Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), in which 9-1-1 dispatchers provide CPR instructions over the telephone, has been shown to nearly double the rate of bystander CPR. We ...sought to identify factors that hampered the identification of cardiac arrest by 9-1-1 dispatchers and prevented or delayed the provision of dispatcher-assisted CPR chest compressions.
We reviewed dispatch recordings for 476 out-of-hospital cardiac arrests occurring between January 1, 2011, and December 31, 2011. We found that the dispatcher correctly identified cardiac arrest in 80% of reviewed cases and 92% of cases in which they were able to assess patient consciousness and breathing. The median time to recognition of the arrest was 75 seconds. Chest compressions following dispatcher-assisted CPR instructions occurred in 62% of cases when the dispatcher had the opportunity to asses for consciousness and breathing and bystander CPR was not already started. The median time to first dispatcher-assisted CPR chest compression was 176 seconds.
Dispatchers are able to accurately diagnose cardiac arrest over the telephone, but recognition is likely not possible in all circumstances. In some cases, recognition of cardiac arrest may be improved through training in the detection of agonal respirations. Delays in the delivery of dispatcher-assisted CPR chest compressions are common and are attributable to a mixture of dispatcher behavior and factors beyond the control of the dispatcher. Performance standards for the successful and quick recognition of cardiac arrest and delivery of first chest compressions should be adopted as metrics against which emergency medical services systems can measure their performance.
Abstract Background Approximately 359,400 out-of-hospital cardiac arrests occur in the United States every year, and around 60% of them are treated by emergency medical services (EMS) personnel. In ...order to alleviate the impact of this public health burden, some communities have trained police officers as first responders so that they can provide cardiopulmonary resuscitation and defibrillation to cardiac arrest patients. This paper is a review of the current literature on the impact of police automated external defibrillators (AEDs) programs in these communities. Methods and results A literature search of electronic journal databases was conducted to identify articles that evaluated police AED programs and quantified survival rates. The 10 articles that met the inclusion criteria were very heterogeneous in terms of study design, controlling for confounders, outcome definitions, and comparison groups. Two communities found a statistically significant difference in survival and 6 studies reported a statistically significant difference in time to defibrillation after the implementation of these programs. The weighted mean survival rate of the study groups was higher than that of the control groups ( p < 0.001), as was the weighted mean survival rate of the group first shocked by police compared to those first shocked by EMS (39.4% vs. 28.6%, p < 0.001). The pooled relative risk of survival was 1.4 (95% CI: 1.3–1.6). Conclusions Though there are many challenges in initiating these programs, this literature review shows that time to defibrillation decreased and survival from out-of-hospital cardiac arrests increased with the implementation of police AED programs.
The potential impact of efforts in Europe to improve survival from out-of-hospital cardiac arrest is unclear, in part, because estimates of incidence and survival are uncertain. The aim of the ...investigation was to determine a representative European incidence and survival from cardiac arrest in all-rhythms and in ventricular fibrillation treated by the emergency medical services (EMS).
We used Medline to identify peer-reviewed articles published between 1 January 1980 and 30 June 2004 that reported a European community's EMS cardiac arrest experience. Inclusion criteria required the study to include at least 25 cases, report of the total number of all-rhythm and/or ventricular fibrillation arrests, and information about population size and study duration. The incidence was computed by dividing the total number of events by the product of the community's population and the study duration.
Reports from 37 communities met the inclusion criteria. A total of 18,105 all-rhythm EMS-treated cardiac arrests occurred during 48 million person-years of observation, resulting in an overall incidence for all-rhythm arrests of 37.72 per 100,000 person-years. Incidence of ventricular fibrillation arrest was 16.84 per 100,000 person-years. Survival was 10.7% for all-rhythm and 21.2% for ventricular fibrillation cardiac arrest. Applying these results to the European population, approximately, 275,000 persons would experience, all-rhythm cardiac arrest treated by the EMS with 29,000 persons surviving to hospital discharge.
The results provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of cardiac arrest in Europe.
CPR with chest compression alone or with rescue breathing Rea, Thomas D; Fahrenbruch, Carol; Culley, Linda ...
New England journal of medicine/The New England journal of medicine,
07/2010, Letnik:
363, Številka:
5
Journal Article
Recenzirano
Odprti dostop
The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders to provide chest compression ...alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing.
We conducted a multicenter, randomized trial of dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-of-hospital cardiac arrest for whom dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomes included a favorable neurologic outcome at discharge.
Of the 1941 patients who met the inclusion criteria, 981 were randomly assigned to receive chest compression alone and 960 to receive chest compression plus rescue breathing. We observed no significant difference between the two groups in the proportion of patients who survived to hospital discharge (12.5% with chest compression alone and 11.0% with chest compression plus rescue breathing, P=0.31) or in the proportion who survived with a favorable neurologic outcome in the two sites that assessed this secondary outcome (14.4% and 11.5%, respectively; P=0.13). Prespecified subgroup analyses showed a trend toward a higher proportion of patients surviving to hospital discharge with chest compression alone as compared with chest compression plus rescue breathing for patients with a cardiac cause of arrest (15.5% vs. 12.3%, P=0.09) and for those with shockable rhythms (31.9% vs. 25.7%, P=0.09).
Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing. (Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation; ClinicalTrials.gov number, NCT00219687.)
Background: The potential impact of efforts to improve the chain of survival for out-of-hospital sudden cardiac arrest (SCA) is unclear in part because estimates of the incidence of treatable cases ...of SCA are uncertain. The aim of the investigation was to determine a representative national incidence of emergency medical services (EMS)-treated all-rhythm and ventricular fibrillation (VF) SCA as well as survival.
Methods: We used Medline to identify peer-reviewed articles published between 1 January 1980 and 31 March 2003 that reported a US community’s EMS SCA experience. Inclusion criteria required the study to include at least 25 cases, report the total number of all-rhythm and/or ventricular fibrillation arrests, and provide information about population size and study duration. Incidence was computed by dividing the total number of SCA events by the product of the community’s population and the study duration.
Results: Reports from 35 communities met the inclusion criteria. A total of 35,801 all-rhythm EMS-treated cardiac arrests occurred during 62.11 million person-years of observation resulting in an overall incidence of 54.99 per 100,000 person-years. The incidence of ventricular fibrillation-rhythm SCA was 21.32 per 100,000 person-years. Sensitivity analyses generally produced similar results. Applying these results to the US population, 155,000 persons would experience EMS-treated all-rhythm SCA and 60,000 persons would experience EMS-treated ventricular fibrillation-rhythm SCA annually in the US. Survival was 8.4% for all-rhythm and 17.7% for ventricular fibrillation SCA.
Conclusion: The results provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of SCA.
Introdução:O impacto potencial dos esforços para melhorar a cadeia de sobrevivência para as paragens cardı́acas súbitas (SCA) pré-hospitalares é desconhecido, em parte porque as estimativas da incidência de casos tratáveis de SCA são imprecisas. O objectivo da investigação foi determinar uma incidência nacional representativa das SCA tratadas pelos Serviços de Emergência Médica (EMS) em todos os ritmos e em fibrilhação ventricular (VF), assim como a sobrevida.
Métodos: Usamos a Medline para identificar artigos revistos por peritos e publicados entre 1 de Janeiro de 1980 e 31 de Março de 2003, apresentando experiências de SCA tratadas pelos EMS em comunidades americanas. Os critérios de inclusão obrigaram a que o estudo incluı́sse pelo menos 25 casos, registos do número total de paragens em todos os ritmos e/ou fibrilhação ventricular e informação sobre o tamanho da população e a duração do estudo. A incidência foi calculada pela razão entre o número total de eventos de SCA e o produto da população pela duração do estudo.
Resultados:Resultados de 35 comunidades cumpriram os critérios de inclusão. Ocorreram 35.801 paragens cardı́acas em todos os ritmos, tratadas pelos EMS, em 62,11 milhões de pessoas/ano de observação, o que resultou numa incidência global de 54,99 por 100.000 pessoas/ano. A incidência de SCA com ritmo de fibrilhação ventricular foi de 21,32 por 100.000 pessoas/ano. As análises de sensibilidade obtiveram resultados similares. Aplicando estes resultados à população dos Estados Unidos, anualmente 155.000 pessoas sofrem SCA em todos os ritmos e 60.000 pessoas sofrem SCA em ritmo de fibrilhação ventricular, tratadas pelos EMS. A sobrevida foi de 8,4% para SCA em todos os ritmos e de 17,7% em fibrilhação ventricular.
Conclusão:Os resultados fornecem uma base para avaliar as limitações e oportunidades dos cuidados dos EMS em relação ao peso das SCA na saúde pública.
Antecedentes: El impacto potencial de los esfuerzos para mejorar la cadena de sobrevida para paro cardiaco súbito(SCA) extrahospitalario no es claro en parte porque las estimaciones de la incidencia de casos tratables de SCA es incierta. El objetivo de esta investigación es determinar una incidencia nacional representativa SCA tratados por los servicios de emergencia médicas por todos los ritmos y por fibrilación ventricular(VF) al igual que la sobrevida.
Métodos: Usamos Medline para identificar artı́culos de revisión publicados entre Enero 1 1980 y Marzo 31 2003 que reportara la experiencia de SCA tratado por EMD en la comunidad de EEUU. Los criterios de inclusión del estudio requirieron que el estudio fuera de al menos 25 casos, que reportara el numero total de SCA por todos los ritmos y / o por VF, y que proporcionara información acerca del tamaño de la población y duración del estudio. La incidencia fue computada dividiendo el número total de eventos SCA por el producto de la población de la comunidad y la duración del estudio.
Resultados: Reportes de 35 comunidades alcanzaron los criterios de inclusión. Ocurrieron un total de 35801 SCA por todos los ritmos, tratados por EMS ocurrieron durante 62.11 millones de persona-años de observación resultando en una incidencia global de 54.99 por 100000persona-año. La incidencia de SCA por VF fue de 21.32 por 100000 persona-año.Los análisis de sensibilidad generalmente produjeron resultados similares. Al aplicar los resultados a la población de EEUU, 155000 personas experimentarı́an SCA por todos los ritmos tratado por EMS y 60000 personas experimentarı́an SCA en VF tratado por EMS anualmente en los EEUU. La sobrevida fue 8.4% para SCA por todos los ritmos y 17.7% para SCA porVF.
Conclusión: El resultado proporciona un medio para evaluar oportunidades y limitaciones de los cuidados de EMS con relación a los marcos de salud pública del SCA.
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.
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