General practice and cardiac arrest community first response in Ireland.

BACKGROUND: In Ireland, the MERIT 3 scheme enables doctors to volunteer as cardiac arrest community first responders and receive text message alerts from emergency medical services (EMS) to facilitate early care. AIM: To establish the sustainability, systems and clinical outcomes of a novel, general practice based, cardiac arrest first response initiative over a four-year period. METHODS: Data on alerts, responses, incidents and outcomes were gathered prospectively using EMS control data, incident data reported by responders and corroborative data from the national Out-of-Hospital Cardiac Arrest Registry. RESULTS: Over the period 2016-2019, 196 doctors joined MERIT 3 and 163 (83.2%) were alerted on one or more occasions; 61.3% of those alerted responded to at least one alert. Volunteer doctors attended 300 patients of which 184 (61.3%) had suffered OHCA and had a resuscitation attempt. Responders arrived to OHCA before EMS on 75 occasions (40.8%), initiated chest compressions on seven occasions (3.8%), and brought the first defibrillator on 42 occasions (22.8%). Information on the first monitored rhythm was available for 149/184 (81.0%) patients and was shockable in 30/149 (20.1%); in 9/30 cases, shocks were administered by responders. The overall survival rate was 11.0% (national survival rate 7.3%). Doctors also provided advanced life support and were closely involved in decision making on ceasing resuscitation. CONCLUSION: The MERIT 3 initiative in Ireland has been sustained over a four-year period and has demonstrated the ability of volunteer doctors to provide early care for OHCA patients as well as more complex interventions including end-of-life care. Further development of this strategy is warranted.

GPs who volunteer to be first responders for out-of-hospital cardiac arrest: A qualitative study.

Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of premature mortality. Survival is possible when timely cardiopulmonary resuscitation and defibrillation are available in the community. GPs are well placed to provide early OHCA care and significantly increased rates of survival are achieved when GPs participate in resuscitation. A novel project alerts volunteer GP first responders to nearby OHCAs in Ireland.Objectives: To explore the reasons why GPs volunteer to be OHCA first responders and their experience of participation.Methods: A qualitative study involving in-depth, semi-structured interviews followed by thematic analysis was undertaken in 2017/18. Fourteen GPs from differing geographical areas in Ireland, who volunteered as OHCA first-responders were recruited to participate by purposive methods.Results: GP participation in OHCA voluntary first response was understood as a function of GPs relationship to the community, their ability to manage competing demands in their personal and professional lives and also specific participatory gains. GPs expressed both altruistic motivations and a sense of obligation. GPs described a complex, multifaceted role in providing OHCA first response; they derived an inherent sense of satisfaction in delivering potentially life-saving interventions but also in the provision of holistic, compassionate end-of-life care for patients and their families. Participation was not without psychosocial risk for GPs.Conclusion: GPs volunteer to provide early OHCA emergency care because of their relationship to the community. Care provided is complex and includes both resuscitation and end-of-life care.

Ten years of cardiac arrest resuscitation in Irish general practice.

AIM: The aim of this study is to establish the role and outcome of general practitioner (GP) involvement in out of hospital cardiac arrest (OHCA) resuscitation in the Republic of Ireland. METHODS: A ten year prospective observational study involving a cohort of Irish general practices. SETTING: 521 general practice settings distributed throughout the Republic of Ireland, representing approximately one quarter of all practices and a third of Irish GPs. PARTICIPANTS: 534 patients suffering cardiac arrest in the community for whom resuscitation was attempted. INTERVENTIONS: Cardiac arrest with resuscitation attempted (CARA) in which a GP played a role. RESULTS: Over a ten year period almost half of participating practices reported one or more CARAs. A total of 534 CARAs were reported at a variety of locations; 161 (30%) had ROSC (return of spontaneous circulation) at some point, with outcome data available for 147/161; 90 patients survived to hospital discharge. Most survivors for whom follow up data are available were discharged home and were completely independent. The highest rate of survival was achieved when CARAs occurred at a GP practice premises (47.4%). CONCLUSIONS: Resuscitation following OHCA is a key task in general practice. Over time a significant number of GPs encounter OHCA, attempt resuscitation and achieve higher survival to hospital discharge rates than occur nationally among OHCAs in Ireland. We conclude that a defibrillator should be routinely available at all general practices and staff should have appropriate resuscitation skills.

Cardiac arrest in Irish general practice: an observational study from 426 general practices.

SETTING: Sudden Cardiac Death accounts for approximately 5000 deaths in Ireland each year. Nationally, out-of-hospital cardiac arrest has a very low resuscitation rate, reported at less than 5%. Ireland has a well developed general practice network which routinely manages emergencies arising in the community setting. However, little is known about its potential impact on Sudden Cardiac Death. This study reports on the incidence and management of cardiac arrest in Irish general practice. METHOD: A national training/equipment project in defibrillation in general practice (MERIT) has established a network to prospectively report all cardiac arrests with a resuscitation attempt in general practice. Three monthly surveys of the network record events; structured debriefing uses a modified Utstein template to detail events and their outcomes. RESULTS: 426 practices reported data during a 36-month period (85-97% response rate to surveys), reporting 144 events, of which data are available on 136 events. 88.4% of events were witnessed, 31.6% by general practice staff. 58.2% of events occurred in the general practice or in the patient's home. The general practitioner (GP) was on scene before the ambulance in 72.6% of cases and 52.3% of the patients involved were patients of the GP attending. 52.3% of patients were defibrillated, 32.6% had return of spontaneous circulation at some point and 26 patients (19.5%) were discharged from hospital. CONCLUSIONS: Cardiac arrest in general practice is compatible with structured, effective interventions and significant rates of successful resuscitation. All general practices should be capable of providing this care.