Epidemiology and outcomes of out-of-hospital cardiac arrest in a developing country-a multicenter cohort study

Resuscitation highlights in 2011

Bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest

The effect of bystander CPR on survival of out-of-hospital cardiac arrest victims

Extracorporeal Cardiopulmonary Resuscitation: Prehospital or In-Hospital Cannulation?

Background: cardiopulmonary resuscitation (CPR) is crucial for survival in patients with out-of-hospital cardiac arrest (OHCA). Therefore, it is imperative to study factors that may modify the effectiveness of CPR. Bystander CPR is one of the most powerful first-aid techniques, and many have debated the factors that hinder its initiation. Female gender has been associated with a reduced likelihood of receiving CPR in public; however, no studies have investigated how gender may influence the effectiveness of CPR. Hypothesis: gender modifies the survival benefit of bystander CPR in OHCA. Methods: this multicenter prospective cohort study collected data from September 2019 through March 2021. Information on OHCA characteristics and patient care was gathered by 42 facilities located in the Kanto region of Japan. Terminology and definitions followed the Utstein templates and relevant international guidelines. Adult patients aged 18 and older were included, while those with missing information on gender, witness status, or bystander CPR were excluded. The primary outcome was 30-day survival. Crude statistics were used to compare survival rates by gender (women and men) between patients who did and did not receive bystander CPR. Cox proportional hazards regression was employed to adjust for potential confounders, including age, location of OHCA by prefecture, time of OHCA occurrence, witnessed arrest, initial rhythm, cause of cardiac arrest, and the use of therapeutic hypothermia. Results: out of a total of 9,909 patients, 9,081 were included in the analysis. Of these, 3,459 were women and 5,622 were men. A higher proportion of women received bystander CPR (n = 1,582; 45.5%) compared to men (n = 2,399; 42.7%; p = 0.004). Among women, the survival rate was 5.4% for those who received bystander CPR and 3.4% for those who did not, yielding a risk ratio of 1.6. In men, the corresponding survival rates were 11.0% with bystander CPR and 4.5% without, with a risk ratio of 2.4. The hazard ratio (HR) of bystander CPR for 30-day survival was 1.3 in women (95% CI: 0.9–1.9; p = 0.124) and 1.5 in men (95% CI: 1.2–1.9; p < 0.001). Conclusions: in this study setting in Japan, women received bystander CPR in numbers similar to those of men when OHCA occurred. However, the increase in the chance of survival from bystander CPR for women appeared to be not as high as that for men.

The recommendations for electrical therapies described in this section are designed to improve survival from SCA and life-threatening arrhythmias. Whenever defibrillation is attempted, rescuers must coordinate high-quality CPR with defibrillation to minimize interruptions in chest compressions and to ensure immediate resumption of chest compressions after shock delivery. The high first-shock efficacy of newer biphasic defibrillators led to the recommendation of single shocks plus immediate CPR instead of 3-shock sequences that were recommended prior to 2005 to treat VF. Further data are needed to refine recommendations for energy levels for defibrillation and cardioversion using biphasic waveforms.

Out-of-hospital cardiac arrest outcomes when law enforcement arrives before emergency medical services

Introduction: The “chain of survival” is a 5-link theoretical construct that has been central to cardiac arrest resuscitation for over 40 years. Although the role of each link has been extensively studied, little is known about the impact of performing the chain of survival in sequence. The purpose of this study was to estimate the proportion of out-of-hospital cardiac arrest (OHCA) responses by Emergency Medical Services (EMS) that had an intact chain of survival sequence response, and the effect of this on survival to hospital discharge. Methods: We conducted a prospective cohort study of adult (>age 20 years) OHCA patients using data collected between 2005-2007 by the Resuscitation Outcomes Consortium (ROC). ROC is a research network involving 10 research sites and 264 EMS agencies across North America. Using routinely collected data, we coded cases as receiving an intact or non-intact chain of survival sequence based on EMS cardio pulmonary resuscitation (CPR), rhythm analysis or defibrillation, epinephrine administration or endotracheal intubation, and transport to a hospital with an electrophysiology lab or percutaneous coronary intervention capability, contingent on the patient’s condition when EMS arrived. Multiple variable logistic regression was performed, adjusting for known (Utstein) survival predictors, to estimate the independent effect of intact chain of survival sequence on survival to hospital discharge. REB approval was obtained. Results: We enrolled12,821 OHCA cases, of which, 29.4% (n=3,773) had an intact chain of survival and 7.6% (n=972) survived to hospital discharge. Cases with an intact chain of survival were younger, and more likely to arrest in public, receive bystander CPR, occur in the USA and specific ROC sites, and had faster EMS response times. The adjusted odds ratio of survival to hospital discharge with an intact chain of survival sequence was 2.4 (95% CI: 2.1-2.8). A sensitivity analysis of 4,056 cases with known timing of endotracheal intubation found a similar adjusted odds ratio of 2.1 (95% CI: 1.6-2.8). Conclusion: Our results indicate that OCHA resuscitation with an intact chain of survival occurs in approximately 1/3 of cases, and results in over a two-fold increase in the odds of surviving to hospital discharge. Initiatives to improve EMS teamwork and increase the proportion of OHCA resuscitation with an intact chain of survival appear to be warranted.

SUMMARYApproximately 8000 people suffer from an out-of-hospital cardiac arrest (OHCA) in the Republic of Croatia every year. OHCA survival rates generally remain low despite major advances in resuscitation. Its incidence and survival rate are well known in many European countries, but reliable data on OHCA in Croatia are lacking. The aim of the study was to determine survival rate of patients with OHCA in the Republic of Croatia and the importance of the community bystander cardiopulmonary resuscitation (CPR) rates in the survival chain. This prospective observational study performed between October 1, 2017 and December 31, 2017 included all adult patients with OHCA in Croatia who were treated by Emergency Medical Services (EMS). OHCA data were collected from the Croatian Institute of Emergency Medicine database and Utstein cardiac arrest data collection form. Descriptive data presentation was used in the analyses. Data were expressed as absolute frequencies and percentages and central tendency measures. Testing of correlations in return of spontaneous circulation (ROSC) was performed by logistic regression. During the observation period, a total of 1763 adult patients without signs of circulation were assessed by EMS in Croatia and 760 (43%) adult patients were resuscitated by EMS personnel. Outcomes measured in ROSC until emergency department admission were reported in 126 (17%) cases. Shockable rhythm vs. non-shockable rhythm (OR: 5.832, 95% CI: 3.621-9.392; p<0.001) and bystander witnessed cardiac arrest (OR: 8.213, 95% CI: 2.554-26.411, p<0.001) were significantly associated with a higher probability of survival. There was no significant difference in correlation with day or night shift, etiology of cardiac arrest and bystander CPR variables. Survival rate of OHCA patients who received CPR until emergency department admission in Croatia was 17%. A higher survival rate post-OHCA was more likely among patients who received bystander CPR and had shockable rhythm.

Objective To investigate the epidemiological features of out-of-hospital cardiac arrest (OHCA) in Zhejiang and to analysis factors associated with outcomes for providing evidence on improving the success rate of cardiopulmonary resuscitation (CPR). Methods Clinical data of 493 patients with OHCA collected from the emergency department (ED) of Zhejiang Provincial People's Hospital, Ningbo Emergency Medical Service Center and Shaoxing Emergency Medical Service Center from January 2012 to August 2016 were analyzed retrospectively. All the data were recorded following the Utstein style included causes of arrest, location of arrest, first arrest rhythm, witnessed by bystanders, bystander CPR, pre-hospital defibrillation, pre-hospital intubation, pre-hospital epinephrine administration, emergency medical services (EMS) response time, return of spontaneous circulation (ROSC) at scene/enroute, ROSC at ED, admission to hospital, survival to hospital discharge and neurological outcomes at discharge. Factors associated with 30 days survival rate of patients with OHCA were analyzed. Results 493 patients were enrolled, of whom 342 were male and 151 were female. The average age was (58.8±21.4) years. The causes of arrests consisted of cardiac etiology (219 cases), trauma (155 cases), respiratory disease (22 cases), drowning (19 cases), electrocution (8 cases) and others (70 cases). Most of the events occurred at home (65.1%) and public places (22.7%). 55.2% patients were witnessed by bystanders while bystander CPR was performed in only 2.6% cases. Asystole was the predominant rhythm (78.7%) observed by the ambulance crew at the arrest site while only 5.5% first arrest rhythms were ventricular fibrillation/ventricular tachycardia (VF/VT). Only 6.9% patients underwent pre-hospital defibrillation. Pre-hospital intubations were attempted in 16.4% patients. Epinephrine was administered in 56.4% patients at scene or in ambulances. EMS response time was (13.6±8.0) minutes. 4.5% patients had ROSC at scene/enroute and 7.7% had ROSC at ED. Only 9.7% patients were admitted to hospital and 1.2% discharged alive. 0.8% patients were still in hospital on 30th day. The 30-day survival rate was 2.0% (10/493) and only 0.8% patients had neurologically favorable survivals [with the cerebral performance category (CPC) score of 1 or 2]. Witnessed by bystanders (3.31% vs. 0.45%), VF/VT as the first arrest rhythm (7.41% vs. 1.72%), bystander CPR (15.38% vs. 1.67%), pre-hospital defibrillation (8.82% vs. 1.53%) and EMS response time < 10 minutes (3.57% vs. 0.74%) could improve 30-day survival rate of OHCA significantly (all P < 0.05). Conclusion Resuscitation survival of OHCA in Zhejiang province was unsatisfactory. Improvements are required in series aspects of OHCA survival chain. Key words: Out-of-hospital cardiac arrest; Cardiopulmonary resuscitation; Epidemiology; Outcome; Emergency medical services response time

Background: In nonshockable cardiac arrest (CA) patients, the 2020 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from CA, as with the 2015 CPR guidelines. However, it is unknown whether the 2015 guidelines contributed to the favorable neurological outcomes in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines on adult CA patients using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA). Methods: From the data of this registry, between 2011 and 2020, we included adult witnessed OHCA patients due to cardiac etiology who had non-shockable rhythm as an initial rhythm. We excluded patients who received prehospital care in 2011, 2015, 2016, and 2020 because it was difficult to distinguish prehospital care based on either 2010 CPR guidelines, 2015, or 2020. We also excluded patients who received bystander CPR by citizens because we cannot assess the quality of bystander CPR. Study patients were divided into two groups based on the different CPR guidelines; the era of the 2010 guidelines (2010G) and the era of the 2015 guidelines (2015G). The endpoint was the favorable neurological outcome at 30 days after OHCA. Potential confounding factors based on biological plausibility and previous studies were included in the multivariable logistic regression analysis. These variables included the age, sex (male, female), advanced airway or not, the administration of adrenaline or not, the administration of saline or not, and time interval from call EMS to the scene. Results: Of the 1,259,960 patients registered in the All-Japan Utstein Registry, the data of 54,219 patients were included in this analysis. The 2015G was significantly higher in the 30-day favorable neurological outcome than the 2010G (2010G vs. 2015G = 1.5% vs. 1.8%: p=0.008). In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in OHCA patients in the 2015G compared to in the 2010G was 1.37 (95%CI 1.19-1.58, p&lt;0.001). Conclusion: In the OHCA patients with non-shockable rhythm, the 2015 CPR guidelines were superior to the 2010 guidelines in terms of neurological benefits.

Emergency Medical Services handoff of patients in cardiac arrest in the Emergency Department: A retrospective video review study of duration and details of handoff

<i>Circulation:</i> Clinical Summaries

The first description of modern cardiopulmonary resuscitation (CPR) included the instruction to compress the chest “about 60 times per minute”1; however, the optimal compression rate was unknown. Franz Koenig is credited with describing the original technique for external cardiac massage, which included a compression rate of 30 to 40 per minute.2 But in the first published description of external cardiac massage in 1892, Friedrich Maass documented a better clinical response with a rate of 120 per minute.2 To this day, the optimal compression rate is the subject of controversy. Animal data indicate that cardiac output increases with compression rates up to as high as 150 per minute.3 In a canine model of prolonged cardiac arrest, compression rates of 120 per minute compared with 60 per minute increased mean aortic (systolic and diastolic) and coronary perfusion pressures, and 24-hour survival (61% versus 15%, P =0.03).4 In a study of 9 patients undergoing CPR, a compression rate of 120 per minute generated higher aortic peak pressures and coronary perfusion pressures compared with a compression rate of 60 per minute (the rate recommended by the 1980 American Heart Association [AHA] guidelines). This evidence is supported by another study of 23 patients in cardiac arrest in which compressions at 120 per minute resulted in significantly higher end-tidal carbon dioxide values compared with compressions at 80 per minute.5 Article see p 3004 The first large, prospective, observational study of the influence of chest compression rate on patient survival was published in this journal in 2005.6 The number of delivered chest compressions was recorded by trained observers during in-hospital resuscitation attempts. A higher chest compression rate was associated with a higher rate of return of spontaneous circulation (ROSC). The mean chest compression rate for initial survivors was 90 …

Sex-Based Disparities in Receiving Bystander Cardiopulmonary Resuscitation by Location of Cardiac Arrest in Japan