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Neurological outcome after telephone CPR in a rural EMS system
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Abstracts / Resuscitation 106S (2016) e23–e95
AP116 Neurological outcome after telephone CPR in a rural EMS system Hartwig Marung 1 , Jan-Thorsten Graesner 1,∗ , Achim Hackstein 3 , Sebastian Gierets 2 , Ulf Linstedt 2 1 University of Schleswig-Holstein Medical Centre, Kiel, Germany 2 Diakoniekrankenhaus, Flensburg, Germany 3 Integrated Communications Centre, Harrislee, Germany
Purpose of the study: Based on data from urban EMS systems in North America and Europe, ERC guidelines 2010 and 2015 advocate telephone CPR (T-CPR) as a means of improving survival after OHCA [1,2]. Data from rural EMS systems is not available so far. Materials and methods: Retrospective analysis of dispatch, EMS and hospital protocols from Harrislee Communications Centre serving a population of 515.000 in rural Northern Germany. Primary end point was survival at hospital discharge with favourable neurological outcome (CPC 1 + 2) in 2010 before implementation versus 2011 when T-CPR was introduced. Results: A total of 788 patient records were available for analysis: n = 315 without T-CPR (2010), n = 336 without T-CPR (2011), n = 137 with T-CPR (2011). Demographic data and EMS arrival times did not differ significantly between groups. T-CPR rate was 29.0%. Survival with favourable neurological outcome was significantly higher after T-CPR (9.5%; n = 13) than without T-CPR (4.5%; n = 15; p < 0.05; OR 0.471; 95%CI 0.218–1.015). All T-CPR patients showed excellent or good neurological function (CPC 1 + 2) whereas one quarter of patients without T-CPR had adverse neurological outcome (n = 4 CPC 4; n = 1 CPC 3). Overall survival rose from 4.4% (2010) to 7.6% (2011; p < 0.01). Conclusions: Our study is the first to show that T-CPR is effective in scarcely populated areas. Analysis of 2012 to 2015 data is currently performed.
References 1. Nolan JP, et al. ERC guidelines; 2010. 2. Monsieurs KG, et al. ERC guidelines; 2015.
http://dx.doi.org/10.1016/j.resuscitation.2016.07.164 AP117 Survival trends and health care cost following out-of-hospital cardiac arrest in the United States: 1995–2013 Shaker M. Eid ∗ , Aiham Albaeni, Nisha Chandra-Strobos The Johns Hopkins University, Baltimore, MD, USA Background: The international resuscitation committees have put forward multiple strategies to optimize health-care delivery and expenditure following cardiac arrest. We sought to identify national trends in survival and healthcare cost post out-of-hospital cardiac arrest (OHCA). Methods: We used the 1995 to 2013 Nationwide Inpatient Sample database to identify adults ≥18 years, with an ICD-9 code principal diagnosis of ventricular fibrillation (427.41) or cardiac arrest (427.5). Age and gender adjusted survival rates were studied in the overall sample and by initial rhythm. Temporal trends in survival, hospital charges and cost were examined with year
as a continuous variable (1995–2013) added to the multivariable regression model. All charges and costs were adjusted using the consumer price index with 2015 as the index year. Results: From 1995 to 2013, of 247,684 OHCA patients who survived to hospital admission, 126,690 (51.1%) had ventricular fibrillation, and 123,098 (49.3%) survived to hospital discharge. Mean age was 66.7 ± 14 years. There was no significant increase in the proportion of survivors to hospital discharge from 49.9% (95% CI 39.8–60.0%) in 1995 to 54.0% (95% CI 46.3–61.8%) in 2013 (Ptrend = 0.56). However, there was a significant increase in VF survival from 73.1% (95% CI 60.8–85.5%) in 1995 to 79.0% (95% CI 70.9–87.2%) in 2013 (Ptrend < 0.001). In addition, a significant decrease in survival to discharge was noted in non-VF rhythm from 28.2% (95% CI 15.4–41.0%) in 1995 to 19.9% (95% CI 10.0–29.8%) in 2013 (Ptrend < 0.001). The median inflationadjusted total hospital charges and costs for the overall cohort were $29,038 [$13,254, $77,499] and $10,079 [$4,893, $25,320] respectively. Both cost and charges increased significantly over years (All Ptrend < 0.001). Conclusions: We found a significant increase in expenditure and economic burden in caring for OHCA patients with minimal change in overall survival. Guidelines dissemination and clinical provider education on quality, low-cost, high-value care are essential for better control of national health-care costs and expenditure. http://dx.doi.org/10.1016/j.resuscitation.2016.07.165 AP118 The impact of the economic recession on the outcome of CPR performed on out-of-hospital cardiac arrests: Data from the emergency department of a Greek general hospital Zisimangelos Solomos 1,∗ , Maria Tatsi 1 , Victoria Psomiadou 1 , Emmanouil Spathis 2 1
Pammakaristos General Hospital, Athens, Greece School of Economic Theory, National and Kapodistrian University of Athens, Athens, Greece 2
Purpose: The aim of this study is to assess the impact of the austerity measures, implemented in the Hellenic Healthcare System, during the ongoing national economic crisis. Data from a Greek general hospital regarding the outcomes of cardiopulmonary resuscitation (CPR), attempted in the emergency setting, were collected. Materials and methods: A retrospective study was conducted on all the patients who experienced an out-of-hospital cardiac arrest and were transferred to the emergency department of our hospital during an 8-year period (2007–2014). The cardiac arrests were divided into two 4-year sessions (2007–2010 and 2011–2014). The first and second quadrennium represented the pre-crisis and the economic crisis period, respectively. Data concerning victims’ return of spontaneous circulation (ROSC) and 24-h survival after CPR were then compared between the two periods using Z-test (two-tailed hypothesis), with p values below 0.05 being considered statistically significant. Results: Cardiac arrests in the first group were 201 versus 230 cardiac arrests in the second one. There was no significant change in ROSC (8.53% vs. 7.41%, p = 0.80) and 24-h survival (5.43% vs. 3.70%, p = 0.62) of the victims on whom CPR was performed in the ER between the 2 periods. On the other hand, there was a statistically significant increase in the percentage of victims on whom CPR was performed (56.1% vs. 26.9%, p < 0.05) during the second period. Conclusions: The financial regulations that have been put in place in our institution due to the recent economic crisis led to no significant change in the immediate and 24-h survival of out-ofhospital cardiac arrest victims treated in our ER department. On
Abstracts / Resuscitation 106S (2016) e23–e95
AP116 Neurological outcome after telephone CPR in a rural EMS system Hartwig Marung 1 , Jan-Thorsten Graesner 1,∗ , Achim Hackstein 3 , Sebastian Gierets 2 , Ulf Linstedt 2 1 University of Schleswig-Holstein Medical Centre, Kiel, Germany 2 Diakoniekrankenhaus, Flensburg, Germany 3 Integrated Communications Centre, Harrislee, Germany
Purpose of the study: Based on data from urban EMS systems in North America and Europe, ERC guidelines 2010 and 2015 advocate telephone CPR (T-CPR) as a means of improving survival after OHCA [1,2]. Data from rural EMS systems is not available so far. Materials and methods: Retrospective analysis of dispatch, EMS and hospital protocols from Harrislee Communications Centre serving a population of 515.000 in rural Northern Germany. Primary end point was survival at hospital discharge with favourable neurological outcome (CPC 1 + 2) in 2010 before implementation versus 2011 when T-CPR was introduced. Results: A total of 788 patient records were available for analysis: n = 315 without T-CPR (2010), n = 336 without T-CPR (2011), n = 137 with T-CPR (2011). Demographic data and EMS arrival times did not differ significantly between groups. T-CPR rate was 29.0%. Survival with favourable neurological outcome was significantly higher after T-CPR (9.5%; n = 13) than without T-CPR (4.5%; n = 15; p < 0.05; OR 0.471; 95%CI 0.218–1.015). All T-CPR patients showed excellent or good neurological function (CPC 1 + 2) whereas one quarter of patients without T-CPR had adverse neurological outcome (n = 4 CPC 4; n = 1 CPC 3). Overall survival rose from 4.4% (2010) to 7.6% (2011; p < 0.01). Conclusions: Our study is the first to show that T-CPR is effective in scarcely populated areas. Analysis of 2012 to 2015 data is currently performed.
References 1. Nolan JP, et al. ERC guidelines; 2010. 2. Monsieurs KG, et al. ERC guidelines; 2015.
http://dx.doi.org/10.1016/j.resuscitation.2016.07.164 AP117 Survival trends and health care cost following out-of-hospital cardiac arrest in the United States: 1995–2013 Shaker M. Eid ∗ , Aiham Albaeni, Nisha Chandra-Strobos The Johns Hopkins University, Baltimore, MD, USA Background: The international resuscitation committees have put forward multiple strategies to optimize health-care delivery and expenditure following cardiac arrest. We sought to identify national trends in survival and healthcare cost post out-of-hospital cardiac arrest (OHCA). Methods: We used the 1995 to 2013 Nationwide Inpatient Sample database to identify adults ≥18 years, with an ICD-9 code principal diagnosis of ventricular fibrillation (427.41) or cardiac arrest (427.5). Age and gender adjusted survival rates were studied in the overall sample and by initial rhythm. Temporal trends in survival, hospital charges and cost were examined with year
as a continuous variable (1995–2013) added to the multivariable regression model. All charges and costs were adjusted using the consumer price index with 2015 as the index year. Results: From 1995 to 2013, of 247,684 OHCA patients who survived to hospital admission, 126,690 (51.1%) had ventricular fibrillation, and 123,098 (49.3%) survived to hospital discharge. Mean age was 66.7 ± 14 years. There was no significant increase in the proportion of survivors to hospital discharge from 49.9% (95% CI 39.8–60.0%) in 1995 to 54.0% (95% CI 46.3–61.8%) in 2013 (Ptrend = 0.56). However, there was a significant increase in VF survival from 73.1% (95% CI 60.8–85.5%) in 1995 to 79.0% (95% CI 70.9–87.2%) in 2013 (Ptrend < 0.001). In addition, a significant decrease in survival to discharge was noted in non-VF rhythm from 28.2% (95% CI 15.4–41.0%) in 1995 to 19.9% (95% CI 10.0–29.8%) in 2013 (Ptrend < 0.001). The median inflationadjusted total hospital charges and costs for the overall cohort were $29,038 [$13,254, $77,499] and $10,079 [$4,893, $25,320] respectively. Both cost and charges increased significantly over years (All Ptrend < 0.001). Conclusions: We found a significant increase in expenditure and economic burden in caring for OHCA patients with minimal change in overall survival. Guidelines dissemination and clinical provider education on quality, low-cost, high-value care are essential for better control of national health-care costs and expenditure. http://dx.doi.org/10.1016/j.resuscitation.2016.07.165 AP118 The impact of the economic recession on the outcome of CPR performed on out-of-hospital cardiac arrests: Data from the emergency department of a Greek general hospital Zisimangelos Solomos 1,∗ , Maria Tatsi 1 , Victoria Psomiadou 1 , Emmanouil Spathis 2 1
Pammakaristos General Hospital, Athens, Greece School of Economic Theory, National and Kapodistrian University of Athens, Athens, Greece 2
Purpose: The aim of this study is to assess the impact of the austerity measures, implemented in the Hellenic Healthcare System, during the ongoing national economic crisis. Data from a Greek general hospital regarding the outcomes of cardiopulmonary resuscitation (CPR), attempted in the emergency setting, were collected. Materials and methods: A retrospective study was conducted on all the patients who experienced an out-of-hospital cardiac arrest and were transferred to the emergency department of our hospital during an 8-year period (2007–2014). The cardiac arrests were divided into two 4-year sessions (2007–2010 and 2011–2014). The first and second quadrennium represented the pre-crisis and the economic crisis period, respectively. Data concerning victims’ return of spontaneous circulation (ROSC) and 24-h survival after CPR were then compared between the two periods using Z-test (two-tailed hypothesis), with p values below 0.05 being considered statistically significant. Results: Cardiac arrests in the first group were 201 versus 230 cardiac arrests in the second one. There was no significant change in ROSC (8.53% vs. 7.41%, p = 0.80) and 24-h survival (5.43% vs. 3.70%, p = 0.62) of the victims on whom CPR was performed in the ER between the 2 periods. On the other hand, there was a statistically significant increase in the percentage of victims on whom CPR was performed (56.1% vs. 26.9%, p < 0.05) during the second period. Conclusions: The financial regulations that have been put in place in our institution due to the recent economic crisis led to no significant change in the immediate and 24-h survival of out-ofhospital cardiac arrest victims treated in our ER department. On