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Selected articles referencing reference 3 as of May 6, 2002:(Abstracts Included)
2.) Public access defibrillation: a shocking idea
3.) Reducing mortality from sudden cardiac death in the community: lessons from epidemiology and clinical applications research
4.) Factors modifying the effect of bystander cardiopulmonary resuscitation on survival in out-of-hospital cardiac arrest patients in Sweden
5.) Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.
6.) Life supporting first aid training of the public - review and recommendations
7.) Long-term survival after out-of-hospital cardiac arrest: an 8- year follow-up
8.) Seven years' experience with early defibrillation by police and paramedics in an emergency medical services system
9.) Response times and outcomes for cardiac arrests in Las Vegas casinos
10.) EMT defibrillation does not increase survival from sudden cardiac death in a two-tiered urban-suburban EMS system
11.) Estimating effectiveness of cardiac arrest interventions - A logistic regression survival model
12.) Ethical issues of cardiopulmonary resuscitation: Current practice among emergency physicians
13.) Rhythm changes during resuscitation from ventricular fibrillation in relation to delay until defibrillation, number of shocks delivered and survival
14.) Effectiveness of bystander
CPR
========================== FN ISI Export Format
VR 1.0
PT Journal
AU Rea, TD
Eisenberg, MS
Culley, LL
Becker, L
TI Dispatcher-assisted cardiopulmonary
resuscitation and survival
in cardiac
arrest
SO CIRCULATION
LA English
NR 20
C1 999 3rd Ave,Suite 700, Seattle, WA 98104 USA
Univ Washington, Dept Med, Seattle, WA USA
DE heart arrest; cardiopulmonary resuscitation; arrhythmia;
resuscitation; death; sudden
ID EMERGENCY CPR INSTRUCTION; VENTILATION; TELEPHONE; MODEL
AB Background-Early cardiopulmonary resuscitation (CPR) improves
survival in out-of-hospital cardiac arrest, and
dispatcher-
delivered instruction in CPR can increase the proportion
of
arrest victims who receive bystander CPR before
emergency
medical service (EMS) arrival. However, little is
known about
the survival effectiveness of dispatcher-delivered
telephone
CPR instruction. Methods and Results-We evaluated
a population-
based cohort of EMS-attended adult cardiac arrests
(n=7265)
from 1983 through 2000 in King County, Washington,
to assess
the association between survival to hospital discharge
and 3
distinct CPR groups: no bystander CPR before EMS
arrival (no
bystander CPR), bystander CPR before EMS arrival
requiring
dispatcher instruction (dispatcher-assisted bystander
CPR), and
bystander CPR before EMS arrival not requiring dispatcher
instruction (bystander CPR without dispatcher assistance).
In
this cohort, 44.1% received no bystander CPR before
EMS
arrival, 25.7% received dispatcher-assisted bystander
CPR, and
30.2% received bystander CPR without dispatcher
assistance.
Overall survival was 15.3%. Using no bystander CPR
as the
reference group, the multivariate adjusted odds
ratio of
survival was 1.45 (95% confidence interval [CI],
1.21, 1.73)
for dispatcher-assisted bystander CPR and 1.69 (95%
Cl, 1.42,
2.01) for bystander CPR without dispatcher assistance.
Conclusion-Dispatcher-assisted bystander CPR seems
to increase
survival in cardiac arrest.
CR 2000, CIRCULATION S, V102, P22
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TC 1
BP 2513
EP 2516
PG 4
JI Circulation
PY 2001
PD NOV 20
VL 104
IS 21
GA 494VU
RP Rea TD
999 3rd Ave,Suite 700, Seattle, WA 98104 USA
J9 CIRCULATION
UT ISI:000172307200004
ER
PT Journal
AU Woollard, M
TI Public access defibrillation:
a shocking idea?
SO JOURNAL OF PUBLIC HEALTH
MEDICINE
LA English
NR 49
C1 Univ Wales Coll Med, Lansdowne Hosp, Welsh Ambulance Serv NHS
Trust, Prehosp Emergency Res Unit, Sanatorium Rd,
Cardiff CF1
8UL, S Glam, Wales
Univ Wales Coll Med, Lansdowne Hosp, Welsh Ambulance
Serv NHS Trust, Prehosp Emergency Res Unit, Cardiff CF1 8UL, S Glam, Wales
DE public; defibrillation; AED; lay responder; cardiac arrest
ID HOSPITAL CARDIAC-ARREST; AUTOMATED EXTERNAL DEFIBRILLATOR;
EMERGENCY MEDICAL-SERVICES; CARDIOPULMONARY-RESUSCITATION;
RAPID DEFIBRILLATION; VENTRICULAR-FIBRILLATION;
AMBULANCE
STAFF; SURVIVAL; EXPERIENCE; COMMUNITY
AB Currently, survival from out-of-hospital cardiac arrest in the
United Kingdom is poor. Ambulance response standards
require
that an ambulance reach 75 per cent of cardiac arrests
within 8
min. But a short time to defibrillation from the
onset of
collapse is a key predictor of outcome from out-of-hospital
cardiac arrest. The Department of Health has recently
implemented a lay responder defibrillation programme,
with the
aim of shortening this time interval for victims
in public
places. This initiative utilizes automated external
defibrillators (AEDs). which provide written and
recorded voice
prompts to minimize training requirements and errors
in use.
Lay responder AED programmes with very short response
times
have reported survival to discharge rates of up
to 53 per cent
for patients presenting in ventricular fibrillation
(VF). This
compares well with the results of a meta-analysis
that reported
a survival rate of only 6.4 per cent for traditional
defibrillator-equipped ambulance systems. The annual
incidence
of out-of-hospital cardiac arrest in England is
123 per 100 000
population. Approximately half of these present
in VF, and
could benefit from an AED programme. But only 16
per cent of
cardiac arrests occur in a public place. It has
been calculated
that there are approximately 5000 instances of VF
in public
places each year in England. If half of these patients
can be
reached and administered a first shock within 4
min of their
collapse, an additional 400 victims may survive
each year.
Given the current investment by the DoH of pound2
million, this
suggests a cost per life saved of approximately
pound 505 over
a 10 year period.
CR *AMB SERV ASS, 2000, AMBULANCE UK, V15, P231
*DEP HLTH, 1999, SAV LIV OUR HEALTH N
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TC 0
BP 98
EP 102
PG 5
JI J. Public Health Med.
PY 2001
PD JUN
VL 23
IS 2
GA 445AW
RP Woollard M
Univ Wales Coll Med, Lansdowne Hosp, Welsh Ambulance
Serv NHS Trust, Prehosp Emergency Res Unit, Sanatorium Rd, Cardiff CF1
8UL, S Glam, Wales
J9 J PUBLIC HEALTH MED
UT ISI:000169436100003
ER
PT Journal
AU Sotoodehnia, N
Zivin, A
Bardy, GH
Siscovick, DS
TI Reducing mortality from sudden
cardiac death in the community:
lessons from
epidemiology and clinical applications research
SO CARDIOVASCULAR RESEARCH
LA English
NR 132
C1 Univ Washington, Dept Med, Cardiovasc Hlth Res Unit, 1730 Minor
Ave,Suite 1360,MR9,Box 358080, Seattle, WA 98101
USA
Univ Washington, Dept Med, Cardiovasc Hlth Res Unit,
Seattle, WA 98101 USA
Univ Washington, Dept Epidemiol, Seattle, WA 98101
USA
DE defibrillation; epidemiology; sudden death
ID ACUTE MYOCARDIAL-INFARCTION; PUBLIC-ACCESS DEFIBRILLATION;
CORONARY-ARTERY DISEASE; DECOMPRESSION CARDIOPULMONARY-
RESUSCITATION; IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR;
HOSPITAL
VENTRICULAR-FIBRILLATION; AUTOMATIC EXTERNAL DEFIBRILLATOR;
CONVERTING-ENZYME INHIBITOR; CEREBRAL BLOOD-FLOW;
CLOSED-CHEST
AB The reduction of mortality from sudden cardiac death (SCD) in
the community remains a challenge. Clinical-epidemiologic
studies have identified a range of factors that
are associated
with an increased risk of SCD. While of potential
etiologic and
prognostic importance. these factors have limited
sensitivity
and a low positive predictive value for SCD. On
the other hand,
clinical trials have suggested that a variety of
interventions,
including risk factor reduction, nutritional interventions,
drug therapies, cardiac procedures. and new technologies,
have
the potential to reduce mortality from SCD. In this
review, we
examine what is known about the epidemiology and
clinical
application of interventions to reduce mortality
from SCD; and,
we consider the impact of both prevention and clinical
interventions on mortality from SCD from a community
perspective. There is mounting evidence that supports
both
public health and clinical efforts to prevent the
occurrence of
SCD. There alSO is evidence
suggesting that new technologies,
such as automated external
defibrillators, have the potential
to reduce case-fatality
from SCD. Further progress will depend
on improved methods to
identify persons-at-risk, reduction of
risk factors, and application
of techniques - both simple and
advanced - to improve survival
in victims of SCD. (C) 2001
Published by Elsevier Science
B.V.
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VL 50
IS 2
GA 432GU
RP Siscovick DS
Univ Washington, Dept Med,
Cardiovasc Hlth Res Unit, 1730 Minor Ave,Suite 1360,MR9,Box 358080, Seattle,
WA 98101 USA
J9 CARDIOVASC RES
UT ISI:000168684500004
ER
PT Journal
AU Holmberg, M
Holmberg, S
Herlitz, J
TI Factors modifying the effect
of bystander cardiopulmonary
resuscitation
on survival in out-of-hospital cardiac arrest
patients
in Sweden
SO EUROPEAN HEART JOURNAL
LA English
NR 13
C1 Sahlgrens Univ Hosp, Dept Cardiol, SE-41345
Gothenburg, Sweden
Sahlgrens Univ Hosp, Dept
Cardiol, SE-41345 Gothenburg, Sweden
DE cardiopulmonary resuscitation; bystander;
cardiac arrest
ID OPALS
AB Aim To describe possible factors modifying
the effect of
bystander cardiopulmonary
resuscitation on survival among
patients suffering an out-of-hospital
cardiac arrest. Patients
A national survey in Sweden
among patients suffering out-of-
hospital cardiac arrest and
in whom resuscitative efforts were
attempted. Sixty per cent
of ambulance organizations were
included. Design Prospective
evaluation. Survival was defined
as survival 1 month after
cardiac arrest. Results In all, 14
065 reports were included
in the evaluation. Of these.
resuscitation efforts were
attempted in 10 966 cases, of which
1089 were witnessed by ambulance
crews. The report deals with
the remaining 9877 patients:
of whom bystander cardiopulmonary
resuscitation was attempted
in 36%. Survival to 1 month was
8.2% among patients who received
bystander cardiopulmonary
resuscitation vs 2.5% among
patients who did not receive it
(odds ratio 3.5, 95% confidence
interval 2.9-4.3). The effect
of bystander cardiopulmonary
resuscitation on survival was
related to: (1) the interval
between collapse and the start of
bystander cardiopulmonary
resuscitation (effect more marked in
patients who experienced a
short delay); (2) the quality of
bystander cardiopulmonary
resuscitation (effect more marked if
both chest compressions and
ventilation were performed than if
either of them was performed
alone); (3) the category of
bystander (effect more marked
if bystander cardiopulmonary
resuscitation was performed
by a non-layperson); (4) interval
between collapse and arrival
of the ambulance (effect more
marked if this interval was
prolonged); (5) age (effect more
marked in bystander cardiopulmonary
resuscitation among the
elderly); and (6) the location
of the arrest (effect more
marked if the arrest took
place outside the home). Conclusion
The effect of bystander cardiopulmonary
resuscitation on
survival after an out-of-hospital
cardiac arrest can be
modified by various factors.
Factors that were associated with
the effect of bystander cardiopulmonary
resuscitation were the
interval between the collapse
and the start of bystander
cardiopulmonary resuscitation,
the quality of bystander
cardiopulmonary resuscitation,
whether or not the bystander was
a layperson, the interval
between collapse and the arrival of
the ambulance, age and the
place of arrest. (C) 2001 The
European Society of Cardiology.
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JI Eur. Heart J.
PY 2001
PD MAR
VL 22
IS 6
GA 411ZK
RP Holmberg M
Sahlgrens Univ Hosp, Dept
Cardiol, SE-41345 Gothenburg, Sweden
J9 EUR HEART J
UT ISI:000167529400014
ER
PT Journal
AU Valenzuela, TD
Roe, DJ
Nichol, G
Clark, LL
Spaite, DW
Hardman, RG
TI Outcomes
of rapid defibrillation by security officers after
cardiac arrest
in casinos.
SO NEW ENGLAND JOURNAL OF MEDICINE
LA English
NR 19
C1 Univ Arizona, Coll Med, Dept Emergency Med,
1501 N Campbell
Ave,POB 245057, Tucson, AZ
85724 USA
Univ Arizona, Coll Med, Dept
Emergency Med, Tucson, AZ 85724 USA
Univ Arizona, Coll Publ Hlth,
Dept Epidemiol & Biostat, Tucson, AZ 85724 USA
Univ Ontario, Ottawa Civic
Hosp, Clin Epidemiol Unit, Ottawa, ON, Canada
Clark Cty Fire Dept, Las Vegas,
NV USA
ID PUBLIC-ACCESS DEFIBRILLATION; HEART-ASSOCIATION
REPORT;
RESUSCITATION; POLICE
AB Background: The use of automated external
defibrillators by
persons other than paramedics
and emergency medical technicians
is advocated by the American
Heart Association and other
organizations. However, there
are few data on the outcomes when
the devices are used by nonmedical
personnel for out-of-
hospital cardiac arrest. Methods:
We studied a prospective
series of cases of sudden
cardiac arrest in casinos. Casino
security officers were instructed
in the use of automated
external defibrillators. The
locations where the defibrillators
were stored in the casinos
were chosen to make possible a
target interval of three minutes
or less from collapse to the
first defibrillation. Our
protocol called for a defibrillation
first (if feasible), followed
by manual cardiopulmonary
resuscitation. The primary
outcome was survival to discharge
from the hospital. Results:
Automated external defibrillators
were used in 105 patients
whose initial cardiac rhythm was
ventricular fibrillation.
Fifty-six of the patients (53
percent) survived to discharge
from the hospital. Among the 90
patients whose collapse was
witnessed (86 percent), the
clinically relevant time intervals
were a mean (+/-SD) of
3.5+/-2.9 minutes from collapse
to attachment of the
defibrillator, 4.4+/-2.9 minutes
from collapse to the delivery
of the first defibrillation
shock, and 9.8+/-4.3 minutes from
collapse to the arrival of
the paramedics. The survival rate
was 74 percent for those who
received their first
defibrillation no later than
three minutes after a witnessed
collapse and 49 percent for
those who received their first
defibrillation after more
than three minutes. Conclusions:
Rapid defibrillation by nonmedical
personnel using an automated
external defibrillator can
improve survival after out-of-
hospital cardiac arrest due
to ventricular fibrillation.
Intervals of no more than
three minutes from collapse to
defibrillation are necessary
to achieve the highest survival
rates.
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PY 2000
PD OCT 26
VL 343
IS 17
GA 366PQ
RP Valenzuela TD
Univ Arizona, Coll Med, Dept
Emergency Med, 1501 N Campbell Ave,POB 245057, Tucson, AZ 85724 USA
J9 N ENGL J MED
UT ISI:000090014100001
ER
PT Journal
AU Eisenburger, P
Safar, P
TI Life
supporting first aid training of the public - review and
recommendations
SO RESUSCITATION
LA English
NR 167
C1 Univ Pittsburgh, Med Ctr, Dept Anesthesiol
& Crit Care Med,
Safar Ctr Resuscitat Res,
3434 5th Ave, Pittsburgh, PA 15260
USA
Univ Pittsburgh, Med Ctr,
Dept Anesthesiol & Crit Care Med, Safar Ctr Resuscitat Res, Pittsburgh,
PA 15260 USA
Allgemeines Krankenhaus Wien,
Dept Emergency Med, A-1090 Vienna, Austria
DE basic life support; bystander cardiopulmonary
resuscitation;
education; first aid; emergency
medical services
ID CARDIOPULMONARY-RESUSCITATION SKILLS; HOSPITAL
CARDIAC-ARREST;
TO-MOUTH VENTILATION; AMERICAN-HEART-ASSOCIATION;
BYSTANDER
CPR; METROPOLITAN-AREA; FAMILY
MEMBERS; LAYPERSON CPR; WORKING
GROUP; VENTRICULAR-FIBRILLATION
AB Since the introduction around 1960 of external
cardiopulmonary
resuscitation (CPR) basic
life support (BLS) without equipment,
i.e. steps A (airway control)-B
(mouth-to-mouth breathing)-C
(chest (cardiac) compressions),
training courses by instructors
have been provided, first
to medical personnel and later to
some but not all lay persons.
At present, fewer than 30% of
out-of-hospital resuscitation
attempts are initiated by lay
bystanders. The numbers of
lives saved have remained
suboptimal, in part because
of a weak or absent first link in
the life support chain. This
review concerns education research
aimed at helping more lay
persons to acquire high life
supporting first aid (LSFA)
skill levels and to use these
skills. In the 1960s, Safar
and Laerdal studied and promoted
self-training in LSFA, which
includes: call for the ambulance
(without abandoning the patient)
(now alSO call for an
automatic external defibrillator);
CPR-BLS steps A-B-C;
external hemorrhage control;
and positioning for shock and
unconsciousness (coma). LSFA
steps are psychomotor skills.
Organizations like the American
Red Cross and the American
Heart Association have produced
instructor-courses of many more
first aid skills, or for cardiac
arrest only-not of LSFA skills
needed by all suddenly comatose
victims. Self-training methods
might help all people acquire
LSFA skills. Implementation is
still lacking. Variable proportions
of lay trainees evaluated,
ranging from school children
to elderly persons, were found
capable of performing LSFA
skills on manikins. Audio-tape or
video-tape coached self-practice
on manikins was more effective
than instructor-courses. Mere
viewing of demonstrations (e.g.
televised films) without practice
has enabled more persons to
perform some skills effectively
compared to untrained control
groups. The quality of LSFA.
performance in the field and its
impact on outcome of patients
remain to be evaluated.
Psychological factors have
been associated with skill
acquisition and retention,
and motivational factors with
application. Manikin practice
proved necessary far best skill
acquisition of steps B and
C. Simplicity and repetition proved
important. Repetitive television
spots and brief internet
movies for motivating and
demonstrating would reach all people.
LSFA should be part of basic
health education. LSFA self-
learning laboratories should
be set up and maintained in
schools and drivers' license
stations. The trauma-focused steps
of LSFA are important for
'buddy help' in military combat
casualty care, and natural
mass disasters. (C) 1999 Elsevier
Science Ireland Ltd. All rights
reserved.
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GA 223CZ
RP Safar P
Univ Pittsburgh, Med Ctr,
Dept Anesthesiol & Crit Care Med, Safar Ctr Resuscitat Res, 3434 5th
Ave, Pittsburgh, PA 15260 USA
J9 RESUSCITATION
UT ISI:000081823800001
ER
PT Journal
AU Kuilman, M
Bleeker, JK
Hartman, JAM
Simoons, ML
TI Long-term
survival after out-of-hospital cardiac arrest: an 8-
year follow-up
SO RESUSCITATION
LA English
NR 35
C1 GGD Rotterdam eo, PB 70032, NL-3000 LP Rotterdam,
Netherlands
GGD Rotterdam eo, NL-3000
LP Rotterdam, Netherlands
DE resuscitation; out-of-hospital CPR; bystander
CPR
ID CARDIOPULMONARY-RESUSCITATION; UTSTEIN STYLE;
BYSTANDER CPR;
QUALITY; STROKE; AGE
AB Between 1988 and 1994, 441 patients were successfully
resuscitated outside hospital
in the city of Rotterdam, of whom
276 (63%) were discharged
from hospital alive. Long-term
survival was studied amongst
those who were discharged alive.
The duration of follow-up
averaged 6.71 years. A survival rate
of 88% after 1 year, 81% after
3 years, 77% after 5 years and
73% after 7 years was found.
After multivariate analysis, age,
diagnosis and gender were
found to be independent and
significant predictors of
survival. No significant difference
in survival was found in patients
who had been resuscitated by
emergency personnel, physicians
and bystanders. Patients who
were still alive were sent
a EuroQol-questionnaire. No
differences in outcomes between
the four groups were found.
Since long-term prognosis
after out-of-hospital resuscitation
is satisfactory, learning
programmes for resuscitation should
be continued. (C) 1999 Elsevier
Science Ireland Ltd. All rights
reserved.
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PY 1999
PD JUN
VL 41
IS 1
GA 223CZ
RP Kuilman M
GGD Rotterdam eo, PB 70032,
NL-3000 LP Rotterdam, Netherlands
J9 RESUSCITATION
UT ISI:000081823800003
ER
PT Journal
AU White, RD
Hankins, DG
Bugliosi, TF
TI Seven
years' experience with early defibrillation by police and
paramedics
in an emergency medical services system
SO RESUSCITATION
LA English
NR 22
C1 Mayo Clin & Mayo Fdn, Dept Anesthesiol,
200 1St St SW,
Rochester, MN 55905 USA
Mayo Clin & Mayo Fdn,
Dept Anesthesiol, Rochester, MN 55905 USA
DE advanced life support (ALS); automated external
defibrillator
(AED); cardiac arrest; cardiopulmonary
resuscitation;
defibrillation; emergency
medical services; first responder;
out-of-hospital CPR; ventricular
fibrillation
ID HOSPITAL CARDIAC-ARREST; VENTRICULAR-FIBRILLATION;
CARDIOPULMONARY-RESUSCITATION;
SURVIVAL; INTERVALS; CPR
AB Primary, objective: To assess the outcome
of patients with out-
of-hospital cardiac arrest
with ventricular fibrillation as the
presenting rhythm in an emergency
medical services system
utilizing a combined police/paramedic
response to provide early
defibrillation. Materials
and methods: Police and paramedics
were dispatched from law enforcement
and ambulance
communications centers, respectively.
First-arriving personnel
delivered initial shocks,
all using automated external
defibrillators. Patients were
classified according to response
to initial shocks: restoration
of pulses with shocks only or in
need of advanced life support,
including epinephrine. Discharge
survival was defined as return
to home without disabling
neurologic injury. Results:
Over the 7-year period of study 131
patients presented with ventricular
fibrillation; 58 were first
treated by police and 73 by
paramedics. Restoration of pulses
with shocks only and discharge
survival were not different in
police and paramedic groups,
with overall survival of 40% (53
of 131 patients). Among the
survivors, 19% (18/95 patients)
obtained a spontaneous circulation
only after administration of
epinephrine and other ALS
interventions. Conclusion: Both
restoration of a functional
circulation, without need for
advanced life support interventions,
and discharge survival
without neurologic disability
are very dependent upon the
rapidity with which defibrillation
is accomplished, regardless
of who delivers the shocks.
In addition, a smaller but
significant number of patients
who require ALS interventions,
including epinephrine, for
restoration of a spontaneous
circulation survive to discharge.
Short time differences, on
the order of 1 min, are significant
determinants of both
immediate response to shocks
and discharge survival. (C) 1998
Elsevier Science Ireland Ltd.
All rights reserved.
CR ASPLIN BR, 1998, ACAD EMERG MED, V5, P414
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PY 1998
PD DEC
VL 39
IS 3
GA 170GD
RP White RD
Mayo Clin & Mayo Fdn,
Dept Anesthesiol, 200 1St St SW, Rochester, MN 55905 USA
J9 RESUSCITATION
UT ISI:000078797200002
ER
PT Journal
AU Karch, SB
Graff, J
Young, S
Ho, CH
TI Response
times and outcomes for cardiac arrests in Las Vegas
casinos
SO AMERICAN JOURNAL OF EMERGENCY
MEDICINE
LA English
NR 16
C1 Dept Fire Serv, 500 Casino Ctr Blvd N, Las
Vegas, NV 89101 USA
Dept Fire Serv, Las Vegas,
NV 89101 USA
DE response times; defibrillation; emergency
medical services;
ventricular fibrillation;
cardiopulmonary resuscitation
ID VENTRICULAR-FIBRILLATION; UTSTEIN STYLE; SURVIVAL
RATE;
RESUSCITATION; DEFIBRILLATION;
EXERCISE; PROGRAM
AB This study was conducted to measure emergency
medical services
(EMS) response times in sudden
out-of hospital cardiac arrests
and relate those times to
probability of survival in cardiac
arrest victims in Las Vegas
casino-hotels from January 1993 to
June 1996., Times from 911
activation to casino arrival and
casino arrival to arrival
at patient's side (time to first
defibrillatory shock), as
well as survival to hospital dis
charge, were studied with
regression analysis, Sixty patients
survived (29.3%), Response
times to the hotels for survivors
and nonsurvivors were similar
(4.8 v 5.6 min, P =.44), However,
times from arrival at the
casino to arrival at the patient's
side (5.0 v6.88 min, P =.01)
and elapsed times from 911
activation until first shock(9.88
v12.46 min, P =.02) were
substantially longer for nonsurvivors,
Model fitting disclosed
that with a 911-to-shock time
of 4 minutes, survival
probability was 36%., Odds
decreased by 5% each minute, to 19%
after 23 minutes. Ventricular
fibrillation was the most common
initial rhythm (187 cases)
and was associated with the shortest
times from 911 to shock (10.7
+/- 7.8 min). There was a strong
trend to increased survival
with ventricular fibrillation, The
911-to-shock times in this
study are considerably better than
in other published reports
for large metropolitan EMS systems,
but the time from 911 to shock
was nearly 3 minutes longer for
nonsurvivors, and even those
defibrillated at 4 minutes had
only a 36% chance of survival.
New measures, including use of
the automatic external difibrillator,
to reduce the "vertical"
response are urgently needed.
Copyright (C) 1998 by W.B.
Saunders Company.
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JI Am. J. Emerg. Med.
PY 1998
PD MAY
VL 16
IS 3
GA ZM423
RP Karch SB
Dept Fire Serv, 500 Casino
Ctr Blvd N, Las Vegas, NV 89101 USA
J9 AMER J EMERG MED
UT ISI:000073538700008
ER
PT Journal
AU Sweeney, TA
Runge, JW
Gibbs, MA
Raymond, JM
Schafermeyer, RW
Norton, HJ
Boyle-Whitesel, MJ
TI EMT
defibrillation does not increase survival from sudden
cardiac death
in a two-tiered urban-suburban EMS system
SO ANNALS OF EMERGENCY MEDICINE
LA English
NR 31
C1 Med Ctr Delaware, Christiana Hosp, Dept Emergency
Med, 4755
Ogletown Stanton Rd, Newark,
DE 19718 USA
Med Ctr Delaware, Dept Emergency
Med, Wilmington, DE USA
ID BYSTANDER CARDIOPULMONARY-RESUSCITATION; AUTOMATED
EXTERNAL
DEFIBRILLATORS; VENTRICULAR-FIBRILLATION;
RAPID DEFIBRILLATION;
ARREST; CPR; TELEPHONE; SERVICES;
QUALITY
AB Objective: The use of automatic external defibrillators
(AEDs)
by EMS initial responders
is widely advocated. Evidence
supporting the use of AEDs
is based largely on the experience
of one metropolitan area,
with effect on survival in many
systems not yet proved. We
conducted this study to determine
whether the addition of AEDs
to an EMS system with a response
time of 4 minutes for first-responder
emergency medical
technicians (FREMTs) and 10
minutes for paramedics would affect
survival from cardiac arrest.
Methods: This prospective,
controlled, crossover study
(AED versus no AED) of consecutive
cardiac arrests managed by
24 FREMT fire companies took place
from 1992 to 1995 in Charlotte,
North Carolina, a city of
455,000. Patients were stratified
using the Utstein criteria.
The primary endpoint was survival
to hospital discharge among
patients with bystander-witnessed
arrests of cardiac origin.
Results: Of the 627 patients,
243 were bystander-witnessed
arrests of cardiac origin.
Survival to hospital discharge was
accomplished in 5 of 110 patients
(4.6%; 95% confidence
interval [CI] 0.6% to 8.4%)
with AED compared with 7 of 133
(5.3%, 95% CI 1.5% to 9.1%)
without AED (P=.8). Both groups
were comparable with regard
to age, gender, history of
myocardial infarction, congestive
heart failure or diabetes,
arrest at home, bystander
CPR, and whether or not ventricular
fibrillation (Vf) was the
initial rhythm. For arrests of any
cause, witnessed by bystanders
or EMS personnel, with an
initial rhythm of VF or Ventricular
tachycardia (VT), 5 of 77
(6.5%, 95% CI 1.0% to 12.0%)
with AED survived compared with 8
of 105 patients (7.6%, 95%
CI 2.5% to 12.7%) without AED
(P=.8). Statistically significant
differences were noted in
race and EMS response times
between the two groups, which did
not affect survival. Conclusion:
Addition of AEDs to this EMS
system did not improve survival
from sudden cardiac death. The
data do not support routinely
equipping initial responders with
AEDs as an isolated enhancement,
and raise further doubt about
such expenditures in similar
EMS systems without first
optimizing bystander CFR and
EMS dispatching.
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CARTER WB, 1984, ANN EMERG
MED, V13, P695
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VANHOEYWEGHEN RJ, 1993, RESUSCITATION,
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WIK L, 1994, RESUSCITATION,
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TC 23
BP 234
EP 240
PG 7
JI Ann. Emerg. Med.
PY 1998
PD FEB
VL 31
IS 2
GA YW023
RP Sweeney TA
Med Ctr Delaware, Christiana
Hosp, Dept Emergency Med, 4755 Ogletown Stanton Rd, Newark, DE 19718 USA
J9 ANN EMERG MED
UT ISI:000071887900014
ER
PT Journal
AU Valenzuela, TD
Roe, DJ
Cretin, S
Spaite, DW
Larsen, MP
TI Estimating
effectiveness of cardiac arrest interventions - A
logistic
regression survival model
SO CIRCULATION
LA English
NR 20
C1 UNIV ARIZONA,DEPT SURG,TUCSON,AZ
SEATTLE KING CTY DEPT PUBL
HLTH,EMERGENCY MED SERV DIV,SEATTLE,WA
SHAN CRETIN & ASSOCIATES,SANTA
MONICA,CA
DE cardiopulmonary resuscitation; death; sudden;
defibrillation;
survival
ID AMERICAN-HEART-ASSOCIATION; UTSTEIN STYLE;
DEFIBRILLATION;
RESUSCITATION; SYSTEM
AB Background The study objective was to develop
a simple,
generalizable predictive model
for survival after out-of-
hospital cardiac arrest due
to ventricular fibrillation.
Methods and Results Logistic
regression analysis of two
retrospective series (n =
205 and n = 1667, respectively) of
out-of-hospital cardiac arrests
was performed on data sets from
a Southwestern city (population,
415000; area, 406 km(2)) and a
Northwestern county (population,
1038000; area, 1399 km(2)).
Both are served by similar
two-tiered emergency response
systems. AU arrests were witnessed
and occurred before the
arrival of emergency responders,
and the initial cardiac rhythm
observed was ventricular fibrillation.
The main outcome measure
was survival to hospital discharge.
Patient age. initiation of
CPR by bystanders. interval
from collapse to CPR, interval from
collapse to defibrillation,
bystander CPR/collapse-to-CPR
interval interaction, and
collapse-to-CPR/collapse-to-
defibrillation interval interaction
were significantly
associated with survival.
There was not a significant
difference between observed
survival rates at the two sites
after control for significant
predictors. A simplified
predictive model retaining
only collapse to CPR and collapse to
defibrillation intervals performed
comparably to the more
complicated explanatory model.
Conclusions The effectiveness of
prehospital interventions
for out-of-hospital cardiac arrest
may be estimated from their
influence on collapse to CPR and
collapse to defibrillation
intervals. A model derived from
combined data from two geographically
distinct populations did
not identify site as a predictor
of survival if clinically
relevant predictor variables
were controlled for. This model
can be generalized to other
US populations and used to project
the local effectiveness of
interventions to improve cardiac
arrest survival.
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EDDY DM, 1994, JAMA-J AM MED
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EISENBERG MS, 1990, ANN EMERG
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EISENBERG MS, 1982, NEW ENGL
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GALLAGHER EJ, 1995, JAMA-J
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BP 3308
EP 3313
PG 6
JI Circulation
PY 1997
PD NOV 18
VL 96
IS 10
GA YH188
RP UNIV ARIZONA,DEPT SURG,TUCSON,AZ
J9 CIRCULATION
UT ISI:A1997YH18800014
ER
PT Journal
AU Marco, CA
Bessman, ES
Schoenfeld, CN
Kelen, GD
TI Ethical
issues of cardiopulmonary resuscitation: Current
practice
among emergency physicians
SO ACADEMIC EMERGENCY MEDICINE
LA English
NR 53
C1 JOHNS HOPKINS UNIV,SCH MED,DEPT EMERGENCY
MED,BALTIMORE,MD
DE resuscitation; ethics; survey; CPR; cardiopulmonary
resuscitation; futility
ID HOSPITAL CARDIAC-ARREST; LIFE-SUPPORT; ELDERLY
OUTPATIENTS;
IMPROVING SURVIVAL; ADVANCE
DIRECTIVES; MEDICAL FUTILITY; CARE;
TERMINATION; ATTITUDES; OUTCOMES
AB Objective: To determine current practice and
attitudes among
emergency physicians (EPs)
regarding the initiation and
termination of CPR. Methods:
An anonymous survey was mailed to
randomly selected EPs. Main
outcome measures included
respondents' answers to questions
regarding outcome of
resuscitation, and current
practice regarding initiation,
continuation, and termination
of resuscitation for victims of
cardiopulmonary arrest. Results:
The 1,252 respondents were
from all 50 states, a variety
of practice settings, and varying
board certification. Most
(78%) respondents honor legal advance
directives regarding resuscitation.
Few (7%) follow unofficial
documents, or verbal reports
of advance directives (6%). Many
(62%) make decisions regarding
resuscitation because of fear of
litigation or criticism. A
majority (55%) have recently
attempted numerous resuscitations
despite expectations that
such efforts would be futile.
Most respondents indicated that
ideally, legal concerns should
not influence physician practice
regarding resuscitation (78%),
but that in the current
environment, legal concerns
do influence practice (94%).
Conclusions: Most EPs attempt
to resuscitate patients in
cardiopulmonary arrest, regardless
of futility, except in cases
where a legal advance directive
is available. Many EPs'
decisions regarding resuscitation
are based on concerns of
litigation and criticism,
rather than their professional
judgment of medical benefit
or futility. Compliance with
patients' wishes regarding
resuscitation is low unless a legal
advance directive is present.
Possible solutions to these
problems may include standardized
guidelines for the initiation
and termination of CPR, tort
reform, and additional public
education regarding resuscitation
and advance directives. Key
words: resuscitation; ethics;
survey; CPR; cardiopulmonary
resuscitation; futility.
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RP JOHNS HOPKINS UNIV,SCH MED,DEPT EMERGENCY
MED,BALTIMORE,MD
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UT ISI:A1997XW90600010
ER
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AU Herlitz, J
Bang, A
Holmberg, M
Axelsson, A
Lindkvist, J
Holmberg, S
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in relation to delay until defibrillation, number
of shocks
delivered and survival
SO RESUSCITATION
LA English
NR 12
C1 SAHLGRENS UNIV HOSP,DIV CARDIOL,S-41345 GOTHENBURG,SWEDEN
DE prognosis; rhythm changes; ventricular fibrillation
ID HOSPITAL CARDIAC-ARREST; CARDIOPULMONARY-RESUSCITATION
AB Aim: To describe rhythm changes during the
initial phase of
resuscitation from ventricular
fibrillation in relation to the
interval between collapse
and defibrillation, to survival and
to bystander-initiated cardiopulmonary
resuscitation (CPR).
Patients: All patients who
suffered out-of-hospital cardiac
arrest between 1980 and 1992,
who were reached by the emergency
medical service system (EMS),
in whom resuscitation attempts
were initiated and who were
found in ventricular fibrillation.
Results: In all, 1216 patients
were included in the study.
Among patients who converted
to a pulse-generating rhythm after
the first defibrillation (n
= 119) were 56% discharged from
hospital as compared with
6% among patients who converted to
asystole. The corresponding
figures after the third
defibrillation were 49% and
2%, respectively, and after the
fifth defibrillation 28% and
7%, respectively. Among patients
in whom the first defibrillation
took place less than 5 min
after collapse, 28% directly
converted to a pulse-generating
rhythm as compared with 3%
when the first defibrillation took
place 12 min or more after
collapse. Conclusion: Among patients
who suffer out-of-hospital
cardiac arrest and are found in
ventricular fibrillation,
there is a strong relationship
between survival and initial
rhythm changes after
defibrillation. These rhythm
changes are directly related to
the interval between collapse
and the first defibrillation. (C)
1997 Elsevier Science Ireland
Ltd.
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RP Herlitz J
SAHLGRENS UNIV HOSP,DIV CARDIOL,S-41345
GOTHENBURG,SWEDEN
J9 RESUSCITATION
UT ISI:A1997WH09000004
ER
PT Journal
AU Weil, MH
Tang, WC
Amith, G
Noc, M
TI Effectiveness of bystander CPR
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
LA English
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C1 INST CRIT CARE MED,PALM SPRINGS,CA
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