Utstein Style for emergency care - the first 30 years.

BACKGROUND: Utstein Abbey near Stavanger in Norway, hosted a meeting in 1990 on guidelines for the uniform reporting of data from out-of-hospital cardiac arrest. In this paper we describe the last 30 years of the Utstein style. METHODS: A systematic literature search identified publications from Utstein-style meetings or groups using the Utstein format. RESULTS: 30 outputs were found, describing primarily resuscitation structure, process and outcome measures. They originated from all over the world and from multiple medical disciplines. Some were co-published in multiple journals. CONCLUSIONS: The meeting at Utstein Abbey in 1990 has had a sustained and far-reaching impact, particularly in resuscitation science, implementation and outcomes. The Utstein format will continue to evolve following the key principles from the original meeting and with the ultimate aim of improving patient care and outcomes.

Data concerning the Copenhagen tool: A research tool for evaluation of basic life Support educational interventions.

The data presented in this article are supplementary data related to the research article entitled "The Copenhagen Tool: A research tool for evaluation of BLS educational interventions" (Jensen et al., 2019). We present the following supplementary materials and data: 1) a standardized scenario used to introduce the test for gathering data on internal structure and additional response process; 2) test sheets used for rating test participant via video recordings; 3) interview-guide for collecting additional response process data; 4) items deemed relevant but not essential for laypersons, first responders and health personnel in the modified Delphi consensus process; 5) inter-rater reliability values for raters using the essential items of the tool to evaluate test participants via video recordings; 6) main themes from coding interviews with raters; 7) comparison of rater results and manikin software output.

The Copenhagen Tool a research tool for evaluation of basic life support educational interventions.

INTRODUCTION: Over the past decades, major changes have been made in basic life support (BLS) guidelines and manikin technology. The aim of this study was to develop a BLS evaluation tool based on international expert consensus and contemporary validation to enable more valid comparison of research on BLS educational interventions. METHODS: A modern method for collecting validation evidence based on Messick's framework was used. The framework consists of five domains of evidence: content, response process, internal structure, relations with other variables, and consequences. The research tool was developed by collecting content evidence based on international consensus from an expert panel; a modified Delphi process decided items essential for the tool. Agreement was defined as identical ratings by 70% of the experts. RESULTS: The expert panel established consensus on a three-levelled score depending on expected response level: laypersons, first responders, and health care personnel. Three Delphi rounds with 13 experts resulted in 16 "essential" items for laypersons, 21 for first responders, and 22 for health care personnel. This, together with a checklist for planning and reporting educational interventional studies within BLS, serves as an example to be used for researchers. CONCLUSIONS: An expert panel agreed on a three-levelled score to assess BLS skills and the included items. Expert panel consensus concluded that the tool serves its purpose and can act to guide improved research comparison on BLS educational interventions.

The International Liaison Committee on Resuscitation-Review of the last 25 years and vision for the future.

2017 marks the 25th anniversary of the International Liaison Committee on Resuscitation (ILCOR). ILCOR was formed in 1992 to create a forum for collaboration among principal resuscitation councils worldwide. Since then, ILCOR has established and distinguished itself for its pioneering vision and leadership in resuscitation science. By systematically assessing the evidence for resuscitation standards and guidelines and by identifying national and regional differences, ILCOR reached consensus on international resuscitation guidelines in 2000, and on international science and treatment recommendations in 2005, 2010 and 2015. However, local variation and contextualization of guidelines are evident by subtle differences in regional and national resuscitation guidelines. ILCOR's efforts to date have enhanced international cooperation, and progressively more transparent and systematic collection and analysis of pertinent scientific evidence. Going forward, this sets the stage for ILCOR to pursue its vision to save more lives globally through resuscitation.

Distinguishing between those dying suddenly or not suddenly from coronary heart disease: long-term prospective results from the Northwick Park Heart Study.

AIM: To establish whether ECG findings are associated with subsequent risk of sudden death from coronary heart disease (CHD). METHODS AND RESULTS: Potential risk factors for CHD were measured at entry to the first Northwick Park Heart Study of 2167 men. ECG findings were coded as high or low risk for CHD according to definitions in the Minnesota code. Sudden or non-sudden deaths were defined as occurring in less than or more than 24 hours, respectively. The only factor independently associated with sudden death among the 262 men dying of CHD was high-risk ECG. Of 184 sudden CHD deaths, 34 men (18.5%) had had high-risk ECGs at entry to the study compared with 5 (6.4%) of 78 men who experienced non-sudden deaths (adjusted OR 3.94 (95% CI 1.33 to 11.67)) (p=0.006). Findings were also compared among all 2167 men, where high-risk ECGs were again associated with sudden death. T-wave changes were the main abnormalities associated with a high risk of sudden death. CONCLUSIONS: In a group of men who had not previously experienced major episodes of CHD but who subsequently died from it, there was strong evidence that high-risk ECG changes, mainly T-wave abnormalities, differentiated between those who later died sudden deaths and those who survived for >24 hours.

Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome.

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome.

Increases in survival from out-of-hospital cardiac arrest: a five year study.

OBJECTIVE: This study reports improvements in survival from out-of-hospital cardiac arrest in London over a five year period from 2007 to 2012 and explores the potential reasons for the very striking increases observed. METHODS: Data from the London Ambulance Service's cardiac arrest registry from 2007 to 2012 were analysed retrospectively for all patients who met the Utstein comparator group criteria (an arrest of a presumed cardiac cause that was bystander witnessed with an initial rhythm of VF/VT). RESULTS: We observed an increase in survival from out-of-hospital cardiac arrest during the five year period, with incremental improvements each year from 12% to 32% for the Utstein comparator group of patients. CONCLUSION: We suggest that a range of important changes made to pre-hospital cardiac care in London over the last five years have contributed to the observed increase in survival over the study period. In addition we advocate a range of further initiatives to continue improving survival from out-of-hospital cardiac arrest.

The study protocol for the LINC (LUCAS in cardiac arrest) study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation.

BACKGROUND: The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS™ device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. METHODS/DESIGN: This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1). RESULTS: Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. CONCLUSION: This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS™ device when used in association with defibrillation during on-going CPR.

Comparison of prescription drug costs in the United States and the United Kingdom, part 2: proton pump inhibitors.

STUDY OBJECTIVE: To compare the annual cost of proton pump inhibitors (PPIs) in the United States and in the United Kingdom. DESIGN: Matched-cohort cost analysis. DATA SOURCES: U.K. General Practice Research Database (GPRD) and MarketScan Commercial Claims and Encounter Database, a large, U.S. self-insured medical claims database. STUDY POPULATION: We initially identified more than 1 million people in the GPRD who were younger than 65 years of age and who were prescribed at least one prescription drug in 2005. Each of these people was then matched by year of birth and sex to one person in the U.S. database. From the matched pool, we estimated that 280,000 people were aged 55-64 years from each country. Of these, an estimated 27,230 (9.7%) in the U.S. were prescribed a PPI compared with 22,560 (8.1%) in the U.K. After excluding patients who did not receive the PPI continuously or who switched PPIs during the year, there remained 11,292 people in the U.S. and 9923 in the U.K. who were prescribed a single PPI preparation continuously during 2005 (annual PPI users). MEASUREMENTS AND MAIN RESULTS: Annual drug costs were determined by random sampling. The estimated annual cost/patient in the U.S. ranged from $901 for generic omeprazole to $1485 for lansoprazole. In the U.K., the annual costs were similar, approximately $400 for each PPI, irrespective of whether the agents were available in generic formulation. The total estimated annual cost of PPIs for 2005 in this study group was $14 million in the U.S. compared with $4.1 million in the U.K. CONCLUSION: The cost of continuous use of PPIs covered by private insurance companies in the U.S. in 2005 was more than 3 times the cost covered by the U.K. government. This result is consistent with the findings of an earlier study on relative costs of statins between the countries.

Protocol C: a nonguidelines-compliant approach to improve survival of patients with out-of-hospital cardiac arrest.

PURPOSE OF REVIEW: To describe a resuscitation protocol for out-of-hospital cardiac arrest designed for healthcare professionals that demands more from rescuers than does conventional cardiopulmonary resuscitation. It was introduced with the aim of improving survival that has remained disappointingly poor worldwide. RECENT FINDINGS: Survival to hospital discharge, that could be measured accurately in one city, improved appreciably with the use of the novel protocol. The implications are discussed in relation to the scientific background and relevant literature. SUMMARY: Uniform resuscitation protocols for lay and for professional use may not be appropriate. Only randomized trials can indicate the potential value of this challenge to conventional wisdom.

Utstein-style audit of Protocol C: a non-standard resuscitation protocol for healthcare professionals.

INTRODUCTION: International guidelines for basic life support and defibrillation are identical for lay people and healthcare professionals. In 2002, a small meeting hosted by the Resuscitation Council (UK) debated recent advances in resuscitation science, along with the possibility of more demanding procedures for treating out of hospital cardiac arrest (OHCA) that could take advantage of the expertise available with professional use. The resulting algorithm known as Protocol C could not be tested in a randomized trial for reasons relating to consent, but was introduced by one ambulance service as an observational study. Results from a 2-year period from one city within the service area are presented, using the Utstein style of reporting to show the recommended 'comparator' group whilst also providing epidemiological data on the frequency of cardiac arrest within the community and the outcome of all resuscitation attempts. METHODS: Manual methods were used to collect data from 2009 and 2010 for cases of cardiac arrest treated by crews from the two ambulance stations within the city of Brighton and Hove. All transported patients were tracked individually through the hospital because no official method of data linkage is available. Outcome data were obtained for survival to hospital discharge, or to 30 days for the few who remained in hospital care for that duration. RESULTS: In the epidemiological analysis, 454 patients with OHCA were treated over 2 years, of whom 151 (33%) had sustained return of spontaneous circulation (ROSC) at hospital handover and 59 (13%) survived to discharge or for 30 days. Within the 'comparator' group of 79 patients, 47 (59%) achieved sustained ROSC to hospital handover and 24 (30%) survived. CONCLUSION: The use of Protocol C has been associated with rates of sustained ROSC to hospital and of survival to discharge that have reached the range of international best practice. The improvement noted in this observational study cannot be ascribed to the new protocol alone; any wider use should await randomized trials to test the impact of this single variable. Meanwhile, wider adoption of the Utstein system to compare results for treatment of OHCA will provide a potent stimulus for emergency services to seek ways of improving outcome.