Prehospital cardiac arrest — a critical analysis of factors affecting survival

Stueven, Harlan A; Waite, Elizabeth M.; Troiano, Philip; Mateer, James R

doi:10.1016/0300-9572(89)90041-5

Cited by 44 publications

(3 citation statements)

References 7 publications

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“…Initial cardiac rhythm: Numerous studies have shown that initial arrest rhythm is an important prognostic factor for patient survival. 11,12 In this study, initial arrest rhythm was identifi ed as the most signifi cant reason for poor outcome in residential areas, even after adjustment for other background factors. The high incidence of non-shockable rhythms in the residential group may be related to EMS response time or the presence of bystander CPR.…”

Section: Agementioning

confidence: 59%

Effect of Location of Out-of-Hospital Cardiac Arrest on Survival Outcomes

Liang²,

Fook‐Chong³

et al. 2013

Ann Acad Med Singap

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Introduction: This study aims to study how the effect of the location of patient collapses from cardiac arrest, in the residential and non-residential areas within Singapore, relates to certain survival outcomes. Materials and Methods: A retrospective cohort study of data were done from the Cardiac Arrest and Resuscitation Epidemiology (CARE) project. Out-of-hospital cardiac arrest (OHCA) data from October 2001 to October 2004 (CARE) were used. All patients with OHCA as confirmed by the absence of a pulse, unresponsiveness and apnoea were included. All events had occurred in Singapore. Analysis was performed and expressed in terms of the odds ratio (OR) and the corresponding 95% confidence interval (CI). Results: A total of 2375 cases were used for this analysis. Outcomes for OHCA in residential areas were poorer than in non-residential areas—1638 (68.9%) patients collapsed in residential areas, and 14 (0.9%) survived to discharge. This was significantly less than the 2.7% of patients who survived after collapsing in a non-residential area (OR 0.31 [0.16 – 0.62]). Multivariate logistic regression analysis showed that location alone had no independent effect on survival (adjusted OR 1.13 [0.32 – 4.05]); instead, underlying factors such as bystander CPR (OR 3.67 [1.13 – 11.97]) and initial shockable rhythms (OR 6.78 [1.95 – 23.53]) gave rise to better outcomes. Conclusion: Efforts to improve survival from OHCA in residential areas should include increasing CPR by family members, and reducing ambulance response times. Key words: Emergency Medical Services, Non-residential, Prehospital, Residential

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Section: Agementioning

confidence: 59%

Effect of Location of Out-of-Hospital Cardiac Arrest on Survival Outcomes

Liang²,

Fook‐Chong³

et al. 2013

Ann Acad Med Singap

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“…About half of all facilities reported a delay of 5 or more minutes in EMT response time, while about one‐sixth reported a delay of more than 10 minutes. Several studies have shown successful CPR to be related to EMT response times, initiation of advanced life support in less than 10 minutes, and shorter CPR duration 17–22 . Bedell et al reported that 95% of survivors of in‐patient CPR were resuscitated in less than 15 minutes, 2 while Bonnin et al reported rare survivors (only those with persistent ventricular tachycardia) in out‐of‐hospital CPR efforts lasting more than 25 minutes 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Not‐for‐profit facilities were more likely to initiate CPR for unwitnessed arrests. Many other studies have documented extremely poor survivability of patients following unwitnessed arrests 3, 17, 18, 25 . In a report by Tresch et al, 50% of nursing home CPR efforts in Milwaukee County, Wisconsin, were made on patients with unwitnessed arrests.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Resuscitation Policies in Long‐Term Care Facilities

Kane

Burns

1997

J American Geriatrics Society

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Poor efficacy in this population was the main reason given for policies of never initiating CPR. Specific factors relating to CPR efficacy, such as EMT response time and ease of maintaining trained staff, were not major influences. Almost 30% of facilities offering CPR would perform it in unwitnessed situations, despite unlikely success. Many decisions about CPR may not be fully informed as nurses and physicians are not often assigned to discuss advance directives with residents or surrogates. Utilization of CPR in nursing homes offering resuscitation is low.

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Delaying Defibrillation to Give Basic Cardiopulmonary Resuscitation to Patients With Out-of-Hospital Ventricular Fibrillation

Wik

Hansen²,

Fylling³

et al. 2003

JAMA

566

115

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ContextDefibrillation as soon as possible is standard treatment for patients with ventricular fibrillation. A nonrandomized study indicates that after a few minutes of ventricular fibrillation, delaying defibrillation to give cardiopulmonary resuscitation (CPR) first might improve the outcome.ObjectiveTo determine the effects of CPR before defibrillation on outcome in patients with ventricular fibrillation and with response times either up to or longer than 5 minutes.Design, Setting, and PatientsRandomized trial of 200 patients with out-of-hospital ventricular fibrillation in Oslo, Norway, between June 1998 and May 2001. Patients received either standard care with immediate defibrillation (n = 96) or CPR first with 3 minutes of basic CPR by ambulance personnel prior to defibrillation (n = 104). If initial defibrillation was unsuccessful, the standard group received 1 minute of CPR before additional defibrillation attempts compared with 3 minutes in the CPR first group.Main Outcome MeasurePrimary end point was survival to hospital discharge. Secondary end points were hospital admission with return of spontaneous circulation (ROSC), 1-year survival, and neurological outcome. A prespecified analysis examined subgroups with response times either up to or longer than 5 minutes.ResultsIn the standard group, 14 (15%) of 96 patients survived to hospital discharge vs 23 (22%) of 104 in the CPR first group (P = .17). There were no differences in ROSC rates between the standard group (56% [58/104]) and the CPR first group (46% [44/96]; P = .16); or in 1-year survival (20% [21/104] and 15% [14/96], respectively; P = .30). In subgroup analysis for patients with ambulance response times of either up to 5 minutes or shorter, there were no differences in any outcome variables between the CPR first group (n = 40) and the standard group (n = 41). For patients with response intervals of longer than 5 minutes, more patients achieved ROSC in the CPR first group (58% [37/64]) compared with the standard group (38% [21/55]; odds ratio [OR], 2.22; 95% confidence interval [CI], 1.06-4.63; P = .04); survival to hospital discharge (22% [14/64] vs 4% [2/55]; OR, 7.42; 95% CI, 1.61-34.3; P = .006); and 1-year survival (20% [13/64] vs 4% [2/55]; OR, 6.76; 95% CI, 1.42-31.4; P = .01). Thirty-three (89%) of 37 patients who survived to hospital discharge had no or minor reductions in neurological status with no difference between the groups.ConclusionsCompared with standard care for ventricular fibrillation, CPR first prior to defibrillation offered no advantage in improving outcomes for this entire study population or for patients with ambulance response times shorter than 5 minutes. However, the patients with ventricular fibrillation and ambulance response intervals longer than 5 minutes had better outcomes with CPR first before defibrillation was attempted. These results require confirmation in additional randomized trials.

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Prehospital cardiac arrest — a critical analysis of factors affecting survival

Cited by 44 publications

References 7 publications

Effect of Location of Out-of-Hospital Cardiac Arrest on Survival Outcomes

Effect of Location of Out-of-Hospital Cardiac Arrest on Survival Outcomes

Cardiopulmonary Resuscitation Policies in Long‐Term Care Facilities

Delaying Defibrillation to Give Basic Cardiopulmonary Resuscitation to Patients With Out-of-Hospital Ventricular Fibrillation

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