- Email: [email protected]
AS19 Engaging a whole community in resuscitation
S6
Abstracts, Resuscitation 2011 – Implementation / Resuscitation 82S1 (2011) S1–S34
AS19
AS21
Engaging a whole community in resuscitation
Significant decreases in amplitude spectrum area during pre-defibrillation pauses in chest compression in out-of-hospital cardiac arrest patients
Anne Møller Nielsen 1 , Dan Lou Isbye 1 , Freddy Lippert 2 , Lars Rasmussen 1 1 Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark 2 Head Office, The Capital Region of Denmark, Hillerød, Denmark
Giuseppe Ristagno 1 , Weilun Quan 2 , Qing Tan 2 , Frederick Geheb 2 , Gary Freeman 2 , Wanchun Tang 3 1 2
Background: Survival after out-of-hospital cardiac arrest (OHCA) is influenced by each link in the chain of survival. On the Danish island of Bornholm (population 42,000, area 588 km2 ) 22% of witnessed OHCA patients (2004) received bystander basic life support (BLS) and none survived an OHCA in 2001–2003. Therefore, a project was conducted aiming to improve survival by strengthening each link in the chain of survival combined with a mass media focus on resuscitation. Materials and Methods: Laypersons completed a 24-min DVD-based-selfinstruction BLS course or 4-h BLS/AED courses. The local television station had broadcasts about resuscitation. The ambulance attendants were trained and the staff at the island hospital completed a BLS course or more advanced courses. A telephone survey assessed attitudes regarding resuscitation among randomly selected citizens before (N=824) and after (N=815) the intervention. Results: During 2 years 9.226 people (22% of the population) completed the short course and 2.453 (6% of the population) completed the 4-h course. The number of automated external defibrillators (AEDs) increased from 3 to 147. AEDs were used in 7 cases of OHCA (N=98).The telephone survey revealed that the proportions of citizens who would definitely provide chest compressions and mouth-to-mouth ventilation before and after the project were 59% and 63% (p=0.11), and 58% and 59% (p=0.65), respectively. The proportion willing to use an AED increased from 44% to 65% (p<0.0001).The bystander BLS rate for all-aetiology witnessed OHCA patients (N=40) increased from 22% [95% CI: 3–60] in 2004 to 67.5% [95% CI: 52–80]. Survival to discharge for all-aetiology, all rhythms OHCA (N=96) was 5.2% [95% CI: 2–12], and the survival to discharge for witnessed all-aetiology OHCA with initial shockable rhythm (N=15) was 20% [95% CI: 6–46]. Conclusion: Strengthening all links in the chain of survival was associated with significant increases in bystander BLS rates and survival after out-of-hospital cardiac arrest.
3
Mario Negri Institute, Milan, Italy Zoll Medical Corp., Chelmsford, MA, USA Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA
Introduction: Interruptions in chest compression (CC) cause important decreases in coronary perfusion and translate into major compromises in the success of resuscitation efforts and outcomes. Amplitude spectrum area (AMSA), which is calculated by fast Fourier transformation of ventricular fibrillation (VF) waveform, has been recognized as an accurate predictor of successful defibrillation (DF), as well as valid monitor of the effectiveness of chest compression. Accordingly, AMSA is related to heart perfusion and viability during CPR. We therefore hypothesized that pre-DF pauses, causing reduction in heart perfusion, will yield to AMSA decreases overtime. Methods: ECG data were obtained from patients through an internal registry of ZOLL AED Pro and AED Plus defibrillators from multiple areas in the US. The sampling rate of the ECG data files was 250 Hz. AMSA was calculated every 256 points, representing respectively 1.05 sec ECG windows, throughout a 16 sec pre-DF pause observed before each DF attempt, due to rhythm analyses and defibrillator charge. Changes in AMSA values during the pause were compared at the beginning of CC interruption, and 8 and 16 secs later. Results: A total of 1162 DF attempts from 489 cardiac arrest patients were included in the analyses. AMSA decreased during the 16 sec pre-DF pauses from 6.3 at the beginning, to 5.6 and 5.3 mV Hz, after 8 and 16 secs respectively (p<0.0001). Considering only the first DF attempts (n=489), AMSA decreased more pronouncedly during pauses, from 7.2 at the beginning, to 6.2 and 5.7 mV Hz, after 8 and 16 secs respectively (p<0.0001). Conclusions: Pre-DF pauses caused significant decreases in AMSA over the 16 sec interval. These decreases in AMSA might be directly related to the reduced myocardial perfusion and ultimately anticipate decreases in DF success.
AS22 AS20 The relationship between team leadership behaviour and quality of CPR Joyce Yeung 1 , Robin Davies 1 , Gavin Perkins 2 1 2
Heart of England NHS Foundation Trust, Birmingham, UK Warwick Medical School, University of Warwick, Warwick, UK
Impact of dispatch-assisted CPR instructions on bystander CPR and survival rates: A before-after multi-centre study Christian Vaillancourt 1 , Ann Kasaboski 3 , Manya Charette 3 , Stanley Morrow 2 , George A. Wells 4 , Ian G. Stiell 1 1
Univeristy of Ottawa, Ottawa, Ontario, Canada Ottawa Paramedic Service, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada 4 University of Ottawa Heart Institute, Ottawa, Ontario, Canada 2
Background: The quality of CPR is of critical importance in determining patient outcome. The contribution of team leadership behaviour on technical skills has not been clearly determined. This study aims to identify the relationship between leadership behaviour and quality of CPR and characteristics of a teamleader that is associated with better team leadership skills. Materials and Methods: 40 advanced life support (ALS) providers were videotaped leading a team in during a standardised cardiac arrest simulation. Participants included both doctors and allied health professionals. Background data were collected including age, gender, professional group, date of last ALS course attended, ALS instructor/provider status (I/P) and leading of any cardiac arrest in the preceding 6 months. Videos were reviewed independently by 2 reviewers. Each participant was scored independently by 2 reviewers using the CASTest score and Leadership Behaviour Description Questionnaire (LBDQ) for leadership skills. Process-focused quality of CPR data was collected directly from manikin and video recordings. Multiple regression analyses were performed to examine how the background of the team leader affects leadership and performance. Results: Good leadership skills were associated with significantly better overall technical performance as measured by CASTest performance score (R2 Linear = 0.752, p<0.001). Team leaders with better leadership score performed better quality of CPR with significantly shorter time to first shock (p=0.001) and pre-shock pauses (p=0.002); with lower hands off ratio approaching significance (p=0.057). After multiple regression analyses, ALS instructor status was the only significant background factor associated with better performance (I 89.5/100 [85.3/100–93.7/100] vs P 70.3/100 [66.6/100–74.1/100], p<0.001) and leadership skills (I 30.4/40 [28.1/4– 32.8/40] vs P 19.4/40 [17.4/40–21.4/40], p<0.001). Conclusions: There is an association between team leadership behaviours and overall quality of CPR. Developing leadership behaviours should be considered an integral part of resuscitation training. Research into the leadership behaviour and quality of CPR in real life is needed.
3
Introduction: There currently exist no study powerful enough to conclude in a survival benefit from 9-1-1 dispatch-assisted CPR instructions. We sought to determine the definite impact of such instructions on bystander CPR and survival to hospital discharge rates for adult out-of-hospital cardiac arrest (OOHCA) victims. Methods: We conducted the only ethically possible study, a before-after trial enrolling OOHCA patients not witnessed by EMS for which resuscitation was attempted in seven cities, with a BLS-D/ALS tiered EMS service. We measured victim and system characteristics during a 44-month period before the introduction of dispatch-assisted CPR instructions (April, 2004), and during the 35-month period following a study run-in phase to reach our 6,000-case required sample size. Prospective data collection and quality was standardized for all communities. Data analyses include descriptive statistics, attributable risk (AR) with Student’s t-test, adjusted OR with 95% CI, and time series analyses. Results: There were 2,942 cases between Aug. 1, 2000 and March 30, 2004, and 3,293 cases between Jan. 1, 2007 and Oct. 31, 2009. Victim characteristics were similar in the before and after groups: mean age 68.5, male 66.9%, witnessed 43.4%, residential location 85.3%, except for initial rhythm VF/VT which was higher in the before 30.6% compared to the after 25.0% group. Bystander CPR rates increased from 15.0% to 28.7% from the before to the after group (AR 13.7%; 95% CI: 11.7–15.7%, p<0.0001). Similarly, survival increased from 4.1% to 5.2% (AR 1.1%; 95% CI: 0.0–2.1%, p=0.05). The adjusted OR of survival as a result of dispatch-assisted CPR instructions is 1.45; 95% CI: 1.01–2.09. Conclusions: This is the first study powerful enough to determine a bystander CPR and survival to hospital discharge benefit from dispatch-assisted CPR instructions. These results could significantly impact public health policies and the 2015 resuscitation guideline recommendations regarding CPR instructions.
Abstracts, Resuscitation 2011 – Implementation / Resuscitation 82S1 (2011) S1–S34
AS19
AS21
Engaging a whole community in resuscitation
Significant decreases in amplitude spectrum area during pre-defibrillation pauses in chest compression in out-of-hospital cardiac arrest patients
Anne Møller Nielsen 1 , Dan Lou Isbye 1 , Freddy Lippert 2 , Lars Rasmussen 1 1 Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark 2 Head Office, The Capital Region of Denmark, Hillerød, Denmark
Giuseppe Ristagno 1 , Weilun Quan 2 , Qing Tan 2 , Frederick Geheb 2 , Gary Freeman 2 , Wanchun Tang 3 1 2
Background: Survival after out-of-hospital cardiac arrest (OHCA) is influenced by each link in the chain of survival. On the Danish island of Bornholm (population 42,000, area 588 km2 ) 22% of witnessed OHCA patients (2004) received bystander basic life support (BLS) and none survived an OHCA in 2001–2003. Therefore, a project was conducted aiming to improve survival by strengthening each link in the chain of survival combined with a mass media focus on resuscitation. Materials and Methods: Laypersons completed a 24-min DVD-based-selfinstruction BLS course or 4-h BLS/AED courses. The local television station had broadcasts about resuscitation. The ambulance attendants were trained and the staff at the island hospital completed a BLS course or more advanced courses. A telephone survey assessed attitudes regarding resuscitation among randomly selected citizens before (N=824) and after (N=815) the intervention. Results: During 2 years 9.226 people (22% of the population) completed the short course and 2.453 (6% of the population) completed the 4-h course. The number of automated external defibrillators (AEDs) increased from 3 to 147. AEDs were used in 7 cases of OHCA (N=98).The telephone survey revealed that the proportions of citizens who would definitely provide chest compressions and mouth-to-mouth ventilation before and after the project were 59% and 63% (p=0.11), and 58% and 59% (p=0.65), respectively. The proportion willing to use an AED increased from 44% to 65% (p<0.0001).The bystander BLS rate for all-aetiology witnessed OHCA patients (N=40) increased from 22% [95% CI: 3–60] in 2004 to 67.5% [95% CI: 52–80]. Survival to discharge for all-aetiology, all rhythms OHCA (N=96) was 5.2% [95% CI: 2–12], and the survival to discharge for witnessed all-aetiology OHCA with initial shockable rhythm (N=15) was 20% [95% CI: 6–46]. Conclusion: Strengthening all links in the chain of survival was associated with significant increases in bystander BLS rates and survival after out-of-hospital cardiac arrest.
3
Mario Negri Institute, Milan, Italy Zoll Medical Corp., Chelmsford, MA, USA Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA
Introduction: Interruptions in chest compression (CC) cause important decreases in coronary perfusion and translate into major compromises in the success of resuscitation efforts and outcomes. Amplitude spectrum area (AMSA), which is calculated by fast Fourier transformation of ventricular fibrillation (VF) waveform, has been recognized as an accurate predictor of successful defibrillation (DF), as well as valid monitor of the effectiveness of chest compression. Accordingly, AMSA is related to heart perfusion and viability during CPR. We therefore hypothesized that pre-DF pauses, causing reduction in heart perfusion, will yield to AMSA decreases overtime. Methods: ECG data were obtained from patients through an internal registry of ZOLL AED Pro and AED Plus defibrillators from multiple areas in the US. The sampling rate of the ECG data files was 250 Hz. AMSA was calculated every 256 points, representing respectively 1.05 sec ECG windows, throughout a 16 sec pre-DF pause observed before each DF attempt, due to rhythm analyses and defibrillator charge. Changes in AMSA values during the pause were compared at the beginning of CC interruption, and 8 and 16 secs later. Results: A total of 1162 DF attempts from 489 cardiac arrest patients were included in the analyses. AMSA decreased during the 16 sec pre-DF pauses from 6.3 at the beginning, to 5.6 and 5.3 mV Hz, after 8 and 16 secs respectively (p<0.0001). Considering only the first DF attempts (n=489), AMSA decreased more pronouncedly during pauses, from 7.2 at the beginning, to 6.2 and 5.7 mV Hz, after 8 and 16 secs respectively (p<0.0001). Conclusions: Pre-DF pauses caused significant decreases in AMSA over the 16 sec interval. These decreases in AMSA might be directly related to the reduced myocardial perfusion and ultimately anticipate decreases in DF success.
AS22 AS20 The relationship between team leadership behaviour and quality of CPR Joyce Yeung 1 , Robin Davies 1 , Gavin Perkins 2 1 2
Heart of England NHS Foundation Trust, Birmingham, UK Warwick Medical School, University of Warwick, Warwick, UK
Impact of dispatch-assisted CPR instructions on bystander CPR and survival rates: A before-after multi-centre study Christian Vaillancourt 1 , Ann Kasaboski 3 , Manya Charette 3 , Stanley Morrow 2 , George A. Wells 4 , Ian G. Stiell 1 1
Univeristy of Ottawa, Ottawa, Ontario, Canada Ottawa Paramedic Service, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada 4 University of Ottawa Heart Institute, Ottawa, Ontario, Canada 2
Background: The quality of CPR is of critical importance in determining patient outcome. The contribution of team leadership behaviour on technical skills has not been clearly determined. This study aims to identify the relationship between leadership behaviour and quality of CPR and characteristics of a teamleader that is associated with better team leadership skills. Materials and Methods: 40 advanced life support (ALS) providers were videotaped leading a team in during a standardised cardiac arrest simulation. Participants included both doctors and allied health professionals. Background data were collected including age, gender, professional group, date of last ALS course attended, ALS instructor/provider status (I/P) and leading of any cardiac arrest in the preceding 6 months. Videos were reviewed independently by 2 reviewers. Each participant was scored independently by 2 reviewers using the CASTest score and Leadership Behaviour Description Questionnaire (LBDQ) for leadership skills. Process-focused quality of CPR data was collected directly from manikin and video recordings. Multiple regression analyses were performed to examine how the background of the team leader affects leadership and performance. Results: Good leadership skills were associated with significantly better overall technical performance as measured by CASTest performance score (R2 Linear = 0.752, p<0.001). Team leaders with better leadership score performed better quality of CPR with significantly shorter time to first shock (p=0.001) and pre-shock pauses (p=0.002); with lower hands off ratio approaching significance (p=0.057). After multiple regression analyses, ALS instructor status was the only significant background factor associated with better performance (I 89.5/100 [85.3/100–93.7/100] vs P 70.3/100 [66.6/100–74.1/100], p<0.001) and leadership skills (I 30.4/40 [28.1/4– 32.8/40] vs P 19.4/40 [17.4/40–21.4/40], p<0.001). Conclusions: There is an association between team leadership behaviours and overall quality of CPR. Developing leadership behaviours should be considered an integral part of resuscitation training. Research into the leadership behaviour and quality of CPR in real life is needed.
3
Introduction: There currently exist no study powerful enough to conclude in a survival benefit from 9-1-1 dispatch-assisted CPR instructions. We sought to determine the definite impact of such instructions on bystander CPR and survival to hospital discharge rates for adult out-of-hospital cardiac arrest (OOHCA) victims. Methods: We conducted the only ethically possible study, a before-after trial enrolling OOHCA patients not witnessed by EMS for which resuscitation was attempted in seven cities, with a BLS-D/ALS tiered EMS service. We measured victim and system characteristics during a 44-month period before the introduction of dispatch-assisted CPR instructions (April, 2004), and during the 35-month period following a study run-in phase to reach our 6,000-case required sample size. Prospective data collection and quality was standardized for all communities. Data analyses include descriptive statistics, attributable risk (AR) with Student’s t-test, adjusted OR with 95% CI, and time series analyses. Results: There were 2,942 cases between Aug. 1, 2000 and March 30, 2004, and 3,293 cases between Jan. 1, 2007 and Oct. 31, 2009. Victim characteristics were similar in the before and after groups: mean age 68.5, male 66.9%, witnessed 43.4%, residential location 85.3%, except for initial rhythm VF/VT which was higher in the before 30.6% compared to the after 25.0% group. Bystander CPR rates increased from 15.0% to 28.7% from the before to the after group (AR 13.7%; 95% CI: 11.7–15.7%, p<0.0001). Similarly, survival increased from 4.1% to 5.2% (AR 1.1%; 95% CI: 0.0–2.1%, p=0.05). The adjusted OR of survival as a result of dispatch-assisted CPR instructions is 1.45; 95% CI: 1.01–2.09. Conclusions: This is the first study powerful enough to determine a bystander CPR and survival to hospital discharge benefit from dispatch-assisted CPR instructions. These results could significantly impact public health policies and the 2015 resuscitation guideline recommendations regarding CPR instructions.