Characteristics of a novel citizen rescue system for out-of-hospital cardiac arrest in the Dutch province of Limburg: relation to incidence and survival.

BACKGROUND: We evaluated the characteristics of a novel text message system notifying citizen rescuers in cases of out-of-hospital circulatory arrest (OHCA) in the Dutch province of Limburg, including their relation to incidence and survival. METHODS AND RESULTS: The study area comprised 2,153 km2 (831 mi2) with 1.12 mio. inhabitants. During the 2­year study period approximately 9,000 volunteers were registered, about 60% male, 59% with no experience in actual resuscitation, and 27.4% healthcare professionals. The system was not activated in 557 of 1,085 (51.3%) OHCAs, frequently because there was no resuscitation setting present yet at the time of the emergency call. Rescuers were notified on 1,076 occasions, with no resuscitation setting being present in 548 of 1,076 (50.9%) notifications. OHCA incidence rates were 67 per 100,000 inhabitants per year, 95 per 100,000 men and 39 per 100,000 women standardised for age with the European Standard Population. The mean number of notifications per volunteer was 1.3 times per year. Higher volunteer density was related to increased survival if at least one volunteer attended the cardiac arrest. If the density exceeded 0.75%, survival increased to 34.8% compared to 20.6% at a density below 0.25%. CONCLUSION: In about half of OHCAs needing resuscitation the system was activated and in approximately half of the notifications resuscitation proved to be justified. Volunteers are notified 1.3 times per year on average. Survival was related to volunteer density, suggesting that further improvement can be achieved by increasing the number of citizen rescuers.

Correction to: Circumstances and causes of sudden circulatory arrests in the Dutch province of Limburg and the involvement of citizen rescuers.

Correction to:Neth Heart J 2017 https://doi.org/10.1007/s12471-017-1057-1 In the version of the article originally published online, there was an error in the last section of the Discussion. It is stated that 'In 42% of the OHCAs a volunteer alert would have been appropriate, but the alert system ….

Circumstances and causes of sudden circulatory arrests in the Dutch province of Limburg and the involvement of citizen rescuers.

BACKGROUND: Recently we showed that a citizen volunteer system using text message alerts improves survival of out-of-hospital sudden circulatory arrest (OHCA). It is important to characterise the OHCA population encountered by the volunteers regarding circumstances and causes of the arrests. METHODS AND RESULTS: Eligible for this study were 968 OHCAs that occurred between April 2012 and April 2014 in the Dutch province of Limburg. The distribution of causes of OHCA, patient characteristics and resuscitation settings were compared between 492 arrests wherein volunteers were notified and 476 arrests where the dispatcher decided not to do so. In case of notification, the cause of OHCA was known in 345 cases and of cardiac origin (treatable) in 83.2% (287/345). About 41% of the cardiac arrests were caused by acute or chronic coronary artery disease. OHCA occurred within the home environment in about 84%. The OHCA was witnessed in 75% of the cases. In 60.9% of the cases a witness or bystander had already started basic life support. However, in approximately 18% of the OHCAs the volunteer was the first to start basic life support before arrival of the ambulance. In about 75% of the OHCAs the ambulance arrived at 6 minutes or later after time of notification by the dispatch centre. CONCLUSION: The volunteer system is predominantly activated in situations for which it was developed; cases with cardiac aetiology (58%) and cases in the home environment (84%). The majority of patients encountered by the volunteers had 'hearts too good to die', underscoring the benefit of deploying citizen rescuers in programs to improve survival of OHCA.

Out-of-hospital cardiac arrest: the prospect of E-CPR in the Maastricht region.

AIM: The current outcome of out-of-hospital cardiac arrest (OHCA) patients in the Maastricht region was analysed with the prospect of implementing extracorporeal cardiopulmonary resuscitation (E-CPR). METHODS: A retrospective analysis of adult patients who were resuscitated for OHCA during a 24-month period was performed. RESULTS: 195 patients (age 66 [57-75] years, 82 % male) were resuscitated for OHCA by the emergency medical services and survived to admission at the emergency department. Survival to hospital discharge was 46.2 %. Notable differences between non-survivors and survivors were observed and included: age (70 [58-79] years) vs. (63 [55-72] years, p = 0.01), chronic heart failure (18 vs. 7 %, p = 0.02), shockable rhythm (67 vs. 99 %, p < 0.01), and return of spontaneous circulation (ROSC) at departure from the site of the arrest (46 vs. 99 %, p < 0.01) and on arrival to the emergency department (43 vs. 98 %, p < 0.01), respectively. Acute coronary syndrome was diagnosed in 32 % of non-survivors vs. 59 % among survivors, p < 0.01. Therapeutic hypothermia was provided in non-survivors (20 %) vs. survivors (43 %), p < 0.01. Percutaneous coronary intervention (PCI) was performed in 14 % of non-survivors while 52 % of survivors received PCI (p < 0.01). No statistical significance was observed in terms of gender, witnessed arrest, bystander CPR, or automated external defibrillator deployed among the cohort. At hospital discharge, moderately severe neurological disability was present in six survivors. CONCLUSION: These observations are compatible with the notion that a shockable rhythm, ROSC, and post-arrest care improve survival outcome. Potentially, initiating E-CPR in the resuscitation phase in patients with a shockable rhythm and no ROSC might serve as a bridge to definite treatment and improve survival outcome.

Measuring outcome after cardiac arrest: construct validity of Cerebral Performance Category.

INTRODUCTION: Approximately half of the survivors of cardiac arrest have cognitive impairments due to hypoxic brain injury. To describe the outcome after a cardiac arrest, the Cerebral Performance Category (CPC) is frequently used. Although widely used, its validity is still debatable. OBJECTIVE: To investigate the construct validity of the Cerebral Performance Category in survivors of a cardiac arrest. Participants were 18 years and older that survived a cardiac arrest more than six months. METHODS: Cross-sectional design. A method to administer the CPC in a structured and reproducible manner was developed. This 'Structured CPC' was administered by a structured interview. Construct variables were Cognitive Failure Questionnaire (CFQ), Barthel Index (BI), Frenchay Activity Index (FAI), Community Integration Questionnaire (CIQ) and Quality of Life after Brain Injury (Qolibri). Associations were tested based on Spearman correlation coefficients. RESULTS: A total of 62 participants responded. In 58 (94%) patients the CPC was determined, resulting in CPC 1 (48%), CPC 2 (23%) and CPC 3 (23%). The CPC-scoring correlated significantly with the CFQ (r=-0.40); BI (r=-0.57); FAI (r=-0.65), CIQ (r=-0.53) and Qolibri (r=-0.67). DISCUSSION AND CONCLUSIONS: In this study we developed the 'Structured CPC' to improve the transparency and reproducibility of the original CPC. A moderate correlation between the 'Structured CPC' and the constructs 'activities', 'participation' and 'quality of life' confirmed the validity of the 'Structured CPC'. CLINICAL MESSAGE: The 'Structured CPC' can be used as an instrument to measure the level of functioning after cardiac arrest.

Locally advanced verrucous carcinoma of the oral cavity: treatment using customized mold HDR brachytherapy instead of hemi-maxillectomy.

BACKGROUND: Oral verrucous carcinomas are locally invasive but rarely metastasize. Current treatment options include surgery and external beam radiotherapy (EBRT). In medical inoperable patients or irresectable tumors, high-dose-rate (HDR) brachytherapy is a valid alternative. CASE: We present an 85-year-old man with functionally irresectable cT3N0M0 verrucous carcinoma superficially spreading along the upper alveolar ridge to the retro-alveolar triangle, with infiltration of the left soft and hard palate and buccal mucosa. Using a customized intraoral mold, this patient was treated with HDR brachytherapy delivering a dose of 48 Gy in 12 fractions three times per week. Treatment was well tolerated, and after prolonged confluent mucositis the tumor is in complete remission. REVIEW OF LITERATURE AND CONCLUSION: The scarce literature on customized mold HDR brachytherapy in maxillary tumors is reviewed and recommendations for other head and neck tumors are given.