Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups

Huang, Jyun-Bin; Lee, Kuo-Hsin; Ho, Yu-Ni; Tsai, Meng-Chang; Wu, Woei-Cherng; Cheng, Fu-Jen

doi:10.1186/s12873-020-00400-4

Cited by 24 publications

(20 citation statements)

References 34 publications

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“…These results are also consistent with current knowledge about prognostic factors in OHCA. Advanced age [26], a high number of comorbidities [27], a nonwitnessed OHCA, absence of bystander administered CPR [28] and traumatic aetiology are indeed well known to reduce survival rates after an OHCA [29]. These medical decisions not to attempt advanced resuscitation, made on the basis of knowledge of poor prognostic factors, are also consistent with decisions made when a physician believes that the prognosis is very poor and that further treatment would be futile [30].…”

Section: Discussionmentioning

confidence: 85%

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Payot

Fehlmann

Suppan

et al. 2021

IJERPH

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The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

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Section: Discussionmentioning

confidence: 85%

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Payot

Fehlmann

Suppan

et al. 2021

IJERPH

View full text Add to dashboard Cite

show abstract

“…These results are also consistent with current knowledge about prognostic factors in OHCA. Advanced age [26], a high number of comorbidities [27], a non-witnessed OHCA, absence of bystander administered CPR [28] and traumatic aetiology are indeed well known to reduce survival rates after an OHCA [29]. These medical decisions not to attempt advanced resuscitation, made on the basis of knowledge of poor prognostic factors, are also consistent with decisions made when a physician believes that the prognosis is very poor and that further treatment would be futile [30].…”

Section: Discussionmentioning

confidence: 87%

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Payot¹,

Fehlmann²,

Suppan³

et al. 2021

Preprint

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The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

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“…It is suitable for patients from school age to adulthood and can be applied easily without complicated adjustment. Increasing safety and motivation in lay rescuers is vital as bystander CPR and public location of emergencies were reported to be independent prognostic factors for survival to hospital discharge in OHCA patients [16] . If the device is stored together with AEDs in public locations the device would be on hand in approximately 5% to 10% of cases [17] .…”

Section: Consequences Of the Hypothesis And Discussionmentioning

confidence: 99%

Barrier resuscitation by lay rescuers during COVID-19 pandemic

Lederer¹,

Isser²

2021

Medical Hypotheses

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Aerosols generated from chest compressions and ventilation attempts in patients with cardiac arrest may cause airborne infections. Accordingly, the interim international resuscitation guidelines have restricted basic life support by lay rescuers to compression only and the use of an automated external defibrillator during the COVID-19 pandemic. Although these measures may diminish the risk of infection for laypersons, the missing respiratory support can be detrimental for patients with hypoxia-related cardiac arrest. To overcome this shortcoming we want to introduce a special tool that allows ventilation during barrier resuscitation by laypersons. We hypothesize that the application of a device made of a polyvinyl chloride shield with a centrally installed S-shaped ventilation pipe with integrated filter can provide adequate ventilation while concurrently protecting patient and rescuer from airborne agents. Aerosols from air leakage are removed by adhesion and drainage below the barrier. No specific training other than basic life support is needed. We suggest that a tool of this kind be considered essential equipment and stored together with disposable gloves in public access locations.

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Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups

Cited by 24 publications

References 34 publications

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Barrier resuscitation by lay rescuers during COVID-19 pandemic

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