Prehospital Advanced Cardiac Life Support for Out‐of‐hospital Cardiac Arrest: A Cohort Study

Cournoyer, Alexis; Notebaert, Éric; Iseppon, Massimiliano; Cossette, Sylvie; Londei-Leduc, Luc; Lamarche, Yoan; Morris, Judy; Piette, Éric; Daoust, Raoul; Chauny, Jean‐Marc; Sokoloff, Catalina; Cavayas, Yiorgos Alexandros; Paquet, Jean; Denault, André

doi:10.1111/acem.13246

Cited by 21 publications

(13 citation statements)

References 34 publications

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“…The methods used to collect and extract the data for the initial registry have been described previously. 3,18,21 Patient data are entered by the paramedic on a "run-sheet" following every call. Patients suffering from an OHCA are identified using these run-sheets.…”

Section: Methods and Measurementsmentioning

confidence: 99%

“…1,2 Rates of survival for these patients remain low, with only 5% to 10% of all OHCA surviving to hospital discharge. 1,3,4 However, patients with an initial shockable rhythm, such as ventricular fibrillation and pulseless ventricular tachycardia, have a better prognosis than patients whose initial rhythm is non-shockable (pulseless electrical activity or asystole). 3,[5][6][7] This may be explained by shockable rhythms being a marker of earlier intervention (i.e., prior to deterioration to asystole) or simply that the single best available therapy for patients suffering from a cardiac arrest (defibrillation) is only effective in patients with these rhythms.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,4 However, patients with an initial shockable rhythm, such as ventricular fibrillation and pulseless ventricular tachycardia, have a better prognosis than patients whose initial rhythm is non-shockable (pulseless electrical activity or asystole). 3,[5][6][7] This may be explained by shockable rhythms being a marker of earlier intervention (i.e., prior to deterioration to asystole) or simply that the single best available therapy for patients suffering from a cardiac arrest (defibrillation) is only effective in patients with these rhythms. [8][9][10][11][12] The efficacy of a single shock to terminate a malignant ventricular arrhythmia is reported to be over 85% when using a biphasic waveform.…”

Section: Introductionmentioning

confidence: 99%

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The prognostic significance of repeated prehospital shocks for out-of-hospital cardiac arrest survival

Cournoyer

Notebaert

Cossette

et al. 2018

CJEM

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ObjectivesPatients suffering from an out-of-hospital cardiac arrest (OHCA) associated with an initial shockable rhythm have a better prognosis than their counterparts. The implications of recurrent or refractory malignant arrhythmia in such context remain unclear. The objective of this study is to evaluate the association between the number of prehospital shocks delivered and survival to hospital discharge among patients in OHCA.MethodsThis cohort study included adult patients with an initial shockable rhythm over a 5-year period from a registry of OHCA in Montreal, Canada. The relationship between the number of prehospital shocks delivered and survival to discharge was described using dynamic probabilities. The association between the number of prehospital shocks delivered and survival to discharge was assessed using multivariable logistic regression.ResultsA total of 1,788 patients (78% male with a mean age of 64 years) were included in this analysis, of whom 536 (30%) received treatments from an advanced care paramedic. A third of the cohort (583 patients, 33%) survived to hospital discharge. The probability of survival was highest with the first shock (33% [95% confidence interval 30%-35%]), but decreased to 8% (95% confidence interval 4%-13%) following nine shocks. A higher number of prehospital shocks was independently associated with lower odds of survival (adjusted odds ratio=0.88 [95% confidence interval 0.85-0.92], p < 0.001).ConclusionSurvival remains possible even after a high number of shocks for patients suffering from an OHCA with an initial shockable rhythm. However, requiring more shocks is independently associated with worse survival.

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Section: Methods and Measurementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The prognostic significance of repeated prehospital shocks for out-of-hospital cardiac arrest survival

Cournoyer

Notebaert

Cossette

et al. 2018

CJEM

Self Cite

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“…However, obtaining oh-ROSC through advanced cardiac life support is itself not associated with an improvement in the survival to hospital discharge in patients with CPA, so achieving a balance between obtaining oh-ROSC over time and early transportation to perform aggressive medical treatment in hospital may be important for treating patients with CPA in the prehospital setting. [ 16 ]…”

Section: Discussionmentioning

confidence: 99%

Impact of automated external defibrillator as a recent innovation for the resuscitation of cardiac arrest patients in an Urban City of Japan

Takeuchi

Nagasawa²,

Jitsuiki³

et al. 2018

J Emerg Trauma Shock

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“…A number of studies revealed that prehospital advanced life support (ALS) was not effective for OHCA patients (6)(7)(8)(9)(10). The experience of the paramedics exposed to the OHCA patients affects the treatment of cardiac arrest; however, the actual exposure of the paramedics is rare and declining.…”

Section: Introductionmentioning

confidence: 99%

Prehospital Advanced Cardiac Life Support with a Smartphone-Based Direct Medical Oversight in a Metropolitan City, Korea

2021

ircmj

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Out-of-hospital cardiac arrest is considered an important health care problem because it causes family breakdown and enormous social loss due to sudden death. Despite the efforts of many medical policymakers, paramedics, and doctors, the survival rate after cardiac arrest is only marginally increasing. Objective: This study aimed to determine whether advanced life support (ALS) under physician’s direct medical oversight during an emergency through video call on smartphones was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes on the "Smart Advanced Life Support (SALS)" pilot project. Methods: This study was conducted using a "Before-After" controlled trial. The OHCA patients were divided into two periods in a metropolitan city. The basic life support (BLS group) and ALS using video calls on smartphones (SALS group) were performed in the 'Before' and 'After' phases in 2014 and 2015, respectively. The OHCA patients over 18 years of age were included in this study. On the other hand, the patients with trauma, poisoning, and family’s unwillingness, as well as those who received no resuscitation were excluded from the study. The primary and secondary outcomes were survival to discharge and a good neurological outcome (cerebral performance category [CPC] 1-2), respectively. A propensity score matching was conducted to equalize potential prognostic factors in both groups. The adjusted odds ratio (OR) and 95% confidence interval (95% CI) were calculated for survival to discharge and good neurological outcome. Results: In total, 235 and 198 OHCA patients were enrolled in the BLS and the SALS groups, respectively. The outcomes were better in the SALS group, compared to the BLS group regarding the survival to discharge (9.8% vs. 6.8%, P<0.001) and good neurological outcome (6.6% vs. 4.0%, P<0.001), respectively. Regarding propensity score matching, 304 cases were randomly assigned to the SALS and BLS groups. The survivals to discharge rates after matching were 9.2% and 7.2% in the SALS and the BLS groups, respectively (P=0.06). Furthermore, the good neurological outcome rate was 5.9% in the SALS group versus 3.9% in the BLS group (p=0.008). The adjusted ORs of the SALS group were estimated at 1.33 (95% CI: 1.00-1.77) for survival to discharge and 1.73 (95% CI: 1.19-2.53) for the good neurologic outcome, compared to those in the BLS group. Conclusion: An emergency medical system intervention using the SALS protocol was associated with a signiﬁcant increase in prehospital ROSC and improved survival and neurologic outcome after OHCA.

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Prehospital Advanced Cardiac Life Support for Out‐of‐hospital Cardiac Arrest: A Cohort Study

Cited by 21 publications

References 34 publications

The prognostic significance of repeated prehospital shocks for out-of-hospital cardiac arrest survival

The prognostic significance of repeated prehospital shocks for out-of-hospital cardiac arrest survival

Impact of automated external defibrillator as a recent innovation for the resuscitation of cardiac arrest patients in an Urban City of Japan

Prehospital Advanced Cardiac Life Support with a Smartphone-Based Direct Medical Oversight in a Metropolitan City, Korea

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