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1.
Revue Medicale de Bruxelles ; 43(2):110-116, 2022.
Article in French | EMBASE | ID: covidwho-1887427

ABSTRACT

Introduction : The pandemic caused by the SARS-CoV-2 virus has affected nearly 240 million people around the world. This pandemic has had a great impact on individual and collective clinical practice. Objective : Impact of SARS-CoV-2 on out-of-hospital cardiac arrest (OCAH), through gender, context, initial rhythm, survival and neurological recovery. Design, settings, and participants : A retrospective analysis of a cohort of OCAH patients who were treated by the mobile emergency and intensive care unit (MICU) of the Erasme hospital - University clinics of Brussels was conducted. All interventions concerning an OCAH, from 01/01/2019 to 12/31/2019, reflecting a non-pandemic period and from 01/01/2020 to 12/31/2020, reflecting a period of SARSCoV-2 pandemic were analyzed. Main results : This study shows an increase in the male/ female ratio, as well as an increase in the number of OCAH. During the second wave, more than half of OCAHs had a suspected respiratory etiology. This period indicate an increase in ventricular fibrillation, as well as better autonomy and neurological sequelae, despite the statistical tests between a non-pandemic and a pandemic SARS-CoV-2 period were not significant. Conclusion : This retrospective cohort of patients who used MICU of HE-CUB during a non-pandemic and a pandemic period, highlights the impact of SARS-CoV-2 in absolute numbers on OCAH.

2.
Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine ; 77(sup1):1-33, 2022.
Article in English | EMBASE | ID: covidwho-1886341
3.
Front Pediatr ; 10: 846410, 2022.
Article in English | MEDLINE | ID: covidwho-1887120

ABSTRACT

Background: Out-of-hospital cardiac arrest (OHCA) in children is a critical condition with a poor prognosis. After the coronavirus disease 2019 (COVID-19) pandemic developed, the epidemiology and clinical characteristics of the pediatric emergency department (PED) visits have changed. This study aimed to analyze the impact of the COVID-19 pandemic on pediatric OHCA in the PED. Methods: From January 2018 to September 2021, we retrospectively collected data of children (18 years or younger) with a definite diagnosis of OHCA admitted to the PED. Patient data studied included demographics, pre-/in-hospital information, treatment modalities; and outcomes of interest included sustained return of spontaneous circulation (SROSC) and survival to hospital-discharge (STHD). These were analyzed and compared between the periods before and after the COVID-19 pandemic. Results: A total of 97 patients with OHCA (68 boys and 29 girls) sent to the PED were enrolled in our study. Sixty cases (61.9%) occurred in the pre-pandemic period and 37 during the pandemic. The most common age group was infants (40.2%) (p = 0.018). Asystole was the most predominant cardiac rhythm (72.2%, P = 0.048). Eighty patients (82.5%) were transferred by the emergency medical services, 62 (63.9%) gained SROSC, and 25 (25.8%) were STHD. During the COVID-19 pandemic, children with non-trauma OHCA had significantly shorter survival duration and prolonged EMS scene intervals (both p < 0.05). Conclusion: During the COVID-19 pandemic, children with OHCA had a significantly lower rate of SROSC and STHD than that in the pre-pandemic period. The COVID-19 pandemic has changed the nature of PED visits and has affected factors related to ROSC and STHD in pediatric OHCA.

4.
Int J Emerg Med ; 15(1): 26, 2022 Jun 09.
Article in English | MEDLINE | ID: covidwho-1883516

ABSTRACT

BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) outbreak on out-of-hospital cardiac arrest (OHCA) has been of interest worldwide. However, evidence from low-resource emergency medical service systems is limited. This study investigated the effects of the COVID-19 outbreak on the prehospital management and outcomes of OHCA in Thailand. METHODS: This multicentered, retrospective, observational study compared the management and outcomes of OHCA for 2 periods: pre-COVID-19 (January-September 2019) and during the outbreak (January-September 2020). Study data were obtained from the Thai OHCA Network Registry. The primary outcome was survival rate to hospital discharge. Data of other OHCA outcomes and prehospital care during the two periods were also compared. RESULTS: The study enrolled 691 patients: 341 (49.3%) in the pre-COVID-19 period and 350 (50.7%) in the COVID-19 period. There was a significant decrease in the survival rate to discharge during the COVID-19 outbreak (7.7% vs 2.2%; adjusted odds ratio [aOR], 0.34; 95% confidence interval [CI], 0.15-0.95). However, there were no significant differences between the 2 groups in terms of their rates of sustained return of spontaneous circulation (33.0% vs 31.3%; aOR, 1.01; 95% CI, 0.68-1.49) or their survival to intensive care unit/ward admission (27.8% vs 19.8%; aOR, 0.78; 95% CI, 0.49-1.15). The first-responder response interval was significantly longer during the COVID-19 outbreak (median [interquartile range] 5.3 [3.2-9.3] min vs 10 [6-14] min; P < 0.001). There were also significant decreases in prehospital intubation (66.7% vs 48.2%; P < 0.001) and prehospital drug administration (79.5% vs 70.6%; P = 0.024) during the COVID-19 outbreak. CONCLUSION: There was a significant decrease in the rate of survival to hospital discharge of patients with OHCA during the COVID-19 outbreak in Thailand. Maintaining the first responder response quality and encouraging prehospital advanced airway insertion might improve the survival rate during the COVID-19 outbreak.

5.
Journal of Medical Internet Research ; 2022.
Article in English | ProQuest Central | ID: covidwho-1871841

ABSTRACT

Background: Prompt and proficient basic life support (BLS) maneuvers are essential to increasing the odds of survival after out-of-hospital cardiac arrest. However, significant time can elapse before the arrival of professional rescuers. To decrease these delays, many countries have developed first responder networks. These networks are composed of BLS-certified lay or professional rescuers who can be dispatched by emergency medical communication centers to take care of those who experience out-of-hospital cardiac arrest. Many systems are, however, limited by a relatively low number of active first responders, and first-year medical and dental students may represent an almost untapped pool of potential rescuers. On top of providing an enhanced BLS coverage to the population, this could also help medical students be better prepared to their future role as certified health care providers and address societal expectations regarding health care students. Objective: Our objective was to describe the impact of a short motivational intervention followed by a blended BLS course (e-learning and practice session) designed to motivate first-year medical and dental students to enlist as first responders. Methods: A short, web-based, motivational intervention presenting this project took place, and first-year University of Geneva, Faculty of Medicine students were provided with a link to the study platform. Those who agreed to participate were redirected to a demographic questionnaire before registering on the platform. The participants were then asked to answer a second questionnaire designed to determine their baseline knowledge prior to following an interactive e-learning module. Upon completion, a web-based booking form enabling them to register for a 1-hour practice session was displayed. These sessions were held by senior medical students who had been trained and certified as BLS instructors. The participants who attended these practice sessions were asked to answer a postcourse questionnaire before receiving the certificate enabling them to register as first responders. Results: Out of the 529 first-year students registered at University of Geneva, Faculty of Medicine on January 14, 2021, 190 (35.9%) initially agreed to participate. Moreover, 102 (19.3%) attended the practice sessions, and 48 (9.1%) had completed all training and enlisted as first responders on the dedicated platform, Save a Life, at 6 months (July 14, 2021). Postcourse confidence in resuscitation skills was associated with a higher likelihood of registering as first responder (P=.03). No association was found between prior BLS knowledge and the probability of registering to a practice session (P=.59), of obtaining a course completion certificate (P=.29), or of enlisting as first responder (P=.56). Conclusions: This study shows that a motivational intervention associated with a short BLS course can convince medical students to enlist as first responders. Further studies are needed to understand the rather low proportion of medical students finally registering as first responders. International Registered Report Identifier (IRRID): RR2-10.2196/24664

8.
Modern Pathology ; 35(SUPPL 2):1371-1372, 2022.
Article in English | EMBASE | ID: covidwho-1857315

ABSTRACT

Background: Current research comparing CPR-associated injuries between those receiving LUCAS device and manual CPR has primarily focused on patients who suffered out-of-hospital cardiac arrest. During the SARS-CoV-2 pandemic, more hospitals leveraged mechanical CPR devices to provide distant yet high quality chest compressions for in-hospital cardiac arrest (IHCA) patients. We sought to investigate autopsy thoracic injury patterns in in-hospital non-traumatic cardiac arrests, comparing traditional manual compressions with the mechanical LUCAS device compressions. Design: Autopsies were screened for a history of in-hospital cardiopulmonary resuscitation in the absence of prior traumatic injuries at a single, large quaternary care center from 1/1/2018 to 06/30/2021. 20 received LUCAS compressions and 40 received manual compressions. Student's T-Tests were used to compare means for continuous variables, while chi-squared and Fischer's exact tests were used for categorical variables. An alpha of 0.05 was chosen as the threshold for statistical significance. Results: A statistically significant decrease in the rate of sternal fractures and rate of multiple sternal fractures during mechanical CPR was found. A statistically significant increase in other soft tissue injuries, such as pleural wall or lung injuries was seen in mechanical CPR cases, while an increased rate of bilateral rib fractures was noted in manual compression cases. Conversely, no difference in the number or laterality of rib fractures were noted. There was no significant difference in age, biological sex, or rate of scoliosis or kyphosis between cohorts. Results are listed in table 1. (Table Presented) Little research has looked at the injury patterns of mechanical CPR in the IHCA patient population. These results point to a potential difference in thoracic injury patterns from manual compressions when compared to LUCAS device compressions. The statistically significant decrease in sternal fractures with mechanical compressions is noteworthy. Conversely, the increase in other soft tissue injury demands further examination. The decrease in bilateral rib fractures with LUCAS use suggests that placement of the device may play a role in the epidemiology of rib injuries, but not in the number of ribs injured. Further research should examine rib injuries in more detail, and quantify additional comorbidities in both survivors and non-survivors of cardiac arrest.

9.
Circ J ; 2022 Apr 22.
Article in English | MEDLINE | ID: covidwho-1799074

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) pandemic may have influenced the prehospital emergency care and deaths of individuals experiencing an out-of-hospital cardiac arrest (OHCA).Methods and Results: We analyzed the registry data of 2,420 and 2,371 OHCA patients in Osaka City, Japan in 2019 and 2020, respectively, according to the 3 waves of the COVID-19 pandemic. Patient outcomes were compared using multivariable logistic regression analyses with the 2019 data as the reference. Bystander cardiopulmonary resuscitation (CPR) was initiated significantly less frequently in 2020 than in 2019 (2019: 48.0%, 2020: 42.7%, P<0.001), particularly during the first wave (2019: 47.2%, 2020: 42.9%, P=0.046) and second wave (2019: 48.1%, 2020: 41.2%, P=0.010), but not during the third wave (2019: 49.2%, 2020: 44.1%, P=0.066). The public-access automated external defibrillator was less frequently applied during the first wave (2019: 12.6%, 2020: 9.9%, P=0.043), with no significant difference during the second wave (2019: 12.5%, 2020: 12.8%, P=0.863) and third wave (2019: 13.7%, 2020: 13.0%, P=0.722). There was a significant difference in 1-month survival with favorable neurological outcomes (2019: 4.6%, 2020: 3.3%, P=0.018), with a 28% reduction in the adjusted odds ratio in 2020 (0.72; 95% confidence interval: 0.52-0.99, P=0.044). CONCLUSIONS: Bystander CPR and neurologically favorable outcomes after OHCA decreased significantly during the COVID-19 pandemic in Japan.

10.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793863

ABSTRACT

Introduction: Glan Clwyd Hospital (GCH) has offered a 24/7 Percutaneous Coronary Intervention (PCI) service in North Wales (population approx. 690,000) since 2017 and has been designated one of three Welsh Cardiac Arrest Centres. The aim of the study was to evaluate the impact of this development upon resource requirements and outcomes. Methods: Retrospective review of the ICU Ward Watcher database to identify patients undergoing CPR in the 24 h prior to admission April 2013-April 2021. Patients likely to have sustained Out-of-Hospital Cardiac Arrest (OOHCA) of primary cardiac aetiology (OOHCAC) were identified from primary/secondary diagnoses and free text entry. Data were subsequently analysed using Excel and SPSS. The project was registered as a service evaluation. Results: There were 367 ICU admissions following cardiac arrest;245 were OOHCA, of which 189 were considered OOHCA-C. Annual OOHCA admissions increased through the study period from 12 (2013-2014) to 50 (2019-2020) before decreasing to 29 during COVID-19 pandemic (2020-2021). OOHCA bed days increased from 38 in 2013-2014 to 215 in 2019-2020, falling to 169 in 2020-2021. Proportions of OOHCA-C patients undergoing pre-ICU PCI increased with time (33% in 2013-2014 to 47% in 2020-2021). Hospital mortality following OOHCA was 61.2% and OOHCA-C was 59.7%;temporal trends did not reach statistical significance. Main factors from first 24 h of ICU admission associated with hospital mortality are presented below. On logistic regression, only lactate, central temperature and lack of pre-ICU PCI significantly predicted hospital mortality (p < 0.001) (Table 1). Conclusions: Centralising cardiac arrest care has led to an appreciable rise in ICU bed occupancy. Although overall hospital mortality for OOHCA-C remains high and appreciating potential selection bias, a significant association between PCI and survival to hospital discharge appears to support clinical pathways enabling PCI access following OOHA-C [1]. (Table Presented).

11.
Am J Emerg Med ; 57: 1-5, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1783128

ABSTRACT

INTRODUCTION: Emerging research demonstrates lower rates of bystander cardiopulmonary resuscitation (BCPR), public AED (PAD), worse outcomes, and higher incidence of OHCA during the COVID-19 pandemic. We aim to characterize the incidence of OHCA during the early pandemic period and the subsequent long-term period while describing changes in OHCA outcomes and survival. METHODS: We analyzed adult OHCAs in Texas from the Cardiac Arrest Registry to Enhance Survival (CARES) during March 11-December 31 of 2019 and 2020. We stratified cases into pre-COVID-19 and COVID-19 periods. Our prehospital outcomes were bystander cardiopulmonary resuscitation (BCPR), public AED use (PAD), sustained ROSC, and prehospital termination of resuscitation (TOR). Our hospital survival outcomes were survival to hospital admission, survival to hospital discharge, good neurological outcomes (CPC Score of 1 or 2) and Utstein bystander survival. We created a mixed effects logistic regression model analyzing the association between the pandemic on outcomes, using EMS agency as the random intercept. RESULTS: There were 3619 OHCAs (45.0% of overall study population) in 2019 compared to 4418 (55.0% of overall study population) in 2020. Rates of BCPR (46.2% in 2019 to 42.2% in 2020, P < 0.01) and PAD (13.0% to 7.3%, p < 0.01) decreased. Patient survival to hospital admission decreased from 27.2% in 2019 to 21.0% in 2020 (p < 0.01) and survival to hospital discharge decreased from 10.0% in 2019 to 7.4% in 2020 (p < 0.01). OHCA patients were less likely to receive PAD (aOR = 0.5, 95% CI [0.4, 0.8]) and the odds of field termination increased (aOR = 1.5, 95% CI [1.4, 1.7]). CONCLUSIONS: Our study adds state-wide evidence to the national phenomenon of long-term increased OHCA incidence during COVID-19, worsening rates of BCPR, PAD use and survival outcomes.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Adult , COVID-19/epidemiology , COVID-19/therapy , Humans , Incidence , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Pandemics , Registries , Texas/epidemiology
13.
Journal of the American College of Cardiology ; 79(9):1083, 2022.
Article in English | EMBASE | ID: covidwho-1757968

ABSTRACT

Background Sonothrombolysis using diagnostic ultrasound and microbubbles has been proposed as a potential adjunctive treatment that could reduce microvascular obstruction (MVO) in patients with ST-elevation myocardial infarction (STEMI). In this preliminary analysis of an ongoing randomized controlled trial on the efficacy of sonothrombolysis after percutaneous coronary intervention (PCI) in STEMI patients with MVO, we sought to assess whether a difference could be observed between the treatment and control group with respect to the occurrence of early and late serious adverse events (SAE). Methods Patients with STEMI and persistent ST-elevation on the electrocardiogram (ECG) after PCI were randomized to sonothrombolysis (> 60 high mechanical index pulses in the apical 4-, 2- and 3-chamber view during an infusion of commercially available microbubbles) or sham (low mechanical index imaging with < 6 HMI pulses for perfusion imaging). All SAEs, defined according to the International guidelines for Good Clinical Practice (ICH-GCP), were recorded and divided in early (<1 month) and late (<6 months) SAEs. Results Forty-five patients were included in the trial. In total, 12 SAEs occurred: 4 in the sonothrombolysis group (2 early, 2 late), 8 in the control group (6 early, 2 late). In the sonothrombolysis group, the SAEs consisted of out-of-hospital cardiac arrest, gastrointestinal bleeding, collapse with subdural hematoma and endocarditis. In the control group, the listed SAEs were all-cause death (2x), hospitalization for heart failure, pneumonia, COVID-infection, diabetes mellitus, non ST-elevation myocardial infarction and aspecific chest paint. Conclusion Sonothrombolysis after PCI in patients with high-risk STEMI and MVO is not associated with an increased occurrence of early or late SAEs. Further clinical trials are needed to comment on the efficacy of sonothrombolysis in this patient population.

14.
Annals of Emergency Medicine ; 78(4):S119, 2021.
Article in English | EMBASE | ID: covidwho-1748245

ABSTRACT

Study Objective: Telephone cardiopulmonary resuscitation (T-CPR) instruction is crucial by 911 telecommunicators (Tcom) prior to emergency medical services (EMS) arrival for identified out-of-hospital cardiac arrest (OOHCA). Timely identification of OOHCA and successful T-CPR instructions are important for improved survival and neurological outcome. This study aims to describe barriers in providing T-CPR instruction to reporting parties (RP) in an urban 911 Dispatch center prior to the COVID-19 pandemic compared to during the COVID-19 pandemic. Methods: This is a retrospective analysis of a 911 urban dispatch center T-CPR instruction over an 18-month period during April 1, 2019 and August 31, 2020. Study period includes eleven months prior to the declared COVID-19 pandemic in the United States, using February 1, 2020 as the cutoff, and 7 months after. Inclusion criteria were all cardiac arrest calls recognized and type coded by our Tcom. Exclusion criteria were calls that had incomplete data or did not require T-CPR instruction by Tcom due to CPR in progress, obvious dead on arrival or do not resuscitate (DNR) orders. Calls that needed T-CPR instruction, but was not provided by Tcom were analyzed. Descriptive data is presented in proportions, with corresponding p-value from chi- square analysis. Results: A total of 1,144 OOHCA calls were included. T-CPR instruction was needed for 635 calls (58%). Out of the calls who needed T-CPR instruction, 445 (70%) had T-CPR provided and 190 (30%) T-CPR not provided. There was no difference in providing T-CPR instruction in the pre vs. post COVID-19 groups, 69% vs. 71%, (p=0.670). Of the 190 T-CPR not provided, barriers included;38 (19%) RP was not with the patient, 12 (6.3%) had language barrier, 89 (47%) RP refused, 53 (29%) had physical limitation, 43 (22%) had emotional state limitation, RP did not understand 15 (7.9%) and Aid Arrived 17 (8.9%). From this barrier group, there were pre and post COVID-19 statistical differences in language barriers (pre: 4%, post: 14%, p=0.023) and minimal difference for RP refused (pre: 51%, post: 34%, p=0.053). Conclusion: We found no difference in frequency for providing T-CPR instruction before the COVID-19 pandemic versus during the pandemic. Of the 190 calls that did not receive T-CPR instruction, language difficulty was a significant barrier in the post pandemic group. Overall, caller refusal and physical limitation were the greatest barriers in providing T-CPR instruction.

15.
Journal of the Hong Kong College of Cardiology ; 28(2):77, 2020.
Article in English | EMBASE | ID: covidwho-1743663

ABSTRACT

Objectives: To analyse the incidence of emergency medical serviceattended out-of-hospital cardiac arrests (OHCAs) and prehospital return of spontaneous circulation (ROSC) outcomes in Singapore from January to May 2020, as compared to the same period in 2018 and 2019. Methods: This was a retrospective observational study comparing current and previous emergency medical service (EMS) data and OHCA records maintained by the Singapore Civil Defence Force (SCDF). These figures were tabulated from data input by experienced paramedics responding to EMS calls and verified by an internal audit team. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines, and examined factors that may have contributed to an increase or decrease in OHCA incidence and prehospital ROSC attainments during the different time periods. Results: Coronavirus Disease 2019 (COVID-19) is a global pandemic of unparalleled scale. Despite total EMS call volumes and overall OHCA incidence remaining comparable to pre-COVID periods, there was a concerning decrease in pre-hospital ROSC attainments between January to May 2020 (an average of 8.4%). Based on multivariable logistic regression, this was much lower when compared to previous years, where the pre-hospital ROSC rates remained around 12% (p<0.001). Further analyses did not reveal significant differences in terms of the median age of OHCA victims, the percentage of shockable rhythm or response times. However, it was noted that more OHCAs were occurring in residential homes, while those in public spaces decreased considerably compared to previous years (p<0.001). In addition, there was also a drop in the overall bystander cardiopulmonary resuscitation (CPR) rates compared to pre-COVID periods (p<0.001). Conclusion: The findings remain preliminary and follow-up data in the subsequent months are necessary to further investigate these trends. Nonetheless, they provide important lessons for public education and pandemic preparedness. To strengthen the first links in the survival chain, members of the public should be educated to initiate CPR and automated external defibrillator (AED) for any non-responsive victim (even without mouth-to-mouth ventilation).

16.
Resuscitation ; 172: 74-83, 2022 03.
Article in English | MEDLINE | ID: covidwho-1740147

ABSTRACT

INTRODUCTION: The Australasian Resuscitation Outcomes Consortium (Aus-ROC) out-of-hospital cardiac arrest (OHCA) Epistry (Epidemiological Registry) now covers 100% of Australia and New Zealand (NZ). This study reports and compares the Utstein demographics, arrest characteristics and outcomes of OHCA patients across our region. METHODS: We included all OHCA cases throughout 2019 as submitted to the Epistry by the eight Australian and two NZ emergency medical services (EMS). We calculated crude and age-standardised incidence rates and performed a national and EMS regional comparison. RESULTS: We obtained data for 31,778 OHCA cases for 2019: 26,637 in Australia and 5,141 in NZ. Crude incidence was 107.9 per 100,000 person-years in Australia and 103.2/100,000 in NZ. Overall, the majority of OHCAs occurred in adults (96%), males (66%), private residences (76%), were unwitnessed (63%), of presumed medical aetiology (83%), and had an initial monitored rhythm of asystole (64%). In non-EMS-witnessed cases, 38% received bystander CPR and 2% received public defibrillation. Wide variation was seen between EMS regions for all OHCA demographics, arrest characteristics and outcomes. In patients who received an EMS-attempted resuscitation (13,664/31,778): 28% (range across EMS = 13.1% to 36.7%) had return of spontaneous circulation (ROSC) at hospital arrival and 13% (range across EMS = 9.9% to 20.7%) survived to hospital discharge/30-days. Survival in the Utstein comparator group (bystander-witnessed in shockable rhythm) varied across the EMS regions between 27.4% to 42.0%. CONCLUSION: OHCA across Australia and NZ has varied incidence, characteristics and survival. Understanding the variation in survival and modifiable predictors is key to informing strategies to improve outcomes.


Subject(s)
Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Adult , Australia/epidemiology , Humans , Male , New Zealand/epidemiology , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Registries
17.
J Clin Med ; 11(5)2022 Mar 07.
Article in English | MEDLINE | ID: covidwho-1736967

ABSTRACT

In pre-hospital settings, efficient cardiopulmonary resuscitation (CPR) is challenging; therefore, the application of mechanical CPR devices continues to increase. However, the evidence of the benefits of using mechanical CPR devices in pre-hospital settings for adult out-of-hospital cardiac arrest (OHCA) is controversial. This meta-analysis compared the effects of mechanical and manual CPR applied in the pre-hospital stage on clinical outcomes after OHCA. Cochrane Library, PubMed, Embase, and ClinicalTrials.gov were searched from inception until October 2021. Studies comparing mechanical and manual CPR applied in the pre-hospital stage for survival outcomes of adult OHCA were eligible. Data abstraction, quality assessment, meta-analysis, trial sequential analysis (TSA), and grading of recommendations, assessment, development, and evaluation were conducted. Seven randomized controlled and 15 observational studies were included. Compared to manual CPR, pre-hospital use of mechanical CPR showed a positive effect in achieving return of spontaneous circulation (ROSC) and survival to admission. No difference was found in survival to discharge and discharge with favorable neurological status, with inconclusive results in TSA. In conclusion, pre-hospital use of mechanical CPR devices may benefit adult OHCA in achieving ROSC and survival to admission. With low certainty of evidence, more well-designed large-scale randomized controlled trials are needed to validate these findings.

18.
J Am Heart Assoc ; 11(6): e024140, 2022 03 15.
Article in English | MEDLINE | ID: covidwho-1731380

ABSTRACT

Background Little is known about how COVID-19 influenced engagement of citizen responders dispatched to out-of-hospital cardiac arrest (OHCA) by a smartphone application. The objective was to describe and analyze the Danish Citizen Responder Program and bystander interventions (both citizen responders and nondispatched bystanders) during the first COVID-19 lockdown in 2020. Methods and Results All OHCAs from January 1, 2020, to June 30, 2020, with citizen responder activation in 2 regions of Denmark were included. We compared citizen responder engagement for OHCA in the nonlockdown period (January 1, 2020, to March 10, 2020, and April 21, 2020, to June 30, 2020) with the lockdown period (March 11, 2020, to April 20, 2020). Data are displayed in the order lockdown versus nonlockdown period. Bystander cardiopulmonary resuscitation rates did not differ in the 2 periods (99% versus 92%; P=0.07). Bystander defibrillation (9% versus 14%; P=0.4) or return-of-spontaneous circulation (23% versus 23%; P=1.0) also did not differ. A similar amount of citizen responders accepted alarms during the lockdown (6 per alarm; interquartile range, 6) compared with the nonlockdown period (5 per alarm; interquartile range, 5) (P=0.05). More citizen responders reported performing chest-compression-only cardiopulmonary resuscitation during lockdown compared with nonlockdown (79% versus 59%; P=0.0029), whereas fewer performed standardized cardiopulmonary resuscitation, including ventilations (19% versus 38%; P=0.0061). Finally, during lockdown, more citizen responders reported being not psychologically affected by attending an OHCA compared with nonlockdown period (68% versus 56%; P<0.0001). Likewise, fewer reported being mildly affected during lockdown (26%) compared with nonlockdown (35%) (P=0.003). Conclusions The COVID-19 lockdown in Denmark was not associated with decreased bystander-initiated resuscitation in OHCAs attended by citizen responders.


Subject(s)
COVID-19/epidemiology , Cardiopulmonary Resuscitation/statistics & numerical data , Emergency Medical Services/statistics & numerical data , Out-of-Hospital Cardiac Arrest , COVID-19/prevention & control , Cardiopulmonary Resuscitation/methods , Communicable Disease Control , Denmark/epidemiology , Disease Outbreaks , Humans , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Retrospective Studies
19.
J Emerg Med ; 2022 Mar 04.
Article in English | MEDLINE | ID: covidwho-1720296

ABSTRACT

BACKGROUND: Cardiopulmonary resuscitation (CPR) performed by lay rescuers can increase a person's chance of survival. The COVID-19 pandemic enforced prevention policies that encouraged social distancing, which disrupted conventional modes of health care education. Tele-education may benefit CPR training during the pandemic. OBJECTIVE: Our aim was to compare CPR knowledge and skills using tele-education vs. conventional classroom teaching methods. METHODS: A noninferiority trial was conducted as a Basic Life Support workshop. Participants were randomly assigned to a tele-education or conventional group. Primary outcomes assessed were CPR knowledge and skills and secondary outcomes assessed were individual skills, ventilation, and chest compression characteristics. RESULTS: Pretraining knowledge scores (mean ± standard deviation [SD] 3.50 ± 2.18 vs. 4.35 ± 1.70; p = 0.151) and post-training knowledge scores (7.91 ± 2.14 vs. 8.52 ± 0.90; p = 0.502) of the tele-education and conventional groups, respectively, had no statistically significant difference. Both groups' training resulted in a significant and comparable gain in knowledge scores (p < 0.001). The tele-education and conventional groups skill scores (mean ± SD 78.30 ± 6.77 vs. 79.65 ± 9.93; p = 0.579) had no statistical difference. Skillset scores did not differ statistically except for the compression rate and ventilation ratio; the conventional group performed better (p = 0.042 vs. p = 0.017). The tele-education and conventional groups' number of participants passed the skill test (95.5% and 91.3%, respectively; p = 1.000). CONCLUSIONS: Tele-education offers a pragmatic and reasonably effective alternative to conventional CPR training during the COVID-19 pandemic.

20.
Front Cardiovasc Med ; 9: 799446, 2022.
Article in English | MEDLINE | ID: covidwho-1709658

ABSTRACT

BACKGROUND: Mortality after out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) remains high despite numerous efforts to improve outcome. For patients with suspected coronary cause of arrest, coronary angiography is crucial. However, there are other causes and potentially life-threatening injuries related to cardiopulmonary resuscitation (CPR), which can be detected by routine computed tomography (CT). MATERIALS AND METHODS: At Hannover Medical School, rapid coronary angiography and CT are performed in successfully resuscitated OHCA patients as a standard of care prior to admission to intensive care. We analyzed all patients who received CT following OHCA with ROSC over a three-year period. RESULTS: There were 225 consecutive patients with return of spontaneous circulation following out-of-hospital cardiac arrest. Mean age was 64 ± 13 years, 75% were male. Of them, 174 (77%) had witnessed arrest, 145 (64%) received bystander CPR, and 123 (55%) had a primary shockable rhythm. Mean time to ROSC was 24 ± 20 min. There were no significant differences in CT pathologies in patients with or without ST-segment elevations in the initial ECG. Critical CT findings qualifying as a potential cause for cardiac arrest were intracranial bleeding (N = 6), aortic dissection (N = 5), pulmonary embolism (N = 17), pericardial tamponade (N = 3), and tension pneumothorax (N = 11). Other pathologies were regarded as consequences of CPR and relevant for further treatment: aspiration (N = 62), rib fractures (N = 161), sternal fractures (N = 50), spinal fractures (N = 11), hepatic bleeding (N = 12), and intra-abdominal air (N = 3). CONCLUSION: Early CT fallowing OHCA uncovers a high number of causes and consequences of OHCA and CPR. Those are relevant for post-arrest care and are frequently life-threatening, suggesting that CT can contribute to improving prognosis following OHCA.

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