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Cardiopulmonary resuscitation performed by trained providers and shorter time to emergency medical team arrival increased patients' survival rates in Istra County, Croatia: a retrospective study.

ABSTRACT: AIM:To assess the effect of the time for emergency medical services (EMS) arrival on resuscitation outcome in the transition period of the EMS system in Istra County. METHODS:This retrospective study analyzed the data from 1440 patients resuscitated between 2011 and 2017. The effect of demographic data, period of the year, time for EMS arrival, initial cardiopulmonary resuscitation (CPR) provider, initial cardiac rhythm, and airway management method on CPR outcome was assessed with multivariate logistic regression. RESULTS:Survivors were younger than non-survivors (median of 66 vs 70 years, P<0.001) and had shorter time for EMS arrival (median of 6 vs 8 min, P<0.001). The proportion of non-survivors was significantly higher when initial basic life support (BLS) was performed by bystanders without training (83.8%) or when no CPR was performed before EMS team arrival (87.3%) than when BLS was performed by medical professionals (66.8%) (P<0.001). Sex, airway management, and tourist season had no effect on CPR outcome. CONCLUSION:Since the time for arrival and level of CPR provider training showed a significant effect on CPR outcome, further organizational effort should be made to reduce the time for EMS arrival and increase the number of individuals trained in BLS.

SUBMITTER: Bakran K

PROVIDER: S-EPMC6734581 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Cardiopulmonary resuscitation performed by trained providers and shorter time to emergency medical team arrival increased patients' survival rates in Istra County, Croatia: a retrospective study.

Bakran Katerina K Šribar Andrej A Šerić Monika M Antić-Šego Gordana G Božić Marija Ana MA Prijić Aleksandra A Lacković Taša T Peršec Jasminka J

Croatian medical journal 20190801 4

<h4>Aim</h4>To assess the effect of the time for emergency medical services (EMS) arrival on resuscitation outcome in the transition period of the EMS system in Istra County.<h4>Methods</h4>This retrospective study analyzed the data from 1440 patients resuscitated between 2011 and 2017. The effect of demographic data, period of the year, time for EMS arrival, initial cardiopulmonary resuscitation (CPR) provider, initial cardiac rhythm, and airway management method on CPR outcome was assessed wit ...[more]

PMID: 31483118

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Project description:BACKGROUND:The prognosis in refractory out-of-hospital cardiac arrest (OHCA) with ongoing cardiopulmonary resuscitation (CPR) at hospital arrival is often considered dismal. The use of extracorporeal cardiopulmonary resuscitation (eCPR) for perfusion enhancement during resuscitation has shown variable results. We aimed to investigate outcome in refractory OHCA patients managed conservatively without use of eCPR. METHODS:We included consecutive OHCA patients with refractory arrest or prehospital return of spontaneous circulation (ROSC) in the Copenhagen area in 2002-2011. RESULTS:A total of 3992 OHCA patients with resuscitation attempts were included; in 2599, treatment was terminated prehospital, and 1393 (35%) were brought to the hospital either with ROSC (n?=?1285, 92%) or with refractory OHCA (n?=?108, 8%). Of patients brought in with refractory OHCA, 56 (52%) achieved ROSC in the emergency department. There were no differences between patients with refractory OHCA or prehospital ROSC with regard to age, sex, comorbidities, or etiology of OHCA. Time to emergency medical services (EMS) arrival was similar, whereas time to ROSC (when ROSC was achieved) was longer in refractory OHCA patients (EMS, 6 (5-9] vs. 7 [5-10] min, p?=?0.8; ROSC, 15 [9-22] vs. 27 [20-41] min, p?<?0.001). Independent factors associated with transport with refractory OHCA instead of prehospital termination of therapy were OHCA in public (OR, 3.6 [95% CI, 2.2-5.8]; p?<?0.001), witnessed OHCA (OR, 3.7 [2.0-7.1]; p?<?0.001), shockable rhythm (OR, 3.0 [1.9-4.7]; p?<?0.001), younger age (OR, 1.2 [1.1-1.2]; p?<?0.001), and later calendar year (OR, 1.4 [1.2-1.6]; p?<?0.001). Thirty-day survival was 20% in patients with refractory OHCA compared with 42% in patients with prehospital ROSC (p?<?0.001). Four of 28 refractory OHCA patients with duration of resuscitation >?60 min achieved ROSC. No difference in favorable neurological outcome in patients surviving to discharge was found (prehospital ROSC 84% vs. refractory OHCA 86%; p?=?0.7). CONCLUSIONS:Survival after refractory OHCA with ongoing CPR at hospital arrival was significantly lower than among patients with prehospital ROSC. Despite a lower survival, the majority of survivors with both refractory OHCA and prehospital ROSC were discharged with a similar degree of favorable neurological outcome, indicating that continued efforts in spite of refractory OHCA are not in vain and may still lead to favorable outcome even without eCPR.

Project description:IntroductionExtracorporeal cardiopulmonary resuscitation (ECPR) is associated with improved outcomes in select populations, however, crisis resource management (CRM) in this setting is logistically challenging. This study evaluates the impact of ECPR simulation on self-perceived confidence and collaboration of intensive care unit team members.MethodsThis is a prospective observational study analyzing data obtained between July 2018-December 2019. This study focused on non-surgical members of critical care team consisting of pediatric intensivists, resident physicians, registered nurses, respiratory therapists. Participants were expected to perform cardiopulmonary resuscitation (CPR) during the ECPR event, participate in code-team responsibilities and provide ancillary support during cannulation. Pre- and post-simulation surveys employed the Likert scale (1 = not at all confident, 5 = highly confident) to assess self-perceived scores in specified clinical competencies.ResultsTwenty-nine providers participated in the simulation; 38% had prior ECPR experience. Compared to mean pre-study Likert scores (2.4, 2.4, 2.5), post-simulation scores increased (4.2, 4.4, 4.3) when self-evaluating: confidence in assessing patients needing ECPR, confidence in participating in ECPR workflow and confidence in performing high-quality CPR, respectively. Post-simulation values of >3 were reported by 100% of participants in all domains (p < .0001). All participants indicated the clinical scenario and procedural environment to be realistic and appropriately reflective of situational stress. Additionally, 100% of participants reported the simulation to improve perceived team communication and teamwork skills.ConclusionThis study demonstrated preliminary feasibility of pediatric ECPR simulation in enhancing independent provider confidence and team communication. This self-perceived improvement may establish a foundation for cohesive CRM, in preparation for a real life ECPR encounter.

Project description:BackgroundThe effectiveness and indications of open-chest cardiopulmonary resuscitation (OCCPR) have been still debatable. Although current guidelines state that the presence of signs of life (SOL) is an indication for OCCPR, scientific evidence corroborating this recommendation has been scarce. This study aimed to compare the effectiveness of OCCPR to closed-chest cardiopulmonary resuscitation (CCCPR) in severe trauma patients with SOL upon arrival at the emergency department (ED).MethodsA retrospective cohort study analyzing data from the Trauma Quality Improvement Program (TQIP) database, a nationwide trauma registry in the USA, between 2010 and 2016 was conducted. Severe trauma patients who had SOL upon arrival at the hospital and received cardiopulmonary resuscitation within the first 6 h of ED admission were identified. Survival to hospital discharge was evaluated using logistic regression analysis, instrumental variable analysis, and propensity score matching analysis adjusting for potential confounders.ResultsA total of 2682 patients (OCCPR 1032; CCCPR 1650) were evaluated; of those 157 patients (15.2%) in the OCCPR group and 193 patients (11.7%) in the CCCPR group survived. OCCPR was significantly associated with higher survival to hospital discharge in both the logistic regression analysis (adjusted odds ratio [95% confidence interval] = 1.99 [1.42-2.79], p < 0.001) and the instrumental variable analysis (adjusted odds ratio [95% confidence interval] = 1.16 [1.02-1.31], p = 0.021). In the propensity score matching analysis, 531 matched pairs were generated, and the OCCPR group still showed significantly higher survival at hospital discharge (89 patients [16.8%] in the OCCPR group vs 58 patients [10.9%] in the CCCPR group; odds ratio [95% confidence interval] = 1.66 [1.13-2.42], p = 0.009).ConclusionsCompared to CCCPR, OCCPR was associated with significantly higher survival at hospital discharge in severe trauma patients with SOL upon ED arrival. Further studies to confirm these results and to assess long-term neurologic outcomes are needed.

Project description:ObjectivesThe incidence of bystander cardiopulmonary resuscitation (CPR) is low in China. CPR training could improve public attitudes and willingness, but at present, the attitudes of the public after online training are unclear. This study investigated individual attitudes towards CPR, the willingness to perform it in emergencies along with the main obstacles and the overall effects of online training.DesignQuestionnaires were distributed to investigate the public attitudes and willingness towards performing bystander CPR.SettingQuestionnaires were accessible after the online course 'First Aid'.Participants1888 students who attended 'First Aid' from December 2019 to 1 January 2020 and then completed the questionnaire voluntarily.ResultsThe majority understood CPR (96.7%) and displayed a willingness to learn (98.4%) and to disseminate CPR knowledge (82.0%). Characteristics associated with more positive attitudes included women, the 26-35-year olds and those in medical-related occupations (p<0.05). Only 34.8% had CPR training before. Most people would willingly perform CPR on a close family member. Compared with the standard CPR (S-CPR), the public preferred chest compression-only CPR (CO-CPR) (p<0.01). The top three obstacles to performing CO-CPR were lack of confidence (26.7%), fear of harming the victim (23.4%) and causing legal trouble (20.7%), while regarding S-CPR, fear of disease transmission (22.9%) ranked second. Women, those in poor health and in medical-related occupations, were more likely to perform CPR (p<0.05). The confidence to perform CPR was improved remarkably after online training (p<0.05).ConclusionsThe overwhelming majority of respondents showed positive attitudes and willingness towards CPR. In some cases, there is still reluctance, especially towards S-CPR. Obstacles arise mainly due to lack of confidence in administering CPR, while online CPR training can markedly improve it. Therefore, we should focus on disseminating CPR knowledge, targeting those who are less willing to perform CPR and helping overcome their obstacles by online training.

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Cardiopulmonary resuscitation performed by trained providers and shorter time to emergency medical team arrival increased patients' survival rates in Istra County, Croatia: a retrospective study.

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Cardiopulmonary resuscitation performed by trained providers and shorter time to emergency medical team arrival increased patients' survival rates in Istra County, Croatia: a retrospective study.

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