Increased bystander intervention when volunteer responders attend out-of-hospital cardiac arrest

AIM: The primary aim was to investigate the association between alarm acceptance compared to no-acceptance by volunteer responders, bystander intervention, and survival in out-of-hospital cardiac arrest. MATERIALS AND METHODS: This retrospective observational study included all suspected out-of-hospital cardiac arrests (OHCAs) with activation of volunteer responders in the Capital Region of Denmark (1 November 2018 to 14 May 2019), the Central Denmark Region (1 November 2018 to 31 December 2020), and the Northern Denmark Region (14 February 2020 to 31 December 2020). All OHCAs unwitnessed by Emergency Medical Services (EMS) were analyzed on the basis on alarm acceptance and arrival before EMS. The primary outcomes were bystander cardio-pulmonary resuscitation (CPR), bystander defibrillation and secondary outcome was 30-day survival. A questionnaire sent to all volunteer responders was used with respect to their arrival status. RESULTS: We identified 1,877 OHCAs with volunteer responder activation eligible for inclusion and 1,725 (91.9%) of these had at least one volunteer responder accepting the alarm (accepted). Of these, 1,355 (79%) reported arrival status whereof 883 (65%) arrived before EMS. When volunteer responders accepted the alarm and arrived before EMS, we found increased proportions and adjusted odds ratio for bystander CPR {94 vs. 83%, 4.31 [95% CI (2.43–7.67)] and bystander defibrillation [13 vs. 9%, 3.16 (1.60–6.25)]} compared to cases where no volunteer responders accepted the alarm. CONCLUSION: We observed a fourfold increased odds ratio for bystander CPR and a threefold increased odds ratio for bystander defibrillation when volunteer responders accepted the alarm and arrived before EMS

Cardiopulmonary Resuscitation Training in Schools Following 8 Years of Mandating Legislation in Denmark:A Nationwide Survey

Background School cardiopulmonary resuscitation ( CPR ) training has become mandatory in many countries, but whether legislation has translated into implementation of CPR training is largely unknown. We assessed CPR training of students following 8 years of legislative mandates in Denmark. Methods and Results A nationwide cross‐sectional survey of Danish school leadership (n=1240) and ninth‐grade homeroom teachers (n=1381) was carried out for school year 2013‐2014. Qualitative interviews and the Theory of Planned Behavior were used to construct the survey. Logistic regression models were employed to identify factors associated with completed CPR training. Information from 63.1% of eligible schools was collected: 49.3% (n=611) of leadership and 48.2% (n=665) of teachers responded. According to teachers, 28.4% (95% CI 25.0% to 32.0%) and 10.3% (95% CI 8.1% to 12.8%) of eligible classes had completed CPR and automated external defibrillator training, respectively. Among leadership, 60.2% (95% CI 56.2% to 64.1%) reported CPR training had occurred during the 3 years prior to the survey. Factors associated with completed CPR training included believing other schools were conducting training (odds ratio [ OR ] 9.68 [95% CI 4.65‐20.1]), awareness of mandating legislation ( OR 4.19 [95% CI 2.65‐6.62]), presence of a school CPR training coordinator ( OR 3.01 [95% CI 1.84‐4.92]), teacher feeling competent to conduct training ( OR 2.78 [95% CI 1.74‐4.45]), and having easy access to training material ( OR 2.08 [95% CI 1.57‐2.76]). Conclusions Despite mandating legislation, school CPR training has not been successfully implemented. Completed CPR training was associated with believing other schools were conducting training, awareness of mandating legislation, presence of a school CPR training coordinator, teachers teacher feeling competent to conduct training, and having easy access to training material. Facilitating these factors may increase rates of school CPR training. </jats:sec

The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction

BACKGROUND: Renal dysfunction in patients with acute myocardial infarction (MI) is an important predictor of short- and long-term outcome. Cardiac abnormalities dominated by left ventricular (LV) hypertrophy are common in patients with chronic renal dysfunction. However, limited data exists on the association between LV systolic- and diastolic function assessed by comprehensive echocardiography and renal dysfunction in contemporary unselected patients with acute MI.METHODS: We prospectively included 1054 patients with acute MI (mean age 63 years, 73% male) and performed echocardiographic assessment of systolic and diastolic function within 48 hours of admission as well as estimated glomerular filtration rate (eGFR).RESULTS: Reduced eGFR was significantly associated with LV mass, LV ejection fraction, LV global strain (GLS) and E/e' ratio. After multivariable adjustment, E/e' ratio (P = .0096) remained the only echocardiographic measure independently associated with decreasing eGFR. During follow-up a total of 113 patients (10.7%) patients experienced the composite endpoint of all-cause mortality or hospitalization for heart failure. An eGFR &lt;60 mL/min per 1.73 m(2) was significantly associated with outcome (HR, 1.71; 95% CI, 1.12-2.62; P = .0131) after adjustment for age, diabetes, hypertension, Killip class &gt;1, multivessel disease and troponin. The prognostic impact of an eGFR &lt;60 mL/min per 1.73 m(2) was only modestly altered by addition of LV mass or E/e' ratio whereas addition of LV ejection fraction or GLS attenuated its importance considerably.CONCLUSION: Renal dysfunction in patients with acute MI is independently associated with echocardiographic evidence of increased LV filling pressure. However, the prognostic importance of renal dysfunction is attenuated to a greater degree by LV longitudinal systolic function.</p

Uric acid in advanced heart failure: relation to central haemodynamics and outcome

Objective The role of hyperuricaemia as a prognostic maker has been established in chronic heart failure (HF) but limited information on the association between plasma uric acid (UA) levels and central haemodynamic measurements is available.Methods A retrospective study on patients with advanced HF referred for right heart catherisation. Regression analyses were constructed to investigate the association between UA and haemodynamic variables. Cox models were created to investigate if UA was a significant predictor of adverse outcome where log1.1(UA) was used to estimate the effect on outcome associated with a 10% increase in UA levels.Results A total of 228 patients were included (77% males, age 49±12 years, mean left ventricular ejection fraction (LVEF) of 17%±8%). Median UA was 0.48 (0.39–0.61) mmol/L. UA level was associated to pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) in univariable (both p&lt;0.001) and multivariable regression analysis (p&lt;0.004 and p=0.025 for PCWP and CI). When constructing multivariable Cox models including PCWP, CI, central venous pressure, age, estimated glomerular filtration rate (eGFR), use of loop diuretics and LVEF, log1.1(UA) independently predicted the combined endpoint (left ventricular assist device, total artificial heart implantation, heart transplantation or all-cause mortality) (hazard ratio (HR): 1.10 (1.03–1.17), p=0.004) as well as all-cause mortality (HR: 1.15 (1.06–1.25), p=0.001).Conclusions Elevated UA is associated with greater haemodynamic impairment in advanced HF. In adjusted Cox models (age, eGFR, LVEF and haemodynamics), UA predicts the combined endpoint and all-cause mortality in long-term follow-up