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1.
Ir J Med Sci ; 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32052370

RESUMO

Quality of life of out-of-hospital cardiac arrest (OHCA) survivors is believed to be as important as a factor in resuscitation outcome as the survival rate. The aim of this investigation is to assess the quality of life outcomes of survivors of out-of- hospital cardiac arrest in the Munster region. OHCAR was used to identify survivors who were contacted in writing to invite their participation. Internationally standardized phone based questionnaires were utilized to assess quality of life. The mean age of participants was 63.5 years with 85% male and 15% female. Eighty percent (n = 16) had no issues with mobility, 90% (n = 18) had no issues with personal care, 90% could undertake all usual activities, and 90% (n = 18) experienced no anxiety or depression. In conclusion, survivors of OHCA in the Munster area, who participated in this study, survive at a very high functional level.

2.
Resuscitation ; 148: 218-226, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32027980

RESUMO

BACKGROUND: The epidemiology and outcome after out-of-hospital cardiac arrest (OHCA) varies across Europe. Following on from EuReCa ONE, the aim of this study was to further explore the incidence of and outcomes from OHCA in Europe and to improve understanding of the role of the bystander. METHODS: This prospective, multicentre study involved the collection of registry-based data over a three-month period (1st October 2017 to 31st December 2017). The core study dataset complied with the Utstein-style. Primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital admission. Secondary outcome was survival to hospital discharge. RESULTS: All 28 countries provided data, covering a total population of 178,879,118. A total of 37,054 OHCA were confirmed, with CPR being started in 25,171 cases. The bystander cardiopulmonary resuscitation (CPR) rate ranged from 13% to 82% between countries (average: 58%). In one third of cases (33%) ROSC was achieved and 8% of patients were discharged from hospital alive. Survival to hospital discharge was higher in patients when a bystander performed CPR with ventilations, compared to compression-only CPR (14% vs. 8% respectively). CONCLUSION: In addition to increasing our understanding of the role of bystander CPR within Europe, EuReCa TWO has confirmed large variation in OHCA incidence, characteristics and outcome, and highlighted the extent to which OHCA is a public health burden across Europe. Unexplained variation remains and the EuReCa network has a continuing role to play in improving the quality management of resuscitation.

3.
Scand J Trauma Resusc Emerg Med ; 27(1): 112, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842928

RESUMO

BACKGROUND: In Europe, survival rates after out-of-hospital cardiac arrest (OHCA) vary widely. Presence/absence and differences in implementation of systems dispatching First Responders (FR) in order to arrive before Emergency Medical Services (EMS) may contribute to this variation. A comprehensive overview of the different types of FR-systems used across Europe is lacking. METHODS: A mixed-method survey and information retrieved from national resuscitation councils and national EMS services were used as a basis for an inventory. The survey was sent to 51 OHCA experts across 29 European countries. RESULTS: Forty-seven (92%) OHCA experts from 29 countries responded to the survey. More than half of European countries had at least one region with a FR-system. Four categories of FR types were identified: (1) firefighters (professional/voluntary); (2) police officers; (3) citizen-responders; (4) others including off-duty EMS personnel (nurses, medical doctors), taxi drivers. Three main roles for FRs were identified: (a) complementary to EMS; (b) part of EMS; (c) instead of EMS. A wide variation in FR-systems was observed, both between and within countries. CONCLUSIONS: Policies relating to FRs are commonly implemented on a regional level, leading to a wide variation in FR-systems between and within countries. Future research should focus on identifying the FR-systems that most strongly influence survival. The large variation in local circumstances across regions suggests that it is unlikely that there will be a 'one-size fits all' FR-system for Europe, but examining the role of FRs in the Chain of Survival is likely to become an increasingly important aspect of OHCA research.


Assuntos
Serviços Médicos de Emergência , Socorristas , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Reanimação Cardiopulmonar , Bases de Dados Factuais , Serviços Médicos de Emergência/estatística & dados numéricos , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Taxa de Sobrevida
5.
Cochrane Database Syst Rev ; 7: CD012764, 2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31323120

RESUMO

BACKGROUND: Mobilization of community first responders (CFRs) to the scene of an out-of-hospital cardiac arrest (OHCA) event has been proposed as a means of shortening the interval from occurrence of cardiac arrest to performance of cardiopulmonary resuscitation (CPR) and defibrillation, thereby increasing patient survival. OBJECTIVES: To assess the effect of mobilizing community first responders (CFRs) to out-of-hospital cardiac arrest events in adults and children older than four weeks of age, in terms of survival and neurological function. SEARCH METHODS: We searched the following databases for relevant trials in January 2019: CENTRAL, MEDLINE (Ovid SP), Embase (Ovid SP), and Web of Science. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov, and we scanned the abstracts of conference proceedings of the American Heart Association and the European Resuscitation Council. SELECTION CRITERIA: We included randomized and quasi-randomized trials (RCTs and q-RCTs) that compared routine emergency medical services (EMS) care versus EMS care plus mobilization of CFRs in instances of OHCA.Trials with randomization by cluster were eligible for inclusion, including cluster-design studies with intervention cross-over.In some communities, the statutory ambulance service/EMS is routinely provided by the local fire service. For the purposes of this review, this group represents the statutory ambulance service/EMS, as distinct from CFRs, and was not included as an eligible intervention.We did not include studies primarily focused on opportunistic bystanders. Individuals who were present at the scene of an OHCA event and who performed CPR according to telephone instruction provided by EMS call takers were not considered to be CFRs.Studies primarily assessing the impact of specific additional interventions such as administration of naloxone in narcotic overdose or adrenaline in anaphylaxis were also excluded.We included adults and children older than four weeks of age who had experienced an OHCA. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed all titles and abstracts received to assess potential eligibility, using set inclusion criteria. We obtained and examined in detail full-text copies of all papers considered potentially eligible, and we approached authors of trials for additional information when necessary. We summarized the process of study selection in a PRISMA flowchart.Three review authors independently extracted relevant data using a standard data extraction form and assessed the validity of each included trial using the Cochrane 'Risk of bias' tool. We resolved disagreements by discussion and consensus.We synthesized findings in narrative fashion due to the heterogeneity of the included studies. We used the principles of the GRADE system to assess the certainty of the body of evidence associated with specific outcomes and to construct a 'Summary of findings' table. MAIN RESULTS: We found two completed studies involving a total of 1136 participants that ultimately met our inclusion criteria. We also found one ongoing study and one planned study. We noted significant heterogeneity in the characteristics of interventions and outcomes measured or reported across these studies, thus we could not pool study results.One completed study considered the dispatch of police and fire service CFRs equipped with automatic external defibrillators (AEDs) in an EMS system in Amsterdam and surrounding areas. This study was an RCT with allocation made by cluster according to non-overlapping geographical regions. It was conducted between 5 January 2000 and 5 January 2002. All participants were 18 years of age or older and had experienced witnessed OHCA. The study found no difference in survival at hospital discharge (odds ratio (OR) 1.3, 95% confidence interval (CI) 0.8 to 2.2; 1 RCT; 469 participants; low-certainty evidence), despite the observation that all 72 incidences of defibrillation performed before EMS arrival occurred in the intervention group (OR and 95% CI - not applicable; 1 RCT; 469 participants; moderate-certainty evidence). This study reported increased survival to hospital admission in the intervention group (OR 1.5, 95% CI 1.1 to 2.0; 1 RCT; 469 participants; moderate-certainty evidence).The second completed study considered the dispatch of nearby lay volunteers in Stockholm, Sweden, who were trained to perform cardiopulmonary resuscitation (CPR). This represented a supplementary CFR intervention in an EMS system where police and fire services were already routinely dispatched to OHCA in addition to EMS ambulances. This study, an RCT, included both witnessed and unwitnessed OHCA and was conducted between 1 April 2012 and 1 December 2013. Participants included adults and children eight years of age and older. Researchers found no difference in 30-day survival (OR 1.34, 95% CI 0.79 to 2.29; 1 RCT; 612 participants; low-certainty evidence), despite a significant increase in CPR performed before EMS arrival (OR 1.49, 95% CI 1.09 to 2.03; 1 RCT; 665 participants; moderate-certainty evidence).Neither of the included completed studies considered neurological function at hospital discharge or at 30 days, measured by cerebral performance category or by any other means. Neither of the included completed studies considered health-related quality of life. The overall certainty of evidence for the outcomes of included studies was low to moderate. AUTHORS' CONCLUSIONS: Moderate-certainty evidence shows that context-specific CFR interventions result in increased rates of CPR or defibrillation performed before EMS arrival. It remains uncertain whether this can translate to significantly increased rates of overall patient survival. When possible, further high-quality RCTs that are adequately powered to measure changes in survival should be conducted.The included studies did not consider survival with good neurological function. This outcome is likely to be important to patients and should be included routinely wherever survival is measured.We identified one ongoing study and one planned trial whose results once available may change the results of this review. As this review was limited to randomized and quasi-randomized trials, we may have missed some important data from other study types.


Assuntos
Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência , Socorristas , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Criança , Cardioversão Elétrica , Humanos , Parada Cardíaca Extra-Hospitalar/mortalidade , Qualidade da Assistência à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida
6.
Emerg Med J ; 36(8): 479-484, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31142552

RESUMO

BACKGROUND: Our objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA). METHODS: We performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R. RESULTS: We identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%). CONCLUSIONS: The BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.


Assuntos
Competência Clínica/normas , Parada Cardíaca Extra-Hospitalar/mortalidade , Ordens quanto à Conduta (Ética Médica) , Competência Clínica/estatística & dados numéricos , Técnicas de Apoio para a Decisão , Humanos , Parada Cardíaca Extra-Hospitalar/psicologia , Sistema de Registros/estatística & dados numéricos
7.
Resuscitation ; 138: 168-181, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30898569

RESUMO

INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. METHODS: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n=232). RESULTS: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. CONCLUSIONS: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.

8.
PLoS One ; 14(1): e0208113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30601816

RESUMO

BACKGROUND: Cardiac arrest is an event with a limited prognosis which has not substantially changed since the first description of cardiopulmonary resuscitation (CPR) in 1960. A promising new treatment approach may be mechanical CPR devices (mechanical CPR). METHODS: In a retrospective analysis of the German Resuscitation Registry between 2007-2014, we examined the outcome after using mechanical CPR on return of spontaneous circulation (ROSC) in adults with out-of-hospital cardiac arrest (OHCA). We compared mechanical CPR to manual CPR. According to preclinical risk factors, we calculated the predicted ROSC-after-cardiac-arrest (RACA) score for each group and compared it to the rate of ROSC observed. Using multivariate analysis, we adjusted the influence of the devices' application on ROSC for epidemiological factors and therapeutic measures. RESULTS: We included 19,609 patients in the study. ROSC was achieved in 51.5% of the mechanical CPR group (95%-CI 48.2-54.8%, ROSC expected 42.5%) and in 41.2% in the manual CPR group (95%-CI 40.4-41.9%, ROSC expected 39.2%). After multivariate adjustment, mechanical CPR was found to be an independent predictor of ROSC (OR 1.77; 95%-CI 1.48-2.12). Duration of CPR is a key determinant for achieving ROSC. CONCLUSIONS: Mechanical CPR was associated with an increased rate of ROSC and when adjusted for risk factors appeared advantageous over manual CPR. Mechanical CPR devices may increase survival and should be considered in particular circumstances according to a physicians' decision, especially during prolonged resuscitation.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Reprodutibilidade dos Testes , Estudos Retrospectivos
9.
J Rural Health ; 35(1): 78-86, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-28842929

RESUMO

PURPOSE: Variation in incidence is a universal feature of out-of-hospital cardiac arrest (OHCA). One potential source of variation is the rurality of the location where the OHCA incident occurs. While previous work has used a simple binary approach to define rurality, the purpose of this study was to use a categorical approach to quantify the impact of urban-rural classification on OHCA incidence in the Republic of Ireland. METHODS: The observed versus expected ratio of OHCA incidence where resuscitation was attempted for the period January 1, 2012, to December 31, 2014, was calculated for each of the 3,408 electoral divisions (ED). EDs were then classified into 1 of 6 urban-rural classes. Multilevel modeling was used to test for variation in incidence ratios (IR) across the urban-rural classes. FINDINGS: A total of 4,755 cases of adult OHCA, not witnessed by Emergency Medical Services, where resuscitation was attempted were included in the study. The number of EDs in each category was as follows: city (n = 477); town (n = 293); near village (n = 182); remote village (n = 84); near rural (n = 1,479); remote rural (n = 893). The IR per ED varied from 0 to 18.38 (EDs, n = 3,408). Multilevel modeling showed that 2.36% of variation in IR was due to urban-rural classification. This dropped to 0.45% when adjusted for ED deprivation score and median distance to an ambulance station. The addition of other explanatory variables did not improve the model. CONCLUSION: OHCA variation in Ireland is limited and almost fully explained by area-level deprivation and proximity to ambulance stations.

10.
Open Heart ; 5(2): e000912, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30402259

RESUMO

Objective: Resuscitation from out-of-hospital cardiac arrest (OHCA) is largely determined by the availability of cardiopulmonary resuscitation (CPR) and defibrillation within 5-10 min of collapse. The potential contribution of organised groups of volunteers to delivery of CPR and defibrillation in their communities has been little studied. Ireland has extensive networks of such volunteers; this study develops and tests a model to examine the potential impact at national level of these networks on early delivery of care. Methods: A geographical information systems study considering all statutory ambulance resource locations and all centre point locations for community first responder (CFR) schemes that operate in Ireland were undertaken. ESRI ArcGIS Desktop 10.4 was used to map CFR and ambulance base locations. ArcGIS Online proximity analysis function was used to model 5-10 min drive time response areas under sample peak and off-peak conditions. Response areas were linked to Irish population census data so as to establish the proportion of the population that have the potential to receive a timely cardiac arrest emergency response. Results: This study found that CFRs are present in many communities throughout Ireland and have the potential to reach a million additional citizens before the ambulance service and within a timeframe where CPR and defibrillation are likely to be effective treatments. Conclusion: CFRs have significant potential to contribute to survival following OHCA in Ireland. Further research that examines the processes, experiences and outcomes of CFR involvement in OHCA resuscitation should be a scientific priority.

11.
Scand J Trauma Resusc Emerg Med ; 26(1): 37, 2018 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-29724238

RESUMO

BACKGROUND: Variation in reported incidence and outcome based on aggregated data is a persistent feature of out-of-hospital cardiac arrest (OHCA) epidemiology. OBJECTIVE: To investigate the extent to which patient-level analysis using core 'Utstein' variables explains inter-country variation between Sweden and the Republic of Ireland. METHODS: A retrospective cross-sectional comparative study was performed, including all Swedish and Irish OHCA cases attended by Emergency Medical Services (EMS-attended OHCA) where resuscitation was attempted from 1st January 2012 to 31st December 2014. Incidence rates per 100,000 population were adjusted for age and gender. Two subgroups were extracted: (1) Utstein - adult patients, bystander-witnessed collapse, presumed medical aetiology, initial shockable rhythm and (2) Emergency Medical Service (EMS)-witnessed events. Multivariable logistic regression analysis was used to identify predictors of survival following multiple imputations of data. RESULTS: Five thousand eight hundred eighty six Irish and 15,303 Swedish patients were included. Swedish patients were older than Irish patients (median age 71 vs. 66 years respectively). Adjusted incidence was significantly higher in Sweden compared to the Republic of Ireland (52.9 vs. 43.1 per 100,000 population per year). Proportionate survival in Sweden was greater for both subgroups and all age categories. Regression analysis of the Utstein subgroup predicted approximately 17% of variation in outcome, but there was a large unexplained 'country effect' for survival in favour of Sweden (OR 4.40 (95% CI 2.55-7.56)). CONCLUSIONS: Using patient level data, a proportion of inter-country variation was explained, but substantial variation was not explained by the core Utstein variables. Researchers and policy makers should be aware of the potential for unmeasured differences when comparing OHCA incidence and outcomes between countries.


Assuntos
Parada Cardíaca Extra-Hospitalar/epidemiologia , Adulto , Idoso , Estudos Transversais , Coleta de Dados , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Incidência , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Suécia/epidemiologia
12.
Resuscitation ; 127: 58-62, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29550496

RESUMO

BACKGROUND: The highest achievable survival rate following out-of-hospital cardiac arrest is unknown. Data from airports serving international destinations (international airports) provide the opportunity to evaluate the success of pre-hospital resuscitation in a relatively controlled but real-life environment. METHODS: This retrospective cohort study included all cases of out-of-hospital cardiac arrest at international airports with resuscitation attempted between January 1st, 2013 and December 31st, 2015. Crude incidence, patient, event characteristics and survival to hospital discharge/survival to 30 days (survival) were calculated. Mixed effect logistic regression analyses were performed to identify predictors of survival. Variability in survival between airports/countries was quantified using the median odds ratio. RESULTS: There were 800 cases identified, with an average of 40 per airport. Incidence was 0.024/100,000 passengers per year. Percentage survival for all patients was 32%, and 58% for patients with an initial shockable heart rhythm. In adjusted analyses, initial shockable heart rhythm was the strongest predictor of survival (odds ratio, 36.7; 95% confidence interval [CI], 15.5-87.0). In the bystander-witnessed subgroup, delivery of a defibrillation shock by a bystander was a strong predictor of survival (odds ratio 4.8; 95% CI, 3.0-7.8). Grouping of cases was significant at country level and survival varied between countries. CONCLUSIONS: In international airports, 32% of patients survived an out-of-hospital cardiac arrest, substantially more than in the general population. Our analysis suggested similarity between airports within countries, but differences between countries. Systematic data collection and reporting are essential to ensure international airports continually maximise activities to increase survival.


Assuntos
Aeroportos/estatística & dados numéricos , Reanimação Cardiopulmonar/estatística & dados numéricos , Desfibriladores/provisão & distribução , Cardioversão Elétrica/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , Idoso , Reanimação Cardiopulmonar/métodos , Feminino , Humanos , Incidência , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Retrospectivos
13.
Int J Health Geogr ; 17(1): 6, 2018 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-29458377

RESUMO

BACKGROUND: Internationally, the majority of out-of-hospital cardiac arrests where resuscitation is attempted (OHCAs) occur in private residential locations i.e. at home. The prospect of survival for this patient group is universally dismal. Understanding of the area-level factors that affect the incidence of OHCA at home may help national health planners when implementing community resuscitation training and services. METHODS: We performed spatial smoothing using Bayesian conditional autoregression on case data from the Irish OHCA register. We further corrected for correlated findings using area level variables extracted and constructed for national census data. RESULTS: We found that increasing deprivation was associated with increased case incidence. The methodology used also enabled us to identify specific areas with higher than expected case incidence. CONCLUSIONS: Our study demonstrates novel use of Bayesian conditional autoregression in quantifying area level risk of a health event with high mortality across an entire country with a diverse settlement pattern. It adds to the evidence that the likelihood of OHCA resuscitation events is associated with greater deprivation and suggests that area deprivation should be considered when planning resuscitation services. Finally, our study demonstrates the utility of Bayesian conditional autoregression as a methodological approach that could be applied in any country using registry data and area level census data.


Assuntos
Serviços Médicos de Emergência/métodos , Mapeamento Geográfico , Acesso aos Serviços de Saúde , Vida Independente , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Teorema de Bayes , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Vida Independente/estatística & dados numéricos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/diagnóstico , Fatores de Risco
14.
Emerg Med J ; 34(10): 659-664, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28655755

RESUMO

INTRODUCTION: Age influences survival from an out-of-hospital cardiac arrest (OHCA) but it is unclear to what extent. Improved understanding of the impact of increasing age may be helpful in improving decision making on who should receive attempted resuscitation to optimise outcomes and minimise inappropriate end-of-life management. Our aim is to describe the demographics, characteristics and outcomes following resuscitation attempts in OHCA patients aged 70 years and older in Ireland. METHODS: Data were extracted from the national OHCA Register. Patient and event characteristics were compared across three age categories (70-79; 80-89; ≥90 years). Multivariable logistic regression was used to determine the predictors of the primary outcome (survival to hospital discharge). RESULTS: A total of 2281 patients aged 70 years and older were attended by emergency medical services and had resuscitation attempted between 2012 and 2014. Overall survival to hospital discharge was 2.9%. For those aged 70-79 years, 80-89 years, 90 years and older survival to hospital discharge in each age group was 4.0%, 1.8% and 1.4%, respectively. Older age (adjusted OR (AOR) 0.95 95% CI 0.90 to 0.99) and having an arrest in the subjects own home (AOR 0.14 95% CI 0.07 to 0.28) were independent predictor associated with reduced odds of survival to hospital discharge. An initial shockable rhythm (AOR 17.9. 95% CI 8.19 to 39.2) and having a bystander witnessed OHCA (AOR 3.98. 95% CI 1.38 to 11.50) were independent predictors associated with increased odds of survival to hospital discharge. CONCLUSION: In those aged 70 years and older, the rate of survival to hospital discharge declined with increasing age group. Younger age, an initial shockable rhythm and witnessed arrest were independent predictors of survival to hospital discharge.


Assuntos
Parada Cardíaca Extra-Hospitalar/epidemiologia , Sistema de Registros/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Irlanda/epidemiologia , Modelos Logísticos , Masculino , Estudos Retrospectivos
16.
Emerg Med J ; 33(11): 776-781, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27485262

RESUMO

BACKGROUND: National data collection provides information on out-of-hospital cardiac arrest (OHCA) incidence, management and outcomes that may not be generalisable from smaller studies. This retrospective cohort study describes the first 2 years' results from the Irish National Out-of-Hospital Cardiac Arrest Register (OHCAR). METHODS: Data on OHCAs attended by emergency medical services (EMS) where resuscitation was attempted (EMS-treated) were collected from ambulance services and entered onto OHCAR. Descriptive analysis of the study population was performed, and regression analysis was performed on the subgroup of adult patients with a bystander-witnessed event of presumed cardiac aetiology and an initial shockable rhythm (Utstein group). RESULTS: 3701 EMS-treated OHCAs were recorded for the study period (1 January 2012-31 December 2013). Incidence was 39/100 000 population/year. In the Utstein group (n=577), compared with the overall group, there was a higher proportion of male patients, public event location, bystander cardiopulmonary resuscitation (CPR) and early defibrillation. Median EMS call-response interval was similar in both groups. A higher proportion of patients in the Utstein group achieved return of spontaneous circulation (35% vs 17%) and survival to hospital discharge (22% vs 6%). After multivariate adjustment for the Utstein group, the following variables were found to be independent predictors of the outcome survival to hospital discharge: public event location (OR 3.1 (95% CI 1.9 to 5.0)); bystander CPR (2.4 (95% CI 1.2 to 4.9)); EMS response of 8 min or less (2.2 (95% CI 1.3 to 3.6)). CONCLUSIONS: This study highlights the role of nationwide registries in quantifying, monitoring and benchmarking OHCA incidence and outcome, providing baseline data upon which service improvement effects can be measured.


Assuntos
Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , Avaliação de Resultados da Assistência ao Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Incidência , Lactente , Irlanda , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Análise de Regressão , Estudos Retrospectivos , Análise de Sobrevida
17.
Resuscitation ; 105: 188-95, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27321577

RESUMO

INTRODUCTION: The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe. METHODS: This was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries. RESULTS: Data on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge. CONCLUSION: The results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe. EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , Idoso , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Prospectivos , Sistema de Registros , Análise de Sobrevida
20.
Scand J Trauma Resusc Emerg Med ; 23: 7, 2015 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-25927980

RESUMO

BACKGROUND: There is substantial variation in the incidence, likelihood of attempted resuscitation and outcomes from out-of-hospital cardiac arrest (OHCA) across Europe. A European, multi-centre study provides the opportunity to uncover differences throughout Europe and may help find explanations for these differences. Results may also have potential to support the development of quality benchmarking between European Emergency Medical Services (EMS). METHODS/DESIGN: This prospective European study involves 27 different countries. It provides a common Utstein-based dataset, data collection tool and a common data collection period for all participants. Study research questions will address the following: OHCA incidence in different European regions; incidence of cardiopulmonary resuscitation (CPR); initial presenting rhythm in patients where bystanders or EMS start CPR or any other resuscitation intervention; proportion of patients with any return of spontaneous circulation (ROSC); patient status at the end of pre-hospital treatment i.e. ROSC at handover to hospital, ongoing CPR, dead; proportion of patients still alive 30 days after OHCA; proportion of patients discharged alive from hospital. All patients who suffered an OHCA during October 2014 and were attended and/or treated by an EMS and documented in one of the participating registries will be included in the study. Each National Coordinator is responsible for data collection and quality control in his/her country and will transfer unprocessed anonymised data via secure electronic transfer. Descriptive analysis will be performed at European, national and registry level. For endpoints like ROSC, admission or survival, multivariate logistic regression analysis will be performed. DISCUSSION: Documenting differences in epidemiology, treatment and outcome in out-of-hospital cardiac arrest throughout Europe is a first step in finding explanations for these differences. Study results might also support the development of quality benchmarking between Emergency Medical Services (EMS) which in turn will facilitate initiatives to improve OHCA outcome in Europe. TRIAL REGISTRATION: The EuReCa ONE Study is registered by ClinicalTrials.gov National Coordinator T02236819 ).


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Sistema de Registros , Europa (Continente)/epidemiologia , Humanos , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Prospectivos , Análise de Sobrevida
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