Resuscitation
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Randomized Controlled Trial
Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest.
This study explores why resuscitation is withheld when emergency medical staff arrive at the scene of a cardiac arrest and identifies modifiable factors associated with this decision. ⋯ Resuscitation was withheld by ambulance staff in over one in ten (13.1%) victims of out of hospital cardiac arrest on the basis of futility. These cases were associated with a very low rate of bystander CPR. Future studies should explore strengthening the 'Chain of Survival' to increase the community bystander CPR response and evaluate the effect on the numbers of survivors from out of hospital cardiac arrest.
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Quantitative waveform measures of the ventricular fibrillation (VF) electrocardiogram (ECG) predict defibrillation outcome. Calculation requires an ECG epoch without chest compression artifact. However, pauses in CPR can adversely affect survival. Thus the potential use of waveform measures is limited by the need to pause CPR. We sought to characterize the relationship between the length of the CPR-free epoch and the ability to predict outcome. ⋯ Waveform measures predict defibrillation outcome using very brief ECG epochs, a quality that may enable their use in current resuscitation algorithms designed to limit CPR interruption.
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Multicenter Study
Barriers to Telephone Cardiopulmonary Resuscitation in Public and Residential Locations.
Emergency medical telecommunicators can play a key role in improving outcomes from out-of-hospital cardiac arrest (OHCA) by providing instructions for cardiopulmonary resuscitation (CPR) to callers. Telecommunicators, however, frequently encounter barriers that obstruct the Telephone CPR (TCPR) process. The nature and frequency of these barriers in public and residential locations have not been well investigated. The aim of this study is to identify the barriers to TCPR in public and residential locations. ⋯ This study revealed that barriers to TCPR are distributed differently across public and residential locations. Understanding these differences can aid in the development of strategies to enhance bystander CPR and improve overall patient outcomes.
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Approximately 424,000 out-of-hospital cardiac arrests (OHCA) occur in the US annually. As automated external defibrillators (AED) are an important part of the community response to OHCA, we investigated how well the spatial demand (likelihood of OHCA) was met by the spatial supply (AEDs) in a dense urban environment. ⋯ The difference in coverage by area and risk seems to indicate efficient placement of existing AEDs. Our findings also highlight the possible benefits to expanding the influence of AEDs by lowering search times, and identify opportunities to improve AED coverage in the study area. This article offers one method by which local officials can use spatial data to prioritize attention for AED placement and coverage.
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Multicenter Study
Factors impacting upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients.
Explore, understand and address issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to out-of-hospital cardiac arrest (OHCA) patients. ⋯ Agonal breathing continues to be the main barrier to recognition of cardiac arrest. Individual differences among dispatchers' strategies can directly impact on performance, mainly due to the wide definition of cardiac arrest and lack of uniform tools for assessment of breathing.