Dispatcher assessments for agonal breathing improve detection of cardiac arrest.

AIM OF STUDY: To determine if a new protocol can increase the detection of agonal respirations by emergency medical dispatchers and thus the presence of cardiac arrest. METHODS: This is a prospective before and after study performed in a large metropolitan city. Cases were identified by review of all cardiac arrests called into a central medical control office. Data were collected through review of tapes and documentation obtained from routine quality assurance audits of these cardiac arrests at the dispatch office as well as reports written by paramedics at the scene of each case. Data were collected for 8 months prior to and 4 months after the implementation of a new dispatcher protocol designed to identify the presence of agonal breathing which included counting the respiratory rate, holding the phone next to the patient, and identifiers used to describe this type of breathing. RESULTS: During the 8 months prior to implementation of the new protocol, no patient had agonal respirations detected compared with 22 patients detected in the 4 months after implementation. The percentage of patients who did not have EMD criteria for cardiac arrest, but actually were in cardiac arrest decreased from 28.0% (168/599) to 18.8% (68/362; p=0.0012). Survival to ED admission was similar between the two groups. Bystanders started CPR significantly more frequently after the new protocol was instituted (60.9% before vs. 71.5% afterward, p=0.006). CONCLUSION: Introduction of a new 9-1-1 dispatcher assessment protocol to assess for the presence of agonal respirations can significantly increase the detection cardiac arrest over the telephone.

Mechanical devices for cardiopulmonary resuscitation.

PURPOSE OF REVIEW: The most current practice guidelines for cardiopulmonary resuscitation published by the American Heart Association and European Resuscitation Council have placed the highest priority on achieving the most optimal circulation possible following sudden cardiac arrest through the delivery of early, consistent, high-quality and infrequently interrupted chest compressions during resuscitative efforts. The purpose of this review is to analyze the most recent trials involving adjunct mechanical devices designed to optimize blood flow to vital organs during cardiopulmonary resuscitation conditions. RECENT FINDINGS: Six devices show substantial promise based on the compelling results of numerous animal and small-scale clinical trials. All of these promising interventions, however, have yet to be validated in definitive clinical trials, particularly those examining long-term survival and neurological function. SUMMARY: Markedly enhanced circulation during cardiopulmonary resuscitation efforts has been found to be a critical element for effecting successful resuscitation. Preliminary studies of adjunct mechanical cardiopulmonary resuscitation devices have revealed significant increases in improved hemodynamics in both animal models and human studies, as well as improvements in short-term human survival in the clinical setting. Several of these devices are currently undergoing definitive clinical trials that hopefully will establish irrefutable efficacy and improved long-term neurological outcomes.