Cardiac arrest care and emrgency medical services in Canada

Ottawa Health Research Institute, Department of Emergency Medicine, University of Ottawa, Ontario.
The Canadian journal of cardiology (Impact Factor: 3.71). 10/2004; 20(11):1081-90.
Source: PubMed


Heart disease is the primary cause of mortality in Canada and survival to hospital discharge from out-of-hospital cardiac arrest is low.
To provide an overview of the outcomes for out-of-hospital cardiac arrest in Canada.
A national, descriptive, Utstein-style analysis of cardiac arrest care and emergency medical services was conducted. Data were compiled from five sources: the City of Edmonton Emergency Response Department, the British Columbia Ambulance Service, the Nova Scotia Emergency Health Services, the Urgences-santé corporation of the Montreal Metropolitan region and the Ontario Prehospital Advanced Life Support (OPALS) Study database.
There were 5288 cardiac arrests from a range of small communities to large provincial cardiac arrest registries in 2002. They were men (62.6% to 70.1%) in their sixties and seventies, witnessed (35.2% to 55.0%), rarely receiving bystander cardiopulmonary resuscitation (CPR) (14.7% to 46.0%), often in asystole (35.7% to 51.3%), arresting at home (56.1%) and rarely surviving to hospital discharge (4.3% to 9.0%). Bystander CPR and early first responder defibrillation were significantly associated with increased survival. Cardiac arrest incidence rates per 100,000 varied between 53 and 59 among provinces and followed a downward trend.
The results of this study could be an important first step toward a national cardiac arrest registry comparing the impact of regional differences in patient and system characteristics. Many communities do not have accurate data on their performance with regards to the chain of survival, or need to significantly improve their capacity for providing citizen bystander CPR and rapid first responder defibrillation.

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Available from: Christian Vaillancourt
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    • "Despite the significant decline in coronary artery disease (CAD) mortality in the second half of the 20th century [3], sudden cardiac death (SCD) continues to claim 250 000 to 300 000 US lives annually [4]. In North America and Europe the annual incidence of SCD ranges between 50 to 100 per 100 000 in the general population [5] [6] [7] [8]. Because of the absence of emergency medical response systems in most world regions, worldwide estimates are currently not available [9]. "
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    ABSTRACT: Investigations show that millions of people all around the world die as the result of sudden cardiac death (SCD), each year. These deaths can be reduced by using medical equipments such as defibrillators. However, there are no suitable ways to predict sudden cardiac death, if there exist; doctors can take good decisions for patients at risk. In this paper, we investigated a way to predict sudden cardiac death. To do this, after extraction of the HRV signal from ECG signal, some linear, time-frequency (TF) and non-linear features have been extracted from HRV signal. Then, the dimension of features space reduced by applying feature selection and finally, healthy people and people at risk of SCD, are classified by kNN (k Nearest Neighbor) and MLP (Multilayer Perceptron) neural network. To evaluate the capabilities of analytical methods in classification , we have compared the classification rates for both separate and combined nonlinear and TF features. The results show that there are features in the HRV signal of patients prone to SCD just near the occurrence of SCD, which is quite different from normal people. Also results show that the combination of time-frequency and nonlinear features have a better ability to detect this difference. The results show that, four minutes before SCD, there is a significant difference to detect it earlier, and this is enough time to save the patient by doctors or medical centers.
    Full-text · Dataset · Sep 2013
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    • "In out-of-hospital cardiac arrest, up to 40% of the initial arrhythmias were either VT or VF.12,13 In some of recent studies, pulseless electrical activity/asystole was found in 52% of patients versus 48% for VT/VF. "
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    ABSTRACT: Background: The aim of this study was to determine characteristics of patients with sudden cardiac arrest (SCA) and/or sudden cardiac death (SCD). We need an effective risk stratification method for SCD in patients without low left ventricular ejection fraction (LVEF). Methods: The study population of this cross-sectional study consisted of 241 patients with SCA or SCD who were admitted to an academic hospital, in Tehran, Iran, from 2011 through 2012. SCD was defined as unexpected death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute changes in cardiovascular status, or an unobserved death in which the patient was seen and known to be doing well within the previous 24 hours. Survivors of aborted SCD were also included in the study. Clinical and paraclinical characteristics as well as emergency department complications of patients were recorded. Results: The mean age of population was 66.0 ± 16.5 (17 to 90 years). Among the patients, 166 (68.9 %) were male, 50 (20.7%) were smoker, 77 (32.0%) had hypertension, 47 (19.5%) had diabetes mellitus, 21 (8.7%) had hyperlipidemia, and 32 (13.3%) had renal insufficiency. According to New York Health Association (NYHA) functional class, 31 (12.9%) patients were asymptomatic, 42 (17.4) and 99 (41.1%) subjects were in NYHA I and II, respectively and only 69 (28.6%) patients were in NYHA III or IV. In this study, presenting arrhythmia was pulseless electrical activity or asystole which was observed in 130 (53.9%) subjects. Ventricular tachycardia (VT) or ventricular fibrillation (VF) was seen in 53 (22%) patients. Cardiopulmonary resuscitation in emergency room was successful only in 46 (19.1%) subjects. Conclusion: Low ejection fraction (EF) may be an independent predictor of sudden cardiac death in patients, but it is not enough. While implantable cardioverter defibrillators can save lives, we are lacking effective risk stratification and prevention methods for the majority of patients without low EF who will experience SCD.
    Full-text · Article · Sep 2013 · ARYA Atherosclerosis
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    • "Between one third and one half of out-of-hospital cardiac arrests in Canada are witnessed by a bystander [1]. With early access to EMS, bystander cardiopulmonary resuscitation (CPR) is the most important factor in predicting successful outcome for these patients, associated with a nearly four-fold increase in the odds of surviving [2]. "
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    ABSTRACT: Background The optimal age to begin CPR training is a matter of debate. This study aims to determine if elementary schoolchildren have the capacity to administer CPR efficiently. Methods This quasi-experimental study took place in a Quebec City school. Eighty-two children 10 to 12 years old received a 6-hour CPR course based on the American Heart Association (AHA) Guidelines. A comparison group of 20 adults who had taken the same CPR course was recruited. After training, participants’ performance was evaluated using a Skillreporter manikin. The primary outcome was depth of compressions. The secondary outcomes were compression rate, insufflation volume and adherence to the CPR sequence. Children’s performance was primarily evaluated based on the 2005 AHA standards and secondarily compared to the adults’ performance. Results Schoolchildren did not reach the lower thresholds for depth (28.1 +/− 5.9 vs 38 mm; one-sided p = 1.0). The volume of the recorded insufflations was sufficient (558.6 +/222.8 vs 500 ml; one-sided p = 0.02), but there were a significant number of unsuccessful insufflation attempts not captured by the Skillreporter. The children reached the minimal threshold for rate (113.9 +/−18.3 vs 90/min; one-sided p < 0.001). They did not perform as well as the adults regarding compression depth (p < 0.001), but were comparable for insufflation volume (p = 0.83) and CPR sequence. Conclusions In this study, schoolchildren aged 10–12 years old did not achieve the standards for compression depth, but achieved adequate compression rate and CPR sequence. When attempts were successful at generating airflow in the Skillreporter, insufflation volume was also adequate.
    Full-text · Article · May 2013 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
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