Resuscitation
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We aimed to assess temporal changes in the incidence of OHCAs of presumed cardiac and non-cardiac aetiologies. ⋯ Our data indicates that by 2052, non-cardiac aetiologies could be the leading cause of OHCA in our region. These findings have important EMS-system and public health implications.
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Comparative Study
Bringing into Focus Treatment Limitation and DNACPR Decisions: How COVID-19 has Changed Practice.
The COVID-19 pandemic has introduced further challenges into Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions. Existing evidence suggests success rates for CPR in COVID-19 patients is low and the risk to healthcare professionals from this aerosol-generating procedure complicates the benefit/harm balance of CPR. ⋯ During the COVID-19 pandemic, the emphasis on senior decision making and conversations around ceilings of treatment appears to have changed practice, with a higher proportion of patients having DNACPR/TEAL status documented. Understanding patient preferences around life-sustaining treatment versus comfort care is part of holistic practice and supports shared decision making. It is unclear whether these attitudinal changes will be sustained after COVID-19 admissions decrease.
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Worldwide, call-taker recognition of out-of-hospital cardiac arrests (CA) suffers from poor accuracy, leading to missed opportunities for dispatcher-assisted cardiopulmonary resuscitation (DACPR) in CA patients and inappropriate DACPR in non-CA patients. Diagnostic protocols typically ask 2 questions in sequence: 'Is the patient conscious?' and 'Is the patient breathing normally?' As part of quality improvement efforts, our national emergency medical call centre changed the breathing question to an instruction for callers to place their hand onto the patient's abdomen to evaluate for the presence of breathing. ⋯ Dispatch assessment using the hand on abdomen method appeared feasible but uptake by dispatch staff was moderate. Diagnostic performance of this method should be verified in randomised trials.