Health-care workers are thought to be highly exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to investigate the prevalence of antibodies against SARS-CoV-2 ...in health-care workers and the proportion of seroconverted health-care workers with previous symptoms of COVID-19.
In this observational cohort study, screening was offered to health-care workers in the Capital Region of Denmark, including medical, nursing, and other students who were associated with hospitals in the region. Screening included point-of-care tests for IgM and IgG antibodies against SARS-CoV-2. Test results and participant characteristics were recorded. Results were compared with findings in blood donors in the Capital Region in the study period.
Between April 15 and April 23, 2020, we screened 29 295 health-care workers, of whom 28 792 (98·28%) provided their test results. We identified 1163 (4·04% 95% CI 3·82–4·27) seropositive health-care workers. Seroprevalence was higher in health-care workers than in blood donors (142 3·04% of 4672; risk ratio RR 1·33 95% CI 1·12–1·58; p<0·001). Seroprevalence was higher in male health-care workers (331 5·45% of 6077) than in female health-care workers (832 3·66% of 22 715; RR 1·49 1·31–1·68; p<0·001). Frontline health-care workers working in hospitals had a significantly higher seroprevalence (779 4·55% of 16 356) than health-care workers in other settings (384 3·29% of 11 657; RR 1·38 1·22–1·56; p<0·001). Health-care workers working on dedicated COVID-19 wards (95 7·19% of 1321) had a significantly higher seroprevalence than other frontline health-care workers working in hospitals (696 4·35% of 15 983; RR 1·65 1·34–2·03; p<0·001). 622 53·5% of 1163 seropositive participants reported symptoms attributable to SARS-CoV-2. Loss of taste or smell was the symptom that was most strongly associated with seropositivity (377 32·39% of 1164 participants with this symptom were seropositive vs 786 2·84% of 27 628 without this symptom; RR 11·38 10·22–12·68). The study is registered at ClinicalTrials.gov, NCT04346186.
The prevalence of health-care workers with antibodies against SARS-CoV-2 was low but higher than in blood donors. The risk of SARS-CoV-2 infection in health-care workers was related to exposure to infected patients. More than half of seropositive health-care workers reported symptoms attributable to COVID-19.
Lundbeck Foundation.
Among patients in Denmark who survived for 30 days after out-of-hospital cardiac arrest, bystander CPR and bystander defibrillation were associated with significantly lower risks of brain damage or ...nursing home admission and of death from any cause than no bystander intervention.
Dispatching citizen responders through a smartphone application (app) holds the potential to increase bystander cardiopulmonary resuscitation (CPR) and defibrillation in out-of-hospital cardiac ...arrest (OHCA).
This study investigated arrival at the OHCA location of app-dispatched citizen responders before the Emergency Medical Services (EMS) and the association with bystander CPR and bystander defibrillation.
Suspected OHCAs with alerted citizen responders from September 1, 2017, to August 31, 2018, were included. Citizen responders located 1.8 km (1.1 miles) from the OHCA were dispatched to start CPR or retrieve an automated external defibrillator. OHCAs where at least 1 citizen responder arrived before EMS were compared with OHCAs where EMS arrived first. In both groups, random bystanders could be present before the arrival of citizen responders and the EMS. Primary outcomes were bystander CPR and bystander defibrillation, which included CPR and defibrillation by citizen responders and random bystanders.
Citizen responders were alerted in 819 suspected OHCAs, of which 438 (53.5%) were confirmed cardiac arrests eligible for inclusion. At least 1 citizen responder arrived before EMS in 42.0% (n = 184) of all included OHCAs. When citizen responders arrived before EMS, the odds for bystander CPR increased (odds ratio: 1.76; 95% confidence interval: 1.07 to 2.91; p = 0.027) and the odds for bystander defibrillation more than tripled (odds ratio: 3.73; 95% confidence interval: 2.04 to 6.84; p < 0.001) compared with OHCAs in which citizen responders arrived after EMS.
Arrival of app-dispatched citizen responders before EMS was associated with increased odds for bystander CPR and a more than 3-fold increase in odds for bystander defibrillation. (The HeartRunner Trial; NCT03835403)
Display omitted
Emergency medical dispatchers fail to identify approximately 25% of cases of out of hospital cardiac arrest, thus lose the opportunity to provide the caller instructions in cardiopulmonary ...resuscitation. We examined whether a machine learning framework could recognize out-of-hospital cardiac arrest from audio files of calls to the emergency medical dispatch center.
For all incidents responded to by Emergency Medical Dispatch Center Copenhagen in 2014, the associated call was retrieved. A machine learning framework was trained to recognize cardiac arrest from the recorded calls. Sensitivity, specificity, and positive predictive value for recognizing out-of-hospital cardiac arrest were calculated. The performance of the machine learning framework was compared to the actual recognition and time-to-recognition of cardiac arrest by medical dispatchers.
We examined 108,607 emergency calls, of which 918 (0.8%) were out-of-hospital cardiac arrest calls eligible for analysis. Compared with medical dispatchers, the machine learning framework had a significantly higher sensitivity (72.5% vs. 84.1%, p < 0.001) with lower specificity (98.8% vs. 97.3%, p < 0.001). The machine learning framework had a lower positive predictive value than dispatchers (20.9% vs. 33.0%, p < 0.001). Time-to-recognition was significantly shorter for the machine learning framework compared to the dispatchers (median 44 seconds vs. 54 s, p < 0.001).
A machine learning framework performed better than emergency medical dispatchers for identifying out-of-hospital cardiac arrest in emergency phone calls. Machine learning may play an important role as a decision support tool for emergency medical dispatchers.
Dispatch of lay volunteers trained in cardiopulmonary resuscitation (CPR) and equipped with automated external defibrillators (AEDs) may improve survival in cases of out-of-hospital cardiac arrest ...(OHCA). The aim of this study was to investigate the functionality and performance of a smartphone application for locating and alerting nearby trained laymen/women in cases of OHCA.
A system using a smartphone application activated by Emergency Dispatch Centres was used to locate and alert laymen/women to nearby suspected OHCAs. Lay responders were instructed either to perform CPR or collect a nearby AED. An online survey was carried out among the responders.
From February to August 2016, the system was activated in 685 cases of suspected OHCA. Among these, 224 cases were Emergency Medical Services (EMSs)-treated OHCAs (33%). EMS-witnessed cases (n = 11) and cases with missing survey data (n = 15) were excluded. In the remaining 198 OHCAs, lay responders arrived at the scene in 116 cases (58%), and prior to EMSs in 51 cases (26%). An AED was attached in 17 cases (9%) and 4 (2%) were defibrillated. Lay responders performed CPR in 54 cases (27%). Median distance to the OHCA was 560 m (IQR 332–860 m), and 1280 m (IQR 748–1776 m) via AED pick-up. The survey-answering rate was 82%.
A smartphone application can be used to alert CPR-trained lay volunteers to OHCAs for CPR. Further improvements are needed to shorten the time to defibrillation before EMS arrival.
BACKGROUND:Bystander-initiated cardiopulmonary resuscitation (CPR) increases patient survival after out-of-hospital cardiac arrest, but it is unknown to what degree bystander CPR remains positively ...associated with survival with increasing time to potential defibrillation. The main objective was to examine the association of bystander CPR with survival as time to advanced treatment increases.
METHODS:We studied 7623 out-of-hospital cardiac arrest patients between 2005 and 2011, identified through the nationwide Danish Cardiac Arrest Registry. Multiple logistic regression analysis was used to examine the association between time from 911 call to emergency medical service arrival (response time) and survival according to whether bystander CPR was provided (yes or no). Reported are 30-day survival chances with 95% bootstrap confidence intervals.
RESULTS:With increasing response times, adjusted 30-day survival chances decreased for both patients with bystander CPR and those without. However, the contrast between the survival chances of patients with versus without bystander CPR increased over timewithin 5 minutes, 30-day survival was 14.5% (95% confidence interval CI12.8–16.4) versus 6.3% (95% CI5.1–7.6), corresponding to 2.3 times higher chances of survival associated with bystander CPR; within 10 minutes, 30-day survival chances were 6.7% (95% CI5.4–8.1) versus 2.2% (95% CI1.5–3.1), corresponding to 3.0 times higher chances of 30-day survival associated with bystander CPR. The contrast in 30-day survival became statistically insignificant when response time was >13 minutes (bystander CPR vs no bystander CPR3.7% 95% CI2.2–5.4 vs 1.5% 95% CI0.6–2.7), but 30-day survival was still 2.5 times higher associated with bystander CPR. Based on the model and Danish out-of-hospital cardiac arrest statistics, an additional 233 patients could potentially be saved annually if response time was reduced from 10 to 5 minutes and 119 patients if response time was reduced from 7 (the median response time in this study) to 5 minutes.
CONCLUSIONS:The absolute survival associated with bystander CPR declined rapidly with time. Yet bystander CPR while waiting for an ambulance was associated with a more than doubling of 30-day survival even in case of long ambulance response time. Decreasing ambulance response time by even a few minutes could potentially lead to many additional lives saved every year.
Abstract
Aims
Bystander cardiopulmonary resuscitation (CPR) has increased in several countries following nationwide initiatives to facilitate bystander resuscitative efforts in out-of-hospital ...cardiac arrest (OHCA). We examined the importance of public or residential location of arrest on temporal changes in bystander CPR and outcomes.
Methods and results
From the nationwide Danish Cardiac Arrest Registry, all OHCAs from 2001 to 2014 of presumed cardiac cause and between 18 and 100 years of age were identified. Arrests witnessed by emergency medical services personnel were excluded. Of 25 505 OHCAs, 26.4% (n = 6738) and 73.6% (n = 18 767) were in public and residential locations, respectively. Bystander CPR increased during 2001–2014 in both locations: from 36.4% 95% confidence interval (CI) 30.6–42.6% to 83.1% (95% CI 80.0–85.8%) in public (P < 0.001) and from 16.0% (95% CI 13.2–19.3%) to 61.0% (95% CI 58.7–63.2%) in residential locations (P < 0.001). Concurrently, 30-day survival increased in public from 6.4% (95% CI 4.0–10.0%) to 25.2% (95% CI 22.1–28.7%) (P < 0.001), and in residential from 2.9% (95% CI 1.8–4.5%) to 10.0% (95% CI 8.7–11.4%) (P < 0.001). Among 2281 30-day survivors, 1-year risk of anoxic brain damage/nursing home admission during 2001–2014 decreased from 18.8% (95% CI 6.6–43.0%) to 6.8% (95% CI 3.9–11.8%) in public (P < 0.001), whereas the corresponding change was insignificant in residential locations from 11.8% (95% CI 3.3–34.3) to 17.6% (95% CI 12.7–23.9%) (P = 0.52).
Conclusion
During 2001–2014, bystander CPR and 30-day survival more than doubled in both public and residential OHCA locations. A significant decrease in anoxic brain damage/nursing home admission was observed among 30-day survivors in public, but not among survivors from residential OHCAs.
Background Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) increases neurologically intact survival in out-of-hospital cardiac arrest (OHCA) according to several studies. This systematic ...review summarizes neurologically intact survival outcomes of DA-CPR in comparison with bystander-initiated CPR and no bystander CPR in OHCA. Methods The systematic review was conducted according to the PRISMA guidelines. All studies including adult and/or pediatric OHCAs that compared DA-CPR with bystander-initiated CPR or no bystander CPR were included. Primary outcome was neurologically intact survival at discharge, one-month or longer. Studies were searched for in PubMed (MEDLINE), EMBASE, and the Cochrane Library databases. The risk of bias was evaluated using the Newcastle-Ottawa Scale. Results The search string generated 4742 citations of which 33 studies were eligible for inclusion. Due to overlapping study populations, the review included 14 studies. All studies were observational. The study populations were heterogeneous and included adult, pediatric and mixed populations. Some studies reported only witnessed cardiac arrests, arrests of cardiac ethiology, and/or shockable rhythm. The individual studies scored between six and nine on the Newcastle-Ottawa Scale of risk of bias. The median neurologically intact survival at hospital discharge with DA-CPR was 7.0% (interquartile range (IQR): 5.1-10.8%), with bystander-initiated CPR 7.5% (IQR: 6.6-10.2%), and with no bystander CPR 4.4% (IQR: 2.0-9.0%) (four studies). At one-month neurologically intact survival with DA-CPR was 3.1% (IQR: 1.6-3.4%), with bystander-initiated CPR 5.7% (IQR: 5.0-6.0%), and with no bystander CPR 2.5% (IQR: 2.1-2.6%) (three studies). Conclusion Both DA-CPR and bystander-initiated CPR increase neurologically intact survival compared with no bystander CPR. However, DA-CPR demonstrates inferior outcomes compared with bystander-initiated CPR. Early CPR is crucial, thus in cases where bystanders have not initiated CPR, DA-CPR provides an opportunity to improve neurologically intact survival following OHCA. Variability in OHCA outcomes across studies and multiple confounding factors were identified. Keywords: Dispatcher-assisted CPR, Telephone-assisted CPR, T-CPR, DA-CPR, Cardiopulmonary resuscitation, Out-of-hospital cardiac arrest, Cardiac arrest, Emergency medical services, Medical dispatch, Systematic review
BACKGROUND—Despite wide dissemination, use of automated external defibrillators (AEDs) in community settings is limited. We assessed how AED accessibility affected coverage of cardiac arrests in ...public locations.
METHODS AND RESULTS—We identified cardiac arrests in public locations (1994–2011) in terms of location and time and viewed them in relation to the location and accessibility of all AEDs linked to the emergency dispatch center as of December 31, 2011, in Copenhagen, Denmark. AED coverage of cardiac arrests was defined as cardiac arrests within 100 m (109.4 yd) of an AED and further categorized according to AED accessibility at the time of cardiac arrest. Daytime, evening, and nighttime were defined as 8 AM to 3:59 PM, 4 to 11:59 PM, and midnight to 7:59 AM, respectively. Of 1864 cardiac arrests in public locations, 61.8% (n=1152) occurred during the evening, nighttime, or weekends. Of 552 registered AEDs, 9.1% (n=50) were accessible at all hours, and 96.4% (n=532) were accessible during the daytime on all weekdays. Regardless of AED accessibility, 28.8% (537 of 1864) of all cardiac arrests were covered by an AED. Limited AED accessibility decreased coverage of cardiac arrests by 4.1% (9 of 217) during the daytime on weekdays and by 53.4% (171 of 320) during the evening, nighttime, and weekends.
CONCLUSIONS—Limited AED accessibility at the time of cardiac arrest decreased AED coverage by 53.4% during the evening, nighttime, and weekends, which is when 61.8% of all cardiac arrests in public locations occurred. Thus, not only strategic placement but also uninterrupted AED accessibility warrant attention if public-access defibrillation is to improve survival after out-of-hospital cardiac arrest.
Young children are among the most frequent patients at medical call centers, even though they are rarely severely ill. Respiratory tract symptoms are among the most prevalent reasons for contact in ...pediatric calls. Triage of children without visual cues and through second-hand information is perceived as difficult, with risks of over- and under-triage.
To study the safety and feasibility of introducing video triage of young children with respiratory symptoms at the medical helpline 1813 (MH1813) in Copenhagen, Denmark, as well as impact on patient outcome.
Prospective quality improvement study including 617 patients enrolled to video or standard telephone triage (1:1) from February 2019-March 2020. Data originated from MH1813 patient records, survey responses, and hospital charts. Primary outcome was difference in patients staying at home eight hours after the call. Secondary outcomes weas hospital outcome, feasibility and acceptability. Adverse events (intensive care unit admittance, lasting injuries, death) were registered. Logistic regression was used to test the effect on outcomes. The COVID-19 pandemic shut the study down prematurely.
In total, 54% of the included patients were video-triaged., and 63% of video triaged patients and 58% of telephone triaged patients were triaged to stay at home, (p = 0.19). Within eight and 24 hours, there was a tendency of fewer video-triaged patients being assessed at hospitals: 39% versus 46% (p = 0.07) and 41% versus 49% (p = 0.07), respectively. At 24 hours after the call, 2.8% of the patients were hospitalized for at least 12 hours. Video triage was highly feasible and acceptable (>90%) and no adverse events were registered.
Video triage of young children with respiratory symptoms at a medical call center was safe and feasible. Only about 3% of all children needed hospitalization for at least 12 hours. Video triage may optimize hospital referrals and increase health care accessibility.
PDF
