- Email: [email protected]
Locations of sudden cardiac arrest over a 3 year period and associated outcomes
Abstracts / Resuscitation 96S (2015) 5–42
Basic Life Support AS013 The FirstAED global positioning system organizes a first responder team with distinct roles and ensures the possibility for early cardiopulmonary resuscitation and defibrillation Finn Lund Henriksen 1,∗ , Henrik Schakow 1 , Mogens Lytken Larsen 2 1
The AED Center, Department of Cardiology, Odense University Hospital, Odense, Denmark 2 Department of Health Science and Technology, Aalborg University, Aalborg, Denmark Purpose: FirstAED is an auxiliary to the public emergency services and enables the dispatcher to send an organized team of first responders to the scene. FirstAED organizes three first responders in a team: no. 1 reaches the patient to give cardiopulmonary resuscitation (CPR); no. 2 brings the Automated External Defibrillator (AED); and no. 3 is the on-site coordinator. The aim is to shorten the first responder response time at emergency calls and the time to the AED on-site to below 5–6 min. Methods: CPR and first aid is provided by 175 trained lay first responders who use their smartphones. The population purchased 95 AEDs which are available around the clock and placed less than two kilometres apart. FirstAED global positioning system (GPS)track the nearby first responders who can accept or reject the alarm. FirstAED chooses the three most optimally placed first responders who accepted the alarm. Results: During the first 24 months the FirstAED GPS system was used 718 times. FirstAED entailed a guarantee for first responder CPR and a significant reduction in median response time to 4 min 9 s. The comparable median ambulance response time was 13 min and 20 s. The AED was on-site in more than 99% of the cases and with a median on-site time of 5 min and 47 s. Three first responders arrived in 89.1%, two first responders in 7.1%, one first responder in 3.0% of the cases. The first responders arrived before the ambulance in 94.3% and at the same time in 2.4% of the cases. The first responders were involved in cardiac arrests, serious respiratory arrests, and a patient with subarrachnoid hemorrhage. Conclusions: GPS-tracking and a team structure with distinct roles reduces the response times and ensures the possibility for early CPR and defibrillation. http://dx.doi.org/10.1016/j.resuscitation.2015.09.025 AS014 Self-adhesive electrodes do not cause burning, arcing or reduced shock efficacy when placed on metal items Rebecca Di Maio 1,∗ , Peter O’Hare 1 , Paul Crawford 1 , Allister McIntyre 1 , Paul McCanny 1 , Hannah Torney 1 , Jennifer Adgey 2 1 2
HeartSine Technologies Ltd., Belfast, UK Royal Victoria Hospital, Belfast, UK
Objective: The 2010 AHA guidelines have noted that sparking from poorly applied defibrillator paddles can cause fire. The purpose of this study was to evaluate the impact on defibrillation safety and effectiveness of placing disposable adhesive pads over an underwired bra. The potential for arcing, burning or conduction by an applied shock was assessed in an attempt to establish if injury
11
could be caused to the patient or if first shock defibrillation efficacy is reduced. Methods: A porcine model was fitted with a suitably sized underwired bra, with a section of the underwire intentionally exposed. The adhesive AED pad was placed in direct contact with the bra’s metal wire, to maximize the potential of arcing or other adverse events. VF was induced and defibrillation was administered using an AED, 15 s after induction of VF. Pre and post resuscitation recordings of arterial blood pressure and pulse duration were noted. The animal and bra were both assessed for evidence of arcing, burning or other skin damage. Findings: A total of 126 shocks were adminstered using 4 pigs, at an energy of 200 J with a recovery period of 3 min between shocks. No arcing was observed and with no redirection of current from the patient for any of the shocks. In addition, there was 100% 1st shock success with no instances of refibrillation. Furthermore, no incidences of scorching or burning of the bra or animal or other skin damage to the animal was observed. Conclusions: This study demonstrates that poor placement of adhesive pads does not pose a risk to either operators or patients of arcing, burning or decreasing shock efficacy when applied suboptimally. In the rare case where burning may occur the risk-benefit ratio strongly favors the delivery of timely therapy over significantly delayed or potentially no therapy. http://dx.doi.org/10.1016/j.resuscitation.2015.09.026 AS015 Locations of sudden cardiac arrest over a 3 year period and associated outcomes Hannah Torney 2,∗ , Rebecca Di Maio 1 , Laura Davis 2 , Colette McIntyre 2 , Joy Taggart 2 , Rudolph W. Koster 3 , A.A.J. Adgey 4 1
NIBEC, University of Ulster, Jordanstown, UK HeartSine Technologies Ltd., Belfast, UK 3 Cardiology Department, University of Amsterdam, Amsterdam, The Netherlands 4 Royal Victoria Hospital, Belfast, UK 2
Objective: The purpose of implantable defibrillation is to ensure high risk patients are given the greatest chance of successful resuscitation. The earlier the onset of sudden cardiac arrest, the greater the chance of a patient presenting with a shockable rhythm. Applying this theory to public access defibrillation, reminds us of the importance of the “early access” link in the “chain of survival”. Therefore if public access defibrillation times can be reduced to minutes, chances of successful resuscitation are significantly improved. The objective of this sub-analysis of 791 patients was to assess the impact of response time on presenting rhythm and outcome, and to determine if response time is location dependent. Methods: Worldwide patient data collection was initiated in October 2012 in accordance with the Declaration of Helsinki. Patient records were anonymised prior to data entry and analysis and were subject to audit. Age, gender, location of arrest, 1st shock success and patient outcome were collected. Response time, pre-shock CPR duration, and each patient’s medical history was captured if available. Findings: A sub-analysis was performed on 124 patients who suffered sudden cardiac arrests in public locations worldwide, including the US, UK, Amsterdam, Singapore, and Australia. Patient ages ranged from 10 to 91 years with 84.3% male and 15.7% female. A total of 69 (57.0%) patients were in a shockable rhythm. Of these, 53 patients achieved a first shock success (80.3%). The median
12
Abstracts / Resuscitation 96S (2015) 5–42
response time was 3 min 35 s. Finally, 49 patients survived to hospital admission (74.2%). Conclusions: These results are comparable to previous EMS studies which have shown a clear relationship between response time and outcome. This analysis highlights the importance of increasing the population of public access defibrillators, minimally trained operators and robust monitoring of the devices in situ to ensure they are ready for use in an emergency. http://dx.doi.org/10.1016/j.resuscitation.2015.09.027 AS016 Lethal fails without lethal endings – Simulation based BLS training with the use of peer to peer teaching Robert Pleskot 1,∗ , Barbara Niznanska 2 , Karel Stepanek 3 , Matus Niznansky 4 , Libuse Ourodova 2 1 ZDrSEM, Simulation-Based First Aid And Emergency Medicine Teaching Centre, Prague, Czech Republic 2 Department of Anesthesiology and Intensive Care, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, ZDrSEM, Simulation-Based First Aid and Emergency Medicine, Prague, Czech Republic 3 Emergency Medical Service Usti nad LabemZDrSEM, Simulation-Based First Aid and Emergency Medicine Teaching Centre, Usti nad Labem, Czech Republic 4 Department of Cardiovascular Surgery, First Faculty of Medicine Charles University in Prague and General University Hospital in PragueZDrSEM, Simulation-Based First Aid and Emergency Medicine Teaching, Prague, Czech Republic
Purpose of the study: Our aim was to develop a system that would enable intensive simulation-based BLS training for a large number of medical students with use of peer teaching. One of the basic skills that all medical students should acquire is the ability to react in life threatening situations. However, the percentage of med school graduates who are able to help effectively is low. Young doctors do not lack theory, as it is well taught at faculties, but they lack skills and practise. The most effective teaching method to learn these skills is simulation-based training. However, it is very demanding regarding time, number of teachers and material and so it is often left out of med schools’ curriculum. Materials and methods: We designed a two phase program based on peer teaching. In the first phase 20 medical students (4–6th year) passed 25 h of BLS lecturer training. During the second phase they led BLS courses for 96 students split in groups of 12. Supervising doctor was present only for quality control and feedback. The courses consisted of training and a number of model situations and took place in an outdoor environment of hospital park. Results: During the final exam 95% of students were able to react appropriately in a complex simulation of cardiac arrest. In a post-course questionnaire 70% of students claimed increase of selfconfidence to provide BLS in public. The quality of peer teaching was evaluated as above the faculty’s average by students and this was confirmed by supervising doctors too. Conclusion: BLS training based on simulations is accomplishable even for a large number of students if peer teaching is involved. The use of human role-players and real environment in scenarios is easily accessible and increases the effectivity of
simulations. Appropriately used simulation-based education is highly effective. Acknowledgements: This project has been raised as a cooperation between ZDrSEM – simulation-based first aid teaching centre and Charles University in Prague. http://dx.doi.org/10.1016/j.resuscitation.2015.09.028
CPR Quality AS017 Does feedback on CPR quality in AEDs increase survival after out-of-hospital cardiac arrest? Marco Bo Hansen 1,∗ , Lars Simon Rasmussen 1 , Thea Palsgaard Møller 2 , Marianne Agerskov 1 , Mads Wissenberg 3 , Freddy Knudsen Lippert 2 , Anne Møller Nielsen 1 1
Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark 2 The Emergency Medical Services, The Capital Region of Denmark and Copenhagen, University of Copenhagen, Copenhagen, Denmark 3 Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark Introduction: Knowledge concerning the effect of feedback mechanisms in automated external defibrillators (AEDs) on clinical outcome is limited. We hypothesized that out-of-hospital cardiac arrest (OHCA) victims would have a higher proportion of return of spontaneous circulation (ROSC) on admission to hospital and 30day survival if bystanders used an AED with audiovisual feedback or a metronome compared to an AED without feedback mechanisms. Materials and methods: In a 3-year period, we collected data on OHCAs in the Capital Region of Denmark (population 1.7 million) with an AED applied prior to ambulance arrival. AED data were obtained from the Emergency Medical Dispatch Centre and patient data retrieved from the Danish Cardiac Arrest Registry and from medical records. Feedback on depth and compression rate was verified by the electrocardiograms downloaded from the AEDs. Results: A total of 198 OHCAs had an AED applied before ambulance arrival; of these 62 (31%) provided audiovisual feedback (Table 1) and 140 (71%) used a metronome (Table 2). We found no difference in ROSC according to audiovisual feedback, 55% (95% CI, 43–67%) vs. 54% (95% CI, 46–63%, p = 0.96) and no difference in 30-day survival, 39% (95% CI, 28–51%) vs. 42% (95% CI, 34–50%, p = 0.67), respectively. We found no difference in ROSC according to use of a metronome, 56% (95% CI, 48–64%) vs. 50% (95% CI, 38–62%, p = 0.41) and 30-day survival was not different, 41% (95% CI, 34–50%) vs. 40% (95% CI, 28–53%, p = 0.82), respectively. More-
Table 1 Out-of-hospital cardiac arrest with deployment of automated external defibrillators from October 27, 2011 to October 26, 2014.
Basic Life Support AS013 The FirstAED global positioning system organizes a first responder team with distinct roles and ensures the possibility for early cardiopulmonary resuscitation and defibrillation Finn Lund Henriksen 1,∗ , Henrik Schakow 1 , Mogens Lytken Larsen 2 1
The AED Center, Department of Cardiology, Odense University Hospital, Odense, Denmark 2 Department of Health Science and Technology, Aalborg University, Aalborg, Denmark Purpose: FirstAED is an auxiliary to the public emergency services and enables the dispatcher to send an organized team of first responders to the scene. FirstAED organizes three first responders in a team: no. 1 reaches the patient to give cardiopulmonary resuscitation (CPR); no. 2 brings the Automated External Defibrillator (AED); and no. 3 is the on-site coordinator. The aim is to shorten the first responder response time at emergency calls and the time to the AED on-site to below 5–6 min. Methods: CPR and first aid is provided by 175 trained lay first responders who use their smartphones. The population purchased 95 AEDs which are available around the clock and placed less than two kilometres apart. FirstAED global positioning system (GPS)track the nearby first responders who can accept or reject the alarm. FirstAED chooses the three most optimally placed first responders who accepted the alarm. Results: During the first 24 months the FirstAED GPS system was used 718 times. FirstAED entailed a guarantee for first responder CPR and a significant reduction in median response time to 4 min 9 s. The comparable median ambulance response time was 13 min and 20 s. The AED was on-site in more than 99% of the cases and with a median on-site time of 5 min and 47 s. Three first responders arrived in 89.1%, two first responders in 7.1%, one first responder in 3.0% of the cases. The first responders arrived before the ambulance in 94.3% and at the same time in 2.4% of the cases. The first responders were involved in cardiac arrests, serious respiratory arrests, and a patient with subarrachnoid hemorrhage. Conclusions: GPS-tracking and a team structure with distinct roles reduces the response times and ensures the possibility for early CPR and defibrillation. http://dx.doi.org/10.1016/j.resuscitation.2015.09.025 AS014 Self-adhesive electrodes do not cause burning, arcing or reduced shock efficacy when placed on metal items Rebecca Di Maio 1,∗ , Peter O’Hare 1 , Paul Crawford 1 , Allister McIntyre 1 , Paul McCanny 1 , Hannah Torney 1 , Jennifer Adgey 2 1 2
HeartSine Technologies Ltd., Belfast, UK Royal Victoria Hospital, Belfast, UK
Objective: The 2010 AHA guidelines have noted that sparking from poorly applied defibrillator paddles can cause fire. The purpose of this study was to evaluate the impact on defibrillation safety and effectiveness of placing disposable adhesive pads over an underwired bra. The potential for arcing, burning or conduction by an applied shock was assessed in an attempt to establish if injury
11
could be caused to the patient or if first shock defibrillation efficacy is reduced. Methods: A porcine model was fitted with a suitably sized underwired bra, with a section of the underwire intentionally exposed. The adhesive AED pad was placed in direct contact with the bra’s metal wire, to maximize the potential of arcing or other adverse events. VF was induced and defibrillation was administered using an AED, 15 s after induction of VF. Pre and post resuscitation recordings of arterial blood pressure and pulse duration were noted. The animal and bra were both assessed for evidence of arcing, burning or other skin damage. Findings: A total of 126 shocks were adminstered using 4 pigs, at an energy of 200 J with a recovery period of 3 min between shocks. No arcing was observed and with no redirection of current from the patient for any of the shocks. In addition, there was 100% 1st shock success with no instances of refibrillation. Furthermore, no incidences of scorching or burning of the bra or animal or other skin damage to the animal was observed. Conclusions: This study demonstrates that poor placement of adhesive pads does not pose a risk to either operators or patients of arcing, burning or decreasing shock efficacy when applied suboptimally. In the rare case where burning may occur the risk-benefit ratio strongly favors the delivery of timely therapy over significantly delayed or potentially no therapy. http://dx.doi.org/10.1016/j.resuscitation.2015.09.026 AS015 Locations of sudden cardiac arrest over a 3 year period and associated outcomes Hannah Torney 2,∗ , Rebecca Di Maio 1 , Laura Davis 2 , Colette McIntyre 2 , Joy Taggart 2 , Rudolph W. Koster 3 , A.A.J. Adgey 4 1
NIBEC, University of Ulster, Jordanstown, UK HeartSine Technologies Ltd., Belfast, UK 3 Cardiology Department, University of Amsterdam, Amsterdam, The Netherlands 4 Royal Victoria Hospital, Belfast, UK 2
Objective: The purpose of implantable defibrillation is to ensure high risk patients are given the greatest chance of successful resuscitation. The earlier the onset of sudden cardiac arrest, the greater the chance of a patient presenting with a shockable rhythm. Applying this theory to public access defibrillation, reminds us of the importance of the “early access” link in the “chain of survival”. Therefore if public access defibrillation times can be reduced to minutes, chances of successful resuscitation are significantly improved. The objective of this sub-analysis of 791 patients was to assess the impact of response time on presenting rhythm and outcome, and to determine if response time is location dependent. Methods: Worldwide patient data collection was initiated in October 2012 in accordance with the Declaration of Helsinki. Patient records were anonymised prior to data entry and analysis and were subject to audit. Age, gender, location of arrest, 1st shock success and patient outcome were collected. Response time, pre-shock CPR duration, and each patient’s medical history was captured if available. Findings: A sub-analysis was performed on 124 patients who suffered sudden cardiac arrests in public locations worldwide, including the US, UK, Amsterdam, Singapore, and Australia. Patient ages ranged from 10 to 91 years with 84.3% male and 15.7% female. A total of 69 (57.0%) patients were in a shockable rhythm. Of these, 53 patients achieved a first shock success (80.3%). The median
12
Abstracts / Resuscitation 96S (2015) 5–42
response time was 3 min 35 s. Finally, 49 patients survived to hospital admission (74.2%). Conclusions: These results are comparable to previous EMS studies which have shown a clear relationship between response time and outcome. This analysis highlights the importance of increasing the population of public access defibrillators, minimally trained operators and robust monitoring of the devices in situ to ensure they are ready for use in an emergency. http://dx.doi.org/10.1016/j.resuscitation.2015.09.027 AS016 Lethal fails without lethal endings – Simulation based BLS training with the use of peer to peer teaching Robert Pleskot 1,∗ , Barbara Niznanska 2 , Karel Stepanek 3 , Matus Niznansky 4 , Libuse Ourodova 2 1 ZDrSEM, Simulation-Based First Aid And Emergency Medicine Teaching Centre, Prague, Czech Republic 2 Department of Anesthesiology and Intensive Care, First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, ZDrSEM, Simulation-Based First Aid and Emergency Medicine, Prague, Czech Republic 3 Emergency Medical Service Usti nad LabemZDrSEM, Simulation-Based First Aid and Emergency Medicine Teaching Centre, Usti nad Labem, Czech Republic 4 Department of Cardiovascular Surgery, First Faculty of Medicine Charles University in Prague and General University Hospital in PragueZDrSEM, Simulation-Based First Aid and Emergency Medicine Teaching, Prague, Czech Republic
Purpose of the study: Our aim was to develop a system that would enable intensive simulation-based BLS training for a large number of medical students with use of peer teaching. One of the basic skills that all medical students should acquire is the ability to react in life threatening situations. However, the percentage of med school graduates who are able to help effectively is low. Young doctors do not lack theory, as it is well taught at faculties, but they lack skills and practise. The most effective teaching method to learn these skills is simulation-based training. However, it is very demanding regarding time, number of teachers and material and so it is often left out of med schools’ curriculum. Materials and methods: We designed a two phase program based on peer teaching. In the first phase 20 medical students (4–6th year) passed 25 h of BLS lecturer training. During the second phase they led BLS courses for 96 students split in groups of 12. Supervising doctor was present only for quality control and feedback. The courses consisted of training and a number of model situations and took place in an outdoor environment of hospital park. Results: During the final exam 95% of students were able to react appropriately in a complex simulation of cardiac arrest. In a post-course questionnaire 70% of students claimed increase of selfconfidence to provide BLS in public. The quality of peer teaching was evaluated as above the faculty’s average by students and this was confirmed by supervising doctors too. Conclusion: BLS training based on simulations is accomplishable even for a large number of students if peer teaching is involved. The use of human role-players and real environment in scenarios is easily accessible and increases the effectivity of
simulations. Appropriately used simulation-based education is highly effective. Acknowledgements: This project has been raised as a cooperation between ZDrSEM – simulation-based first aid teaching centre and Charles University in Prague. http://dx.doi.org/10.1016/j.resuscitation.2015.09.028
CPR Quality AS017 Does feedback on CPR quality in AEDs increase survival after out-of-hospital cardiac arrest? Marco Bo Hansen 1,∗ , Lars Simon Rasmussen 1 , Thea Palsgaard Møller 2 , Marianne Agerskov 1 , Mads Wissenberg 3 , Freddy Knudsen Lippert 2 , Anne Møller Nielsen 1 1
Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark 2 The Emergency Medical Services, The Capital Region of Denmark and Copenhagen, University of Copenhagen, Copenhagen, Denmark 3 Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark Introduction: Knowledge concerning the effect of feedback mechanisms in automated external defibrillators (AEDs) on clinical outcome is limited. We hypothesized that out-of-hospital cardiac arrest (OHCA) victims would have a higher proportion of return of spontaneous circulation (ROSC) on admission to hospital and 30day survival if bystanders used an AED with audiovisual feedback or a metronome compared to an AED without feedback mechanisms. Materials and methods: In a 3-year period, we collected data on OHCAs in the Capital Region of Denmark (population 1.7 million) with an AED applied prior to ambulance arrival. AED data were obtained from the Emergency Medical Dispatch Centre and patient data retrieved from the Danish Cardiac Arrest Registry and from medical records. Feedback on depth and compression rate was verified by the electrocardiograms downloaded from the AEDs. Results: A total of 198 OHCAs had an AED applied before ambulance arrival; of these 62 (31%) provided audiovisual feedback (Table 1) and 140 (71%) used a metronome (Table 2). We found no difference in ROSC according to audiovisual feedback, 55% (95% CI, 43–67%) vs. 54% (95% CI, 46–63%, p = 0.96) and no difference in 30-day survival, 39% (95% CI, 28–51%) vs. 42% (95% CI, 34–50%, p = 0.67), respectively. We found no difference in ROSC according to use of a metronome, 56% (95% CI, 48–64%) vs. 50% (95% CI, 38–62%, p = 0.41) and 30-day survival was not different, 41% (95% CI, 34–50%) vs. 40% (95% CI, 28–53%, p = 0.82), respectively. More-
Table 1 Out-of-hospital cardiac arrest with deployment of automated external defibrillators from October 27, 2011 to October 26, 2014.