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A text Message Alert System For Trained Volunteers Improves Out-of-Hospital Cardiac Arrest Survival
The Journal of Emergency Medicine, Vol. 51, No. 5, pp. 612–619, 2016 0736-4679/$ - see front matter
Abstracts , A TEXT MESSAGE ALERT SYSTEM FOR TRAINED VOLUNTEERS IMPROVES OUT-OF-HOSPITAL CARDIAC ARREST SURVIVAL. Pills RWM, Nelemans PJ, Rahel BM, et al. Resuscitation. 2016;105:182-187 Previous data suggest that survival rates for sudden out-ofhospital circulatory arrest (OHCA) increase when basic life support (BLS) and defibrillation using an Automatic External Defibrillator (AED) is implemented rapidly. While ambulances aim to deliver rapid life-saving measures, their arrival to emergency situations can be delayed. Therefore, it is prudent that other systems be instituted to ensure expeditious BLS and defibrillation to OHCA victims. This was a prospective, population-based survey that evaluated consecutive OHCA resuscitative cases in a well-defined area within the Netherlands over a 24 month period. The goal of this study was to evaluate whether OHCA outcomes improved when trained citizen volunteers responded to OHCA situations via a text message (TM) alert system. When emergency medical services (EMS) was called for a suspected OHCA, a TM would direct volunteers to nearby OHCA victims to either start BLS (1/3 notifications) or to obtain an AED (2/3 notifications) in close proximity. Comparison measures between two scenarios were used. In scenario 1, no volunteers arrived to the OHCA victim prior to EMS so standard care was used. In scenario 2, at least one volunteer arrived to the OHCA victim prior to EMS arrival. The primary outcome was the proportion of OHCA victims who survived to hospital discharge. Secondary outcomes included the proportion of OHCA patients with prehospital return of spontaneous circulation (ROSC), the proportion of patients discharged to a rehab center or nursing home, and Modified Rankin score (mRS) at hospital discharge. Odds ratio as a measure of relative risk with a 95% confidence interval (CI) was used to assess whether presence of TM volunteers improved probability of survival rates of OHCA victims with scenario 1 as a reference group. Multivariable logistic regression analysis was used to assess scenario 2 contributions to OHCA survival rates while adjusting for differences in the two groups. During the 24-month study period there were 1,546 OHCA EMS notifications of which 1,040 underwent resuscitative measures. The TM alert system was activated in only 422 of these instances. Of the 422 presumed OHCA for which the TM alert system was activated, $1 TM volunteer was present in 291 cases (scenario 2) and no TM volunteers (scenario 1) attended in 131 cases. Survival to hospital discharge of 27.1% (79/291) in scenario 2 was significantly higher than 16% (21/131) in
scenario 1. Most notably, patients in scenario 2 had a higher percentage of survival at hospital discharge with an odds ratio of 2.82 (95% CI 1.52-5.24) when potential confounding variables were corrected using multivariable logistic regression analysis. Additionally, of the 1100 patients that survived to hospital discharge, 92 were discharged home while the remainder went to a rehabilitation center/nursing home. The authors concluded that implementation of a TM alert system is effective at increasing survival to hospital discharge for OHCA victims. The investigators also suggest that the survival rates could improve with a higher density and availability of TM volunteers. [Alexa Camarena-Michel, MD Denver Health Medical Center, Denver, CO] Comment: This study corroborates that early BLS/defibrillation of OHCA patients improves survival rates. Additional prospective, randomized controlled trials of the effect of a TM alert system on survival to hospital discharge after OHCA are necessary to gain a more complete understanding of the impact of the TM alert on OHCA outcomes. , COST-EFFECTIVENESS OF HIV PREEXPOSURE PROPHYLAXIS FOR PEOPLE WHO INJECT DRUGS IN THE UNITED STATES. Bernard CL, Brandeau ML, Humphreys K, et al. Ann Intern Med. 2016;165:10-19 People who inject drugs (PWID) comprise a large share of new human immunodeficiency virus (HIV) infections. Although prior studies have demonstrated cost-effectiveness of preexposure prophylaxis (PrEP) for men who have sex with men (MSM), no studies have been done to evaluate the benefits and costs of enacting a PrEP practice for PWID. The goal of the analysis was to develop a model of the HIV epidemic reflecting the costs and benefits of implementing a national program for PrEP in the PWID population in the United States. The model reflected a 20-year time horizon (20152035) and took many variables into account including cost of PrEP, PrEP efficacy, and HIV transmission characteristics. According to the Centers for Disease Control and Prevention (CDC), PrEP consists of a daily oral medication in conjunction with clinical practices such as HIV screening every 3 months and medication toxicity monitoring every 6 months. In order to isolate the effects of each of these recommendations, 3 scenarios were designed. Scenario 1 evaluated PrEP alone. Scenario 2 evaluated PrEP as well as HIV screening and toxicity monitoring (PrEP+screen). Scenario 3 implemented the same 612
Abstracts , A TEXT MESSAGE ALERT SYSTEM FOR TRAINED VOLUNTEERS IMPROVES OUT-OF-HOSPITAL CARDIAC ARREST SURVIVAL. Pills RWM, Nelemans PJ, Rahel BM, et al. Resuscitation. 2016;105:182-187 Previous data suggest that survival rates for sudden out-ofhospital circulatory arrest (OHCA) increase when basic life support (BLS) and defibrillation using an Automatic External Defibrillator (AED) is implemented rapidly. While ambulances aim to deliver rapid life-saving measures, their arrival to emergency situations can be delayed. Therefore, it is prudent that other systems be instituted to ensure expeditious BLS and defibrillation to OHCA victims. This was a prospective, population-based survey that evaluated consecutive OHCA resuscitative cases in a well-defined area within the Netherlands over a 24 month period. The goal of this study was to evaluate whether OHCA outcomes improved when trained citizen volunteers responded to OHCA situations via a text message (TM) alert system. When emergency medical services (EMS) was called for a suspected OHCA, a TM would direct volunteers to nearby OHCA victims to either start BLS (1/3 notifications) or to obtain an AED (2/3 notifications) in close proximity. Comparison measures between two scenarios were used. In scenario 1, no volunteers arrived to the OHCA victim prior to EMS so standard care was used. In scenario 2, at least one volunteer arrived to the OHCA victim prior to EMS arrival. The primary outcome was the proportion of OHCA victims who survived to hospital discharge. Secondary outcomes included the proportion of OHCA patients with prehospital return of spontaneous circulation (ROSC), the proportion of patients discharged to a rehab center or nursing home, and Modified Rankin score (mRS) at hospital discharge. Odds ratio as a measure of relative risk with a 95% confidence interval (CI) was used to assess whether presence of TM volunteers improved probability of survival rates of OHCA victims with scenario 1 as a reference group. Multivariable logistic regression analysis was used to assess scenario 2 contributions to OHCA survival rates while adjusting for differences in the two groups. During the 24-month study period there were 1,546 OHCA EMS notifications of which 1,040 underwent resuscitative measures. The TM alert system was activated in only 422 of these instances. Of the 422 presumed OHCA for which the TM alert system was activated, $1 TM volunteer was present in 291 cases (scenario 2) and no TM volunteers (scenario 1) attended in 131 cases. Survival to hospital discharge of 27.1% (79/291) in scenario 2 was significantly higher than 16% (21/131) in
scenario 1. Most notably, patients in scenario 2 had a higher percentage of survival at hospital discharge with an odds ratio of 2.82 (95% CI 1.52-5.24) when potential confounding variables were corrected using multivariable logistic regression analysis. Additionally, of the 1100 patients that survived to hospital discharge, 92 were discharged home while the remainder went to a rehabilitation center/nursing home. The authors concluded that implementation of a TM alert system is effective at increasing survival to hospital discharge for OHCA victims. The investigators also suggest that the survival rates could improve with a higher density and availability of TM volunteers. [Alexa Camarena-Michel, MD Denver Health Medical Center, Denver, CO] Comment: This study corroborates that early BLS/defibrillation of OHCA patients improves survival rates. Additional prospective, randomized controlled trials of the effect of a TM alert system on survival to hospital discharge after OHCA are necessary to gain a more complete understanding of the impact of the TM alert on OHCA outcomes. , COST-EFFECTIVENESS OF HIV PREEXPOSURE PROPHYLAXIS FOR PEOPLE WHO INJECT DRUGS IN THE UNITED STATES. Bernard CL, Brandeau ML, Humphreys K, et al. Ann Intern Med. 2016;165:10-19 People who inject drugs (PWID) comprise a large share of new human immunodeficiency virus (HIV) infections. Although prior studies have demonstrated cost-effectiveness of preexposure prophylaxis (PrEP) for men who have sex with men (MSM), no studies have been done to evaluate the benefits and costs of enacting a PrEP practice for PWID. The goal of the analysis was to develop a model of the HIV epidemic reflecting the costs and benefits of implementing a national program for PrEP in the PWID population in the United States. The model reflected a 20-year time horizon (20152035) and took many variables into account including cost of PrEP, PrEP efficacy, and HIV transmission characteristics. According to the Centers for Disease Control and Prevention (CDC), PrEP consists of a daily oral medication in conjunction with clinical practices such as HIV screening every 3 months and medication toxicity monitoring every 6 months. In order to isolate the effects of each of these recommendations, 3 scenarios were designed. Scenario 1 evaluated PrEP alone. Scenario 2 evaluated PrEP as well as HIV screening and toxicity monitoring (PrEP+screen). Scenario 3 implemented the same 612