Outcomes from out-of-hospital cardiac arrest in Detroit
|
|
- Paulina Day
- 5 years ago
- Views:
Transcription
1 Resuscitation (2007) 72, CLINICAL PAPER Outcomes from out-of-hospital cardiac arrest in Detroit Robert B. Dunne a,, Scott Compton a,b,c,d, R.J. Zalenski b, Robert Swor c, Robert Welch d, Brooks F. Bock d a Department of Emergency Medicine, Sinai-Grace Hospital, b Department of Emergency Medicine, John D. Dingell VA Hospital, c Department of Emergency Medicine, William Beaumont Hospital, d Department of Emergency Medicine, Detroit Receiving Hospital, Received 7 October 2005; received in revised form 14 April 2006; accepted 14 April 2006 KEYWORDS Out-of-hospital CPR; Emergency medical services; Adult; Cardiac arrest Summary Objective: To determine the out-of-hospital cardiac arrest survival rate, and prevalence of modifiable factors associated with survival, in Detroit, Michigan, over a 6-month period of time in Methods: A retrospective review of all out-of-hospital cardiac arrests responded to by the Detroit Fire Department, Division of Emergency Medical Services. All elements of the EMS runsheet were transcribed to a database for analysis. Patient hospital records were reviewed to determine survival to hospital admission. All survivors to hospital admission were surveyed later in the Michigan Department of Vital Records death registry search. Results: During this study timeframe, there were 538 confirmed out-of-hospital cardiac arrests within the City of Detroit, of which 67 were excluded for being dead on scene [51 (12.5%)] or having no available hospital records [16 (3.0%)]. Of the remaining 471 patients, 443 (94.1%) died before hospital admission. Only 44 (9.9%) of the 471 patients had a first recorded rhythm of ventricular fibrillation (VF), and 339 (76.5%) were asystolic. Of the 28 patients who survived to hospital admission, only 2 (7.1%) were noted to have a first rhythm of VF, and 15 (53.6%) were asystolic. Only one patient survived to hospital discharge. Conclusions: In this urban setting, out-of-hospital cardiac arrest is an almost uniformly fatal event Published by Elsevier Ireland Ltd. A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi: /j.resuscitation Corresponding author at: 4201 St. Antoine, UHC-6G, Detroit, MI , United States. Tel.: ; fax: address: rdunne@med.wayne.edu (R.B. Dunne) /$ see front matter 2006 Published by Elsevier Ireland Ltd. doi: /j.resuscitation
2 60 R.B. Dunne et al. Introduction A tremendous amount of public resources are spent on planning for, and responding to, out-ofhospital cardiac arrests. These resources include layperson training programs for cardiopulmonary resuscitation (CPR), emergency medical service (EMS) equipment and training, and more recently, publicly accessible automated external defibrillators (AEDs). There is a large body of literature that supports these factors as being associated with survival from out-of-hospital cardiac arrest. This includes provision of bystander CPR, and a rapid EMS response providing early defibrillation. 1,2 Interestingly, however, in the largest study of the impact of an advanced cardiac life support EMS system ever published, no benefit on survival from cardiac arrest was identified. 3 Despite the dramatic increase in public resources commissioned in the past 40 years to respond to cardiac arrests, no evidence exists that suggests there has been a commensurate increase in the overall survival rate. The low survival rate in of cardiac arrest patients reported from cities such as New York City 4 and Chicago 5 in the early 1990s persist in the more recently published results from Los Angeles. 6 Given these reported mortality rates, and our clinical experience, we designed a study to estimate the survival rate from nontraumatic cardiac arrest in the City of Detroit, Michigan. We therefore instituted a non-traumatic cardiac arrest registry for 6 months in 2002 to evaluate both the survival rate and the prevalence of modifiable factors known to improve out-of-hospital cardiac arrest survival. Methods The Detroit Cardiac Arrest Registry (D-CAR) was designed as a retrospective observational cohort study of all adult out-of-hospital cardiac arrests within the City of Detroit. All EMS run sheets generated between 1 January 2002 and 30 June 2002 were obtained from the Detroit Fire Department Division of EMS. These records were searched by three research assistants, with overlapping review, to detect all records with EMS dispatch information or chief complaint described as: cardiac arrest, found down, not breathing, heart attack, or unconscious. Additionally, all records indicating CPR provision or advanced cardiac life support (ACLS) procedures were also included, to obtain information on possible EMS witnessed arrests. All data elements from the EMS records were entered into a Microsoft Access database specifically designed to match the EMS record, and later exported to SPSS (Chicago, IL) for analysis. Each record was reviewed by three investigators (RD, SC, JW) for data completion and validity. Through the above process, a database of all adult ( 18 years) out-of-hospital cardiac arrest patients, and the receiving hospital that they were transported to, was compiled. The emergency department records for these patients were then reviewed for survival to hospital admission. All patients were classified with regard to death in the emergency department and survival to hospital admission. Information on patients, admitted to the hospital, or for whom no emergency department record could be found, were submitted to the Michigan Department of Vital Records for a death registry search. Patients who survived to hospital admission, and whom were not listed in the death registry within 60 days of the hospitalization, were recorded as survivors. This study was approved by the Wayne State University Human Investigations Committee, and by each receiving hospital. Results According to the 2000 United States Census, the City of Detroit is approximately 139 square miles, with 6855 persons per square mile. In 2002, Detroit s population was approximately 950,000 people, of which approximately 10% were 65 years or older. There were approximately 375,000 housing units. Median household income was approximately $30,000, and many residents (26.1%) were living below the poverty level. Residents of the city are predominantly Black (81.6%). During the 6-month study period, there were 62,261 EMS dispatches, and 34,244 transports. Of these, 538 were identified as adult, nontraumatic, out-of-hospital cardiac arrests. This incidence of cardiac arrest (99.1/100,000/year) given the population size and time of study corresponds with published estimates of New York City, 4 Chicago, 5 and Los Angeles. 6 As shown in Figure 1, of the 538 identified cases, 67 (12.5%) were excluded. These exclusions consisted of either pronouncement of death on scene [51 (9.5%)], which in this system requires evidence of advanced rigor or decomposition, or patients listed as dead with no available identifiers [16 (3.0%)].
3 Outcomes from out-of-hospital cardiac arrest in Detroit 61 Figure 1 Out-of-hospital cardiac arrests (OHCAs) 1 January 2002 through 30 June Patient characteristics As shown in Table 1, patients were predominantly Black (70.9%), and arrests most frequently occurred in private residences (79.0%). Mean patient age was 63.3 years (±17.2). Few arrests were witnessed by EMS personnel [24 (5.1%)], and none of these survived to hospital discharge. EMS response characteristics Mean response interval, defined as the time that the EMS ambulance received the call and the time of arrival at the designated address, was 8.36 min, and a response of less than 6 min was noted in 38.1% of all cases. All responding units were ALS ambulances as there are no first responders in this system. This response covered a mean of 3.8 miles to scene (minimum 0, maximum 15). EMS response characteristics are shown in Table 2. Figure 2 describes characteristics of included cardiac arrest cases. Bystander witness information was not available for 56 (12.5%) of 447 non-ems witnessed arrests. The majority (64.5%) of the remaining arrests were not witnessed by a bystander. Of 471 patients, 443 (94.1%) died before hospital admission, 44 (9.9%) of those patients had a first recorded rhythm of ventricular fibrillation (VF), and 339 (76.5%) were asystolic. Sixty-nine patients (14.5%) received cardiac defibrillation. Data for time to first shock was available for 66 of these, average time from EMS receipt of the call to the first shock averaged 14 min. Defibrillation in less than 8 min was achieved in 19 (28.8%). Only 34 (7.2%) patients were noted to have a return of spontaneous circulation in the prehospital setting. Survival There were 28 (5.9%) patients who survived to hospital admission. Of those, only 2 (7.1%) were noted to have a first rhythm of VF, and 15 (53.6%) were
4 62 R.B. Dunne et al. Table 1 Patient characteristics Table 2 EMS response characteristics Characteristics Gender, n (%) Male 238 (50.5%) Female 233 (49.5%) Age, years (n = 462; 9 missing) Mean (S.D.) (17.2) Median (IQR) ( ) Minimum maximum Race, n (%) Black 334 (70.9) White 45 (9.6) Asian 6 (1.3) Hispanic 3 (0.6) Other 1 (0.2) Unknown 82 (17.4) Location, n (%) Private residence 372 (79.0) Public location 35 (7.4) Doctor s office 11 (2.3) Convalescent center 34 (7.2) Other 19 (4.0) asystolic. Only one (0.2%) patient survived to 60 days post admission. Discussion This study documents an almost uniformly fatal outcome from out-of-hospital cardiac arrest in this community. Out-of-hospital cardiac arrest remains a major cause of mortality for adults in the United States. 7 The evolution of the treatment of cardiac arrest has paralleled and in many ways has been responsible for the growth of emergency medical services. Strategies to improve survival have driven improvements in education and equipment for prehospital responders. The majority of the population in the United States lives in metropolitan areas. In New York City, Los Angeles and Chicago EMS systems cardiac arrest survival rate is low. 4 6 Hong Kong also reports a 1.25% survival rate. 8 The OPALS group in Canada report an overall 4.6% survival rate. 9 Rochester, MN reported 40% neurologically intact survivors of 200 patients with ventricular fibrillation, mean time to defibrillation was 5.7 min. Of their non V-fib group there were only four survivors out of Many factors affecting cardiac arrest survival are independent of the EMS system, including rate of bystander CPR, patient demographics, time from collapse to activation of the 911 system, and availability of rapid defibrillation. 11,12 Recent literature has examined the effect of public EMS characteristics EMS miles to scene (n = 469) Mean (S.D.) 3.81 (2.6) Median (IQR) 3.00 ( ) Minimum maximum 0 15 EMS response time a (n = 470) Mean (S.D.) 8.36 (4.5) Median (IQR) 8.00 ( ) Minimum maximum 0 36 Response 6 min, n (%) 179 (38.1) EMS first recorded rhythm, n (%) V-Fib 46 (9.8) V-Tach 4 (1.1) Asystole 354 (75.2) PEA 47 (10.0) Sinus 13 (2.8) Idio-ventricular 5 (1.1) Missing 1 (0.2) Number of shocks provided, n (%) (85.4) 1 21 (4.5) 2 12 (2.5) 3 19 (4.0) 4 9 (1.9) 5 2 (0.4) 6 3 (0.6) 7 2 (0.4) 8 1 (0.2) EMS time to first shock (n = 66) Mean (S.D.) (7.5) Median (IQR) ( ) Minimum maximum 4 45 First shock 8 min, n (%) 19 (28.8) Prehospital ROSC, n (%) Yes 34 (7.2) No 385 (81.7) Not recorded 52 (11.0) a Note: EMS response time is defined as the number of minutes between the EMS call reception and time to arrival at address. access defibrillation 13 and examined the implementation of certain aspects of ALS care in a structured fashion. 2,3 Our system is unique among 200 cities in listed in the Journal of Emergency Medical Services annual survey, in that there is no first response system. 14 All ambulances at the time of this initial collection of data for the Detroit Cardiac Arrest Registry (DCAR) were ALS with at least one paramedic and one basic EMT on the vehicle. EMS is a division of the fire service but operates under a different collective bargaining agreement and there is strict separation between fire suppression assets
5 Outcomes from out-of-hospital cardiac arrest in Detroit 63 Figure 2 Study sample flowchart. and EMS responders. There are no fire-fighter medical responders. Pharmaceutical boxes carried by EMS have been updated to accommodate changes in ACLS algorithms. Hospitals in the city have individually participated in resuscitation studies in the past with low reported survival. 15 Unpublished data from 1987, shortly after deployment of automated defibrillators with basic EMT s, reported 594 arrests and no survivors to hospital discharge. 16 Many municipalities around the world have reported cardiac arrest data using the now standard Utstein Style. 17 Cardiac arrest survival has been used as a quality benchmark for many EMS systems and has driven the development of prehospital advanced life support. 18 Survival from outof-hospital cardiac arrest is very low in our system, in fact lower than is reported in other large metropolitan areas. 4 6 The low rates of ventricular dysrythmia in our study population may related to problems with recognition of cardiac arrest and perhaps a long collapse to call interval. There is also a low rate of bystander CPR, a longer time before first defibrillation, and a high prevalence of asystole as presenting rhythm. Other factors, not specifically examined or documented in the record, such as severe underlying disease may play a part
6 64 R.B. Dunne et al. in decreased survival. Detroit residents have a high prevalence of hypertension, coronary artery disease, diabetes and renal failure. We do not have consistent data regarding the socioeconomic characteristics of the cardiac arrest victims but Detroit has a large number of families below the poverty level. Effecting change on the factors that lead to decreasing cardiac arrest survival is challenging. Urban areas in the United States, including Detroit, face budget crises which limit options. Health care spending and access to care is consistently decreasing for the urban population and more cuts are proposed. In the 2 years before the study period two large hospitals closed, since the end of the study period another hospital has eliminated its inpatient unit and become a free standing emergency department not taking resuscitation patients. This may affect overall response time intervals in the city, because units have to travel farther and spend more time from scene to hospital delaying the time they are available for service. The city has tried adding a few non-transporting EMS units that are simultaneously dispatched with transporting units and these have been observed to occasionally arrive sooner [personal communication Detroit EMS Chief G. Kelly]. There is not enough data on these at this time to determine if there is an effect on out-of-hospital cardiac arrest. There is an increasing demand for a fire based first response system but no specific plan is in place at this time. More CPR training may result in increased rates of bystander CPR and may also increase awareness of cardiac arrest and need for prompt 911 activation. Additional changes may benefit the system and improve survival from out-of-hospital cardiac arrest. Rarely are any patients declared dead in the field after resuscitation is started. Clearly those in our study who had asystole as initial rhythm had a survival rate of 0% and efforts could have been terminated in the field. This would necessitate some changes in the support system available from law enforcement and the medical examiner to rapidly care for the dead in a sensitive manner. Units that did not transport could get back into service more rapidly and be available for other runs. Decreasing the number of very low priority runs that the ALS units are involved in responding to and transporting may increase the ALS availability and impact out-of-hospital cardiac arrest. This solution has proved challenging in Detroit and elsewhere. 19 Public access defibrillation is not likely to affect overall survival. There are no large regular gathering places in the city that are not already staffed by responders. EMS leadership in the city has long been concerned that any examination of data results in blame and criticism and not meaningful improvement. The department s cooperation with this study represents a step forward and open discussion of data can drive positive changes in the system. Additional information on other aspects of our EMS system needs to be collected. Although out-ofhospital cardiac arrest survival is reported to be a common marker of EMS system quality, the multitude of factors in the urban environment may limit the improvement in survival rates. Conclusion The results of this study demonstrate that survival in an urban ALS system with no first responders is very low, but similar to other major metropolitan communities that do have first responders. This is the first systematic examination of cardiac arrest in the Detroit EMS system and provides the basis for future studies which may capitalize on the noted opportunities for improvement. Conflict of interest statement There are no conflicts of interest for any of the authors. Acknowledgement Supported by a grant from Wyeth-Ayers. References 1. Stiell IG, Wells GA, DeMaio VJ, et al. Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS study phase I results. Ontario Prehospital Advanced Life Support. Ann Emerg Med 1999;33(1): Stiell IG, Wells GA, Field BJ, et al. Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support. JAMA 1999;281(13): Stiell IG, Wells GA, Field B, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 2004;351(7): Lombardi G, Gallagher J, Gennis P. Outcome of outof-hospital cardiac arrest in New York City. The Pre- Hospital Arrest Survival Evaluation (PHASE) Study. JAMA 1994;271(9): Becker LB, Ostrander MP, Barrett J, Kondos GT. Outcome of CPR in a large metropolitan area where are the survivors? Ann Emerg Med 1991;20(4):
7 Outcomes from out-of-hospital cardiac arrest in Detroit Eckstein M, Stratton SJ, Chan LS. Cardiac arrest resuscitation evaluation in Los Angeles: CARE-LA. Ann Emerg Med 2005;45(5): Association AH. Heart and Stroke Statistical Update; Leung LP, Wong TW, Tong HK, Lo CB, Kan PG. Out-ofhospital cardiac arrest in Hong Kong. Prehosp Emerg Care 2001;5(3): De Maio VJ, Stiell IG, Spaite DW, et al. CPR-only survivors of out-of-hospital cardiac arrest: implications for out-ofhospital care and cardiac arrest research methodology. Ann Emerg Med 2001;37(6): Bunch TJ, White RD, Gersh BJ, et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 2003;348(26): Nichol G, Detsky AS, Stiell IG, O Rourke K, Wells G, Laupacis A. Effectiveness of emergency medical services for victims of out-of-hospital cardiac arrest: a metaanalysis. Ann Emerg Med 1996;27(6): Eisenberg M, Bergner L, Hallstrom A. Paramedic programs and out-of-hospital cardiac arrest. I. Factors associated with successful resuscitation. Am J Public Health 1979;69(1): Hallstrom AP, Ornato JP, Weisfeldt M, et al. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med 2004;351(7): Cady G. 200 city survey. JEMS 2001 annual report on EMS operational & clinical trends in large, urban areas. JEMS 2002;27(2):46 65, Paradis NA, Martin GB, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA 1990;263(8): Nowak RM. Cardiac Arrest in Detroit. Michigan College of Emergency Physicians Assembly; Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. Task Force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Ann Emerg Med 1991;20(8): Rubin JSR. Clinical benchmarking. In: Swor RAPR, editor. Improving quality in EMS. Dubuque: Kendall Hunt; Dunne RB, Compton S, Welch RD, Zalenski RJ, Bock BF. Prehospital on-site triaging. Prehosp Emerg Care 2003;7(1):85 8.
Over the last 3 decades, advances in the understanding of
Temporal Trends in Sudden Cardiac Arrest A 25-Year Emergency Medical Services Perspective Thomas D. Rea, MD, MPH; Mickey S. Eisenberg, MD, PhD; Linda J. Becker, MA; John A. Murray, MD; Thomas Hearne, PhD
More informationWORKSHEET for Evidence-Based Review of Science for Veterinary CPCR
RECOVER 2011 1 of 6 WORKSHEET for Evidence-Based Review of Science for Veterinary CPCR 1. Basic Demographics Worksheet author(s) James Barr Mailing address: 4474 TAMU Texas A&M University College Station,
More informationRecognition and Treatment of Out-of-Hospital Cardiac Arrests by Non-Emergency Ambulance Services in Singapore
Original Article 445 Recognition and Treatment of Out-of-Hospital Cardiac Arrests by Non-Emergency Ambulance Services in Singapore Nausheen E Doctor, 1 MBBS (S pore), MMed, MRCSEd (A&E), Susan Yap, 1 RN,
More informationA mong patients who have an out-of-hospital cardiac
1114 CARDIOVASCULAR MEDICINE Can we define patients with no chance of survival after outof-hospital cardiac arrest? J Herlitz, J Engdahl, L Svensson, M Young, K-A Ängquist, S Holmberg... See end of article
More informationContinuation of cardiopulmonary resuscitation in a Chinese hospital after unsuccessful EMS resuscitation
142 Journal of Geriatric Cardiology September 2009 Vol 6 No 3 Clinical Research Continuation of cardiopulmonary resuscitation in a Chinese hospital after unsuccessful EMS resuscitation Xiao-Bo Yang 1,
More informationAdvanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest
The new england journal of medicine original article Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest Ian G. Stiell, M.D., George A. Wells, Ph.D., Brian Field, A.C.P., M.B.A., Daniel W.
More informationIs public access defibrillation needed in Hong Kong?
Key words: Cardiopulmonary resuscitation; Electric countershock; Emergency medical services; Heart arrest; Hong Kong!!"!"#!"#$!" CB Lo TW Wong KK Lai Hong Kong Med J 2003;9:113-8 Accident and Emergency
More informationThe ARREST Trial: Amiodarone for Resuscitation After Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation
The ARREST Trial: Amiodarone for Resuscitation After Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation Introduction The ARREST (Amiodarone in out-of-hospital Resuscitation of REfractory Sustained
More informationOut-of-hospital cardiac arrest: two and a half years
Journal of Accident and Emergency Medicine 99, 4-9 Correspondence: T.W. Wong, Consultant, Accident and Emergency Department, Kwong Wah Hospital, Waterloo Road, Yaumati, Kowloon, Hong Kong. Out-of-hospital
More informationRural and remote cardiac outcomes: examination of a state-wide emergency medical service
Rural and remote cardiac outcomes: examination of a state-wide emergency medical service Bronwyn Young, John Woodall, E Enraght-Moony, Vivienne Tippett, Louise Plug, Australian Centre for Prehospital Research
More informationMinnesota Resuscitation Consortium
Minnesota Resuscitation Consortium Dedicated to reducing deaths due to cardiac arrest in all of Minnesota How will we benchmark our success? What means will we pursue to reach this goal? American Heart
More informationRowan County EMS. I m p r o v i n g C a r d i a c A r r e s t S u r v i v a l. Christopher Warr NREMT-P Lieutenant.
Rowan County EMS I m p r o v i n g C a r d i a c A r r e s t S u r v i v a l Christopher Warr NREMT-P Lieutenant Rowan County EMS christopher.warr@rowancountync.gov September 9, 2012 2:44 11:44:00 Mr.
More informationFactors modifying the effect of bystander cardiopulmonary resuscitation on survival in out-of-hospital cardiac arrest patients in Sweden
European Heart Journal (2001) 22, 511 519 doi:10.1053/euhj.2000.2421, available online at http://www.idealibrary.com on Factors modifying the effect of bystander cardiopulmonary resuscitation on survival
More informationOut-of-hospital cardiac arrest: incidence, process of care, and outcomes in an urban city, Korea
Clin Exp Emerg Med 2014;1(2):94-100 http://dx.doi.org/10.15441/ceem.14.021 Out-of-hospital cardiac arrest: incidence, process of care, and outcomes in an urban city, Korea Hanjin Cho 1, Sungwoo Moon 1,
More informationResuscitation 82 (2011) Contents lists available at ScienceDirect. Resuscitation. journal homepage:
Resuscitation 82 (2011) 277 284 Contents lists available at ScienceDirect Resuscitation journal homepage: www.elsevier.com/locate/resuscitation Clinical paper Variation in out-of-hospital cardiac arrest
More informationCLINICAL RESEARCH STUDY
CLINICAL RESEARCH STUDY The Effects of Sex on Out-of-Hospital Cardiac Arrest Outcomes Manabu Akahane, MD, PhD, a Toshio Ogawa, MSc, a Soichi Koike, MD, PhD, b Seizan Tanabe, MD, c Hiromasa Horiguchi, PhD,
More informationProtocol. This trial protocol has been provided by the authors to give readers additional information about their work.
Protocol This trial protocol has been provided by the authors to give readers additional information about their work. Protocol for: Hasselqvist-Ax I, Riva G, Herlitz J, et al. Early cardiopulmonary resuscitation
More informationUniversity of Washington. From the SelectedWorks of Kent M Koprowicz
University of Washington From the SelectedWorks of Kent M Koprowicz 2007 Site variation in EMS Treatment, Transport and Survival in relation to Restoration of Spontaneous Circulation (ROSC) for Adult Out-of-Hospital
More informationStrengthening links in the "chain of survival": a Singapore perspective
Hong Kong Journal of Emergency Medicine Strengthening links in the "chain of survival": a Singapore perspective RA Charles, F Lateef, V Anantharaman Introduction: The concept of the chain of survival is
More informationAutomated external defibrillators and survival after in-hospital cardiac arrest: early experience at an Australian teaching hospital
Automated external defibrillators and survival after in-hospital cardiac arrest: early experience at an Australian teaching hospital Roger J Smith, Bernadette B Hickey and John D Santamaria Early defibrillation
More informationEpinephrine Cardiovascular Emergencies Symposium 2018
Epinephrine Cardiovascular Emergencies Symposium 218 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN High Quality
More informationProf Gavin Perkins Co-Chair ILCOR
Epidemiology of out of hospital cardiac arrest how to improve survival Prof Gavin Perkins Co-Chair ILCOR Chair, Community Resuscitation Committee, Resuscitation Council (UK) Conflict of interest Commercial
More informationOverview and Latest Research on Out of Hospital Cardiac Arrest
L MODULE 1 Overview and Latest Research on Out of Hospital Cardiac Arrest Jamie Jollis, MD Co PI RACE CARS 2 Out of Hospital Cardiac Arrest in U.S. 236 000 to 325 000 people in the United States each year
More informationOTHER FEATURES SMART CPR
SMART CPR Philips has augmented the HeartStart AED s well proven patient analysis logic with SMART CPR, a feature that provides a tool for Medical Directors and Administrators to implement existing or
More informationEPIDEMIOLOGY AND TREATMENT OF CARDIOVASCULAR EMERGENCIES IN URBAN VS. REMOTE AREAS
EPIDEMIOLOGY AND TREATMENT OF CARDIOVASCULAR EMERGENCIES IN URBAN VS. REMOTE AREAS Andrea Semplicini Medicina Interna 1 Ospedale SS. Giovanni e Paolo - Venezia Azienda ULSS 12 Veneziana Dipartimento Medicina
More informationILCOR Evidence Review
ILCOR Evidence Review Task Force BLS 19-Apr-13 Question Status Pending Evidence Collection Short Title Dispatch CPR instructions PICO Question Evidence Reviewers ;#34;#Christian Vaillancourt;#177;#Manya
More informationEthnic Differences in Sudden Cardiac Arrest. Joanna Ghobrial. A Thesis submitted in partial fulfillment of the requirements for the degree of
Ethnic Differences in Sudden Cardiac Arrest Joanna Ghobrial A Thesis submitted in partial fulfillment of the requirements for the degree of Master of Science University of Washington 2014 Committee: Susan
More informationConsensus Paper on Out-of-Hospital Cardiac Arrest in England
Consensus Paper on Out-of-Hospital Cardiac Arrest in England Date: 16 th October 2014 Revision Date: 16 th October 2015 Introduction The purpose of this paper is to bring some clarity to the analysis of
More informationCardiac Arrest Registry Database Office of the Medical Director
Cardiac Arrest Registry Database 2010 Office of the Medical Director 1 Monthly Statistical Summary Cardiac Arrest, December 2010 Western Western Description Division Division % Totals Eastern Division
More informationC ardiac arrest remains a leading cause of cardiovascular
619 PREHOSPITAL CARE Surviving out of hospital cardiac arrest at home: a postcode lottery? R M Lyon, S M Cobbe, J M Bradley, N R Grubb... See end of article for authors affiliations... Correspondence to:
More informationUpdate on Sudden Cardiac Death and Resuscitation
Update on Sudden Cardiac Death and Resuscitation Ashish R. Panchal, MD, PhD Medical Director Center for Emergency Medical Services Assistant Professor Clinical Department of Emergency Medicine The Ohio
More informationAll under the division of cardiovascular medicine University of Minnesota
The Team 1) Demetris Yannopoulos M.D. Medical Director, 2) Kim Harkins, Program Manager 3) Lucinda Klann, CARES Data Manager 4) Esther Almeida, Administrative Assistant All under the division of cardiovascular
More informationAfter this review our system decided to implement guidelines which allowed EMS personnel to
How far is too far? A review of the evidence for Prehospital Termination of Resuscitation after Cardiac Arrest Shalu S. Patel, MD Christine Van Dillen MD University of Florida-Gainesville Out-of-hospital
More informationEarly defibrillation in out-of-hospital sudden cardiac death: an Australian experience
Archives of Emergency Medicine, 1992, 10, 1-7 Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience I. A. SCOTT & G. J. FITZGERALD Ipswich General Hospital, Ipswich, Queensland
More informationOut-of-hospital Cardiac Arrest. Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland
Out-of-hospital Cardiac Arrest Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland Conflict of Interest I have no conflict of interest to disclose regarding this presentation.
More informationDepartment of Surgery, Division of Cardiothoracic Surgery
Review of In-Hospital and Out-of-Hospital Cardiac Arrests at a Tertiary Community Hospital for Potential ECPR Rescue Amanda Broderick 1, Jordan Williams 1, Alexandra Maryashina 1, & James Wu, MD 1 1 Department
More informationVictorian Ambulance Cardiac Arrest Registry (VACAR)
Victorian Ambulance Cardiac Arrest Registry (VACAR) Dr Karen Smith (PhD) VACAR Chair Manager Research and Evaluation Ambulance Victoria Smith K, Bray J, Barnes V, Lodder M, Cameron P, Bernard S and Currell
More informationAutomated External Defibrillation Principle of Early Defibrillation States that all BLS personnel be trained, equipped and allowed to operate a if
1 2 3 4 5 6 Automated External Defibrillation Principle of Early Defibrillation States that all BLS personnel be trained, equipped and allowed to operate a if they are expected to respond to persons in
More informationCardiac Arrest Registry Database Office of the Medical Director
Cardiac Arrest Registry Database 2010 Office of the Medical Director 1 Monthly Statistical Summary Cardiac Arrest, September 2010 Western Western Description Division Division % Totals Eastern Division
More informationOntario Pre-hospital Advanced Life Support (OPALS) Study
Ontario Pre-hospital Advanced Life Support (OPALS) Study February 2005 Ian G. Stiell, MD, MSc, FRCPC Funding Provided by: Canadian Health Services Research Foundation Ontario Ministry of Health and Long-Term
More informationBut unfortunately, the first sign of cardiovascular disease is often the last. Chest-Compression-Only Resuscitation Gordon A.
THE UNIVERSITY OF ARIZONA Sarver Heart Center 1 THE UNIVERSITY OF ARIZONA Sarver Heart Center 2 But unfortunately, the first sign of cardiovascular disease is often the last 3 4 1 5 6 7 8 2 Risk of Cardiac
More informationThe Role of Public Access Defibrillation in the Chain of Survival from Out-of-Hospital Cardiac Arrest
The Role of Public Access Defibrillation in the Chain of Survival from Out-of-Hospital Cardiac Arrest Joseph P. Ornato, MD, FACP, FACC, FACEP Introduction Approximately 400-460,000 cardiac arrests occur
More informationhospital Effect of bystander initiated cardiopulmonary survival after witnessed cardiac arrest outside resuscitation on ventricular fibrillation and
48 Division of Cardiology, Sahlgrenska Hospital, Gothenburg, Sweden J Herlitz L Ekstr6m B Wennerblom A Axelsson A BAng S Holmberg Correspondence to: Dr J Herlitz, Division of Cardiology, Sahlgrenska Hospital,
More informationExplaining Racial Disparities in Incidence of and Survival from Out-of-Hospital Cardiac Arrest
American Journal of Epidemiology ª The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.
More informationScience Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013
Science Behind Resuscitation Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Conflict of Interest No Financial or Industrial Conflicts Slides: Drs. Nelson, Cole and Larabee
More informationChapter 19 Detection of ROSC in Patients with Cardiac Arrest During Chest Compression Using NIRS: A Pilot Study
Chapter 19 Detection of ROSC in Patients with Cardiac Arrest During Chest Compression Using NIRS: A Pilot Study Tsukasa Yagi, Ken Nagao, Tsuyoshi Kawamorita, Taketomo Soga, Mitsuru Ishii, Nobutaka Chiba,
More informationImproving Outcome from In-Hospital Cardiac Arrest
Improving Outcome from In-Hospital Cardiac Arrest National Teaching Institute San Diego, CA Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC Independent CNS/Staff Nurse Objectives 1. Discuss the AHA in-hospital
More informationTHE NEW ZEALAND MEDICAL JOURNAL
THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association Outcomes from out-of-hospital cardiac arrest in the Wellington region of New Zealand. Does use of the Fire Service make a
More informationUpdate on Sudden Cardiac Death and Resuscitation
Update on Sudden Cardiac Death and Resuscitation Ashish R. Panchal, MD, PhD Medical Director Center for Emergency Medical Services Assistant Professor Clinical Department of Emergency Medicine The Ohio
More information5 Key EMS Articles for 2012
5 Key EMS Articles for 2012 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN 5 Key Topics Cardiac Arrest Trauma
More informationIncreasing bystander CPR: potential of a one question telecommunicator identification algorithm
Orpet et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2015) 23:39 DOI 10.1186/s13049-015-0115-1 ORIGINAL RESEARCH Open Access Increasing bystander CPR: potential of a one question
More informationWORKSHEET for Evidence-Based Review of Science for Veterinary CPCR
RECOVER 2011 1 of 7 WORKSHEET for Evidence-Based Review of Science for Veterinary CPCR 1. Basic Demographics Worksheet author(s) Kate Hopper Mailing address: Dept Vet Surgical & Radiological Sciences Room
More informationTENNESSEE Project ADAM. Preventing Sudden Cardiac Death (SCD): Implementing your school s Public Access to Defibrillation (PAD) program.
TENNESSEE Project ADAM Preventing Sudden Cardiac Death (SCD): Implementing your school s Public Access to Defibrillation (PAD) program. In Tennessee IT S THE LAW. All schools equipped with an AED must
More informationSupplementary Online Content
Supplementary Online Content Hasegawa K, Hiraide A, Chang Y, Brown DFM. Association of prehospital advancied airway management with neurologic outcome and survival in patients with out-of-hospital cardiac
More informationResuscitation 85 (2014) Contents lists available at ScienceDirect. Resuscitation. journal homepage:
Resuscitation 85 (2014) 59 64 Contents lists available at ScienceDirect Resuscitation journal homepage: www.elsevier.com/locate/resuscitation Impact of the number of on-scene emergency life-saving technicians
More informationOut-of-hospital cardiac arrests in Helsinki: Utstein
18 Heart 1996;76:18-23 Out-of-hospital cardiac arrests in Helsinki: Utstein style reporting M Kuisma, T Maatta Helsinki Emergency Medical Services System, Department of Health, Helsinki, Finland M Kuisma
More informationTHE FOLLOWING QUESTIONS RELATE TO THE RESUSCITATION COUNCIL (UK) RESUSCITATION GUIDELINES 2005
THE FOLLOWING QUESTIONS RELATE TO THE RESUSCITATION COUNCIL (UK) RESUSCITATION GUIDELINES 2005 1. The guidelines suggest that in out-of-hospital cardiac arrests, attended but unwitnessed by health care
More informationTomohide Komatsu, Kosaku Kinoshita, Atsushi Sakurai, Takashi Moriya, Junko Yamaguchi, Atsunori Sugita, Rikimaru Kogawa, Katsuhisa Tanjoh
Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan Correspondence to Dr Atsushi Sakurai, Division of Emergency
More informationSudden Cardiac Arrest and Death in United States Marathons
Sudden Cardiac Arrest and Death in United States Marathons David Webner, Kevin M. Duprey, Jonathan A. Drezner, Peter Cronholm, William O. Roberts Oct 24, 2012 Med Sci Sports Exerc. 2012;44(10):1843-1845.
More informationAssociation of Neighborhood Characteristics with Bystander-Initiated CPR
original article Association of Neighborhood Characteristics with Comilla Sasson, M.D., David J. Magid, M.D., Paul Chan, M.D., Elisabeth D. Root, Ph.D., Bryan F. McNally, M.D., M.P.H., Arthur L. Kellermann,
More information2015 Interim Training Materials
2015 Interim Training Materials ACLS Manual and ACLS EP Manual Comparison Chart Assessment sequence Manual, Part 2: The Systematic Approach, and Part BLS Changes The HCP should check for response while
More informationSudden Cardiac Arrest
Sudden Cardiac Arrest Amit Sharma, MD, FACP, FACC Interventional Cardiologist Rockledge Regional Medical Center Assistant Professor of Medicine University of Central Florida Disclosures No relevant financial
More informationOutcomes of Therapeutic Hypothermia in Cardiac Arrest. Saad Mohammed Shariff, MBBS Aravind Herle, MD, FACC
Outcomes of Therapeutic Hypothermia in Cardiac Arrest Saad Mohammed Shariff, MBBS Aravind Herle, MD, FACC https://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_427331.pdf
More informationCardiac Arrest January 2017 CPR /3/ Day to Survival Propensity Matched
Cardiac Arrest January 217 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN CPR 217 Used data based on protocol that
More informationOut-Of-Hospital Management and Outcomes of Sudden Cardiac Death Abdelouahab BELLOU, MD, PhD
Out-Of-Hospital Management and Outcomes of Sudden Cardiac Death Abdelouahab BELLOU, MD, PhD Professor of Internal Medicine, Emergency Medicine, Therapeutics. Past President of the European Society for
More informationA large proportion of patients who die from ischaemic
25 CARDIOVASCULAR MEDICINE Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest: change in outcome over 20 years in the community
More informationDisclosure. Co-investigators 1/23/2015
The impact of chest compression fraction on clinical outcomes from shockable out-of-hospital cardiac arrest during the ROC PRIMED trial Sheldon Cheskes, MD CCFP(EM) FCFP Medical Director, Sunnybrook Centre
More informationDevelopments in Cardiopulmonary Resuscitation Guidelines
Developments in Cardiopulmonary Resuscitation Guidelines Bernd W. Böttiger Seite 1 To preserve human life by making high quality resuscitation available to all Outcome after CPR in Germany ROSC ( Return
More informationUse of an Automated, Load-Distributing Band Chest Compression Device for Out-of-Hospital Cardiac Arrest Resuscitation JAMA. 2006;295:
ORIGINAL CONTRIBUTION Use of an Automated, Load-Distributing Band Chest Compression Device for Out-of-Hospital Cardiac Arrest Resuscitation Marcus Eng Hock Ong, MD, MPH Joseph P. Ornato, MD David P. Edwards,
More informationAustralian Resuscitation Outcomes Consortium (Aus-ROC)
Australian Resuscitation Outcomes Consortium (Aus-ROC) A NHMRC Centre of Research Excellence (CRE) in Clinical Research, #1029983 Out-of-hospital cardiac arrest registry ( Epistry ) Presented by Prof Judith
More informationPaediatric out-of-hospital cardiac arrests: epidemiology and outcome
O r i g i n a l A r t i c l e Singapore Med J 2005; 46(6) : 289 Paediatric out-of-hospital cardiac arrests: epidemiology and outcome L P Tham, I Chan Department of Emergency Medicine KK Women s and Children
More informationNationwide Public-Access Defibrillation in Japan
The new england journal of medicine original article Nationwide Public-Access Defibrillation in Japan Tetsuhisa Kitamura, M.D., Taku Iwami, M.D., Takashi Kawamura, M.D., Ken Nagao, M.D., Hideharu Tanaka,
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Chan PS, Nallamothu BK, Krumholz HM, et al. Long-term outcomes
More informationHOW TO SURVIVE ELECTRICAL STORM
HOW TO SURVIVE ELECTRICAL STORM DR. LAURA CHAHOUD, DO EMERGENCY MEDICINE PGY-4 ST MARY MERCY HOSPITAL OUTLINE What is electrical storm? Case intro ACLS Approaches to management Dual axis defibrillation
More informationGETTING TO THE HEART OF THE MATTER. Ritu Sahni, MD, MPH Lake Oswego Fire Department Washington County EMS Clackamas County EMS
GETTING TO THE HEART OF THE MATTER Ritu Sahni, MD, MPH Lake Oswego Fire Department Washington County EMS Clackamas County EMS TAKE HOME POINTS CPR is the most important thing Train like we fight Measure
More informationADVANCED LIFE SUPPORT
ANSWERS IN ITALICS WITH REFERENCES 1. The guidelines suggest that in out-of-hospital cardiac arrests, attended but unwitnessed by health care professionals equipped with a manual defibrillator, the providers
More informationManagement of Cardiac Arrest Based on : 2010 American Heart Association Guidelines
Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines www.circ.ahajournals.org Elham Pishbin. M.D Assistant Professor of Emergency Medicine MUMS C H E S Advanced Life Support
More informationROC PRIMED Questions and Answers
ROC PRIMED Questions and Answers 1) What is the ROC PRIMED study? ROC PRIMED stands for the Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed
More informationOutcomes of Cardiopulmonary Resuscitation Performed in Emergency Department, Hospital Universiti Sains Malaysia
ORIGINAL ARTICLE Outcomes of Cardiopulmonary Resuscitation Performed in Emergency Department, Hospital Universiti Sains Malaysia K S Chew*, Z M Idzwan*, N A R Hisamuddin*, J Kamaruddin**, W A Wan Aasim**
More informationThe 2015 BLS & ACLS Guideline Updates What Does the Future Hold?
The 2015 BLS & ACLS Guideline Updates What Does the Future Hold? Greater Kansas City Chapter Of AACN 2016 Visions Critical Care Conference Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC Independent CNS/Staff
More informationVersion Effective date Changes Prepared By CPR + AED
Version Effective date Changes Prepared By Ver 1.0 23 rd June 2017 First Issue Muhammad Fauzy, Principal Trainer CPR + AED 218E Changi Road, PKMS Building #03-05A Singapore 419737 Tel: 87508086 Fax: 6440
More information18% Survival from In-Hospital Cardiac Arrest Ways we can do better! National Teaching Institute Denver, CO Class Code: 149 A
18% Survival from In-Hospital Cardiac Arrest Ways we can do better! National Teaching Institute Denver, CO Class Code: 149 A Nicole Kupchik RN, MN, CCNS, CCRN, PCCN Independent CNS/Staff Nurse Objectives
More informationEmergency Cardiac Care Guidelines 2015
Emergency Cardiac Care Guidelines 2015 VACEP 2016 William Brady, MD University of Virginia Guidelines 2015 Basic Life Support & Advanced Cardiac Life Support Acute Coronary Syndrome Pediatric Advanced
More informationAn Analysis of Continuous Chest Compression CPR for EMS Providers During Out of Hospital Cardiac Arrest
Illinois Wesleyan University Digital Commons @ IWU Honors Projects Psychology 2010 An Analysis of Continuous Chest Compression CPR for EMS Providers During Out of Hospital Cardiac Arrest Megan L. Gleason
More informationGuideline of Singapore CPR
KACPR Symposium Guideline of Singapore CPR Lim Swee Han MBBS (NUS), FRCS Ed (A&E), FRCP (Edin), FAMS Senior Consultant, Department of Emergency Medicine, Singapore General Hospital Adjunct Associate Professor,
More informationPortage County EMS Annual Skills Labs
Portage County EMS Annual Skills Labs Scope: Provide skills labs for all Emergency Medical Responders and First Response EMTs to assure proficiency of skills and satisfy the Wisconsin State approved Operational
More informationAiming for high quality CPR: why it matters and how we can get there. Benjamin S. Abella, MD, MPhil, FACEP
Aiming for high quality CPR: why it matters and how we can get there Benjamin S. Abella, MD, MPhil, FACEP Clinical Research Director Center for Resuscitation Science Department of Emergency Medicine University
More informationOriginal Article Early Outcomes of Out-of-Hospital Cardiac Arrest after Early Defibrillation: a 24 Months Retrospective Analysis
www.ipej.org 194 Original Article Early Outcomes of Out-of-Hospital Cardiac Arrest after Early Defibrillation: a 24 Months Retrospective Analysis Paolo Terranova 1,2, Paolo Valli 2, Barbara Severgnini
More informationResuscitation 85 (2013) Contents lists available at ScienceDirect. Resuscitation. journal homepage:
Resuscitation 85 (2013) 42 48 Contents lists available at ScienceDirect Resuscitation journal homepage: www.elsevier.com/locate/resuscitation Clinical paper Direction of first bystander call for help is
More informationLifeNet, Inc Annual Report on OUT-OF-HOSPITAL CARDIAC ARRESTS
LifeNet, Inc. 7 Annual Report on OUT-OF-HOSPITAL CARDIAC ARRESTS 7 ANNUAL REPORT ON OUT-OF-HOSPITAL CARDIAC ARRESTS Prepared by LifeNet Clinical Services Team: Randy Bean, Paramedic Texarkana Daniel Stramp
More informationValidation of a Rule for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest
The new england journal of medicine original article Validation of a Rule for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest Laurie J. Morrison, M.D., Laura M. Visentin, B.Sc., Alex Kiss,
More informationin Cardiac Arrest Management Sean Kivlehan, MD, MPH May 2014
in Cardiac Arrest Management Sean Kivlehan, MD, MPH May 2014 1. Capnography 2. Compressions 3. CPR Devices 4. Hypothermia 5. Access 6. Medications Outline Capnography & Termination Significantly Associated
More informationThe evidence behind ACLS: the importance of good BLS
The evidence behind ACLS: the importance of good BLS Benjamin S. Abella, MD, MPhil, FACEP CRS Center for Resuscitation Science Clinical Research Director Center for Resuscitation Science Vice Chair of
More informationOut-of-Hospital Cardiac Arrest in the 1990s: A Population-Based Study in the Maastricht Area on Incidence, Characteristics and Survival
1500 JACC Vol. 30, No. 6 SUDDEN DEATH Out-of-Hospital Cardiac Arrest in the 1990s: A Population-Based Study in the Maastricht Area on Incidence, Characteristics and Survival JACQUELINE J. M. DE VREEDE-SWAGEMAKERS,
More informationPapers. Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trial. Abstract.
Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trial Anouk P van Alem, Rob H Vrenken, Rien de Vos, Jan GPTijssen, Rudolph W Koster
More informationWake County EMS System Peer Review/Clinical Data/System Performance
P a g e 1 Wake County EMS System Peer Review/Clinical Data/System Performance Explanations and Definitions for Reports Wake County EMS engages in regular external review. The System makes quarterly reports
More information1/24/2018. Taking Mechanical CPR to New Heights: Use of Automated Chest Compression Devices in Helicopter EMS Transport.
Taking Mechanical CPR to New Heights: Use of Automated Chest Compression Devices in Helicopter EMS Transport NAEMSP 2018 Annual Meeting January 8-13, 2018 San Diego, CA John W. Lyng, MD, FACEP, FAEMS,
More informationWORKSHEET for Evidence-Based Review of Science for Veterinary CPCR
RECOVER 2011 1 of 9 WORKSHEET for Evidence-Based Review of Science for Veterinary CPCR 1. Basic Demographics Worksheet author(s) Nathan Peterson Date Submitted for review: 7/19/11 Mailing address: 1818
More information