Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

May, Spencer; Zhang, Liying; Foley, Dan; Brennan, Erin; O’Neil, Brian J.; Bork, Ethan; Levy, Phillip D.; Dunne, Robert

doi:10.1161/jaha.118.009831

Cited by 19 publications

(20 citation statements)

References 23 publications

(19 reference statements)

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“…When OHCA occurred in a public place, the chances of ROSC were almost twice as high as when the incident occurred at home. This finding is similar to that of a study in Detroit [15]. It should be considered that in a public place, the probability of the presence of a witness of cardiac arrest who has CPR knowledge and skills is higher.…”

Section: Discussionsupporting

confidence: 87%

Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study

Czapla

Zielińska

Kubica-Cielińska

et al. 2020

BMC Cardiovasc Disord

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Background: Out-of-hospital cardiac arrest (OHCA) is a common reason for calls for intervention by emergency medical teams (EMTs) in Poland. Regardless of the mechanism, OHCA is a state in which the chance of survival is dependent on rapid action from bystanders and responding health professionals in emergency medical services (EMS). We aimed to identify factors associated with return of spontaneous circulation (ROSC). Methods: The medical records of 2137 EMS responses to OHCA in the city of Wroclaw, Poland between July 2017 and June 2018 were analyzed. Results: The OHCA incidence rate for the year studied was 102 cases per 100,000 inhabitants. EMS were called to 2317 OHCA events of which 1167 (50.4%) did not have resuscitation attempted on EMS arrival. The difference between the number of successful and failed cardiopulmonary resuscitations (CPRs) was statistically significant (p < 0.001). Of 1150 patients in whom resuscitation was attempted, ROSC was achieved in 250 (27.8%). Rate of ROSC was significantly higher when CPR was initiated by bystanders (p < 0.001). Patients presenting with asystole or pulseless electrical activity (PEA) had a higher risk of CPR failure (86%) than those with ventricular fibrillation/ventricular tachycardia (VF/VT). Patients with VF/VT had a higher chance of ROSC (OR 2.68, 1.86-3.85) than those with asystole (p < 0.001). The chance of ROSC was 1.78 times higher when the event occurred in a public place (p < 0.001). Conclusions: The factors associated with ROSC were occurrence in a public place, CPR initiation by witnesses, and presence of a shockable rhythm. Gender, age, and the type of EMT did not influence ROSC. Low bystander CPR rates reinforce the need for further efforts to train the public in CPR.

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Section: Discussionsupporting

confidence: 87%

Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study

Czapla

Zielińska

Kubica-Cielińska

et al. 2020

BMC Cardiovasc Disord

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“…Each call for service that is prioritized at the echo or delta level dispatches the nearest ambulance and MFR apparatus. Preferential dispatch of ALS units is absent because of the small number available and the size of the response area [ 2 ].…”

Section: Methodsmentioning

confidence: 99%

“…As few as 6 functioning emergency medical service (EMS) units were in service some days during that period. Since 2013, Detroit has made significant improvements in out-of-hospital cardiac arrest care, from the implementation of non-transporting fire units in a medical role, priority dispatch, dispatch-assisted cardiopulmonary resuscitation (CPR) and community bystander CPR trainings [ 2 ]. The ability to track OHCA data improved significantly after participation in the SaveMIHeart collaborative and the Cardiac Arrest Registry to Enhance Survival (CARES).…”

Section: Introductionmentioning

confidence: 99%

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Effects of the COVID-19 pandemic on out-of-hospital cardiac arrest care in Detroit

Mathew

Harrison

Chalek

et al. 2021

The American Journal of Emergency Medicine

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Introduction In response to the COVID-19 pandemic in Detroit, an earlier termination of resuscitation protocol was initiated in March 2020. To characterize pre-hospital cardiac arrest careduring COVID-19 in Detroit, we analyzed out-of-hospital cardiac arrest (OHCA) rate of ROSC (return of spontaneous circulation) and patient characteristics before and during the COVID-19 pandemic. Methods OHCA data was analyzed between March 10th, 2020 – April 30th,2020 and March 10th, 2019 – April 30th,2019. ROSC, patient demographics, arrest location, initial rhythms, bystander CPR and field termination were compared before and during the pandemic. Descriptive statistics were utilized to compare arrest characteristics between years, and the odds of achieving vs. not achieving ROSC. 2020 vs. 2019 as a predictor for ROSC was assessed with logistic regression. Results 471 patients were included. Arrests increased to 291 during the pandemic vs. 180 in 2019 (62% increase). Age (mean difference + 6; 95% CI: +2.4 to +9.5), arrest location (nursing home OR = 2.42; 95% CI: 1.42–4.31; public place OR = 0.47; 95% CI: 0.25–0.88), BLS response (OR = 0.68; 95% CI: 0.47–0.99), and field termination of resuscitation (OR = 2.36; 95% CI: 1.36–4.07) differed significantly in 2020 compared to 2019. No significant difference was found in the confounder-adjusted odds of ROSC in 2020 vs 2019 (OR = 0.61; 95% CI: 0.34–1.11). Conclusion OHCA increased by 62% during COVID-19 in Detroit, without a significant change in prehospital ROSC. The rate of ROSC remained similar despite the implementation of an early termination of resuscitation protocol in response to COVID-19.

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“…For example, with myocardial infarction, the survival rate may double when someone (e.g., the primary respondent around the patient) promptly performs cardiopulmonary resuscitation (CPR) and may triple when an automated external defibrillator (AED) is used [47]. Since the golden time is just 5 to 10 min for cardiac arrest, the survival rate of emergency patients depends not only on the real-time road traffic flow speed but also appropriate first aid administered before or during transportation [48][49][50].…”

Section: Emergency Medical Vulnerability and Survival Rates By Emergementioning

confidence: 99%

Analysis of Emergency Medical Vulnerability and Survival Rates Following Real-Time Traffic Information

Jeon¹,

Kim

Kang

et al. 2020

Applied Sciences

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Providing rapid access to emergency medical services (EMS) within the “golden time” for survival is important to improve the survival rate of emergency patients. This study analyzes the accessibility of EMS based on driving speed changes following real-time road traffic conditions by time to estimate vulnerable areas for EMS and survival rates of emergency patients. The key results of the network analysis based on real-time road speed and this evaluation of vulnerable areas by village level across South Korea reveal the different characteristics of urban and rural areas to access emergency medical facilities. In urban areas, road traffic congestion during rush hour delays the patients’ access time to EMS. In contrast, in rural areas, the long geographical distance to an emergency medical facility is a hurdle for receiving care from an EMS during the “golden time” because emergency medical facilities are mostly located in urban areas. The existing standard to assess vulnerable areas of EMS accessibility is based on the speed limit of roads, but the time may be underestimated because the speed limit alone does not reflect the real road conditions. The study results show that an effective way to increase the survival rate is receiving immediate first aid treatment, which means that the government should continuously train the public to perform cardiopulmonary resuscitation (CPR) as well as install automated external defibrillators (AEDs) in populated places, and train the public to use them. Reducing assess time to emergency medical centers in urban areas and providing additional manpower to help with first aid in rural areas are reasonable ways to improve the survival rate of emergency patients.

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Improvement in Non‐Traumatic, Out‐Of‐Hospital Cardiac Arrest Survival in Detroit From 2014 to 2016

Cited by 19 publications

References 23 publications

Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study

Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study

Effects of the COVID-19 pandemic on out-of-hospital cardiac arrest care in Detroit

Analysis of Emergency Medical Vulnerability and Survival Rates Following Real-Time Traffic Information

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