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de Greef B, Genbrugge C, Verma S, Medic G, Maurer J, Kooy TA, Hoogmartens O, Sabbe M. Cost-effectiveness of a community first responder system for out-of-hospital cardiac arrest in Belgium. Open Heart 2025; 12:e003098. [PMID: 39961703 PMCID: PMC11836846 DOI: 10.1136/openhrt-2024-003098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 01/30/2025] [Indexed: 02/21/2025] Open
Abstract
OBJECTIVE Out-of-hospital cardiac arrest (OHCA) is a major public health challenge across Europe, with a survival rate of only 8.5% to hospital discharge. Implementing a community first responder (CFR) system, including earlier Basic Life Support and defibrillation, can enhance survival rates and neurological outcomes. This study assesses the cost-effectiveness of two scenarios for implementing such a system in Belgium. METHODS A decision tree and the long-term Markov model were used to evaluate cost-effectiveness by comparing two scenarios with current care standards. Scenario 1 involved an awareness campaign on OHCA, while Scenario 2 included implementing a CFR system with automated external defibrillator (AED) integration, dispatch centre linkage and training for citizen responders. The analysis covered survival to the emergency department, hospital, discharge and neurologically intact survival, with sensitivity analyses to test robustness. RESULTS The awareness campaign and implementation of the CFR system resulted in an incremental cost-effectiveness ratio of €14,976 and €16,442 per quality-adjusted life year gained for scenarios 1 and 2, respectively. Both scenarios showed improvements in survival rates at various stages, including hospital discharge and neurologically intact survival. CONCLUSION This study highlights the benefits of enhancing Belgium's CFR for OHCA patients. It suggests that accessible AEDs, trained CFRs and an integrated emergency response system could improve survival rates and quality of life. These findings can guide policy and resource decisions, potentially improving the effectiveness and cost-efficiency of OHCA emergency services. Additionally, this approach could serve as a model for other regions aiming to strengthen their response to time-sensitive emergencies.
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Affiliation(s)
- Bianca de Greef
- Chief Medical Office - Health Economics and Outcome Research, Philips, Amsterdam, Netherlands
| | - Cornelia Genbrugge
- Emergency Department, University Hospitals Leuven, Leuven, Vlaams-Brabant, Belgium
- Department of Public Health and Primary Care, Research Unit Emergency Medicine, KU Leuven, Leuven, Flanders, Belgium
| | - Sanjay Verma
- Chief Medical Office - Health Economics and Outcome Research, Philips, Amsterdam, Netherlands
| | - Goran Medic
- Chief Medical Office - Health Economics and Outcome Research, Philips, Amsterdam, Netherlands
| | - Joachim Maurer
- Connected Care - Emergency Care, Philips, Amsterdam, Netherlands
| | - Tom A Kooy
- Research and Development Department, Stan B.V, Nunspeet, Netherlands
| | - Olivier Hoogmartens
- Department of Public Health and Primary Care, KU Leuven Leuven Institute for Healthcare Policy, Leuven, Flanders, Belgium
| | - Marc Sabbe
- Emergency Department, University Hospitals Leuven, Leuven, Vlaams-Brabant, Belgium
- Department of Public Health and Primary Care, Research Unit Emergency Medicine, KU Leuven, Leuven, Flanders, Belgium
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Latsios G, Sanidas E, Velliou M, Nikitas G, Bounas P, Parisis C, Synetos A, Toutouzas K, Tsioufis C. Cardiac arrest: Pre-hospital strategies to facilitate successful resuscitation and improve recovery rates. World J Cardiol 2025; 17:100782. [PMID: 39866210 PMCID: PMC11755130 DOI: 10.4330/wjc.v17.i1.100782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 12/06/2024] [Accepted: 12/27/2024] [Indexed: 01/21/2025] Open
Abstract
The estimated annual incidence of out-of-hospital cardiac arrest (OHCA) is approximately 120 cases per 100000 inhabitants in western countries. Although the rates of bystander cardiopulmonary resuscitation (CPR) and use of automated external defibrillator are increasing, the likelihood of survival to hospital discharge is no more than 8%. To date, various devices and methods have been utilized in the initial CPR approach targeting to improve survival and neurological outcomes in OHCA patients. The aim of this review is to discuss strategies that facilitate resuscitation, increase the chance to achieve return to spontaneous circulation and improve survival to hospital discharge and neurological outcomes in the pre-hospital setting.
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Affiliation(s)
- George Latsios
- 1 University Department of Cardiology, "Hippokration" General Hospital, Athens Medical School, Athens 11527, Greece.
| | - Elias Sanidas
- Department of Cardiology, "Laiko" General Hospital, Athens 11527, Greece
| | - Maria Velliou
- Department of Emergency Medicine, Athens Medical School, "Attikon" University Hospital, Athens 12462, Greece
| | - George Nikitas
- Department of Cardiology, Panarkadiko General Hospital, Tripoli 22100, Greece
| | - Pavlos Bounas
- Department of Cardiology, "Thriasio" General Hospital, Elefsina 19600, Greece
| | - Charalampos Parisis
- Department of Cardiology, 404 General Military Hospital, Larisa 41222, Greece
| | - Andreas Synetos
- 1 University Department of Cardiology, "Hippokration" General Hospital, Athens Medical School, Athens 11527, Greece
| | - Konstantinos Toutouzas
- 1 University Department of Cardiology, "Hippokration" General Hospital, Athens Medical School, Athens 11527, Greece
| | - Costas Tsioufis
- 1 University Department of Cardiology, "Hippokration" General Hospital, Athens Medical School, Athens 11527, Greece
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Arai M, Nakashima T, Noguchi T, Hifumi T, Inoue A, Sakamoto T, Kuroda Y, Tahara Y. Association Between Cannula Size of Extracorporeal Membrane Oxygenation and Prognosis in Patients With Out-of-Hospital Cardiac Arrest - A Secondary Analysis of the SAVE-J II Study. Circ J 2025:CJ-24-0442. [PMID: 39864827 DOI: 10.1253/circj.cj-24-0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2025]
Abstract
BACKGROUND Selecting an appropriate cannula size is crucial for achieving an adequate extracorporeal membrane oxygenation (ECMO) flow rate. However, the association between ECMO cannula size and the prognosis of patients with out-of-hospital cardiac arrest (OHCA) has not been fully elucidated. We examined the associations between ECMO cannula size and neurological outcomes and survival at discharge in patients with OHCA who received ECMO. METHODS AND RESULTS This is a secondary analysis of the Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan (SAVE-J II study). The primary and secondary outcomes were favorable neurological outcomes and survival at discharge, respectively. In all, 918 patients were included in the analysis. There were no statistically significant differences between cannula sizes and neurological outcomes. Multivariable analysis showed that increasing body weight (BW)-adjusted sizes of arterial cannulas (odds ratio [OR] 1.04 per 0.01-Fr/kg increase; 95% confidence interval [CI] 1.01-1.07; P=0.011) and venous cannulas (OR 1.04 per 0.01-Fr/kg increase; 95% CI 1.01-1.06; P=0.005) were significantly associated with the survival rate at discharge. Increasing BW-adjusted sizes of arterial cannulas were significantly associated with cannulation site bleeding. CONCLUSIONS There were no significant associations between favorable neurological outcomes and cannula size, whereas larger-sized arterial and venous cannulas were significantly associated with higher survival rates at discharge in patients with OHCA who received ECMO.
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Affiliation(s)
- Marina Arai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Graduate School of Medicine, Tohoku University
| | - Takahiro Nakashima
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
- Department of Emergency Medicine and the Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Aldaas OM, Birgersdotter-Green U. Advancements in automated external and wearable cardiac defibrillators. Curr Opin Cardiol 2025; 40:15-21. [PMID: 39445709 DOI: 10.1097/hco.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
PURPOSE OF REVIEW Survival statistics for out-of-hospital cardiac arrests remain unsatisfactory. Prompt defibrillation of shockable rhythms, such as ventricular fibrillation and pulseless ventricular tachycardia, is crucial for improving survival. Automated external defibrillators (AEDs) and wearable cardiac defibrillators (WCDs) seek to improve the survival rates following out-of-hospital cardiac arrests. We aim to review the indications, utility, advancements, and limitations of AEDs and WCDs, as well as their role in contemporary and future clinical practice. RECENT FINDINGS Recent advancements in these technologies, such as smartphone applications and drone delivery of AEDs and less inappropriate shocks and decreased size of WCDs, have increased their ubiquity and efficacy. However, implementation of this technology remains limited due to lack of resources and suboptimal patient adherence. SUMMARY Out of hospital cardiac arrests continue to pose a significant public health challenge. Advancements in AEDs and WCDs aim to facilitate prompt defibrillation of shockable rhythms with the goal of improving survival rates. However, they remain underutilized due to limited resources and suboptimal patient adherence. As these technologies continue to evolve to become smaller, lighter and more affordable, their utilization and accessibility are expected to improve.
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Affiliation(s)
- Omar M Aldaas
- Division of Cardiology, University of California San Diego, La Jolla, California, USA
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Noor Ali Baig M, Fatmi Z, Khan NU, Rahim Khan U, Raheem A, Abdul Razzak J. Characteristics and outcomes of out-of-hospital-cardiac-arrest in rural and suburban areas of Sindh, Pakistan: A cross-sectional study. Resusc Plus 2025; 21:100840. [PMID: 39807285 PMCID: PMC11728896 DOI: 10.1016/j.resplu.2024.100840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 12/08/2024] [Accepted: 12/09/2024] [Indexed: 01/16/2025] Open
Abstract
Background Despite extensive research on OHCA in urban centres worldwide, there is a significant gap in knowledge regarding these events in less urbanized regions, especially in Low-Middle-Income Countries (LMICs). Aim To determine the characteristics and outcomes of adult out-of-hospital cardiac arrest (OHCA) in rural and suburban districts of Sindh, Pakistan. Methods Data of OHCA patients (>18 years) was collected retrospectively from January 2020 to December 2022, from the medical records of district and tehsil hospitals of the province of Sindh. Data analysis was performed using the Statistical Package Software for the Social Sciences (SPSS) Statistics 29. Results Out of 139 OHCA patients, 75.5 % were males, and 24.5 % were females, with a mean age of 52.78 ± 13.1 years. Most cardiac arrests occurred at home (54.75 %). Only 0.7 % of patients were transported by emergency medical services (EMS), while 59 % arrived via private transport, such as cars or vans. An additional 4.3 % were brought by other ambulance services, including private and philanthropic organizations, and for 36 % of patients, the mode of transportation was undocumented. Cardiac arrests were witnessed in 43.2 % of cases. CPR (either in-hospital or pre-hospital) was performed on 59 % of patients, but only 6.1 % received pre-hospital CPR (Bystander: 1.22 %, Ambulance Staff: 2.44 %, Family Member: 2.44 %). Return of spontaneous circulation (ROSC) was achieved in 14.63 % of patients, while 4.88 % were alive at hospital admission. Conclusion This study highlights significant gaps in the chain of survival for OHCA patients in rural and suburban Sindh, Pakistan, including inadequate EMS utilization, low bystander CPR rates, and delayed hospital care, contributing to poor outcomes. The findings may underestimate true rates due to missing and inconsistent data, emphasizing the need for improved documentation and prospective studies.
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Affiliation(s)
- Mirza Noor Ali Baig
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
- Centre of Excellence for Trauma & Emergencies, The Aga Khan University, Karachi, Pakistan
| | - Zafar Fatmi
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Uzma Rahim Khan
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Raheem
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Junaid Abdul Razzak
- Centre of Excellence for Trauma & Emergencies, The Aga Khan University, Karachi, Pakistan
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Sheikh AP, Grabmayr AJ, Kjølbye JS, Ersbøll AK, Hansen CM, Folke F. Incidence and Outcomes After Out-of-Hospital Cardiac Arrest at Train Stations in Denmark. J Am Heart Assoc 2024; 13:e035733. [PMID: 39494588 PMCID: PMC11935703 DOI: 10.1161/jaha.124.035733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 09/12/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND Following international guidelines, communities have deployed automated external defibrillators at train stations without substantive evidence. METHODS AND RESULTS We geocoded public out-of-hospital cardiac arrests (OHCAs) (2016-2020), automated external defibrillators, and train stations. The stations were divided into the following groups according to passenger flow: 1 (0-499), 2 (500-4999), 3 (5000-9999), and 4 (>10 000) passengers per day. Risk ratios (RRs) were calculated using Poisson regression of rates, and odds ratios (ORs) were analyzed through logistic regression. OHCAs at train stations accounted for 102 (2.3%) of 4467 public OHCAs. The incidence rate (IR) and RR for OHCAs were for group 1: IR, 0.02 OHCA per station per year, RR, 1.0 (reference); group 2: IR, 0.07, RR, 4.1 (95% CI, 2.3-7.3); group 3: IR, 0.25, RR, 12.7 (95% CI, 6.2-25.9); and group 4: IR, 0.34, RR, 16.3 (95% CI, 8.6-30.9). Compared with other public OHCAs, OHCAs at train stations were just as likely to receive bystander cardiopulmonary resuscitation (OR, 1.13 [95% CI, 0.60-2.12]). However, they had higher odds of bystander defibrillation (OR, 1.66 [95% CI, 1.06-2.58]), were more likely to achieve return of spontaneous circulation (OR, 1.88 [95% CI, 1.24-2.85]), and survive 30 days (OR, 2.37 [95% CI, 1.57-3.59]). CONCLUSIONS The incidence of OHCAs at train stations was associated with passenger flow, with the busiest stations having a 16-fold higher risk of OHCAs than the lowest. OHCAs at train stations had better outcomes compared with other public OHCAs.
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Affiliation(s)
- Annam Pervez Sheikh
- Copenhagen University Hospital–Emergency Medical ServicesCapital Region of DenmarkCopenhagenDenmark
| | - Anne Juul Grabmayr
- Copenhagen University Hospital–Emergency Medical ServicesCapital Region of DenmarkCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Julie Samsøe Kjølbye
- Copenhagen University Hospital–Emergency Medical ServicesCapital Region of DenmarkCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Annette Kjær Ersbøll
- Copenhagen University Hospital–Emergency Medical ServicesCapital Region of DenmarkCopenhagenDenmark
- National Institute of Public HealthCopenhagenDenmark
- University of Southern DenmarkCopenhagenDenmark
| | - Carolina Malta Hansen
- Copenhagen University Hospital–Emergency Medical ServicesCapital Region of DenmarkCopenhagenDenmark
- Department of Cardiology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Fredrik Folke
- Copenhagen University Hospital–Emergency Medical ServicesCapital Region of DenmarkCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Department of CardiologyCopenhagen University Hospital – Herlev and GentofteCopenhagenDenmark
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Starks MA, Chu J, Leung KB, Blewer AL, Simmons D, Hansen CM, Joiner A, Cabañas JG, Harmody MR, Nelson RD, McNally BF, Ornato JP, Granger CB, Chan TC, Mark DB. Combinations of First Responder and Drone Delivery to Achieve 5-Minute AED Deployment in OHCA. JACC. ADVANCES 2024; 3:101033. [PMID: 39130039 PMCID: PMC11313029 DOI: 10.1016/j.jacadv.2024.101033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/05/2024] [Accepted: 05/01/2024] [Indexed: 08/13/2024]
Abstract
Background Defibrillation in the critical first minutes of out-of-hospital cardiac arrest (OHCA) can significantly improve survival. However, timely access to automated external defibrillators (AEDs) remains a barrier. Objectives The authors estimated the impact of a statewide program for drone-delivered AEDs in North Carolina integrated into emergency medical service and first responder (FR) response for OHCA. Methods Using Cardiac Arrest Registry to Enhance Survival registry data, we included 28,292 OHCA patients ≥18 years of age between 1 January 2013 and 31 December 2019 in 48 North Carolina counties. We estimated the improvement in response times (time from 9-1-1 call to AED arrival) achieved by 2 sequential interventions: 1) AEDs for all FRs; and 2) optimized placement of drones to maximize 5-minute AED arrival within each county. Interventions were evaluated with logistic regression models to estimate changes in initial shockable rhythm and survival. Results Historical county-level median response times were 8.0 minutes (IQR: 7.0-9.0 minutes) with 16.5% of OHCAs having AED arrival times of <5 minutes (IQR: 11.2%-24.3%). Providing all FRs with AEDs improved median response to 7.0 minutes (IQR: 6.2-7.8 minutes) and increased OHCAs with <5-minute AED arrival to 22.3% (IQR: 16.4%-30.9%). Further incorporating optimized drone networks (326 drones across all 48 counties) improved median response to 4.8 minutes (IQR: 4.3-5.2 minutes) and OHCAs with <5-minute AED arrival to 56.3% (IQR: 46.9%-64.2%). Survival rates were estimated to increase by 34% for witnessed OHCAs with estimated drone arrival <5 minutes and ahead of FR and emergency medical service. Conclusions Deployment of AEDs by FRs and optimized drone delivery can improve AED arrival times which may lead to improved clinical outcomes. Implementation studies are needed.
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Affiliation(s)
- Monique A. Starks
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jamal Chu
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - K.H. Benjamin Leung
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
- Scottish Ambulance Service, Edinburgh, Scotland, United Kingdom
| | - Audrey L. Blewer
- Department of Community and Family Medicine and Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Denise Simmons
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carolina Malta Hansen
- Division of Cardiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
- Division of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen University, Copenhagen, Denmark
| | - Anjni Joiner
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Durham County Emergency Medical Services, Durham, North Carolina, USA
| | - José G. Cabañas
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Wake County EMS, Raleigh, North Carolina, USA
| | - Matthew R. Harmody
- Emergency Medical Services, First Health of the Carolinas, Pinehurst, North Carolina, USA
| | - R. Darrell Nelson
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Bryan F. McNally
- Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA
| | - Joseph P. Ornato
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Christopher B. Granger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Timothy C.Y. Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
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Juul Grabmayr A, Folke F, Samsoee Kjoelbye J, Andelius L, Krammel M, Ettl F, Sulzgruber P, Krychtiuk KA, Sasson C, Stieglis R, van Schuppen H, Tan HL, van der Werf C, Torp-Pedersen C, Kjær Ersbøll A, Malta Hansen C. Incidence and Survival of Out-of-Hospital Cardiac Arrest in Public Housing Areas in 3 European Capitals. Circ Cardiovasc Qual Outcomes 2024; 17:e010820. [PMID: 38766860 PMCID: PMC11186715 DOI: 10.1161/circoutcomes.123.010820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Strategies to reach out-of-hospital cardiac arrests (called cardiac arrest) in residential areas and reduce disparities in care and outcomes are warranted. This study investigated incidences of cardiac arrests in public housing areas. METHODS This register-based cohort study included cardiac arrest patients from Amsterdam (the Netherlands) from 2016 to 2021, Copenhagen (Denmark) from 2016 to 2021, and Vienna (Austria) from 2018 to 2021. Using Poisson regression adjusted for spatial correlation and city, we compared cardiac arrest incidence rates (number per square kilometer per year and number per 100 000 inhabitants per year) in public housing and other residential areas and examined the proportion of cardiac arrests within public housing and adjacent areas (100-m radius). RESULTS Overall, 9152 patients were included of which 3038 (33.2%) cardiac arrests occurred in public housing areas and 2685 (29.3%) in adjacent areas. In Amsterdam, 635/1801 (35.3%) cardiac arrests occurred in public housing areas; in Copenhagen, 1036/3077 (33.7%); and in Vienna, 1367/4274 (32.0%). Public housing areas covered 42.4 (12.6%) of 336.7 km2 and 1 024 470 (24.6%) of 4 164 700 inhabitants. Across the capitals, we observed a lower probability of 30-day survival in public housing versus other residential areas (244/2803 [8.7%] versus 783/5532 [14.2%]). The incidence rates and rate ratio of cardiac arrest in public housing versus other residential areas were incidence rate, 16.5 versus 4.1 n/km2 per year; rate ratio, 3.46 (95% CI, 3.31-3.62) and incidence rate, 56.1 versus 36.8 n/100 000 inhabitants per year; rate ratio, 1.48 (95% CI, 1.42-1.55). The incidence rates and rate ratios in public housing versus other residential areas were consistent across the 3 capitals. CONCLUSIONS Across 3 European capitals, one-third of cardiac arrests occurred in public housing areas, with an additional third in adjacent areas. Public housing areas exhibited consistently higher cardiac arrest incidences per square kilometer and 100 000 inhabitants and lower survival than other residential areas. Public housing areas could be a key target to improve cardiac arrest survival in countries with a public housing sector.
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Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
- Department of Cardiology, Gentofte Hospital (F.F., C.M.H.), Copenhagen University, Denmark
| | - Julie Samsoee Kjoelbye
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
| | - Linn Andelius
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
| | - Mario Krammel
- PULS, Austrian Cardiac Arrest Awareness Association (M.K., F.E., P.S.)
- Emergency Medical Service Vienna, Austria (M.K.)
| | - Florian Ettl
- Department of Emergency Medicine (F.E.) Medical University of Vienna, Austria
- PULS, Austrian Cardiac Arrest Awareness Association (M.K., F.E., P.S.)
| | - Patrick Sulzgruber
- Department of Internal Medicine II, Division of Cardiology (P.S., K.A.K.) Medical University of Vienna, Austria
- PULS, Austrian Cardiac Arrest Awareness Association (M.K., F.E., P.S.)
| | - Konstantin A. Krychtiuk
- Department of Internal Medicine II, Division of Cardiology (P.S., K.A.K.) Medical University of Vienna, Austria
- Duke Clinical Research Institute, Durham, NC (K.A.K.)
| | | | - Remy Stieglis
- Department of Anesthesiology (R.S., H.v.S.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Hans van Schuppen
- Department of Anesthesiology (R.S., H.v.S.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology (H.L.T.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands (H.L.T.)
| | - Christian van der Werf
- Department of Cardiology, Heart Centre, (C.v.d.W.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, the Netherlands (C.v.d.W.)
| | - Christian Torp-Pedersen
- Department of Public Health (C.T.-P.), University of Copenhagen, Denmark
- Department of Cardiology, North Zealand Hospital, Denmark (C.T.-P.)
| | - Annette Kjær Ersbøll
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- National Institute of Public Health, University of Southern Denmark (A.K.E.)
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
- Department of Cardiology, Gentofte Hospital (F.F., C.M.H.), Copenhagen University, Denmark
- Department of Cardiology, Rigshospitalet (C.M.H.), Copenhagen University, Denmark
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Bundgaard Ringgren K, Ung V, Gerds TA, Kragholm KH, Ascanius Jacobsen P, Lyng Lindgren F, Grabmayr AJ, Christensen HC, Mills EHA, Kollander Jakobsen L, Yonis H, Hansen CM, Folke F, Lippert F, Torp-Pedersen C. Prediction model for future OHCAs based on geospatial and demographic data: An observational study. Medicine (Baltimore) 2024; 103:e38070. [PMID: 38728490 PMCID: PMC11081540 DOI: 10.1097/md.0000000000038070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
This study used demographic data in a novel prediction model to identify areas with high risk of out-of-hospital cardiac arrest (OHCA) in order to target prehospital preparedness. We combined data from the nationwide Danish Cardiac Arrest Registry with geographical- and demographic data on a hectare level. Hectares were classified in a hierarchy according to characteristics and pooled to square kilometers (km2). Historical OHCA incidence of each hectare group was supplemented with a predicted annual risk of at least 1 OHCA to ensure future applicability. We recorded 19,090 valid OHCAs during 2016 to 2019. The mean annual OHCA rate was highest in residential areas with no point of public interest and 100 to 1000 residents per hectare (9.7/year/km2) followed by pedestrian streets with multiple shops (5.8/year/km2), areas with no point of public interest and 50 to 100 residents (5.5/year/km2), and malls with a mean annual incidence per km2 of 4.6. Other high incidence areas were public transport stations, schools and areas without a point of public interest and 10 to 50 residents. These areas combined constitute 1496 km2 annually corresponding to 3.4% of the total area of Denmark and account for 65% of the OHCA incidence. Our prediction model confirms these areas to be of high risk and outperforms simple previous incidence in identifying future risk-sites. Two thirds of out-of-hospital cardiac arrests were identified in only 3.4% of the area of Denmark. This area was easily identified as having multiple residents or having airports, malls, pedestrian shopping streets or schools. This result has important implications for targeted intervention such as automatic defibrillators available to the public. Further, demographic information should be considered when implementing such interventions.
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Affiliation(s)
| | - Vilde Ung
- Department of Public Health, University of Copenhagen, København, Denmark
| | | | | | | | | | - Anne Juul Grabmayr
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
- National Clinical Registries, Frederiksberg, Denmark
| | | | | | - Harman Yonis
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Torp-Pedersen
- Department of Public Health, University of Copenhagen, København, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
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10
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Juul Grabmayr A, Folke F, Tofte Gregers MC, Kollander L, Bo N, Andelius L, Jensen TW, Ettl F, Krammel M, Sulzgruber P, Krychtiuk KA, Torp-Pedersen C, Kjær Ersbøll A, Malta Hansen C. Public Out-of-Hospital Cardiac Arrest in Residential Neighborhoods. J Am Coll Cardiol 2023; 82:1777-1788. [PMID: 37879782 DOI: 10.1016/j.jacc.2023.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/17/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Although one-half of all public out-of-hospital cardiac arrests (OHCAs) occur outside private homes in residential neighborhoods, their characteristics and outcomes remain unexplored. OBJECTIVES The authors assessed interventions before ambulance arrival and survival for public OHCA patients in residential neighborhoods. METHODS Public OHCAs from Vienna (2018-2021) and Copenhagen (2016-2020) were designated residential neighborhoods or nonresidential areas. Interventions (cardiopulmonary resuscitation [CPR], automated external defibrillator [AED] attached, and defibrillation) and 30-day survival were compared using a generalized estimation equation model adjusted for age and time of day and presented as ORs. RESULTS We included 1,052 and 654 public OHCAs from Vienna and Copenhagen, respectively, and 68% and 55% occurred in residential neighborhoods, respectively. The likelihood of CPR, defibrillation, and survival in residential neighborhoods vs nonresidential areas (reference) were as follows: CPR Vienna, 73% vs 78%, OR: 0.78 (95% CI: 0.57-1.06), CPR Copenhagen, 83% vs 90%, OR: 0.54 (95% CI: 0.34-0.88), and CPR combined, 76% vs 84%, OR: 0.70 (95% CI: 0.53-0.90); AED attached Vienna, 36% vs 44%, OR: 0.69 (95% CI: 0.53-0.90), AED attached Copenhagen, 21% vs 43%, OR: 0.33 (95% CI: 0.24-0.48), and AED attached combined, 31% vs 44%, OR: 0.53 (95% CI: 0.42-0.65); defibrillation Vienna, 14% vs 20%, OR: 0.61 (95% CI: 0.43-0.87), defibrillation Copenhagen, 16% vs 36%, OR: 0.35 (95% CI: 0.24-0.51), and defibrillation combined, 15% vs 27%, OR: 0.46 (95% CI: 0.36-0.61); and 30-day survival rate Vienna, 21% vs 26%, OR: 0.84 (95% CI: 0.58-1.20), 30-day survival rate Copenhagen, 33% vs 44%, OR: 0.65 (95% CI: 0.47-0.90), and 30-day survival rate combined, 25% vs 36%, OR: 0.73 (95% CI: 0.58-0.93). CONCLUSIONS Two-thirds of public OHCAs occurred in residential neighborhoods with fewer resuscitative efforts before ambulance arrival and lower survival than in nonresidential areas. Targeted efforts to improve early CPR and defibrillation for public OHCA patients in residential neighborhoods are needed.
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Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte, Denmark
| | - Mads Christian Tofte Gregers
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Louise Kollander
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Bo
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linn Andelius
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Theo Walter Jensen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Mario Krammel
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria; Emergency Medical Service Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria; Department of Internal Medicine II - Division of Cardiology Medical University of Vienna, Vienna, Austria
| | - Konstantin A Krychtiuk
- Department of Internal Medicine II - Division of Cardiology Medical University of Vienna, Vienna, Austria; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Christian Torp-Pedersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark
| | - Annette Kjær Ersbøll
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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11
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Lyngby RM, Quinn T, Oelrich RM, Nikoletou D, Gregers MCT, Kjølbye JS, Ersbøll AK, Folke F. Association of Real-Time Feedback and Cardiopulmonary-Resuscitation Quality Delivered by Ambulance Personnel for Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2023; 12:e029457. [PMID: 37830329 PMCID: PMC10757518 DOI: 10.1161/jaha.123.029457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
Background High-quality cardiopulmonary resuscitation (CPR) is associated with improved survival from out-of-hospital cardiac arrest and includes chest compression depth, chest compression rate, and chest compression fraction within international guideline recommendations. Previous studies have demonstrated divergent results of real-time feedback on CPR performance and patient outcomes. This study investigated the association between emergency medical service CPR quality and real-time CPR feedback for out-of-hospital cardiac arrest. Methods and Results This study collected out-of-hospital cardiac arrest data within the Capital Region of Denmark and compared CPR quality delivered by ambulance personnel. Data were collected in 2 consecutive phases from October 2018 to February 2020. Median chest compression depth was 6.0 cm (no feedback) and 5.9 cm (real-time feedback) (P=0.852). Corresponding proportion of guideline-compliant chest compressions for depth was 16.6% and 28.7%, respectively (P<0.001). Median chest compression rate per minute was 111 and 109 (P<0.001), respectively. Corresponding guideline adherence proportion for compression rate was 65.4% compared with 80.4% (P<0.001), respectively. Chest compression fraction was 78.9% compared with 81.9% (P<0.001), respectively. The combination of guideline-compliant chest compression depth and chest compression rate simultaneously was 8.5% (no feedback) versus 18.8% (feedback) (P<0.001). Improvements were not significant for return of spontaneous circulation (odds ratio [OR], 1.08 [95% CI, 0.84-1.39]), sustained return of spontaneous circulation (OR, 1.00 [95% CI, 0.77-1.31]), or survival to hospital discharge (OR, 0.91 [95% CI, 0.64-1.30]). Conclusions Real-time feedback was associated with improved guideline compliance for chest compression depth, rate, and fraction but not return of spontaneous circulation, sustained return of spontaneous circulation, or survival to hospital discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04152252.
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Affiliation(s)
- Rasmus Meyer Lyngby
- Copenhagen Emergency Medical ServicesCopenhagenDenmark
- Kingston University and St. GeorgesUniversity of LondonLondonUnited Kingdom
| | - Tom Quinn
- Kingston University and St. GeorgesUniversity of LondonLondonUnited Kingdom
| | | | - Dimitra Nikoletou
- Kingston University and St. GeorgesUniversity of LondonLondonUnited Kingdom
| | - Mads Christian Tofte Gregers
- Copenhagen Emergency Medical ServicesCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Julie Samsøe Kjølbye
- Copenhagen Emergency Medical ServicesCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical ServicesCopenhagenDenmark
- National Institute of Public HealthUniversity of Southern DenmarkCopenhagenDenmark
| | - Fredrik Folke
- Copenhagen Emergency Medical ServicesCopenhagenDenmark
- Herlev Gentofte University HospitalCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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12
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Elhussain MO, Ahmed FK, Mustafa NM, Mohammed DO, Mahgoub IM, Alnaeim NA, Ali R, Bushra N, Ahamed HK, Abdelrahman N. The Role of Automated External Defibrillator Use in the Out-of-Hospital Cardiac Arrest Survival Rate and Outcome: A Systematic Review. Cureus 2023; 15:e47721. [PMID: 38021997 PMCID: PMC10676231 DOI: 10.7759/cureus.47721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) remains a significant cause of death. The chance of survival significantly increases when immediate defibrillation with an on-site automated external defibrillator (AED) is available. Our aim is to systematically evaluate the impact of public access defibrillators (PAD) on the outcomes of outpatient cardiac arrest. We conducted a systematic review of the data from global studies on the role of bystander and emergency medical service (EMS) interventions, primarily focusing on the usage of AEDs, during OHCA events. The results highlight the critical significance of PADs in improving survival outcomes in OHCA settings. The majority of OHCA incidents occurred in private residences, but public spaces such as schools and airports had better outcomes, likely due to AED accessibility and trained individuals. Placing AEDs in public areas, especially high-risk zones, can boost survival chances. Timely defibrillation, particularly by bystanders, correlated with better survival and neurological conditions. The review emphasizes the importance of widespread cardiopulmonary resuscitation (CPR) and AED training, strategic AED placement, and continuous monitoring of interventions and outcomes to enhance survival rates and neurological recovery after OHCAs. This systematic review showed that bystander interventions, including CPR and AED usage, significantly increased the survival rate. Overall, immediate response and accessibility to AEDs in public areas can significantly improve outcomes in OHCA events.
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Affiliation(s)
- Mohamed O Elhussain
- Family Medicine-Geriatrics, Michigan State University, East Lansing, USA
- Internal Medicine, Sudan Medical Specialization Board, Khartoum, SDN
| | - Fatima K Ahmed
- Family Medicine-Geriatrics, Michigan State University, East Lansing, USA
| | - Nafisa M Mustafa
- Family Medicine-Geriatrics, Michigan State University, East Lansing, USA
| | - Doaa O Mohammed
- Family Medicine-Geriatrics, Michigan State University, East Lansing, USA
| | - Ibrahim M Mahgoub
- Family Medicine-Geriatrics, Michigan State University, East Lansing, USA
| | - Namarig A Alnaeim
- Family Medicine-Geriatrics, Michigan State University, East Lansing, USA
| | - Ragda Ali
- Family Medicine-Geriatrics, Michigan State University, East Lansing, USA
| | - Noura Bushra
- Family Medicine-Geriatrics, Michigan State University, East Lansing, USA
| | - Hassan K Ahamed
- Family Medicine-Geriatrics, Michigan State University, East Lansing, USA
| | - Nadir Abdelrahman
- Family Medicine-Geriatrics, Human Medicine, Michigan State University, East Lansing, USA
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13
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Lafrance M, Canon V, Hubert H, Grunau B, Javaudin F, Recher M, Heidet M. Out-of-hospital cardiac arrests occurring at school in France: A nation-wide retrospective cohort study from the RéAC registry. Resuscitation 2023; 189:109888. [PMID: 37380064 DOI: 10.1016/j.resuscitation.2023.109888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
AIM We sought to describe the characteristics of at-school out-of-hospital cardiac arrests cases, subsequent basic life support, as well as ultimate patient outcomes. METHODS This was a nation-wide, multicentre, retrospective cohort study from the French national population-based RéAC out-of-hospital cardiac arrest registry (July 2011 - March 2023). We compared the characteristics and outcomes of cases occurring at schools vs. in other public places. RESULTS Of the 149,088 national out-of-hospital cardiac arrests, 25,071 were public: 86 (0.3%) and 24,985 (99.7%) in schools and other public places, respectively. At-school out-of-hospital cardiac arrests, in comparison to other public places, were: significantly younger (median: 42.5 vs. 58 years, p < 0.001); more commonly of a medical cause (90.7% vs. 63.8%, p < 0.001), more commonly bystander-witnessed (93.0% vs. 73.4%, p < 0.001) and recipients of bystander cardiopulmonary resuscitation (78.8% vs. 60.6%, p = 0.001) with shorter median no-flow durations (2 min. vs. 7 min.); with greater bystander automated external defibrillator application (38.9% vs. 18.4%) and defibrillation (23.6%, vs. 7.9%; all p < 0.001). At-school patients had greater rates of return of spontaneous circulation than out-of-school ones (47.7%, vs. 31.8%; p = 0.002), higher rates of survival at arrival at hospital (60.5% vs. 30.7%; p < 0.001) and at 30-days (34.9% vs. 11.6%; p < 0.001), and survival with favourable neurological outcomes at 30 days (25.9% vs. 9.2%; p < 0.001). CONCLUSION At-school out-of-hospital cardiac arrests were rare in France, however demonstrated favourable prognostic features and outcomes. The use of automated external defibrillators in at-school cases, while more common than cases occurring elsewhere, should be improved.
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Affiliation(s)
- Martin Lafrance
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France.
| | - Valentine Canon
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France
| | - Hervé Hubert
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France
| | - Brian Grunau
- Univeristy of British Columbia, Department of Emergency Medicine, Vancouver, BC, Canada; Centre for Health Evaluation and Outcomes Sciences (CHEOS), BC RESURECT, Vancouver, BC, Canada
| | - François Javaudin
- Urgences, Hôpital Universitaire de Nantes, Nantes, France; Laboratoire MiHAR, EE1701, Université de Nantes, Nantes, France
| | - Morgan Recher
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; Soins Intensifs Pédiatriques, Hôpital Universitaire Jeanne de Flandre, Lille, France
| | - Matthieu Heidet
- Assistance Publique - Hôpitaux de Paris (AP-HP), SAMU 94 et Urgences, Hôpitaux Universitaires Henri Mondor, Créteil, France; Université Paris-Est Créteil (UPEC), EA-3956 (Control in intelligent networks, CIR), Créteil, France
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14
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Oh YT, Ahn C. Characteristics and Treatment Outcomes of Out-of-Hospital Cardiac Arrests Occurring in Public Places: A National Population-Based Observational Study. J Pers Med 2023; 13:1191. [PMID: 37623442 PMCID: PMC10455591 DOI: 10.3390/jpm13081191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Sudden cardiac arrest, particularly out-of-hospital cardiac arrest (OHCA), is a global public health concern. However, limited research exists on the epidemiology of OHCAs occurring in public places, trends and impact of bystander intervention, and influence of extraordinary circumstances. This study investigated the epidemiological factors, bystander characteristics, and outcomes of OHCAs that occurred in public places in South Korea from 2016 to 2021 and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic. A retrospective analysis was conducted using an Out-of-Hospital Cardiac Arrest Surveillance database, including 33,206 cases of OHCA that occurred in public places. Cases with do-not-resuscitate orders or insufficient data were excluded. A steady increase in bystander-performed cardiopulmonary resuscitation over the years and a constant decrease in bystander automated external defibrillator (AED) use were observed. Survival-to-discharge rates for OHCAs remained relatively steady until a marginal decrease was observed during the pandemic (pandemic, 13.1%; pre-pandemic, 14.4%). Factors affecting survival included the presence of a shockable rhythm, witnessed arrest, cardiac arrest due to disease, use of bystander AED, and period relative to the COVID-19 pandemic. These findings emphasize the critical role of bystanders in outcomes of OHCAs and inform public health strategies on better management of OHCAs in public places.
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Affiliation(s)
- Young Taeck Oh
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea;
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
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15
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Folke F, Shahriari P, Hansen CM, Gregers MCT. Public access defibrillation: challenges and new solutions. Curr Opin Crit Care 2023; 29:168-174. [PMID: 37093002 PMCID: PMC10155700 DOI: 10.1097/mcc.0000000000001051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review the current status of public access defibrillation and the various utility modalities of early defibrillation. RECENT FINDINGS Defibrillation with on-site automated external defibrillators (AEDs) has been the conventional approach for public access defibrillation. This strategy is highly effective in cardiac arrests occurring in close proximity to on-site AEDs; however, only a few cardiac arrests will be covered by this strategy. During the last decades, additional strategies for public access defibrillation have developed, including volunteer responder programmes and drone assisted AED-delivery. These programs have increased chances of early defibrillation within a greater radius, which remains an important factor for survival after out-of-hospital cardiac arrest. SUMMARY Recent advances in the use of public access defibrillation show great potential for optimizing early defibrillation. With new technological solutions, AEDs can be transported to the cardiac arrest location reaching OHCAs in both public and private locations. Furthermore, new technological innovations could potentially identify and automatically alert the emergency medical services in nonwitnessed OHCA previously left untreated.
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Affiliation(s)
- Fredrik Folke
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Clinical Medicine, University of Copenhagen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte
| | - Persia Shahriari
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Clinical Medicine, University of Copenhagen
| | - Carolina Malta Hansen
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mads Christian Tofte Gregers
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Clinical Medicine, University of Copenhagen
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16
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Gregers MCT, Andelius L, Kjoelbye JS, Juul Grabmayr A, Jakobsen LK, Bo Christensen N, Kragh AR, Hansen CM, Lyngby RM, Væggemose U, Torp-Pedersen C, Ersbøll AK, Folke F. Association Between Number of Volunteer Responders and Interventions Before Ambulance Arrival for Cardiac Arrest. J Am Coll Cardiol 2023; 81:668-680. [PMID: 36792282 DOI: 10.1016/j.jacc.2022.11.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/03/2022] [Accepted: 11/08/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Volunteer responder (VR) programs for activation of laypersons in out-of-hospital cardiac arrest (OHCA) have been deployed worldwide, but the optimal number of VRs to dispatch is unknown. OBJECTIVES The purpose of this study was to investigate the association between the number of VRs arriving before Emergency Medical Services (EMS) and the proportion of bystander cardiopulmonary resuscitation (CPR) and defibrillation. METHODS We included OHCAs not witnessed by EMS with VR activation from the Capital Region (September 2, 2017, to May 14, 2019) and the Central Region of Denmark (November 5, 2018, to December 31, 2019). We created 4 groups according to the number of VRs arriving before EMS: 0, 1, 2, and 3 or more. Using a logistic regression model adjusted for EMS response time, we examined associations between the number of VRs arriving before EMS and bystander CPR and defibrillation. RESULTS We included 906 OHCAs. The adjusted ORs for bystander CPR were 2.40 (95% CI: 1.42-4.05), 3.18 (95% CI: 1.39-7.26), and 2.70 (95% CI: 1.32-5.52) when 1, 2, or 3 or more VRs arrived before EMS (reference), respectively. The adjusted OR for bystander defibrillation increased when 1 (1.97 [95% CI: 1.12-3.52]), 2 (2.88 [95% CI: 1.48-5.58]), or 3 or more (3.85 [95% CI: 2.11-7.01]) VRs arrived before EMS (reference). The adjusted OR of bystander defibrillation increased to 1.95 (95% CI: 1.18-3.22) when ≥3 VRs arrived first compared with 1 VR arriving first (reference). CONCLUSIONS We found an association of increased bystander CPR and defibrillation when 1 or more VRs arrived before the EMS with a trend toward increased bystander defibrillation with increasing number of VRs arriving first.
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Affiliation(s)
- Mads Christian Tofte Gregers
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. https://twitter.com/mads_tofte
| | - Linn Andelius
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Julie Samsoee Kjoelbye
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Juul Grabmayr
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Louise Kollander Jakobsen
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Bo Christensen
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Rolin Kragh
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Meyer Lyngby
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Ulla Væggemose
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
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17
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Nielsen CG, Folke F, Andelius L, Hansen CM, Væggemose U, Christensen EF, Torp-Pedersen C, Ersbøll AK, Gregers MCT. Increased bystander intervention when volunteer responders attend out-of-hospital cardiac arrest. Front Cardiovasc Med 2022; 9:1030843. [DOI: 10.3389/fcvm.2022.1030843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
AimThe 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 methodsThis 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.ResultsWe 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.ConclusionWe 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.
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18
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Zinger ND, Blomberg SN, Lippert F, Krafft T, Christensen HC. Impact of integrating out-of-hours services into Emergency Medical Services Copenhagen: a descriptive study of transformational years. Int J Emerg Med 2022; 15:40. [PMID: 36008756 PMCID: PMC9414103 DOI: 10.1186/s12245-022-00442-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Many emergency medical services and out-of-hours systems are facing an increasing demand for primary, ambulance, and secondary care services caused by population aging and a higher prevalence of long-term and complex conditions. In order to ensure safety and efficiency for future demands, many systems are changing their dispersed healthcare services towards a more integrated care system. Therefore, an evaluation of the production and performance over time of such a unified system is desirable. Methods This retrospective quantitative study was performed with dispatch and financial accounting data of Copenhagen Emergency Medical Services for the period 2010–2019. Copenhagen Emergency Medical Services operates both an emergency number and a medical helpline for out-of-hours services. The number of calls to the emergency number, the centralized out-of-hours medical helpline, the number of dispatches, and the annual expenditure of the system are described for both the periods before and after the major reforms. Production of the emergency number and the centralized medical helpline were analyzed separately. Results The average number of dispatches increased from 328 per 10,000 inhabitants in 2010 to 361 per 10,000 inhabitants in 2019. The newly initiated medical helpline received 533 calls per 10,000 inhabitants in its first year and 5 years later 548 calls per 10,000 inhabitants. A cost increase of 10% was observed in the first year after the reforms, but it decreased again to 8% in the following year. Conclusions There is a population demand for a centralized telephone access point for (semi-)emergency medical services. A more integrated EMS system is promising for a sustainable healthcare provision for a growing population with complex healthcare demands and multi-morbidities.
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Affiliation(s)
- Nienke D Zinger
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Stig Nikolaj Blomberg
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Krafft
- Department of Health, Ethics & Society, CAPHRI School of Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Helle Collatz Christensen
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark. .,Danish Clinical Quality Program (RKKP), National Clinical Registries, Copenhagen, Denmark.
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19
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Sudden cardiac arrest in commercial airports: Incidence, responses, and implications. Am J Emerg Med 2022; 59:118-120. [PMID: 35834873 DOI: 10.1016/j.ajem.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/08/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022] Open
Abstract
Billions of travelers pass through airports around the world every year. Airports are a relatively common location for sudden cardiac arrest when compared with other public venues. An increased incidence of cardiac arrest in airports may be due to the large volume of movement, the stress of travel, or adverse effects related to the physiological environment of airplanes. Having said that, airports are associated with extremely high rates of witnessed arrests, bystander interventions (eg. CPR and AED use), shockable arrest rhythms, and survival to hospital discharge. Large numbers of people, a high density of public-access AEDs, and on-site emergency medical services (EMS) resources are probably the major reasons why cardiac arrest outcomes are so favorable at airports. The success of the chain of survival found at airports may imply that applying similar practices to other public venues will translate to improvements in cardiac arrest survival. Airports might, therefore, be one model of cardiac arrest preparedness that other public areas should emulate.
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20
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Out-of-hospital cardiac arrest: Does rurality decrease chances of survival? Resusc Plus 2022; 9:100208. [PMID: 35146464 PMCID: PMC8819014 DOI: 10.1016/j.resplu.2022.100208] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Geographical setting is seldomly taken into account when investigating out-of-hospital cardiac arrest (OHCA). It is a common notion that living in rural areas means a lower chance of fast and effective helpwhen suffering a time-critical event. This retrospective cohort study investigates this hypothesis and compares across healthcare-divided administrative regions. Methods We included only witnessed OHCAs to minimize the risk that outcome was predetermined by time to caller arrival and/or recognition. Arrests were divided into public and residential. Residential arrests were categorized according to population density of the area in which they occurred. We investigated incidence, EMS response time and 30-day survival according to area type and subsidiarily by healthcare-divided administrative region. Results The majority (71%) of 8,579 OHCAs were residential, and 53.2% of all arrests occurred in the most densely populated cell group amongst residential arrests. This group had a median EMS response time of six minutes, whereas the most sparsely populated group had a median of 10 minutes. Public arrests also had a median response time of six minutes. 30-day survival was highest in public arrests (38.5%, [95% CI 36.9;40.1]), and varied only slightly with no statistical significance between OHCAs in densely and sparsely populated areas from 14.8% (95% CI 14.4;15.2) and 13.4% (95% CI 12.2;14.7). Conclusion Our study demonstrates that while EMS response times in Denmark are longer in the rural areas, there is no statistically significant decrease in survival compared to the most densely populated areas.
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21
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van Diepen S, Hansen CM. Modeling optimal AED placement to improve cardiac arrest survival: The challenge is implementation. Resuscitation 2022; 172:201-203. [DOI: 10.1016/j.resuscitation.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
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22
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Resuscitation highlights in 2021. Resuscitation 2022; 172:64-73. [PMID: 35077856 DOI: 10.1016/j.resuscitation.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND This review is the latest in a series of regular annual reviews undertaken by the editors and aims to highlight some of the key papers published in Resuscitation during 2021. METHODS Hand-searching by the editors of all papers published in Resuscitation during 2021. Papers were selected based on then general interest and novelty and were categorised into themes. RESULTS 98 papers were selected for brief mention. CONCLUSIONS Resuscitation science continues to evolve and incorporates all links in the chain of survival.
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23
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Andersen LS, Lorentzen V, Beedholm K. From Suspicion to Recognition-Being a Bystander to a Relative Affected by Acute Coronary Syndrome. QUALITATIVE HEALTH RESEARCH 2022; 32:307-316. [PMID: 34866472 DOI: 10.1177/10497323211050911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Within cardiac research, an overwhelming number of studies have explored factors related to pre-hospital delay. However, there is a knowledge gap in studies that explore the bystander's experiences or significance when an individual is affected by acute coronary syndrome (ACS). We conducted an interview study with 17 individuals affected by ACS and the bystander(s) involved and performed a qualitative thematic analysis. In the pre-hospital phase, the bystander moved from suspicion of illness to recognition of illness while trying to convince the individual affected by ACS (p-ACS) to respond to bodily sensations. This led to conflicts and dilemmas which affected the bystander both before and after the p-ACS was hospitalized. Bystanders may influence pre-hospital delay in both positive and negative direction depending on their own knowledge, convictions, and the nature of their interaction with the p-ACSs. The bystander's influence during the pre-hospital delay is more extensive than previously recognized.
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Affiliation(s)
| | - Vibeke Lorentzen
- Centre for Research in Clinical Nursing, Viborg, Denmark
- Deakin University, Melbourne, Australia
- Aarhus University, Aarhus, Denmark
| | - Kirsten Beedholm
- Department of for Public Health, Aarhus University, Aarhus, Denmark
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24
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Brown TP, Perkins GD, Smith CM, Deakin CD, Fothergill R. Are there disparities in the location of automated external defibrillators in England? Resuscitation 2021; 170:28-35. [PMID: 34757059 PMCID: PMC8786665 DOI: 10.1016/j.resuscitation.2021.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/11/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022]
Abstract
Background Early defibrillation is an essential element of the chain of survival for out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) programmes aim to place automated external defibrillators (AED) in areas with high OHCA incidence, but there is sometimes a mismatch between AED density and OHCA incidence. Objectives This study aimed to assess whether there were any disparities in the characteristics of areas that have an AED and those that do not in England. Methods Details of the location of AEDs registered with English Ambulance Services were obtained from individual services or internet sources. Neighbourhood characteristics of lower layer super output areas (LSOA) were obtained from the Office for National Statistics. Comparisons were made between LSOAs with and without a registered AED. Results AEDs were statistically more likely to be in LSOAs with a lower residential but higher workplace population density, with people predominantly from a white ethnic background and working in higher socio-economically classified occupations (p < 0.05). There was a significant correlation between AED coverage and the LSOA Index of Multiple Deprivation (IMD) (r = 0.79, p = 0.007), with only 27.4% in the lowest IMD decile compared to about 45% in highest. AED density varied significantly across the country from 0.82/km2 in the north east to 2.97/km2 in London. Conclusions In England, AEDs were disproportionately placed in more affluent areas, with a lower residential population density. This contrasts with locations where OHCAs have previously occurred. Future PAD programmes should give preference to areas of higher deprivation and be tailored to the local community.
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Affiliation(s)
- Terry P Brown
- NIHR Applied Research Collaboration West Midlands, Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK.
| | - Gavin D Perkins
- NIHR Applied Research Collaboration West Midlands, Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK; Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | | | - Charles D Deakin
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, Winchester SO21 2RU, UK; University Hospital Southampton NHS Foundation Trust, Southampton S16 6YD, UK
| | - Rachael Fothergill
- Clinical Audit & Research Unit, Clinical & Quality Directorate, London Ambulance Service NHS Trust, HQ Annexe, 8-20 Pocock Street, London SE1 0BW, UK
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25
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Salcido DD, Weiss LS. A glimpse of what could be. Resuscitation 2021; 162:431-432. [PMID: 33798625 DOI: 10.1016/j.resuscitation.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- David D Salcido
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Leonard S Weiss
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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