Abstract 138: Defining System of Care Best Practices for Out-Of-Hospital Cardiac Arrest Survival

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mahshid Abir ◽  
Timothy C Guetterman ◽  
Sydney Fouche ◽  
Samantha Iovan ◽  
Jessica L Lehrich ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Best Practices ◽  
Prehospital Care ◽  
Critical Role ◽  
Spontaneous Circulation ◽  
High Survival ◽  
Factors Associated ◽  
Defining System ◽  
Chain Of Survival ◽  
Hospital Cardiac Arrest

Introduction: EMS system factors key to improved survival for out-of-hospital cardiac arrest (OHCA) have not been well elucidated. This study explores factors associated with sustained return of spontaneous circulation (ROSC) in the field with pulse upon arrival to the ED-a measure of high quality of prehospital care-across the chain of survival. Methods: This sequential mixed methods study used data from the Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) to evaluate variation in OHCA outcomes across EMS agencies. Sites were sampled based on geography, rurality, population density, and survival rate. We visited 1 low-, 1 middle-, and 3 high-survival EMS systems. At each site, we conducted key informant interviews with field staff, mid-level managers, and leadership from EMS, police, fire, and dispatch, as well as multidisciplinary focus groups. Transcripts were coded using a structured codebook and analyzed using thematic analysis. Results: An integrated multidisciplinary approach was critical for timely OHCA care coordination across the chain of survival. Themes that emerged across all stakeholders included: 1) OHCA education and multidisciplinary training; 2) shared awareness of roles in the chain of survival and system-wide response; 4) multidisciplinary QI; and 5) leadership and initiative (Table 1). Conclusions: Recognizing the critical role of each level in the chain of survival, this study identified specific practices from EMS system stakeholders that were associated with improved survival. The next phase of this work will include validating the factors associated with increased survival identified through a statewide survey of EMS agencies in Michigan. The final product of this work will include a toolkit of best practices and an implementation guide.

Abstract 367: Factors That Influence Emergency Responder Treatment Versus Transport Decisions for Out-of-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Valencia Waller ◽  
Sydney Fouche ◽  
Kaitlyn Entel ◽  
Nasma Berri ◽  
Wilson Nham ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Critical Role ◽  
Spontaneous Circulation ◽  
System Of Care ◽  
High Survival ◽  
Key Factors ◽  
Emergency Responder ◽  
Emergency Medical ◽  
Chain Of Survival ◽  
Hospital Cardiac Arrest

Introduction: Emergency medical system factors that improve out-of-hospital cardiac arrest (OHCA) survival have not been well elucidated. This study explores factors important to decisions to transport patients before obtaining sustained return of spontaneous circulation (ROSC) in the field throughout the OHCA system of care. Choosing to treat versus transport is a complex decision and reflects various aspects of EMS care that may differ across agencies at different levels of performance. Methods: This sequential mixed-methods study used data from the Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) for the years 2014—2017 to identify variation in OHCA outcomes across emergency medical services (EMS) agencies. We then sampled emergency medical stakeholders—dispatch, fire, police, EMS, and receiving emergency departments (EDs)—across nine EMS system sites of varied urbanicity: four high-survival, two intermediate-survival, and three low-survival based on a primary outcome of sustained ROSC with pulse upon ED arrival. To qualitatively explore variations in OHCA survival, we conducted key informant and focus group interviews at each site. Qualitative data were analyzed through combined rapid and rigorous analysis, with a focus on treat versus transport decisions in the Advanced Care link of the “chain of survival” within a broader system of care framework. Results: Key factors that weighed into OHCA treatment versus transport decisions pre-ROSC across all sites included: clearly defined roles and protocols, on-scene decision-making authority, distance to the hospital, level of training and expertise, resource availability with regard to personnel and equipment, and payment and reimbursement models. Conclusions: Recognizing the critical role of each link in the “chain of survival,” this study identified key factors that impact treat versus transport decisions from the perspective of EMS stakeholders. The next phase of this work will include validating the importance of the identified factors to OHCA survival through a statewide survey of EMS agencies in Michigan. The final product will be a toolkit of best practices to improve survival across U.S. communities.

scholarly journals High survival rate of 43% in out-of-hospital cardiac arrest patients in an optimised chain of survival

2014 ◽  
Vol 23 (1) ◽  
pp. 20-25 ◽  
Author(s):  
L. W. Boyce ◽  
T. P. M. Vliet Vlieland ◽  
J. Bosch ◽  
R. Wolterbeek ◽  
G. Volker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
High Survival ◽  
High Survival Rate ◽  
Chain Of Survival ◽  
Hospital Cardiac Arrest

scholarly journals Out-of-hospital Cardiac Arrest in the Republic of Crimea: Analysis of Epidemiology and Practice of Care

2020 ◽  
Vol 9 (3) ◽  
pp. 338-347
Author(s):  
A. A. Birkun ◽  
L. P. Frolova ◽  
G. N. Buglak ◽  
S. S. Olefirenko
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Prehospital Care ◽  
Spontaneous Circulation ◽  
Annual Data ◽  
Clear Understanding ◽  
Study Results ◽  
Prehospital Management ◽  
The Republic ◽  
Hospital Cardiac Arrest

Introduction. Efficient organization of measures aimed at decreasing mortality from out-of-hospital cardiac arrest (OHCA) warrants a clear understanding of OHCA epidemiology and performance of the prehospital care system in such cases. The study was aimed at performing respective analysis and identifying the ways for improving prehospital management of OHCA in the Republic of Crimea.Material and methods. Annual data from the Crimean OHCA and Resuscitation Registry for 2018 were utilized. All OHCA cases attended by emergency medical services (EMS) with attempted cardiopulmonary resuscitation (CPR) were included, regardless of cardiac arrest etiology or patients’ age (n=419). For ensuring conformity and comparability of the study results, data collection and analysis were executed in correspondence with the statements of the Utstein recommendations.Results. The overall incidence of EMS-attended OHCA in the Republic of Crimea was 673.3 per 100,000 population per year, the incidence of OHCA with attempted CPR – 21.9 per 100,000 population per year, the proportion of CPR attempts out of all OHCA cases – 3.3%. Mean patient age was 66.9 years, and 52.7% were male. The etiology was cardiac in 42.5% cases. In 71.8% cases OHCA was witnessed by EMS, in 25.5% – by a bystander before EMS arrival. Bystanders initiated CPR in 5.7% cases. The initial rhythm was asystole in 80.4% of all cases. When excluding EMS-witnessed cases, the mean EMS response time was 13 min. 5.0% patients had a sustained return of spontaneous circulation at hospital admission. Survival was associated with lower EMS response time (p=0.027), administration of shock (p<0.001) and advanced airway management with endotracheal tube or laryngeal mask (p=0.047).Conclusion. High incidence of OHCA, low rates of CPR commencement and low rates of survival from OHCA in the Republic of Crimea determine the necessity of implementing a comprehensive program to improve prehospital care in the region. Considering the critical relevance of early intervention in OHCA and the revealed low bystander CPR rate, the measures for involving community into the process of prehospital care should form the basis of this program.

scholarly journals Development and validation of a questionnaire to assess knowledge, attitude and confidence regarding cardiopulmonary resuscitation among ambulance drivers in Malaysia

2019 ◽  
Vol 10 (4) ◽  
pp. 2973-2982
Author(s):  
Jamie Foong Siew Wei ◽  
Mohd Azmani bin Sahar ◽  
Ahmad Zulkarnain Ahmad Zahedi
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Prehospital Care ◽  
Critical Role ◽  
Educational Background ◽  
Medical Intervention ◽  
Face Validity ◽  
Good Test ◽  
Test Retest Reliability ◽  
Hospital Cardiac Arrest

Out of hospital cardiac arrest is a major cause of death worldwide. The outcome from out of hospital cardiac arrest remains poor, thus requiring immediate emergency medical intervention and high-quality cardiopulmonary resuscitation. Ambulance drivers are part of the prehospital care team and therefore play a critical role in providing cardiopulmonary resuscitation to cardiac arrest patient. As present, there is no study that has been developed to assess the knowledge, attitude and confidence regarding cardiopulmonary resuscitation among ambulance drivers. Thus, this study has developed a reliable and validated a questionnaire called AmKAC to evaluate their knowledge, attitude and confidence. The questionnaires are available in two languages, English and Bahasa Malaysia, in view of different educational background. The content validity was then assessed by content experts. Subsequently, the questionnaires underwent face validity which were pretested among 10 ambulance drivers to check for the understanding, language and readability. Afterwards, the refined questionnaires were administered to 108 ambulance drivers from the emergency trauma department of six different hospitals. The process was repeated one week after for the retest. This study reviewed reliable questionnaires in measuring knowledge, attitude and confidence among ambulance driver with Cronbach’s alpha of 0.685, 0.703 and 0.905, respectively. In addition, the questionnaire also showed good test-retest reliability and correlation between the items, by using Spearman’s rho and intraclass coefficient, respectively. In conclusion, the developed, validated AmKAC can be used in future to provide better insights of the ambulance drivers knowledge, attitude and confidence level regarding cardiopulmonary resuscitation permitting organization of courses and training.  

Association of acute resuscitation and post-resuscitation survival with overall risk-standardized survival to discharge for in-hospital cardiac arrest

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Girotra ◽  
B Nallamothu ◽  
Y Tang ◽  
P Chan
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Public Institution ◽  
Hierarchical Regression ◽  
Funding Source ◽  
High Survival ◽  
Return Of Spontaneous Circulation ◽  
Adjusted Rate ◽  
Hospital Cardiac Arrest ◽  
Overall Risk

Abstract Background Although survival for in-hospital cardiac arrest (IHCA) varies markedly across sites, it remains unknown whether high survival at top-performing hospitals is due to high rates of acute resuscitation survival (i.e., achievement of return of spontaneous circulation [ROSC]), post-resuscitation survival (i.e., survival to discharge among patients who achieved ROSC), or both. Methods Using 2015–2018 Get With The Guidelines (GWTG)-Resuscitation data, we identified 290 hospitals (86,426 patients) with IHCA. For each hospital, we calculated overall risk-standardized survival (RSSR) to discharge for IHCA using a previously validated hierarchical regression model and categorized hospitals into quartiles based on that metric. Risk-adjusted rates of acute resuscitation survival (defined as return of spontaneous circulation for &gt;20 minutes [ROSC]) and post-resuscitation survival (defined as the proportion of patients achieving ROSC who survived to hospital discharge) were also computed for each hospital. We examined the correlation between a hospital's overall RSSR with its risk-adjusted rate of acute resuscitation and post-resuscitation survival. Results Among study hospitals, the median RSSR was 25.1% (inter-quartile range [IQR]: 21.9%–27.7%). The median risk-adjusted rate of acute resuscitation survival was 72.4% (IQR: 67.9%–76.9%) and post-resuscitation survival was 34.0% (IQR: 31.5%–37.7%). Hospital rates of RSSR were less strongly correlated with risk-adjusted rates of acute resuscitation survival (rho=0.50, P&lt;0.001) than post-resuscitation survival (rho=0.90, P&lt;0.001). Compared with hospitals in the lowest quartile of RSSR, hospitals in the highest quartile had substantially higher rates of acute resuscitation survival (Q4: 75.4% vs. Q1: 66.8%; P&lt;0.001) and post-resuscitation survival (Q4: 40.3% vs. Q1: 28.7%; P&lt;0.001). Notably, there was no correlation between hospital risk-adjusted rates of acute resuscitation survival and post-resuscitation survival (rho=0.09, P=0.11). Conclusion Hospital that excel in overall IHCA survival in general excel in either acute resuscitation or post-resuscitation care. As most hospital-based quality improvement initiatives largely focus on acute resuscitation survival, our findings suggest that efforts to strengthen post-resuscitation care may offer additional opportunities to improve IHCA survival. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): NHLBI

scholarly journals Effect of preceding medications on resuscitation outcome of out-of-hospital cardiac arrest

2016 ◽  
Vol 65 (3) ◽  
pp. 689-693 ◽  
Author(s):  
Shih-Wen Hung ◽  
Chien-Ming Chu ◽  
Chih-Feng Su ◽  
Li-Ming Tseng ◽  
Tzong-Luen Wang
Keyword(s):  
Cardiac Arrest ◽  
Prehospital Care ◽  
Tertiary Care ◽  
Potential Effect ◽  
Spontaneous Circulation ◽  
Care Hospital ◽  
Favorable Neurological Outcome ◽  
Continuous Use ◽  
The Impact ◽  
Hospital Cardiac Arrest

As evidence regarding the impact of preceding medications on resuscitation outcomes has been inconsistent, this study aimed to analyze the association between preceding medications and resuscitation outcomes in patients experiencing out-of-hospital cardiac arrest (OHCA). This retrospective study included patients with OHCA presenting to a tertiary care hospital by emergency medical service (EMS) between January 2006 and June 2011. Using the Utstein template, data were collected from EMS and hospital medical records for prehospital care, in-hospital care, and medications which were taken continuously for at least 2 weeks preceding OHCA. Primary outcome was the proportion of patients with a survived event. Multivariable logistic regression analyses were performed to evaluate the predictors of survived events. Among the 1381 included patients with OHCA, 552 (40.0%) patients achieved sustained return of spontaneous circulation and 463 (33.5%) patients survived after resuscitation, 96 (7.0%) patients survived until discharge, and 20 (1.4%) patients had a favorable neurological outcome at discharge. The multivariable analyses revealed that use of statins preceding OHCA was independently associated with a greater probability of a survived events (OR=2.09, 95% CI 1.08 to 4.03, p=0.028).Use of digoxin was adversely associated with survived events (OR=0.39, 95% CI 0.16 to 0.90, p=0.028) in patients with OHCA. The continuous use of statins preceding OHCA was positively associated with survived events, while use of digoxin was adversely related. It deserves more attention on medications preceding OHCA because of their potential effect on resuscitation outcomes.

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