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Responsiveness to basic cardiopulmonary resuscitation (CPR) performed by emergency medical technicians (EMTS) and its duration determine the incidence of sustained return of spontaneous circulation (SROSC) in hospital
S48
Abstracts / Resuscitation 81S (2010) S1–S114
AP055
to facilitate the early CPR. OHCAs at home
Responsiveness to basic cardiopulmonary resuscitation (CPR) performed by emergency medical technicians (EMTS) and its duration determine the incidence of sustained return of spontaneous circulation (SROSC) in hospital
Call to arrival
Takei Y. 1 , Inaba H. 1 , Enami M. 1 , Goto Y. 2 , Ohta K. 1
Patients’ age, median (25–75%) Arrest-witnessed Cause-cardiac Telephone-assisted instruction of CPR – attempted CPR by citizens Collapse or recognition to call median (25–75%) Call to bystander CPR median (25–90%) Number of citizens at arrival at patients – multiple 1-Y survival
1 Department
of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan 2 Emergency Medical Centre, Kanazawa University Hospital, Kanazawa, Japan Purpose of the study: To test the hypothesis that responsiveness to basic CPR performed by EMTs and its duration determine the incidence of SROSC in hospital. Methods: The data were prospectively collected by fire departments form 2133 outof hospital cardiac arrests (OHCAs) that were witnessed or recognized by citizens and resuscitated by EMTs without epinephrine administration and tracheal intubation in the period of 2006, April to 2009, March. We applied both monovariate and multiple logistic regression analysis to prove the hypothesis. Sensitivity and specificity were determined to assess the prediction model. Results: Monovariate analysis followed by multiple logistic regression analysis revealed that unwitnessed arrest, unchanged or worsened ECG rhythm by EMTperformed CPR (unresponsiveness to EMT-performed CPR) and prolonged duration of the basic CPR are independent factors associated with unachieved SROSC after in hospital (Table). The basic CPR duration of more than 30 min and unresponsiveness to the basic CPR successfully predicted unachieved SROSC in hospital (sensitivity = 0.3875 and specificity = 0.7823 in unwitnessed cardiac arrests; sensitivity = 0.3704 and specificity = 0.7762 in witnessed cardiac arrests). SROSC
Central region (%) Patient age, y (25–75%) Patient sex – male (%) Unwitnessed by citizens (%) Bystander CPR (%) Call – Arrival at patient, min (25–75%) Arrival at patient – hospital, min (25–75%) Etiology – cardiac (%) Rhythm unchanged or worsen (%)
Odds ratio (CI)
Achieved (n = 327)
Unachieved (n = 1663)
Univariate analysis
Multivariate analysis
170 (52.0) 77 (66–84) 186 (56.9) 158 (48.3) 158 (48.3) 7.4 (5.8–9.9) 25.5 (21–30.3) 151 (46.2) 267 (81.7)
741 (44.6) 77 (66–85) 977 (58.8) 1166 (70.1) 883 (53.1) 7.6 (5.9–10) 27 (21.8–35) 828 (49.8) 1566 (94.2)
1.347 (1.062–1.709) Undefined
1.197 (0.930–1.539) 0.999 (0.992–1.007) 0.815 (0.632–1.051) 0.406 (0.317–0.521) 0.841 (0.656–1.077) 0.999 (0.999–1.000) 1.000 (1.000–1.001) 0.854 (0.666–1.095) 0.284 (0.199–0.407)
0.926 (0.729–1.177) 0.399 (0.313–0.507) 0.826 (0.651–1.047) Undefined Undefined 0.865 (0.682–1.097) 0.276 (0.195–0.390)
Conclusions: Responsiveness to basic CPR performed by EMTs and its duration determine the incidence of SROSC in hospital. These two factors may be applied to judge when and whether advanced CPR may be terminated in hospital. doi:10.1016/j.resuscitation.2010.09.200 AP056 Citizens’ response to out-of-hospital cardiac arrests (OHCAS) in residences of a remote time distance from regional emergency medical service (EMS) system Inaba H. 1 , Takei Y. 1 , Enami M. 1 , Goto Y. 2 , Ohta K. 1 1 Department
of Emergency Medical Science, Kanazawa University GraduateSchool of Medicine, Kanazawa, Japan 2 Emergency Medical Centre, Kanazawa University Hospital, Kanazawa,Japan The purpose of study: To test the hypothesis that citizens in residential area of a remote time distance from regional EMS may differently responds to the OHCAs that occur in their residences. Methods: The data were prospectively collected by fire departments from resuscitation-attempted 3020 OHCAs that occurred at home in the period of 2003, April to 2009, March. The OHCAs of a remote time distance were defined when the intervals of call to arrival were more than or equal to 9 min, an upper IQR value. The characteristics of patients and bystanders or recognizers as well as responses and actions of citizens in these OHCAs were compared with those in other OHCAs of standard time distance. Results: There were no significant differences in incidences of arrest-witnessed, causecardiac, telephone-assisted CPR instruction and CPR by citizens. The outcome of OHCAs was significantly lower and the interval of call to bystander CPR was significantly longer while multiple citizens were present at arrival at patients in OHCAs of a remote time distance. Conclusions: Delayed initiation of bystander CPR may be one of causes of poor outcome of OHCAs of a remote time distance. Education of families in such residences is necessary
Statics
<9 min N = 2258
≥9 min N = 762
76 (64–83) 33.4% 51.6% 58.1% 42.4% 1 (0–3) 1 (0–3) 31.7% (616/1941) 3.4%
78 (68–85) 35.3% 51.1% 55.9% 43.3% 1 (0–4) 1 (0–4) 37.3% (239/640) 1.1%
0.0003 0.347 0.8112 0.2981 0.671 0.187 0.003 <0.01 <0.001
doi:10.1016/j.resuscitation.2010.09.201 AP057 Non-health care providers perform straddle CPR as adequately as conventional CPR Loukas T., Solakis E., Rammou P., Geronatsios K., Konstantinou K., Litos G., Rigopoulos D. 1st department of internal medicine, 401 General Military Hospital, Athens, Greece Purpose: Often the rescuer is obligated to perform cardiopulmonary resuscitation (CPR) in a confined space. Aim of the study was to investigate the efficacy of straddle CPR (stCPR) comparing to conventional CPR (cCPR). Materials and methods: We evaluated professional soldiers who did not have any medical knowledge. They had all attended a CPR course instructed by ERC certified instructors. They also, were taught to perform straddle CPR. Each of them was allowed to perform 2 min conventional CPR on a manikin and 1 h later, 2 min of straddle CPR (chest compressions only) without giving rescue breaths. The manikin was connected with a PC and we were able to record the follow parameters: number of compressions and compression rate, the depth of each compression and the wrong position of the hands. Results: Seventeen participants took place in the study. During cCPR the average compression rate was 107/min (SD 16.088), The average depth of each compression was 44.4 mm (SD 9.709) and the percentage of the wrong hand position was only 4.1% (SD 3.717). During stCPR the average average compression rate was 109 min−1 (SD 16.088), The average depth of each compression was 45.1 mm (SD 9.709) and the percentage of the wrong hand position was 5.7% (SD 3.717). All the above results were within the limits of the ERC 2005 guidelines. Conclusion: Despite the fact that the participants were not health care providers, the results were quite satisfactory. We strongly believe that they were quite efficient in performing CPR of good quality using either the conventional method or stCPR, as far as compression rate, compression depth and right hand position are concerned. doi:10.1016/j.resuscitation.2010.09.202 AP058 Association between detecting agonal breathing and outcome in Vienna (Austria) Wannack S. 1 , Sterz F. 1 , Weiser C. 1 , Nuernberger A. 1 , Schober A. 1 , Stoeckl M. 1 , Malzer R. 2 , Segall B. 2 , Lausch F. 2 1 Department 2
of Emergency Medicine, Medical University of Vienna, Austria Emergency Medical Service, Vienna City Administration, Austria
Purpose: In order to enhance Dispatcher-assisted bystander CPR which is thought to be one important factor of survival after OOHCA agonal breathing must be discovered as soon as possible. Methods: All calls with OOHCA received by the dispatch center of the Emergency Medical Service (EMS) in Vienna were evaluated. Voice recordings were analyzed according to approved international standards and related to neurological outcome and Utstein core data. Results: From February 1st 2009 to January 31st 2010, 614 OOHCA cases occurred prior to EMS arrival. The study group could only include cases with 2nd party callers therefore 173 cases were excluded. The overall survival rate of 10% (43) is the summary of 9% (40) with favourable neurological outcome (CPC1/2) and 1% (3) with unfavorable neurological outcome (CPC 3/4). In the non-survivor group agonal breathing was to be verified in 26% (114) but only 7% (32) were verified correctly
Abstracts / Resuscitation 81S (2010) S1–S114
AP055
to facilitate the early CPR. OHCAs at home
Responsiveness to basic cardiopulmonary resuscitation (CPR) performed by emergency medical technicians (EMTS) and its duration determine the incidence of sustained return of spontaneous circulation (SROSC) in hospital
Call to arrival
Takei Y. 1 , Inaba H. 1 , Enami M. 1 , Goto Y. 2 , Ohta K. 1
Patients’ age, median (25–75%) Arrest-witnessed Cause-cardiac Telephone-assisted instruction of CPR – attempted CPR by citizens Collapse or recognition to call median (25–75%) Call to bystander CPR median (25–90%) Number of citizens at arrival at patients – multiple 1-Y survival
1 Department
of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan 2 Emergency Medical Centre, Kanazawa University Hospital, Kanazawa, Japan Purpose of the study: To test the hypothesis that responsiveness to basic CPR performed by EMTs and its duration determine the incidence of SROSC in hospital. Methods: The data were prospectively collected by fire departments form 2133 outof hospital cardiac arrests (OHCAs) that were witnessed or recognized by citizens and resuscitated by EMTs without epinephrine administration and tracheal intubation in the period of 2006, April to 2009, March. We applied both monovariate and multiple logistic regression analysis to prove the hypothesis. Sensitivity and specificity were determined to assess the prediction model. Results: Monovariate analysis followed by multiple logistic regression analysis revealed that unwitnessed arrest, unchanged or worsened ECG rhythm by EMTperformed CPR (unresponsiveness to EMT-performed CPR) and prolonged duration of the basic CPR are independent factors associated with unachieved SROSC after in hospital (Table). The basic CPR duration of more than 30 min and unresponsiveness to the basic CPR successfully predicted unachieved SROSC in hospital (sensitivity = 0.3875 and specificity = 0.7823 in unwitnessed cardiac arrests; sensitivity = 0.3704 and specificity = 0.7762 in witnessed cardiac arrests). SROSC
Central region (%) Patient age, y (25–75%) Patient sex – male (%) Unwitnessed by citizens (%) Bystander CPR (%) Call – Arrival at patient, min (25–75%) Arrival at patient – hospital, min (25–75%) Etiology – cardiac (%) Rhythm unchanged or worsen (%)
Odds ratio (CI)
Achieved (n = 327)
Unachieved (n = 1663)
Univariate analysis
Multivariate analysis
170 (52.0) 77 (66–84) 186 (56.9) 158 (48.3) 158 (48.3) 7.4 (5.8–9.9) 25.5 (21–30.3) 151 (46.2) 267 (81.7)
741 (44.6) 77 (66–85) 977 (58.8) 1166 (70.1) 883 (53.1) 7.6 (5.9–10) 27 (21.8–35) 828 (49.8) 1566 (94.2)
1.347 (1.062–1.709) Undefined
1.197 (0.930–1.539) 0.999 (0.992–1.007) 0.815 (0.632–1.051) 0.406 (0.317–0.521) 0.841 (0.656–1.077) 0.999 (0.999–1.000) 1.000 (1.000–1.001) 0.854 (0.666–1.095) 0.284 (0.199–0.407)
0.926 (0.729–1.177) 0.399 (0.313–0.507) 0.826 (0.651–1.047) Undefined Undefined 0.865 (0.682–1.097) 0.276 (0.195–0.390)
Conclusions: Responsiveness to basic CPR performed by EMTs and its duration determine the incidence of SROSC in hospital. These two factors may be applied to judge when and whether advanced CPR may be terminated in hospital. doi:10.1016/j.resuscitation.2010.09.200 AP056 Citizens’ response to out-of-hospital cardiac arrests (OHCAS) in residences of a remote time distance from regional emergency medical service (EMS) system Inaba H. 1 , Takei Y. 1 , Enami M. 1 , Goto Y. 2 , Ohta K. 1 1 Department
of Emergency Medical Science, Kanazawa University GraduateSchool of Medicine, Kanazawa, Japan 2 Emergency Medical Centre, Kanazawa University Hospital, Kanazawa,Japan The purpose of study: To test the hypothesis that citizens in residential area of a remote time distance from regional EMS may differently responds to the OHCAs that occur in their residences. Methods: The data were prospectively collected by fire departments from resuscitation-attempted 3020 OHCAs that occurred at home in the period of 2003, April to 2009, March. The OHCAs of a remote time distance were defined when the intervals of call to arrival were more than or equal to 9 min, an upper IQR value. The characteristics of patients and bystanders or recognizers as well as responses and actions of citizens in these OHCAs were compared with those in other OHCAs of standard time distance. Results: There were no significant differences in incidences of arrest-witnessed, causecardiac, telephone-assisted CPR instruction and CPR by citizens. The outcome of OHCAs was significantly lower and the interval of call to bystander CPR was significantly longer while multiple citizens were present at arrival at patients in OHCAs of a remote time distance. Conclusions: Delayed initiation of bystander CPR may be one of causes of poor outcome of OHCAs of a remote time distance. Education of families in such residences is necessary
Statics
<9 min N = 2258
≥9 min N = 762
76 (64–83) 33.4% 51.6% 58.1% 42.4% 1 (0–3) 1 (0–3) 31.7% (616/1941) 3.4%
78 (68–85) 35.3% 51.1% 55.9% 43.3% 1 (0–4) 1 (0–4) 37.3% (239/640) 1.1%
0.0003 0.347 0.8112 0.2981 0.671 0.187 0.003 <0.01 <0.001
doi:10.1016/j.resuscitation.2010.09.201 AP057 Non-health care providers perform straddle CPR as adequately as conventional CPR Loukas T., Solakis E., Rammou P., Geronatsios K., Konstantinou K., Litos G., Rigopoulos D. 1st department of internal medicine, 401 General Military Hospital, Athens, Greece Purpose: Often the rescuer is obligated to perform cardiopulmonary resuscitation (CPR) in a confined space. Aim of the study was to investigate the efficacy of straddle CPR (stCPR) comparing to conventional CPR (cCPR). Materials and methods: We evaluated professional soldiers who did not have any medical knowledge. They had all attended a CPR course instructed by ERC certified instructors. They also, were taught to perform straddle CPR. Each of them was allowed to perform 2 min conventional CPR on a manikin and 1 h later, 2 min of straddle CPR (chest compressions only) without giving rescue breaths. The manikin was connected with a PC and we were able to record the follow parameters: number of compressions and compression rate, the depth of each compression and the wrong position of the hands. Results: Seventeen participants took place in the study. During cCPR the average compression rate was 107/min (SD 16.088), The average depth of each compression was 44.4 mm (SD 9.709) and the percentage of the wrong hand position was only 4.1% (SD 3.717). During stCPR the average average compression rate was 109 min−1 (SD 16.088), The average depth of each compression was 45.1 mm (SD 9.709) and the percentage of the wrong hand position was 5.7% (SD 3.717). All the above results were within the limits of the ERC 2005 guidelines. Conclusion: Despite the fact that the participants were not health care providers, the results were quite satisfactory. We strongly believe that they were quite efficient in performing CPR of good quality using either the conventional method or stCPR, as far as compression rate, compression depth and right hand position are concerned. doi:10.1016/j.resuscitation.2010.09.202 AP058 Association between detecting agonal breathing and outcome in Vienna (Austria) Wannack S. 1 , Sterz F. 1 , Weiser C. 1 , Nuernberger A. 1 , Schober A. 1 , Stoeckl M. 1 , Malzer R. 2 , Segall B. 2 , Lausch F. 2 1 Department 2
of Emergency Medicine, Medical University of Vienna, Austria Emergency Medical Service, Vienna City Administration, Austria
Purpose: In order to enhance Dispatcher-assisted bystander CPR which is thought to be one important factor of survival after OOHCA agonal breathing must be discovered as soon as possible. Methods: All calls with OOHCA received by the dispatch center of the Emergency Medical Service (EMS) in Vienna were evaluated. Voice recordings were analyzed according to approved international standards and related to neurological outcome and Utstein core data. Results: From February 1st 2009 to January 31st 2010, 614 OOHCA cases occurred prior to EMS arrival. The study group could only include cases with 2nd party callers therefore 173 cases were excluded. The overall survival rate of 10% (43) is the summary of 9% (40) with favourable neurological outcome (CPC1/2) and 1% (3) with unfavorable neurological outcome (CPC 3/4). In the non-survivor group agonal breathing was to be verified in 26% (114) but only 7% (32) were verified correctly