. The shockable initial rhythm where CPR was initiated by laypersons was recorded in 41/123 (33%) cases. The shockable initial rhythm with full sequence CPR was performed was 22/41 (54%) whereas the initial shockable rhythm was present in 19/4 (46%) patients where CCO was performed. Patients with ROSC in OHCA where laymen started to perform CPR were achieved in 47/123 (38%) cases. The outcome with ROSC at patients where laymen did not attempt CPR was achieved in 146/870 (17%) cases. Conclusion: The influences of witnesses - laymen and early CPR by the same bystanders have indisputable impact in outcome and ROSC in out-of-hospital cardiac arrest patients with EMS intervention. Further researches should be focused on better introduction and understanding of the mechanisms which have influence on laymen active involvements with CPR initiation on scene.
... [24][25][26] Various factors have been reported to have varying effects on the incidence, outcomes of out-of-hospital cardiac arrests (OHCA), as well as the impact of demographics such as age and sex on effective bystander CPR provision. [27][28][29][30][31] Recently, two reports on bystander CPR involving Nigerian teachers have been documented. 32,33 Meanwhile, more baseline data is still needed in this advocacy for possible incorporation of bystander CPR training in Nigerian schools and further contribution to the body of knowledge in this subject. ...
Objective: To assess the impact of age and sex on the bystander CPR Knowledge in a group of Nigerian student teachers. Materials and Methods: A quasi-experimental study design was used with the cohort made up of forty one (41) male and forty one (41) female undergraduate students of Physical and Health Education with 40 participants in the 17-20 years age group and 42 participants belonging to the 21-28 years of age bracket were randomly selected from the larger main cohort for analysis of possible impact of age and sex on their pre-training and post-training cardiopulmonary resuscitation knowledge. In addition to the descriptive statistics, one-way analysis of variance (ANOVA) was used to test the null hypotheses generated with significance level set at P < 0.05. Results: No significant age impact was found on the pre-training and post-training CPR knowledge of the student teachers (P > 0.05). However, there was a positive impact of male gender on post-training CPR knowledge of the participants (P <0.001). Conclusion: Although age could not impact significantly on the cardiopulmonary resuscitation knowledge of the participants, male gender significantly impacted on the post-training cardiopulmonary resuscitation knowledge of the cohort.
Virtual reality (VR) has been increasingly used in medical education. VR simulations can provide learners with a safe and immersive environment to practice their skills and knowledge. These simulations can range from emergency situations to those for exploring human anatomy. This chapter provides examples of VR use that focuses on emergencies and critical care. VR education for these situations provides invaluable medical simulations from resuscitation to managing life threatening cases with hands-on experiences without real life consequences. It allows trainees to develop critical thinking, decision-making skills, and teamwork under realistic conditions. VR can also be used to teach various skills for surgical procedures, cardiopulmonary resuscitation (CPR), and other important skills.
People in the immediate vicinity of an accident sometimes provide first aid as immediate responders and may form spontaneous groups to provide aid together. Previous research has found conflicting results where first aid is sometimes improved and sometimes unaffected by the cooperation in these groups. This study investigated the effect of competence and the teamwork factors leadership, coordination and swift trust on first aid team performance in immediate responder groups. Ad-hoc groups of three participants with mixed or low emergency response competence acted in a simulated traffic accident. Swift trust and emergency response competence increased first aid performance while leadership and coordination did not. Low competence groups were also found to overestimate their team performance while mixed competence groups were found to underestimate their team performance. Further research should investigate how to support swift trust within these groups and explore potential education interventions for improving the effect of teamwork.
This scoping review collates evidence for sex biases in the receipt of bystander cardiopulmonary resuscitation (BCPR) among patients with out‐of‐hospital cardiac arrest patients globally. The MEDLINE, PsycINFO, CENTRAL, and Embase databases were screened for relevant literature, dated from inception to March 9, 2022. Studies evaluating the association between BCPR and sex/gender in patients with out‐of‐hospital cardiac arrest, except for pediatric populations and cardiac arrest cases with traumatic cause, were included. The review included 80 articles on BCPR in men and women globally; 58 of these studies evaluated sex differences in BCPR outcomes. Fifty‐nine percent of the relevant studies (34/58) indicated that women are less likely recipients of BCPR, 36% (21/58) observed no significant sex differences, and 5% (3/58) reported that women are more likely to receive BCPR. In other studies, women were found to be less likely to receive BCPR in public but equally or more likely to receive BCPR in residential settings. The general reluctance to perform BCPR on women in the Western countries was attributed to perceived frailty of women, chest exposure, pregnancy, gender stereotypes, oversexualization of women's bodies, and belief that women are unlikely to experience a cardiac arrest. Most studies worldwide indicated that women were less likely to receive BCPR than men. Further research from non‐Western countries is needed to understand the impact of cultural and socioeconomic settings on such biases and design customized interventions accordingly.
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
This study estimates the effect of a new dispatcher-assisted basic life support training program on the survival outcomes of out-of-hospital cardiac arrest (OHCA).
Before-and-after intervention trials were conducted in Seoul. Patients who suffered OHCA in a private place from January 2014 to December 2017 were included. The intervention group was 3 districts; the other 22 districts were regarded as the control group. The primary outcome was survival up to hospital discharge. The difference-in-difference (DID) was calculated to evaluate changes in the survival outcomes of the 2 groups over the period.
A total of 10,127 OHCA patients were included in the final analysis. OHCA patients in the intervention group were less likely to receive bystander cardiopulmonary resuscitation (57.8% vs 61.1%; P = .02) and showed lower survival outcomes (5.7% vs 6.4% for survival up to hospital discharge; P = .34 and 2.8% vs 3.7% for good neurological recovery; P = .11), but this was not statistically significant. Compared to 2014, good neurological recovery in 2017 was significantly improved in the intervention group (DID for good neurological recovery = 3.2%; 0.6–5.8). There were no statistically significant differences in return of spontaneous circulation and survival up to hospital discharge between the 2 groups (DID for survival to discharge was 1.8% [−1.7 to 5.3] and DID for return of spontaneous circulation was −2.5% [−9.8 to 4.8]).
Improvement in neurological recovery was observed in the 3 districts after implementing the new dispatcher-assisted basic life support training program.
Introduction:
Bystander CPR is vital in improving outcomes for out-of-hospital cardiac arrest. There has been ample literature describing disparities in bystander CPR within specific countries, such as the United States, Australia, and the Netherlands. However, there has not been significant literature describing such disparities between countries.
Methods:
We examined various studies published between 2000 and 2021 that reported rates of bystander CPR in various countries. These bystander CPR rates were correlated with the GDP per capita of that country during the time the study was conducted. The correlation between GDP per capita and rates of bystander CPR was assessed.
Results:
A total of 29 studies in 35 communities across 25 countries were examined. Reported rates of bystander CPR ranged from 1.3% to 72%. From this, a strong and significant correlation between GDP per capita and rates of bystander CPR was apparent; 0.772 (p < .01), r2 = 0.596.
Conclusions:
GDP per capita can be thought of as a composite endpoint that takes into account various aspects of a country's social and economic well-being. Socioeconomically-advantaged communities likely have a better ability to provide CPR education to community members, and our findings mirror localized analyses comparing socioeconomic status and rates of bystander CPR. Future studies should continue to elucidate transnational disparities in cardiac arrest, and efforts should be directed at providing CPR education to communities with low rates of bystander CPR; low-and-middle-income countries may represent attractive targets for such interventions. However, it may be possible that rates of bystander CPR may not improve unless significant upstream improvements to socioeconomic factors take place.
Aim
To investigate whether live video streaming from the bystander’s smartphone to a medical dispatcher can improve the quality of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA).
Methods
After CPR was initiated, live video was added to the communication by the medical dispatcher using smartphone technology. From the video recordings, we subjectively evaluated changes in CPR quality after the medical dispatcher had used live video to dispatcher-assisted CPR (DA-CPR). CPR quality was registered for each bystander and compared with CPR quality after video-instructed DA-CPR. Data were analysed using logistic regression adjusted for bystander’s relation to the patient and whether the arrest was witnessed.
Results
CPR was provided with live video streaming in 52 OHCA calls, with 90 bystanders who performed chest compressions. Hand position was incorrect for 38 bystanders (42.2%) and improved for 23 bystanders (60.5%) after video-instructed DA-CPR. The compression rate was incorrect for 36 bystanders (40.0%) and improved for 27 bystanders (75.0%). Compression depth was incorrect for 57 bystanders (63.3%) and improved for 33 bystanders (57.9%). The adjusted odds ratios for improved CPR after video-instructed DA-CPR were; hand position 5.8 (95% CI: 2.8–12.1), compression rate 7.7 (95% CI: 3.4–17.3), and compression depth 7.1 (95% CI: 3.9–12.9). Hands-off time was reduced for 34 (37.8%) bystanders.
Conclusions
Live video streaming from the scene of a cardiac arrest to medical dispatchers is feasible. It allowed an opportunity for dispatchers to coach those providing CPR which was associated with a subjectively evaluated improvement in CPR performance.
Background and purpose
Out-of-hospital cardiac arrest (OHCA) is one of the most common causes of death in many countries. For OHCA patients to have a good clinical outcome, bystander cardiopulmonary resuscitation (CPR) is extremely significant. It is necessary to study the various characteristics of bystanders to improve bystander CPR quality. We aimed to evaluate the correlation between bystanders' gender and clinical outcomes of patients with OHCA.
Methods
We conducted an observational study by using a prospective, multicenter registry of OHCA resuscitation, provided by the Korean Cardiac Arrest Research Consortium registry from October 2015 to June 2017. The following data were collected: patient's age, patient's gender, witnessed by a layperson, characteristics of the bystanders (age grouped by decade, gender, CPR education, compression method, and perception of automated external defibrillators), arrest place, emergency medical services arrival time, and initial electrocardiogram rhythms. Outcome variables were prehospital return of spontaneous circulation, survival discharge, and cerebral performance category status at discharge.
Results
A total of 691 patients were included in the study. There were significant differences in the initial shockable rhythm and previous CPR training between bystander's gender. Characteristics such as age, patient's gender, witnessed by a layperson, bystander's gender, initial shockable rhythm, and arrest place were significantly associated with neurologic outcome at discharge, using univariable analysis. However, in the multivariate logistic model, there was no significant correlation between bystander's gender and neurologic outcome. In the subgroup analysis using the multivariate logistic model with 291 patients without missing values of CPR education and bystander’ age, there was a significant difference in neurologic outcome depending on bystander's CPR education status.
Conclusion
There was no difference in the neurologic outcomes of OHCA patients based on bystanders' gender. However, according to subgroup analysis, there was a difference in the neurologic outcome depending on the status of bystanders' CPR education and females received less CPR education than males. Therefore, more active CPR education is required.
The aim of this study is to determinate a chance of surviving in bystander CPR in out-of-hospital cardiac arrest (OHCA) in Serbia. Methodology: The study was conducted as a prospective and observational study of the collection of data in the period 2014 -2019 via the National OHCA Registry Serbia. EuReCa program is registered Clinical Trial ID:NCT03130088. Data analysis was done by IBM SPSS Statistics 20. Results: A total of 6312 OHCA is registered. A witness was present in 3655/6312 or 57,9% OHCA, but CPR is done in 365/3655, or 10,2% witness presented OHCA. ROSC is achieved in 9,7% patients, 6,6% patients which CPR by bystander were not done and 28,1% patients in which CPR by bystander were done, which is statistically significant (ch2 = 122,792; df = 1; p = 0.000). A chance for ROSC is 5,4 higher when CPR by bystander is done before EMS arrival (OR = 5,4; 95% C.I. 3,967-7.377). ROSC has commonly occurred in older males with shorter EMS time to arrival but most important is bystander CPR. Conclusion: People who experienced out-of-hospital cardiac arrest have a 5,4 higher chance for ROSC which means, finally observing, a higher chance for survival when bystander CPR is performed.
Aim
To assess the current situation and neurologically favourable outcomes after out-of-hospital cardiac arrest (OHCA) with respect to the type of witness.
Methods
This retrospective observational study used data from the All-Japan Utstein Registry of the Fire and Disaster Management Agency collected between January 1, 2016, and December 31, 2016. Patients with cardiogenic OHCA aged ≥18 years who were witnessed by bystanders were included. The primary outcome measure was a neurologically favourable outcome 1 month after the OHCA.
Results
Among the 123,554 patients with OHCA registered between January 1, 2016, and December 31, 2016, 24,856 patients were included. Of them, 15,139 were witnessed by family, and 9,717 were witnessed by non-family (friends, 1,306; colleagues, 951; passers-by, 997; others, 6,463). When witnessed by family, the rate of neurologically favourable outcomes was significantly lower than that when witnessed by non-family (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.41-0.49, P < 0.001). After adjusting for potential confounders, the rate of neurologically favourable outcomes remained lower when OHCA was witnessed by family (OR = 0.88, 95% CI = 0.79-0.99, P = 0.03). However, in subgroup analysis, adjusted ORs for neurologically favourable outcomes were slightly greater for 65–84-year-old women and ≥85-year-old women with family witnesses than for those with non-family witnesses. For all other groups, non-family witnesses outperformed family witnesses.
Conclusion
Family-witnessed OHCA events had fewer neurologically favourable outcomes before and after adjusting for confounders. BLS education for family members may lead to improved prognosis of witnessed cardiogenic OHCAs.
Background Cardiopulmonary resuscitation (CPR) performed by bystanders is a key factor for out-of-hospital cardiac arrest (OHCA) survival. This study aimed to evaluate the relationship between CPR performed by off-duty medical professionals vs. laypersons and one-month survival with favorable neurological outcome after OHCA.
Methods Using a population-based database of OHCA patients in Osaka City, Japan, from 2013 through 2015, we enrolled adult OHCA patients with resuscitation attempts performed by bystanders before the arrival of emergency-medical-service personnel. Multivariable logistic regression analysis was performed to assess the association between CPR performed by off-duty medical professionals vs. laypersons and the OHCA outcome after adjusting for potential confounding factors. The primary outcome measure was one-month survival with favorable neurological outcome, defined as cerebral performance category of 1 or 2.
Results A total of 2,326 subjects were eligible for our study. Among these, 365 (15.7%) patients received CPR by off-duty medical professionals and 1,961 (84.3%) received CPR by laypersons. In the multivariable analysis, there was no difference in favorable neurological outcome between off-duty medical professionals (6.3% [23/365]) and laypersons (5.1% [100/1,961]) among eligible patients (adjusted odds ratio 0.83, 95% confidence interval [0.37–2.06]). This finding was also confirmed in propensity score-matched patients.
Conclusions In Japan where the CPR training or bystander CPR has been widely disseminating, CPR by laypersons had similar effects compared to that by off-duty medical professionals. As this study could not assess the quality of bystander CPR, further studies are essential to verify the effects of the bystander CPR type on OHCA patients.
Purpose:
To investigate temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts and their association with survival after bystander-witnessed out-of-hospital cardiac arrests (OHCAs).
Methods:
We retrospectively analyzed the neurologically favorable 1-month survival and the parameters related to dispatcher assisted cardiopulmonary resuscitation (DA-CPR) and bystander CPR (BCPR) for 227,524 OHCA patients between 2007 and 2013 in Japan. DA-CPR sensitivity for OHCAs, bystander's compliance to DA-CPR assessed by the proportion of bystanders who follow DA-CPR, and performance of BCPR measured by the rate of bystander-initiated CPR in patients without DA-CPR were calculated as indices of resuscitation efforts.
Results:
Performance of BCPR was only similar to temporal variations in the survival (correlation between hourly paired values, R2=0.263, P=0.01): a lower survival rate (3.4% vs 4.2%) and performance of BCPR (23.1% vs 30.8%) during night-time (22:00-5:59) than during non-night-time. In subgroup analyses based on interaction tests, all three indices deteriorated during night-time when OHCAs were witnessed by non-family (adjusted odds ratio, 0.73-0.82), particularly in non-elderly patients. The rate of public access defibrillation for these OHCAs markedly decreased during night-time (adjusted odds ratio, 0.49) with delayed emergency calls and BCPR initiation. Multivariable logistic regression analyses revealed that the survival rate of non-family-witnessed OHCAs was 1.83-fold lower during night-time than during non-night-time.
Conclusions:
Dispatcher-assisted and bystander-initiated resuscitation efforts are low during night-time in OHCAs witnessed by non-family. A divisional alert system to recruit well-trained individuals is needed in order to improve the outcomes of night-time OHCAs witnessed by non-family bystanders.
Objectives:
To determine factors associated with cardiopulmonary resuscitation (CPR) provision by CPR-trained bystanders and to determine factors associated with CPR performance by trained bystanders.
Methods:
The authors performed a prospective, observational study (January 1997 to May 2003) of individuals who called 911 (bystanders) at the time of an out-of-hospital cardiac arrest. A structured telephone interview of adult cardiac-arrest bystanders was performed beginning two weeks after the incident. Elements gathered during interviews included bystander and patient demographics, identifying whether the bystander was CPR trained, when and by whom the CPR was performed, and describing the circumstances of the event. If CPR was not performed, we asked the bystanders why CPR was not performed. Logistic regression was used to calculate odds ratios and 95% confidence intervals (95% CI) for factors associated with CPR performance.
Results:
Of 868 cardiac arrests, 684 (78.1%) bystander interviews were completed. Of all bystanders interviewed, 69.6% were family members of the victims, 36.8% of the bystanders had more than a high-school education, and 54.1% had been taught CPR at some time. In 21.2% of patients, the bystander immediately started CPR, and in 33.6% of cases, someone started CPR before the arrival of emergency medical services (EMS). Important overall predictors of CPR performance were the following: witnessed arrest (OR = 2.3; 95% CI = 1.4 to 3.8); bystander was CPR trained (OR = 6.6; 95% CI = 3.5 to 12.5); bystander had more than a high-school education (OR = 2.0; 95% CI = 1.2 to 3.1), or arrest occurred in a public location (OR = 3.1; 95% CI = 1.7 to 5.8). These variables were significant predictors of CPR performance among CPR-trained bystanders, as was CPR training within five years (OR = 4.5; 95% CI = 2.8 to 7.3). Common reasons that the CPR-trained bystanders cited for not performing CPR were the following: 37.5% stated that they panicked, 9.1% perceived that they would not be able to do CPR correctly, and 1.1% thought that they would hurt the patient. Surprisingly, only 1.1% objected to performing mouth-to-mouth resuscitation.
Conclusions:
A minority of CPR-trained bystanders performed CPR. CPR provision was more common in CPR-trained bystanders with more than a high-school education and when CPR training had been within five years. Previously espoused reasons for not doing CPR (mouth-to-mouth, infectious-disease risk) were not the reasons that bystanders cited for not doing CPR. Further work is needed to maximize CPR provision after CPR training.
As many as 90% of all trauma-related deaths occur in developing nations, and this is expected to get worse with modernisation. The current method of creating an emergency care system by modelling after that of a Western nation is too resource-heavy for most developing countries to handle. A cheaper, more community-based model is needed to establish new emergency care systems and to support them to full maturity.
A needs assessment was undertaken in Manenberg, a township in Cape Town with high violence and injury rates. Community leaders and successfully established local services were consulted for the design of a first responder care delivery model. The resultant community-based emergency first aid responder (EFAR) system was implemented, and EFARs were tracked over time to determine skill retention and usage.
The EFAR system model and training curriculum. Basic EFARs are spread throughout the community with the option of becoming stationed advanced EFARs. All EFARs are overseen by a local organisation and a professional body, and are integrated with the local ambulance response if one exists. On competency examinations, all EFARs tested averaged 28.2% before training, 77.8% after training, 71.3% 4 months after training and 71.0% 6 months after training. EFARs reported using virtually every skill taught them, and further review showed that they had done so adequately.
The EFAR system is a low-cost, versatile model that can be used in a developing region both to lay the foundation for an emergency care system or support a new one to maturity.
Chest compression-only bystander cardiopulmonary resuscitation (CPR) may be as effective as conventional CPR with rescue breathing for out-of-hospital cardiac arrest.
To investigate the survival of patients with out-of-hospital cardiac arrest using compression-only CPR (COCPR) compared with conventional CPR.
A 5-year prospective observational cohort study of survival in patients at least 18 years old with out-of-hospital cardiac arrest between January 1, 2005, and December 31, 2009, in Arizona. The relationship between layperson bystander CPR and survival to hospital discharge was evaluated using multivariable logistic regression.
Survival to hospital discharge.
Among 5272 adults with out-of-hospital cardiac arrest of cardiac etiology not observed by responding emergency medical personnel, 779 were excluded because bystander CPR was provided by a health care professional or the arrest occurred in a medical facility. A total of 4415 met all inclusion criteria for analysis, including 2900 who received no bystander CPR, 666 who received conventional CPR, and 849 who received COCPR. Rates of survival to hospital discharge were 5.2% (95% confidence interval [CI], 4.4%-6.0%) for the no bystander CPR group, 7.8% (95% CI, 5.8%-9.8%) for conventional CPR, and 13.3% (95% CI, 11.0%-15.6%) for COCPR. The adjusted odds ratio (AOR) for survival for conventional CPR vs no CPR was 0.99 (95% CI, 0.69-1.43), for COCPR vs no CPR, 1.59 (95% CI, 1.18-2.13), and for COCPR vs conventional CPR, 1.60 (95% CI, 1.08-2.35). From 2005 to 2009, lay rescuer CPR increased from 28.2% (95% CI, 24.6%-31.8%) to 39.9% (95% CI, 36.8%-42.9%; P < .001); the proportion of CPR that was COCPR increased from 19.6% (95% CI, 13.6%-25.7%) to 75.9% (95% CI, 71.7%-80.1%; P < .001). Overall survival increased from 3.7% (95% CI, 2.2%-5.2%) to 9.8% (95% CI, 8.0%-11.6%; P < .001).
Among patients with out-of-hospital cardiac arrest, layperson compression-only CPR was associated with increased survival compared with conventional CPR and no bystander CPR in this setting with public endorsement of chest compression-only CPR.
The interval between collapse and emergency call influences the prognosis of out-of-hospital cardiac arrest (OHCA). To reduce the interval, it is essential to identify the causes of delay.
Basal data were collected prospectively by fire departments from 3746 OHCAs witnessed or recognised by citizens and in which resuscitation was attempted by emergency medical technicians (EMTs) between 1 April 2003 and 31 March 2008. EMTs identified the reasons for call delay by interview.
The delay, defined as an interval exceeding 2 min (median value), was less frequent in the urban region, public places and for witnessed OHCAs. Delay was more frequent in care facilities and for elderly patients and OHCAs with longer response times. Multiple logistic regression analysis indicated that urban regions, care facilities and arrest witnesses are independent factors associated with delay. The ratio of correctable causes (human factors) was high at care facilities and at home, compared with other places. Calling others was a major reason for delay in all places. Performing cardiopulmonary resuscitation (CPR) and other treatments was another major reason at care facilities. Large delay, defined as an interval exceeding 5 min (upper-quartile value), was an independent factor associated with a low 1-year survival rate.
The incidence of correctable causes of delay is high in the community. Correction of emergency call manuals in care facilities and public relation efforts to facilitate an early emergency call may be necessary. Basic life support (BLS) education should be modified to minimise delays related to making an emergency call.
The health and policy implications of regional variation in incidence and outcome of out-of-hospital cardiac arrest remain to be determined.
To evaluate whether cardiac arrest incidence and outcome differ across geographic regions.
Prospective observational study (the Resuscitation Outcomes Consortium) of all out-of-hospital cardiac arrests in 10 North American sites (8 US and 2 Canadian) from May 1, 2006, to April 30, 2007, followed up to hospital discharge, and including data available as of June 28, 2008. Cases (aged 0-108 years) were assessed by organized emergency medical services (EMS) personnel, did not have traumatic injury, and received attempts at external defibrillation or chest compressions or resuscitation was not attempted. Census data were used to determine rates adjusted for age and sex.
Incidence rate, mortality rate, case-fatality rate, and survival to discharge for patients assessed or treated by EMS personnel or with an initial rhythm of ventricular fibrillation.
Among the 10 sites, the total catchment population was 21.4 million, and there were 20,520 cardiac arrests. A total of 11,898 (58.0%) had resuscitation attempted; 2729 (22.9% of treated) had initial rhythm of ventricular fibrillation or ventricular tachycardia or rhythms that were shockable by an automated external defibrillator; and 954 (4.6% of total) were discharged alive. The median incidence of EMS-treated cardiac arrest across sites was 52.1 (interquartile range [IQR], 48.0-70.1) per 100,000 population; survival ranged from 3.0% to 16.3%, with a median of 8.4% (IQR, 5.4%-10.4%). Median ventricular fibrillation incidence was 12.6 (IQR, 10.6-5.2) per 100,000 population; survival ranged from 7.7% to 39.9%, with a median of 22.0% (IQR, 15.0%-24.4%), with significant differences across sites for incidence and survival (P<.001).
In this study involving 10 geographic regions in North America, there were significant and important regional differences in out-of-hospital cardiac arrest incidence and outcome.
To compare the survival rate from out-of-hospital cardiac arrest in rural and urban areas of Victoria, and to investigate the factors associated with these differences.
Retrospective case series using data from the Victorian Ambulance Cardiac Arrest Registry.
All out-of-hospital cardiac arrests occurring in Victoria that were attended by Rural Ambulance Victoria or the Metropolitan Ambulance Service.
1790 people who suffered a bystander-witnessed cardiac arrest between January 2002 and December 2003.
Bystander cardiopulmonary resuscitation was more likely in rural (65.7%) than urban areas (48.4%) (P = 0.001). Urban patients with bystander-witnessed cardiac arrest were more likely to arrive at an emergency department with a cardiac output (odds ratio [OR], 2.92; 95% CI, 1.65-5.17; P < 0.001), and to be discharged from hospital alive than rural patients (urban, 125/1685 [7.4%]; rural, 2/105 [1.9%]; OR, 4.13; 95% CI, 1.09-34.91). Major factors associated with survival to hospital admission were distance of cardiac arrest from the closest ambulance branch (OR, 0.87; 95% CI, 0.82-0.92), endotracheal intubation (OR, 3.46; 95% CI, 2.49-4.80), and the presence of asystole (OR, 0.50; 95% CI, 0.38-0.67) or pulseless electrical activity (OR, 0.73; 95% CI, 0.56-0.95) on arrival of the first ambulance crew.
Survival rates differ between urban and rural cardiac arrest patients. This is largely due to a difference in ambulance response time. As it is impractical to substantially decrease response times in rural areas, other strategies that may improve outcome after cardiac arrest require investigation.
To determine the optimal refresher training interval for lay volunteer responders in the English National Defibrillator Programme who had previously undertaken a conventional 4-h initial class and a first refresher class at 6 months.
Subjects were randomised to receive either two additional refresher classes at intervals of 7 and 12 months or one additional refresher class after 12 months.
Greater skill loss had occurred when the second refresher class was undertaken at 12 compared with 7 months. Skill retention however, was higher in the former group, ultimately resulting in no significant difference in final skill performance. There was no significant difference in performance between subjects attending two versus three refresher classes. On completion of refresher training all subjects were able to deliver countershocks, time to first shock decreased by 17s in both groups, and the proportion of subjects able to perform most skills increased. The execution of several important interventions remained poor, regardless of the total number of classes attended or the interval between them. These included CPR skills, defibrillation pad placement, and pre-shock safety checks. Refresher classes held more frequently and at shorter intervals increased subjects' self-assessed confidence, possibly indicating greater preparedness to use an AED in a real emergency.
This study shows that the ability to deliver countershocks is maintained whether the second refresher class is held at seven or 12 months after the first. To limit skill deterioration between classes, however, refresher training intervals should not exceed 7 months. The quality of instruction given should be monitored carefully. Learning and teaching strategies require review to improve skill acquisition and maintenance.
OBJECTIVES: To determine factors associated with cardiopulmonary resuscitation (CPR) provision by CPR-trained bystanders and to determine factors associated with CPR performance by trained bystanders. METHODS: The authors performed a prospective, observational study (January 1997 to May 2003) of individuals who called 911 (bystanders) at the time of an out-of-hospital cardiac arrest. A structured telephone interview of adult cardiac-arrest bystanders was performed beginning two weeks after the incident. Elements gathered during interviews included bystander and patient demographics, identifying whether the bystander was CPR trained, when and by whom the CPR was performed, and describing the circumstances of the event. If CPR was not performed, we asked the bystanders why CPR was not performed. Logistic regression was used to calculate odds ratios and 95% confidence intervals (95% CI) for factors associated with CPR performance. RESULTS: Of 868 cardiac arrests, 684 (78.1%) bystander interviews were comp
Background— Early cardiopulmonary resuscitation (CPR) improves survival in out-of-hospital cardiac arrest, and dispatcher-delivered instruction in CPR can increase the proportion of arrest victims who receive bystander CPR before emergency medical service (EMS) arrival. However, little is known about the survival effectiveness of dispatcher-delivered telephone CPR instruction.
Methods and Results We evaluated a population-based cohort of EMS-attended adult cardiac arrests (n=7265) from 1983 through 2000 in King County, Washington, to assess the association between survival to hospital discharge and 3 distinct CPR groups: no bystander CPR before EMS arrival (no bystander CPR), bystander CPR before EMS arrival requiring dispatcher instruction (dispatcher-assisted bystander CPR), and bystander CPR before EMS arrival not requiring dispatcher instruction (bystander CPR without dispatcher assistance). In this cohort, 44.1% received no bystander CPR before EMS arrival, 25.7% received dispatcher-assisted bystander CPR, and 30.2% received bystander CPR without dispatcher assistance. Overall survival was 15.3%. Using no bystander CPR as the reference group, the multivariate adjusted odds ratio of survival was 1.45 (95% confidence interval [CI], 1.21, 1.73) for dispatcher-assisted bystander CPR and 1.69 (95% CI, 1.42, 2.01) for bystander CPR without dispatcher assistance.
Conclusion Dispatcher-assisted bystander CPR seems to increase survival in cardiac arrest.
Received April 3, 2001; revision received August 31, 2001; accepted September 17, 2001.
Ambulance response time is a major factor associated with survival in out-of-hospital cardiac arrests (OHCAs); the fast emergency vehicle pre-emption system (FAST™) aids response time by controlling traffic signals. This eight-year observational study investigated whether FAST™ implementation reduced response times and improved OHCA outcomes.
Data was prospectively collected from 1161 OHCAs that were not witnessed by emergency medical technicians from April 1, 2003, to March 31, 2011. The study took place in Kanazawa city, where ambulances without FAST™ (non-FAST™-equipped) were being progressively replaced by new FAST™-equipped ambulances. OHCA data, including the response times recorded in seconds, were collected and compared between the FAST™-equipped and non-FAST™-equipped ambulances. OHCA outcomes were subsequently compared in the subgroup of OHCAs managed by emergency medical technicians without tracheal intubation or epinephrine administration. The primary end-point of this study was one-year (1-Y) survival.
The median response time significantly differed between the FAST™-equipped and non-FAST™-equipped groups at 327 and 381 s, respectively. The 1-Y survival rates were 7.0% in the FAST™-equipped group and 2.8% in the non-FAST™-equipped group. Logistic regression analysis revealed that the dispatch of a FAST™-equipped ambulance was an independent factor for 1-Y survival (adjusted odds ratio = 3.077, 95% confidence interval = 1.180-9.350).
The FAST™ implementation significantly reduced ambulance response times and improved OHCA outcomes in Kanazawa city.
Review:
An increased number of rescuers may improve the survival rate from out-of-hospital cardiac arrests (OHCAs). The majority of OHCAs occur at home and are handled by family members.
Materials and methods:
Data from 5078 OHCAs that were witnessed by citizens and unwitnessed by citizens or emergency medical technicians from January 2004 to March 2010 were prospectively collected. The number of rescuers was identified in 4338 OHCAs and was classified into two (single rescuer (N=2468) and multiple rescuers (N=1870)) or three (single rescuer, two rescuers (N=887) and three or more rescuers (N=983)) groups. The backgrounds, characteristics and outcomes of OHCAs were compared between the two groups and among the three groups.
Results:
When all OHCAs were collectively analysed, an increased number of rescuers was associated with better outcomes (one-year survival and one-year survival with favourable neurological outcomes were 3.1% and 1.9% for single rescuers, 4.1% and 2.0% for two rescuers, and 6.0% and 4.6% for three or more rescuers, respectively (p=0.0006 and p<0.0001)). A multiple logistic regression analysis showed that the presence of multiple rescuers is an independent factor that is associated with one-year survival (odds ratio (95% confidence interval): 1.539 (1.088-2.183)). When only OHCAs that occurred at home were analysed (N=2902), the OHCAs that were handled by multiple rescuers were associated with higher incidences of bystander CPR but were not associated with better outcomes.
Conclusions:
In summary, an increased number of rescuers improves the outcomes of OHCAs. However, this beneficial effect is absent in OHCAs that occur at home.
Background There is a growing number of community first responder (CFR) groups in the UK who provide emergency care in their local communities.
Objective To understand why people volunteer for, and continue to be active in CFR groups.
Design Qualitative study, using focus groups of CFRs. Five focus groups were conducted, with a total of 35 participants.
Results Ideas of altruism and a sense of community were found to be important to volunteers, though motives were complex and individual. Many volunteers had some sort of prior experience relevant to the CFR role, either as health professionals or first-aiders.
Conclusion Though volunteers' motives had some commonalities with the limited literature, there were issues that were unique to the CFR context. The flexibility and autonomy of CFR volunteering was particularly attractive to volunteers. It remains to be seen how sustainable the CFR model is.
In 2007, the Ishikawa Medical Control Council initiated the continuous quality improvement (CQI) project for telephone-assisted cardiopulmonary resuscitation (telephone-CPR), which included instruction on chest-compression-only CPR, education on how to recognise out-of-hospital cardiac arrests (OHCAs) with agonal breathing, emesis and convulsion, recommendations for on-line or redialling instructions and feedback from emergency physicians. This study aimed to investigate the effect of this project on the incidence of bystander CPR and the outcomes of OHCAs.
The baseline data were prospectively collected on 4995 resuscitation-attempted OHCAs, which were recognised or witnessed by citizens rather than emergency medical technicians during the period of February 2004 to March 2010. The incidence of telephone-CPR and bystander CPR, as well as the outcomes of the OHCAs, was compared before and after the project.
The incidence of telephone-CPR and bystander CPR significantly increased after the project (from 42% to 62% and from 41% to 56%, respectively). The incidence of failed telephone-CPR due to human factors significantly decreased from 30% to 16%. The outcomes of OHCAs significantly improved after the projects. A multiple logistic regression analysis revealed that the CQI project is one of the independent factors associated with one-year (1-Y) survival with favourable neurological outcomes (odds ratio=1.81, 95% confidence interval=1.20-2.76).
The CQI project for telephone-CPR increased the incidence of bystander CPR and improved the outcome of OHCAs. A CQI project appeared to be essential to augment the effects of telephone-CPR.
The aim of this study was to evaluate the rate and reason for refusal of telephone-based cardiopulmonary resuscitation (CPR) instruction by bystanders after the implementation of the dispatch center's systematic telephone CPR protocol.
Over a 15-month period the authors prospectively collected all case records from the emergency medical services (EMS) dispatch center when CPR had been proposed to the bystander calling in and recorded the reason for declining or not performing that the bystander spontaneously mentioned. All pediatric and adult traumatic and nontraumatic cases were included. Situations when resuscitation had been spontaneously initiated by bystanders were excluded.
During the study period, dispatchers proposed CPR on 264 occasions: 232 adult nontraumatic cases, 17 adult traumatic cases, and 15 pediatric (traumatic and nontraumatic) cases. The proposal was accepted in 163 cases (61.7%, 95% confidence interval [CI] = 54.6% to 66.5%), and CPR was eventually performed in 134 cases (51%, 95% CI = 43.2% to 55.3%). In 35 of the cases where resuscitation was not carried out, the condition of the patient or conditions at the scene made this decision medically appropriate. Of the remaining 95 cases, 55 were due to physical limitations of the caller, and 33 were due to emotional distress.
The telephone CPR acceptance rate of 62% in this study is comparable to those of other similar studies. Because bystanders' physical condition is one of the keys to success, the rate may not improve as the population ages.
The aim of this investigation was to estimate and contrast the global incidence and outcome of out-of-hospital cardiac arrest (OHCA) to provide a better understanding of the variability in risk and survival of OHCA.
We conducted a review of published English-language articles about incidence of OHCA, available through MEDLINE and EmBase. For studies including adult patients and both adult and paediatric patients, we used Utstein data reporting guidelines to calculate, summarize and compare incidences per 100,000 person-years of attended OHCAs, treated OHCAs, treated OHCAs with a cardiac cause, treated OHCA with ventricular fibrillation (VF), and survival-to-hospital discharge rates following OHCA.
Sixty-seven studies from Europe, North America, Asia or Australia met inclusion criteria. The weighted incidence estimate was significantly higher in studies including adults than in those including adults and paediatrics for treated OHCAs (62.3 vs 34.7; P<0.001); and for treated OHCAs with a cardiac cause (54.6 vs 40.8; P=0.004). Neither survival to discharge rates nor VF survival to discharge rates differed statistically significant among studies. The incidence of treated OHCAs was higher in North America (54.6) than in Europe (35.0), Asia (28.3), and Australia (44.0) (P<0.001). In Asia, the percentage of VF and survival to discharge rates were lower (11% and 2%, respectively) than those in Europe (35% and 9%, respectively), North America (28% and 6%, respectively), or Australia (40% and 11%, respectively) (P<0.001, P<0.001).
OHCA incidence and outcome varies greatly around the globe. A better understanding of the variability is fundamental to improving OHCA prevention and resuscitation.
The majority of out-of-hospital cardiac arrests (OHCAs) occur in residential locations, but knowledge about strategic placement of automated external defibrillators in residential areas is lacking. We examined whether residential OHCA areas suitable for placement of automated external defibrillators could be identified on the basis of demographic characteristics and characterized individuals with OHCA in residential locations.
We studied 4828 OHCAs in Copenhagen between 1994 and 2005. The incidence and characteristics of OHCA were examined in every 100 x 100-m (109.4 x 109.4-yd) residential area according to its underlying demographic characteristics. By combining > or =2 demographic characteristics, it was possible to identify 100 x 100-m (109.4 x 109.4-yd) areas with at least 1 arrest every 5.6 years (characterized by >300 persons per area and lowest income) to 1 arrest every 4.3 years (characterized by >300 persons per area, lowest income, low education, and highest age). These areas covered 9.0% and 0.8% of all residential OHCAs, respectively. Individuals with OHCA in residential locations differed from public ones in that the patients were older (70.6 versus 60.6 years; P<0.0001), the ambulance response interval was longer (6.0 versus 5.0 minutes; P<0.0001), arrests occurred more often at night (21.2% versus 11.2%; P<0.0001), the patients had ventricular fibrillation less often (12.8% versus 38.1%; P<0.0001), and the patients had a worse 30-day survival rate (3.2% versus 13.9%; P<0.0001).
On the basis of simple demographic characteristics of a city center, we could identify residential areas suitable for automated external defibrillator placement. Individuals with OHCA in residential locations were more likely to have characteristics associated with poor outcome compared with public arrests.
Hands-only cardiopulmonary resuscitation (HO-CPR) is recommended as an alternative to standard CPR (STD-CPR). Studies have shown a degradation of adequate compressions with HO-CPR after 2 min when performed by young, healthy medical students. Elderly rescuers' ability to maintain an adequate compression rate and depth until emergency medical services (EMS) arrives is unknown.
The specific aim of this study was to compare elderly rescuers' ability to maintain adequate compression rate and depth during HO-CPR and STD-CPR in a manikin model.
In this prospective, randomized crossover study, 17 elderly volunteers performed both HO-CPR and STD-CPR, separated by at least 2 days, on a manikin model for 9 min each. The primary endpoint was the number of adequate chest compressions (> 38 mm) delivered per minute. Secondary endpoints were total compressions, compression rate, and the number of breaks taken for rest.
There was no difference in the number of adequate compressions between groups in the first minute; however, the STD-CPR group delivered significantly more adequate chest compressions in minutes 2-9 (p<0.05). The total number of compressions delivered was significantly greater in the HO-CPR than STD-CPR group when considering the entire resuscitation period. A significantly greater number of rescuers took breaks for rest during HO-CPR than STD-CPR.
Although HO-CPR resulted in a greater number of overall compressions than STD-CPR, STD-CPR resulted in a greater number of adequate compressions in all but the first minute of resuscitation.
Rescuer fatigue during cardiopulmonary resuscitation (CPR) is a likely contributor to variable CPR quality during clinical resuscitation efforts, yet investigations into fatigue and CPR quality degradation have only been performed in simulated environments, with widely conflicting results.
We sought to characterize CPR quality decay during actual in-hospital cardiac arrest, with regard to both chest compression (CC) rate and depth during the delivery of CCs by individual rescuers over time.
Using CPR recording technology to objectively quantify CCs and provide audiovisual feedback, we prospectively collected CPR performance data from arrest events in two hospitals. We identified continuous CPR "blocks" from individual rescuers, assessing CC rate and depth over time.
135 blocks of continuous CPR were identified from 42 cardiac arrests at the two institutions. Median duration of continuous CPR blocks was 112s (IQR 101-122). CC rate did not change significantly over single rescuer performance, with an initial mean rate of 105+/-11/min, and a mean rate after 3 min of 106+/-9/min (p=NS). However, CC depth decayed significantly between 90s and 2 min, falling from a mean of 48.3+/-9.6mm to 46.0+/-9.0mm (p=0.0006) and to 43.7+/-7.4mm by 3 min (p=0.002).
During actual in-hospital CPR with audiovisual feedback, CC depth decay became evident after 90s of CPR, but CC rate did not change. These data provide clinical evidence for rescuer fatigue during actual resuscitations and support current guideline recommendations to rotate rescuers during CC delivery.
Survival from out-of-hospital cardiac arrest in cities with populations of more than 1 million has not been studied adequately. This study was undertaken to determine the overall survival rate for Chicago and the effect of previously reported variables on survival, and to compare the observed survival rates with those previously reported.
Consecutive prehospital arrest patients were studied prospectively during 1987.
The study area was the city of Chicago, which has more than 3 million inhabitants in 228 square miles. The emergency medical services system, with 55 around-the-clock ambulances and 550 paramedics, is single-tiered and responds to more than 200,000 emergencies per year.
We studied 3,221 victims of out-of-hospital cardiac arrest on whom paramedics attempted resuscitation.
Ninety-one percent of patients were pronounced dead in emergency departments, 7% died in hospitals, and 2% survived to hospital discharge. Survival was significantly greater with bystander-witnessed arrest, bystander-initiated CPR, paramedic-witnessed arrest, initial rhythm of ventricular fibrillation, and shorter treatment intervals.
The overall survival rates were significantly lower than those reported in most previous studies, all based on smaller communities; they were consistent with the rates reported in the one comparable study of a large city. The single factor that most likely contributed to the poor overall survival was the relatively long interval between collapse and defibrillation. Logistical, demographic, and other special characteristics of large cities may have affected the rates. To improve treatment of cardiac arrest in large cities and maximize the use of community resources, we recommend further study of comparable metropolitan areas using standardized terms and methodology. Detailed analysis of each component of the emergency medical services systems will aid in making improvements to maximize survival of out-of-hospital cardiac arrest.
Dispatcher-delivered telephone instruction in cardiopulmonary resuscitation (CPR) has been proposed to increase rates of bystander CPR in cases of out-of-hospital cardiac arrest. We tested the efficacy of a previously developed CPR message using a recording mannikin in a high stress, simulated cardiac arrest scenario. Community volunteers were unaware they would perform CPR until immediately before each trial. Performance of volunteers without prior CPR training (group A, n = 65) who received telephone instruction was compared with that of previously trained volunteers (group B, n = 43) who received the same message. Performances of both groups were also compared with a third group (group C, n = 43) composed of previously trained volunteers who did not receive the message. Quality of CPR was graded by three CPR instructors using explicit criteria. Printout strips from the recording mannikins were also analyzed. Evaluators were unaware of the training status of volunteers. The three groups were of comparable sex, race, and educational level, but group C was significantly younger than groups A and B (31.7 vs. 37.7 years, p less than 0.001). Because of the time required for telephone instruction, groups A and B started chest compressions a mean of 4.0 minutes after collapse compared with 1.2 minutes for group C (p less than 0.0001). We found that the previously untrained volunteers of group A performed CPR of an overall quality comparable to that performed by previously trained members of group C. Group A performed chest compressions significantly better than group C (p less than 0.02) but had greater problems performing effective ventilations.(ABSTRACT TRUNCATED AT 250 WORDS)
We developed a cardiopulmonary resuscitation (CPR) message that can be given via telephone by emergency dispatchers directly to an individual reporting a cardiac arrest. The message was developed and evaluated on the basis of empirical observation of CPR performance of 203 community volunteers during simulated cardiac arrest events. The majority of volunteers were women, aged 30 to 80 years, who had not had previous CPR training. An average of five ventilation and compression cycles were given within five minutes using telephone instruction. We judged the quality of CPR to be comparable to the performance of individuals who have received formal training. The specific words used in the message directly determined adequacy of performance, and resulted in significantly better CPR performance than did impromptu instruction offered by professional dispatchers (P less than or equal to .02).
To evaluate the influence of quality of bystander cardiopulmonary resuscitation (CPR) on outcome in prehospital cardiac arrest we consecutively included patients with prehospital cardiac arrest treated by paramedics in a community run ambulance system in Oslo, Norway from 1985 to 1989. Good CPR was defined as palpable carotid or femoral pulse and intermittent chest expansion with inflation attempts. Outcome measure was hospital discharge rate. One hundred and forty-nine of 334 patients (45%) received bystander CPR. The discharge rate after good BCPR (23%) was higher than after no good BCPR (1%, P < 0.0005) or after no BCPR (6%, P < 0.0005). There was no difference between no good and no BCPR (P = 0.1114). There were no differences in paramedic response interval between the groups, but the mean interval from start of unconsciousness to initiation of CPR (arrest-CPR interval) was significantly shorter in the group receiving good bystander CPR (2.5 min, 95% confidence interval (CI): 1.7-3.3 min) than no good CPR (6.6 min, CI: 5.2-8.0 min) or no bystander CPR (7.8 min, CI: 7.2-8.4 min). Bystanders started CPR more frequently in public than in the patient's home (58 vs. 34%, P < 0.0005). Good bystander CPR was associated with a shorter arrest-CPR interval and improved hospital discharge rate as compared to no good BCPR or no BCPR.
To examine the independent relationship between effectiveness of bystander cardiopulmonary resuscitation (CPR) and survival following out-of-hospital cardiac arrest.
Prospective observational cohort.
New York City.
A total of 2071 consecutive out-of-hospital cardiac arrests meeting Utstein criteria.
Trained prehospital personnel assessed the quality of bystander CPR on arrival at the scene. Satisfactory execution of CPR required performance of both adequate compressions and ventilations in conformity with current American Heart Association guidelines.
Adjusted association between CPR effectiveness and survival. Survival was defined as discharge from hospital to home.
Outcome was determined on all members of the inception cohort--none were lost to follow-up. When the association between bystander CPR and survival was adjusted for effectiveness of CPR in the parent data set (N = 2071), only effective CPR was retained in the logistic model (adjusted odds ratio [OR] = 5.7; 95% confidence interval [CI], 2.7 to 12.2; P < .001). Of the subset of 662 individuals (32%) who received bystander CPR, 305 (46%) had it performed effectively. Of these, 4.6% (14/305) survived vs 1.4% (5/357) of those with ineffective CPR (OR = 3.4; 95% CI, 1.1 to 12.1; P < .02). After adjustment for witness status, initial rhythm, interval from collapse to CPR, and interval from collapse to advanced life support, effective CPR remained independently associated with improved survival (adjusted OR = 3.9; 95% CI, 1.1 to 14.0; P < .04).
The association between bystander CPR and survival in out-of-hospital cardiac arrest appears to be confounded by CPR quality. Effective CPR is independently associated with a quantitatively and statistically significant improvement in survival.
Early cardiopulmonary resuscitation (CPR) improves survival in out-of-hospital cardiac arrest, and dispatcher-delivered instruction in CPR can increase the proportion of arrest victims who receive bystander CPR before emergency medical service (EMS) arrival. However, little is known about the survival effectiveness of dispatcher-delivered telephone CPR instruction.
We evaluated a population-based cohort of EMS-attended adult cardiac arrests (n=7265) from 1983 through 2000 in King County, Washington, to assess the association between survival to hospital discharge and 3 distinct CPR groups: no bystander CPR before EMS arrival (no bystander CPR), bystander CPR before EMS arrival requiring dispatcher instruction (dispatcher-assisted bystander CPR), and bystander CPR before EMS arrival not requiring dispatcher instruction (bystander CPR without dispatcher assistance). In this cohort, 44.1% received no bystander CPR before EMS arrival, 25.7% received dispatcher-assisted bystander CPR, and 30.2% received bystander CPR without dispatcher assistance. Overall survival was 15.3%. Using no bystander CPR as the reference group, the multivariate adjusted odds ratio of survival was 1.45 (95% confidence interval [CI], 1.21, 1.73) for dispatcher-assisted bystander CPR and 1.69 (95% CI, 1.42, 2.01) for bystander CPR without dispatcher assistance.
Dispatcher-assisted bystander CPR seems to increase survival in cardiac arrest.
Bystander cardiopulmonary resuscitation (CPR) increases survival rates. The largest group of cardiac arrest patients are men over the age of 60 in the home, and the most probable potential CPR provider is an older woman who is not likely to have received CPR training. One method to increase the percentage of bystander-initiated CPR in this setting is for CPR instruction to be provided by nurse dispatchers via telephone. Two male and 18 female volunteers with a median age of 78 years and no previous CPR experience performed 9 min of telephone assisted CPR on a manikin. They were randomised to receive telephone instructions in chest compressions alone or standard CPR including mouth-to-mouth ventilation. Variables were registered by a recording manikin, visual observations, and video and audiotape recordings. The median period from dispatcher contact until continuous CPR was significantly longer for standard instructions than for compression only, 4.9 versus 3.4 min, and fewer chest compressions were provided during the 9 min test period, median 124 versus 334 compressions. In both groups the overall CPR performance was of very poor quality, and unlikely to have affected outcome in a real situation. Other telephone assisted CPR scripts should be tested in this potential bystander group.
Dispatcher-assisted telephone cardiopulmonary resuscitation (CPR) instruction can increase the proportion of sudden cardiac arrest victims who receive bystander CPR and has been associated with improved survival. Most sudden cardiac arrest victims, however, do not receive bystander CPR. The study objective was to examine factors that may impede implementation of telephone CPR.
We reviewed dispatcher audio recordings and emergency medical services reports for 404 cases of sudden cardiac arrest that occurred from July 1, 2000, to June 30, 2002, in the study county to assess the phase (1, instructions not offered; 2, instructions offered but declined; or 3, instructions offered and accepted but CPR not implemented) and specific factors within each phase that potentially impede telephone CPR.
Twenty-five percent (99/404) of victims received bystander CPR without dispatch assistance, 34% (139/404) received telephone CPR, and 41% (166/404) did not receive bystander CPR. Each phase of telephone CPR process impeded the implementation of CPR: (1) instructions not offered in 48% (80/166); (2) instructions offered but declined in 31% (52/166); and (3) instructions offered and accepted but CPR not implemented in 21% (34/166). During the first phase, telephone CPR was potentially impeded most frequently because the victim was reported to have signs of life (51/80, 64%); during the second and third phases, telephone CPR was most often impeded because of bystander physical limitation (32/86, 37%). Emotional distress, disease transmission, disagreeable victim characteristics, or medicolegal concerns uncommonly impeded telephone CPR (10/86, 12%).
Factors potentially impeding telephone CPR can be identified. Although many are logistically challenging, some may be addressable and hence provide opportunities to strengthen the chain of survival.
Outcome following cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002 a task force of ILCOR met in Melbourne. Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (i.e., essential and desirable) data elements recommended by previous Utstein consensus conference. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (C) 2004 Published by Elsevier Ireland Ltd.
The current standard for cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) retraining for laypersons is a four-hour course every two years. Others have documented substantial skill deterioration during this time period.
To evaluate 1) the retention of core CPR and AED skills among volunteer laypersons and 2) the time required to retrain laypersons to proficiency as a function of time since initial training.
This was an observational follow-up study evaluating CPR and AED skill retention and testing/retraining time up through 17 months after initial training. The study took place at 1,260 facilities recruited by 24 North American clinical research centers, and included 6,182 volunteer laypersons participating in the Public Access Defibrillation (PAD) Trial. Training to proficiency in either CPR only (N = 2,426) or CPR+AED (N = 3,756) was followed by testing/retraining provided three to 17 months later. Retraining was done in brief, one-on-one, individualized, interactive sessions. The outcome studied was instructors' global assessments of performance of CPR and AED skill adequacy, i.e., whether CPR actions would likely result in perfusion (yes/no) and whether AED actions would result in a shock through the heart (yes/no).
For global CPR performance, 79%, 73%, and 71% of volunteers tested for the first time since initial training three to five, six to 11, and 12 to 17 months after initial training, respectively, were judged by their instructors as having adequate performance (p < 0.001, chi-square for linear trend). For global AED performance, 91%, 86%, and 84% of volunteers, respectively, were judged as having adequate performance (p < 0.001). The mean (+/- standard deviation) times required to test and retrain volunteers to proficiency were 5.7 (+/- 4.0) minutes for CPR skills and 7.7 (+/- 4.6) minutes for CPR+AED skills.
Among PAD Trial volunteer laypersons participating in a simulated resuscitation, the proportions of volunteers judged by instructors to have adequate CPR and AED skills demonstrated small declines associated with longer intervals between initial training and subsequent testing. However, based on instructors' judgment, large majorities of volunteers still retained both CPR and AED core skills through 17 months after initial training. Furthermore, individual testing and retraining for CPR and AED skills were usually accomplished in less than 10 minutes per volunteer. Additional research is essential to identify training and evaluation techniques that predict adequate CPR and AED skill performance of laypersons when applied to an actual cardiac arrest.
Bystander CPR rates remain low. One reason may be that the thought of responding to an emergency is so stressful that it decreases the willingness of laypersons to respond.
The purpose of this study was to quantify the amount of stress experienced by lay responders to a medical emergency and to identify barriers that may have impeded their response to the event.
Responses from 1243 laypersons responding to an emergency during the Public Access Defibrillation Trial were analyzed in a mixed methods study. Stress related to the event was recorded using a 0 (none) to 5 (severe) scale. Qualitative responses to the question of "What was most difficult?" about the event were analyzed using content analysis.
Reported stress levels were low overall (mean 1.2, median 1.0). Laypersons responding to an emergency presumed to be a cardiac arrest had higher stress than those involved in other events (median 2.0 versus 1.0). Stress levels were higher in residential than in public settings (mean 1.41, median 1.0 versus mean 1.13, median 1.0). Those who fit a certain profile (females, non-native English speakers) reported statistically higher stress levels than others. A total of 614 qualitative responses were studied and aggregated into four major categories of difficulty: practical issues; characteristics of the victim; interpersonal issues; thoughts and feelings of the lay responder. Most difficulties were in the category of practical issues.
Among these study volunteer lay responders, low levels of stress were reported. Incorporating descriptions of the difficulties experienced by lay responders in CPR/AED training curricula may make courses more realistic and useful.
To determine the frequency of agonal breathing during cardiac arrest (CA), its impact on the ability of 9-1-1 dispatchers to identify CA, and the impact of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions on bystander CPR rates.
A before-after observational study enrolling out-of-hospital adult CA patients where resuscitation was attempted in a single city with basic life support with defibrillation/advanced life support tiered emergency medical services. Victim, caller, and system characteristics were measured during two successive nine-month periods before (control group) and after (intervention group) the introduction of dispatch-assisted CPR instructions.
There were 529 CAs between July 1, 2003, and December 31, 2004. Victim characteristics were similar in the control (n = 295) and intervention (n = 234) period; mean age was 68.3 years; 66.7% were male; 50.1% of CAs were witnessed; call-to-vehicle stop was 6 minutes, 37 seconds; ventricular fibrillation/ventricular tachycardia occurred in 29.9%; and the survival rate was 4.0%. Dispatchers identified 56.3% (95% confidence interval [CI] = 48.9% to 63.0%) of CA cases; agonal breathing was present in 37.0% (95% CI = 30.1% to 43.9%) of all CA cases and accounted for 50.0% (95% CI = 39.1% to 60.9%) of missed diagnoses. Callers provided ventilations in 17.2% and chest compressions in 8.3% of cases as a result of the intervention. Long time intervals were observed between call to diagnosis (2 minutes, 38 seconds) and during ventilation instructions (2 minutes, 5 seconds). Bystander CPR rates increased from 16.7% in the control phase to 26.4% in the intervention phase (absolute rate, 9.7%; 95% CI = 8.5% to 11.3%; p = 0.006).
This trial demonstrates an increase in bystander CPR rate after the introduction of dispatch-assisted CPR. Agonal breathing occurred frequently and had a negative impact on the recognition of CA. There were long time intervals between call initiation and diagnosis of CA and during mouth-to-mouth ventilation instructions.
Sudden cardiac arrest (SCA) is a leading cause of death in the United States and Canada. In the United States, each year ≈330 000 people die of coronary heart disease out of the hospital or in emergency departments. Of these, >150 000 SCAs occur out of the hospital.1,2 Despite the development of electrical defibrillation and the more recent implementation of lay rescuer defibrillation programs, the vast majority of these victims do not leave the hospital alive. In studies over the past 15 years, only 1.4% of patients with out-of-hospital arrest in Los Angeles, Calif, survived to hospital discharge3; in Chicago, Ill, the number was 2%,4 and in Detroit, Mich, it was <1%.5 Conversely, a few municipalities such as Seattle, Wash, report much higher survival rates from SCA—more than 15% in 1 study6—which suggests that survival rates need not remain so low. Recent work in Europe and elsewhere has confirmed that a higher survival-to-hospital discharge rate is indeed a realistic goal, with survival rates as high as 9% reported in Amsterdam7 and 21% in Maribor, Slovenia.8
The American Heart Association (AHA) uses 4 links in the “chain of survival” to illustrate the time-sensitive actions required for victims of SCA: (1) early recognition of the emergency and activation of emergency medical services (EMS), (2) early bystander cardiopulmonary resuscitation (CPR), (3) early delivery of shock(s) from a defibrillator if indicated, and (4) early advanced life support and postresuscitation care. Immediate bystander recognition of the emergency and EMS activation are critical. In many communities, however, these actions may be followed by significant delays, because the time interval from activation of EMS to arrival of these medical personnel may be 7 to 8 minutes or longer.4 Therefore, initial care in the first critical minutes after …