Objectives: Previous studies have shown a low but meaningful survival rate in cases of prehospital cardiac arrest with an initial rhythm of asystole. There may be, however, an identifiable subgroup in which resuscitation efforts are futile. This study identified potential field criteria for predicting 100% nonsurvival when the presenting rhythm is asystole in a Basic Life Support-Defibrillation (BLS-D) system. Methods: This prospective cohort study, a component of Phases I and II of the Ontario Prehospital Advanced Life Support (OPALS) Study, was conducted in 21 Ontario communities with BLS-D level of care, and included all adult arrests of presumed cardiac etiology according to the Utstein Style Guidelines. Analyses included descriptive and appropriate univariate tests, as well as multivariate stepwise logistic regression to determine predictors of survival. Results: From 1991 to 1997, 9899 consecutive cardiac arrest cases with the following characteristics: male (67.2%), bystander-witnessed (44.7%), bystander CPR (14.2%), call–response interval (CRI) ≤ 8 minutes (82%) and overall survival (4.3%) were enrolled. Of 9529 cases with available rhythm strip recordings, initial arrest rhythms were asystole in 40.8%, pulseless electrical activity in 21.2% and ventricular fibrillation or ventricular tachycardia in 38%. Of 3888 asystolic patients, 9 (0.2%) survived to discharge; 3 of these cases were unwitnessed arrests with no bystander CPR. There were no survivors if the CRI exceeded 8 minutes. Logistic regression analysis demonstrated that independent predictors of survival to admission were “CRI in minutes” (odds ratio [OR] = 0.87; 95% confidence interval [CI], 0.77–0.98) and “bystander-witnessed” (OR = 2.6; 95% CI, 1.5–4.4). Conclusions: In a BLS-D system, there is a very low but measurable survival rate for prehospital asystolic cardiac arrest. CRIs of over 8 minutes were associated with 100% nonsurvival, whereas unwitnessed arrests with no bystander CPR were not. These data add to the growing literature that will help guide ethical decision-making for protocol development in emergency medical services systems.
In an attempt to reduce the number of people who die from a cardiac arrest in the Stockport area ambulances were equipped with automatic external defibrillator-pacemakers, and ambulance personnel were trained in their use. Over an 18 month period ambulance personnel attended 113 patients in cardiac arrest with these devices. One patient subsequently survived, and three patients survived for up to three days.The reasons for these poor initial results include the failure of bystanders to provide cardiopulmonary resuscitation, a delay in calling for the ambulance, and too few defibrillators being available.
Introduction: The purpose of this prospective study was to determine the impact of obtaining blood specimens in the prehospital setting versus drawing specimens in-hospital. Variables examined were length of time from arrival to laboratory result availability; specimen quality; and emergency department length of stay. Methods: A total of 101 patients were enrolled in the study and assigned to either prehospital group (n = 58) or the in-hospital group (n = 43). Clinical laboratory personnel were blinded to the study groups. Results: Patients in the experimental group had door-to-results times for complete blood cell counts of 26 min shorter than the control group (p < .004). Doorto-results times for serum chemistry studies were 28 min faster than controls (p < .02). There was no significant difference between groups for hemolysis. Conclusions: Collecting samples in the prehospital setting significantly shortens time to results, is not associated with an increase in hemolysis, and may decrease overall emergency department lengths of stay. Key words: divert, door-to-laboratory results availability, length of stay, hemolysis, prehospital lab draw, throughput T HE GOAL of every emergency department (ED) is to see and treat patients in a timely manner. Patient and employee
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