First-response treatment after out-of-hospital cardiac arrest:a survey of current practices across 29 countries in Europe

Background: In Europe, survival rates after out-of-hospital cardiac arrest (OHCA) vary widely. Presence/absence and differences in implementation of systems dispatching First Responders (FR) in order to arrive before Emergency Medical Services (EMS) may contribute to this variation. A comprehensive overview of the different types of FR-systems used across Europe is lacking. Methods: A mixed-method survey and information retrieved from national resuscitation councils and national EMS services were used as a basis for an inventory. The survey was sent to 51 OHCA experts across 29 European countries. Results: Forty-seven (92%) OHCA experts from 29 countries responded to the survey. More than half of European countries had at least one region with a FR-system. Four categories of FR types were identified: (1) firefighters (professional/voluntary); (2) police officers; (3) citizen-responders; (4) others including off-duty EMS personnel (nurses, medical doctors), taxi drivers. Three main roles for FRs were identified: (a) complementary to EMS; (b) part of EMS; (c) instead of EMS. A wide variation in FR-systems was observed, both between and within countries. Conclusions: Policies relating to FRs are commonly implemented on a regional level, leading to a wide variation in FR-systems between and within countries. Future research should focus on identifying the FR-systems that most strongly influence survival. The large variation in local circumstances across regions suggests that it is unlikely that there will be a 'one-size fits all' FR-system for Europe, but examining the role of FRs in the Chain of Survival is likely to become an increasingly important aspect of OHCA research

International variation in survival after out-of-hospital cardiac arrest : A validation study of the Utstein template

Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232). Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8%(range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. Conclusions: The Utstein factors explained 51%. of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.Peer reviewe

JOSEFINA DE LA TORRE MILLARES Y BERNARDO DE LA TORRE BARCELÓ EN LAS CANTERAS [Material gráfico]

Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

Accurate feedback of chest compression depth on a manikin on a soft surface with correction for total body displacement

TrueCPR is a new real-time compression depth feedback device that measures changes in magnetic field strength between a back pad and a chest pad. We determined its accuracy with a manikin on a test bench and on various surfaces. First, calibration and accuracy of the manikin and TrueCPR was verified on a drill press. Then, manual chest compressions were given, on a firm surface and on a foam or air mattress, with feedback of the TrueCPR or Q-CPR accelerometer, to achieve a depth of 50mm. Compression depth measurements by the devices and the manikin were compared. On a hard surface TrueCPR showed a systematic underestimation of 2-3mm in the drill press. Manual tests on a hard surface showed a slightly larger underestimation of 4.5mm. When guided by TrueCPR on a foam or air mattress, the TrueCPR measured a mean(±SD) chest compression depth of 52.0(±1.9)mm and 49.4(±2.6)mm respectively, while the manikin measured 54.4(±1.8)mm and 52.1(±1.4)mm, respectively (p <0.001). When guided by the Q-CPR accelerometer on a foam or air mattress, the accelerometer measured depth of 54.3(±3.6)mm and 56.0(±3.8)mm respectively, compared to the manikin 42.4(±2.3)mm and 34.9(±3.6)mm, respectively (p <0.001). TrueCPR measures depth precisely, independent of the stiffness of the surface upon which the CPR is being performed with a constant inaccuracy of <4.5mm. A sternum-only accelerometer substantially overestimates depth when performing CPR on a soft surface. Correction for body displacement on a soft surface is essential for accurate delivery of chest compressions within the recommended depth rang

Corrigendum to “Time of on-scene resuscitation in out of-hospital cardiac arrest patients transported without return of spontaneous circulation” [Resuscitation 138 (2019)235–242](S030095721930098X)(10.1016/j.resuscitation.2019.03.030)

The authors regret there is an inconsistency in Fig. 3 ‘Time on scene intervals and 30-day survival of patients transported with ongoing CPR’. The number of patients per interval (30 min), displayed in Fig. 3 (n = 165; 270; 192)are incorrect compared to the number of patients described in the Fig. 3 legend (n = 178; 282; 195). The authors have corrected the numbers in Fig. 3 so they correspond with the numbers in the Fig. 3 legend. The authors would like to apologize for any inconvenience caused. [Figure presented]Fig. 3 Time on scene intervals and 30-day survival of patients transported with ongoing CPR. Of 178 patients which were transported within 20 min of time on scene, 13 (7%)survived. Of the 282 patients transported after 20–30 min, 12 (4%)survived and of 195 patients transported after 30 min, 4 (2%)survived

Time of on-scene resuscitation in out of-hospital cardiac arrest patients transported without return of spontaneous circulation

Background: In out-of-hospital cardiac arrest (OHCA), return of spontaneous circulation (ROSC) on scene occurs only in a minority of patients. The optimal duration of resuscitation on scene before transport with ongoing cardiopulmonary resuscitation (CPR) is unknown. Purpose: To determine the time of resuscitation on scene (‘time on scene’) and survival in patients transported with ongoing CPR in the Netherlands. Methods: Data on OHCA patients (>18 years) without ROSC on scene, where resuscitation was started between January 1, 2012 and December 31, 2016 in the Amsterdam Resuscitation Study (ARREST) database were analyzed. Time on scene was related to 30-day survival. Results: Of the 5871 OHCA patients where resuscitation was started, 2437 did not achieve ROSC on scene. Of these, 655 patients were transported with ongoing CPR and 606 (93%) had complete rhythm data. At the moment of transport, 199 (33%) patients had a shockable rhythm, 299 (49%) pulseless electrical activity (PEA) and 108 (18%) asystole as rhythm. Twenty-nine patients (4%) were alive at 30 days. Patients who survived 30 days had a higher proportion of a shockable first monitored rhythm (89% vs. 52%, p < 0.001). Survivors had a significantly shorter time on scene (20 min vs. 26 min, p = 0.004), with the highest survival rate (8%) in patients transported within 20 min. In a multivariable model time on scene (OR 0.94; 95%CI 0.89–0.99) was independently associated with 30-day survival. Conclusion: In OHCA patients transported with ongoing CPR the survival rate significantly declines when time on scene increases

Force and depth of mechanical chest compressions and their relation to chest height and gender in an out-of-hospital setting.

The LUCAS 2 device stores technical data that documents the chest compression process. We analyzed chest wall dimensions and mechanics stored during chest compressions on humans using data gathered with the LUCAS 2 device

The impact of post-resuscitation feedback for paramedics on the quality of cardiopulmonary resuscitation

The Guidelines place emphasis on high-quality cardiopulmonary resuscitation (CPR). This study aims to measure the impact of post-resuscitation feedback on the quality of CPR as performed by ambulance personnel. Two ambulances are dispatched for suspected cardiac arrest. The crew (driver and paramedic) of the first arriving ambulance is responsible for the quality of CPR. The crew of the second ambulance establishes an intravenous access and supports the first crew. All resuscitation attempts led by the ambulance crew of the study region were reviewed by two research paramedics and structured feedback was given based on defibrillator recording with impedance signal. A 12-months period before introduction of post-resuscitation feedback was compared with a 19-months period after introduction of feedback, excluding a six months run-in interval. Quality parameters were chest compression fraction (CCF), chest compression rate, longest peri-shock pause and longest non-shock pause. In the pre-feedback period 55 cases were analyzed and 69 cases in the feedback period. Median CCF improved significantly in the feedback period (79% vs 86%, p <0.001). The mean chest compression rate was within the recommended range of 100-120/min in 87% of the cases in the pre-feedback period and in 90% of the cases in the feedback period (p=0.65). The duration of longest non-shock pause decreased significantly (40s vs 19s, p <0.001), the duration of the longest peri-shock pause did not change significantly (16s vs 13s, p=0.27). Post-resuscitation feedback improves the quality of resuscitation, significantly increasing CCF and decreasing the duration of longest non-shock pause

Cognitive function and quality of life after successful resuscitation from cardiac arrest

Studies on out-of-hospital cardiac arrest (OHCA) use overall performance category (OPC)/cerebral performance category (CPC) as outcome. We studied quality of life, neuro-cognitive functioning and independency in daily life of patients and strain of caregivers 6-12 months after cardiac arrest. Two hundred and twenty patients (>18 year) who survived 6-12 months after OHCA and relatives were interviewed by telephone with validated questionnaires (Short-form Health Survey) (SF-12), Modified Rankin Scale (MRS), telephonic interview cognitive status (TICS) and Caregiver Strain Index (CSI) and compared with OPC and CPC at discharge. SF-12 of elderly (≥80 years) was compared to an open Dutch population of ≥80 years. Of all patients, 45% had normal physical and 90% had normal mental SF-12. Eighty-one percent had a normal MRS (MRS≤2). Eighty-four percent had normal TICS. Compared to the reference population, elderly scored 40.5 on the mental physical [corrected] and 53.2 on the physical mental [corrected] SF-12, while the reference population scored 38.1 (θ=0.20) and 54.4 (θ=-0.15), respectively, (n.s.) Of the patients with OPC≤2 and CPC≤2 at discharge 15% scored MRS 3-5 and 15% abnormal TICS at follow-up, respectively. Ninety-two percent of all patients gave their quality of life a value of ≥6 (maximum 10). Patients treated with hypothermia scored on most health outcomes similar to those who did not need such treatment. Sixteen percent of caregivers experienced strain, correlating significantly with TICS of patients. The great majority of survivors have normal functioning and cognition 6-12 months after OHCA. Functional and neuro-cognitive telephonic tests 6-12 months after OHCA are simple and better reflect patients functioning at home than OPC/CPC at discharg

Duration of ventilations during cardiopulmonary resuscitation by lay rescuers and first responders: relationship between delivering chest compressions and outcomes

The 2010 guidelines for cardiopulmonary resuscitation allow 5 seconds to give 2 breaths to deliver sufficient chest compressions and to keep perfusion pressure high. This study aims to determine whether the recommended short interruption for ventilations by trained lay rescuers and first responders can be achieved and to evaluate its consequence for chest compressions and survival. From a prospective data collection of out-of-hospital cardiac arrest, we used automatic external defibrillator recordings of cardiopulmonary resuscitation by rescuers who had received a standard European Resuscitation Council basic life support and automatic external defibrillator course. Ventilation periods and total compressions delivered per minute during each 2 minutes of cardiopulmonary resuscitation cycle were measured, and the chest compression fraction was calculated. Neurological intact survival to discharge was studied in relation to these factors and covariates. We included 199 automatic external defibrillator recordings. The median interruption time for 2 ventilations was 7 seconds (25th-75th percentile, 6-9 seconds). Of all rescuers, 21% took 60, >70, and >80 chest compressions per minute, respectively. The median chest compression fraction was 65% (25th-75th percentile, 59%-71%). Survival was 25% (49 of 199), not associated with long or short ventilation pauses when controlled for covariates. The great majority of rescuers can give 2 rescue breaths in <10 seconds and deliver at least 70 compressions in a minute. Longer pauses for ventilations are not associated with worse outcome. Guidelines may allow longer pauses for ventilations with no detriment to surviva