Effectiveness of a community based out-of-hospital cardiac arrest (OHCA) interventional bundle: Results of a pilot study

Tay, Pamela Jia Min; Pek, Pin Pin; Fan, Qiao; Ng, Yih Yng; Leong, Benjamin Sieu-Hon; Gan, Han Nee; Mao, Desmond Renhao; Chia, Michael Yih Chong; Cheah, Si Oon; Doctor, Nausheen Edwin; Tham, Lai Peng; Ong, Marcus Eng Hock

doi:10.1016/j.resuscitation.2019.10.015

Cited by 33 publications

(42 citation statements)

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“…Arrests during the period after implementation of inter ventions focused on emergency medical services were associated with a slight, non-significant increase in bystan der CPR frequency compared with the preintervention period, from 18•7% (79 of 423 arrests) in the pre-inter vention period to 22 2). The predicted probability of receiving bystander CPR increased with each added intervention (figure 2).…”

Section: Resultsmentioning

confidence: 93%

“…Finally, on April 17, 2015 (run-in completed Oct 16, 2015), Singapore supported the centralised availability of the myResponder mobile application, which crowd sources layperson responders with CPR and automatic external defibrillator training to respond to cardiac arrest events within 400 m of their location. 22 Layperson res ponders do not need to be certified in CPR and automatic external defibrillator use to enrol with myResponder. Additionally, the myResponder application has the ability to show nearby automatic external defibrillators upon acceptance of the case by responders.…”

Section: Methodsmentioning

confidence: 99%

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Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study

Blewer

Shahidah

et al. 2020

The Lancet Public Health

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Background Bystander cardiopulmonary resuscitation (CPR) increases an individual's chance of survival from out-of-hospital cardiac arrest (OHCA), but the frequency of bystander CPR is low in many communities. We aimed to assess the cumulative effect of CPR-targeted public health interventions in Singapore, which were incrementally introduced between 2012 and 2016. Methods We did a secondary analysis of a prospective cohort study of adult, non-traumatic OHCAs, through the Singapore registry. National interventions introduced during this time included emergency services interventions, as well as dispatch-assisted CPR (introduced on July 1, 2012), a training programme for CPR and automated external defibrillators (April 1, 2014), and a first responder mobile application (myResponder; April 17, 2015). Using multilevel mixed-effects logistic regression, we modelled the likelihood of receiving bystander CPR with the increasing number of interventions, accounting for year as a random effect. Findings The Singapore registry contained 11 465 OHCA events between Jan 1, 2011, and Dec 31, 2016. Paediatric arrests, arrests witnessed by emergency medical services, and healthcare-facility arrests were excluded, and 6788 events were analysed. Bystander CPR was administered in 3248 (48%) of 6788 events. Compared with no intervention, likelihood of bystander CPR was not significantly altered by the addition of emergency medical services interventions (odds ratio [OR] 1•33 [95% CI 0•98-1•79]; p=0•065), but increased with implementation of dispatchassisted CPR (3•72 [2•84-4•88]; p<0•0001), with addition of the CPR and automated external defibrillator training programme (6•16 [4•66-8•14]; p<0•0001), and with addition of the myResponder application (7•66 [5•85-10•03]; p<0•0001). Survival to hospital discharge increased after the addition of all interventions, compared with no intervention (OR 3•10 [95% CI 1•53-6•26]; p<0•0001). Interpretation National bystander-focused public health interventions were associated with an increased likelihood of bystander CPR, and an increased survival to hospital discharge. Understanding the combined impact of public health interventions might improve strategies to increase the likelihood of bystander CPR, and inform targeted initiatives to improve survival from OHCA.

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Section: Resultsmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study

Blewer

Shahidah

et al. 2020

The Lancet Public Health

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“…Studies have shown that smart technologies, such as Mobile-Phone Dispatch system and GoodSAM alerter/GoodSAM Responder application and myResponder application, have a greater effect in areas that lack rapid ambulance response and that have low baseline rates of bystander-initiated CPR. 16 The development and widespread popularity of those types of smart technologies in China may allow a trained community member to respond in the first instance, as opposed to the EMS system.…”

Section: Original Researchmentioning

confidence: 99%

When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China

et al. 2020

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BackgroundSeveral Chinese cities have implemented dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), although out-of-hospital cardiac arrest (OHCA) survival rates remain low. We aimed to assess the process compliance, barriers and outcomes of OHCA in one of the earliest implemented (DA-CPR) programmes in China.MethodsWe retrospectively reviewed OHCA emergency dispatch records of Suzhou emergency medical service from 2014 to 2015 and included adult OHCA victims (>18 years) with a bystander-witnessed atraumatic OHCA that was subsequently confirmed by on-site emergency physician. The circumstances and DA-CPR process related to the OHCA event were analysed. Dispatch audio records were reviewed to identify potential barriers to implementation during the DA-CPR process.ResultsOf the 151 OHCA victims, none survived. The median time from patient collapse to call for emergency services and that from call to provision of cardiopulmonary resuscitation instructions was 30 (IQR 20–60) min and 115 (IQR 90–153) s, respectively. Only 110 (80.3%) bystanders/rescuers followed the dispatcher instructions; of these, 51 (46.3%) undertook persistent chest compressions. Major barriers to following the DA-CPR instructions were present in 104 (68.9%) cases, including caller disconnection of the call, distraught mood or refusal to carry out either compressions or ventilations.ConclusionsThe OHCA survival rate and the DA-CPR process were far from optimal. The zero survival rate is disproportionally low compared with survival statistics in high-income countries. The prolonged delay in calling the emergency services negated and rendered futile any DA-CPR efforts. Thus, efforts targeted at developing public awareness of OHCA, calling for help and competency in DA-CPR should be increased.

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“…Until now, PAD programs have mainly focused on public areas because the benefits on survival have been demonstrated [2]. In addition, some studies concluded that the conditions for public defibrillation in residential areas were less favourable for several reasons [2,[29][30][31][32], including a higher rate of non-shockable rhythms [33]. However, the context has changed with the emergence of lay responders who can be alerted by dispatch centres [34].…”

Section: Plos Onementioning

confidence: 99%

How to improve automated external defibrillator placement for out-of-hospital cardiac arrests: A case study

2021

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Introduction In out-of-hospital cardiac arrests (OHCAs), the use of an automatic external defibrillator (AED) by a bystander remains low, as AEDs may be misplaced with respect to the locations of OHCAs. As the distribution of historical OHCAs is potentially predictive of future OHCA locations, the purpose of this study is to assess AED positioning with regard to past locations of OHCAs, in order to improve the efficiency of public access defibrillation programs. Methods This is a retrospective observational study from 2014 to 2018. The locations of historical OHCAs and AEDs were loaded into a geodata processing tool. Median distances between AEDs were collected, as well as the number and rates of OHCAs covered (distance of <100 meters from the nearest AED). Areas with high densities of uncovered OHCAs (hotspots) were identified in order to propose the placement of additional AEDs. Areas over-covered by AEDs (overlays) were also identified in order to propose the relocation of overlapping AEDs. Results There were 2,971 OHCA, 79.3% of which occurred at home, and 633 AEDs included in the study. The global coverage rate was 7.5%. OHCAs occurring at home had a coverage rate of 4.5%. Forty hotspots were identified, requiring the same number of additional AEDs. The addition of these would increase the coverage from 7.5% to 17.6%. Regarding AED overlays, 17 AEDs were found to be relocatable without reducing the AED coverage of historical OHCAs. Discussion This study confirms that geodata tools can assess AED locations and increase the efficiency of their placement. Historical hotspots and AED overlays should be considered, with the aim of efficiently relocating or adding AEDs. At-home OHCAs should become a priority target for future public access defibrillation programs as they represent the majority of OHCAs but have the lowest AED coverage rates.

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Effectiveness of a community based out-of-hospital cardiac arrest (OHCA) interventional bundle: Results of a pilot study

Cited by 33 publications

References 32 publications

Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study

Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study

When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China

How to improve automated external defibrillator placement for out-of-hospital cardiac arrests: A case study

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