- Email: [email protected]
Survival of out-of-hospital sudden cardiac arrest has tripled in the Dutch province Limburg over the last 20 years
S52
Poster Presentations / Resuscitation 84S (2013) S8–S98
AP106
AP107
Facility-specific numbers needed to visit for an on-site AED to be cost-effective
Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment
Hiroshi Kaneko 1 , Tetsuo Hatanaka 2 , Aki Nagase 3 , Tetsuya Sakamoto 4 , Seishiro Marukawa 5
Ing-Marie Larsson 1,∗ , Ewa Wallin 1 , Marja-Leena Kristofferzon 2 , Sten Rubertsson 1
1
Nagoya City Fire Department, Nagoya, Japan Emergency Life-Saving Technique Academy, Kitakyusyu, Japan 3 Health Sciences University of Hokkaido, Sapporo, Japan 4 Teikyo University, Tokyo, Japan 5 Iseikai Hospital, Osaka, Japan 2
1 Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden 2 Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
Background and purpose: In a separate analysis, we estimated the incremental cost-effectiveness ratio (ICER) of an on-site AED in public places to be ∼74,400 EUR. Using this value, we calculated the facility-specific numbers needed to visit (NNV, per day) for an on-site AED to be cost-effective. Materials and methods: Locations of cardiac arrest from 2003 through 2010 were abstracted from the database of the Fire Department of Nagoya City with a population of 2.2 million. The location of cardiac arrest was tallied and grouped into 36 facility categories, and the number of cardiac arrest and of visitors/workers/residents within each category was determined to calculate the facilityspecific probability (Parrest ) that each visitor/worker/resident will experience a shockable cardiac arrest. The incremental qualityadjusted life year (QALY) that would be gained through receiving a public-access defibrillation (PAD) was calculated by comparing the QALY of those patients who did not receive PAD and of those patients who did after adjusting for confounders. The product of Parrest and the incremental QALY yielded an expected QALY gained (QALY) with PAD. NNV was calculated from the formula: NNV =
x + n(y + z) 365 · Parrest (QALY · ICER − CoM)
where x, cost of AED maintenance and consumables (per AED); y, the cost of BLS training (per trainee); z, productivity loss with undergoing BLS training (per trainee); n, the number of trainee (per AED), CoM; incremental cost of medical/nursing care. Results and conclusions:
Parrest NNV
(×10−9 )
Aim of the study: To investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months after cardiac arrest (CA), in patients treated with therapeutic hypothermia (TH). Method: During a 4-year period at three hospitals in Sweden, 26 patients were prospectively included after CA treated with TH. All patients completed the questionnaires Hospital Anxiety and Depression Scale (HADS), Euroqol (EQ5D), Euroqol visual analogue scale (EQ-VAS) and Short Form 12 (SF12) at three occasions, in connection with hospital discharge, and at one and 6 months after CA. Result: There was improvement over time in HRQoL, the EQ5D index (p = 0.002) and the SF12 physical component score (PCS) (p = 0.005). Changes over time in anxiety and depression were not found. Seventy-three percent of patients had an EQ-VAS score below 70 (scale 0–100) on overall health status at discharge from hospital; at 6 months the corresponding figure was 41%. Physical problems were the most common complaint affecting HRQoL. A correlation was found between depression and HRQoL, and this was strongest at six months (rs = −.44 to −.71, p ≤ 0.001). Conclusion: HRQoL is affected negatively in patients who have been treated with TH following CA, but improvement over the first 6 months can be seen. Patients reported lower levels of HRQoL on the physical as compared to mental components. The results indicate that time is an important factor, and patients may require additional support during the initial period after discharge from hospital.
Station
Sports facility
Casino
Factory
Restaurant
Nursing for elderly
http://dx.doi.org/10.1016/j.resuscitation.2013.08.135
4.2 3275
152.0 40
175.3 100
122.0 657
9.0 5370
1685.6 22
AP109
Parrest and NNV for each facility category are shown in the table. We found considerable variation in the Parrest and NNV per day among facilities. These values may help the decision-making process as to what specific facilities may merit placing an on-site AED.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.134
Survival of out-of-hospital sudden cardiac arrest has tripled in the Dutch province Limburg over the last 20 years Ruud Pijls ∗ , Anton Gorgels Maastricht University Medical Centre, Maastricht, The Netherlands Purpose of the study: To assess current survival and related factors of out-of-hospital sudden cardiac arrest (SCA) in the province of Limburg. Materials and methods: Data from all out-of-hospital SCA patients in the province of Limburg in 2012 were collected according to the Utstein Templates.1 Patients were included in the analysis if the origin of SCA was cardiac or unknown, and the SCA did not occur in the ambulance. Survival was compared with data from the Maastricht cardiac arrest registry2 (1991–1994). Results: Of 424 SCA cases included, 70.5% were men, comparable to 72% in 1990s. A total of 23.8% was discharged from the hospital alive. Survivors were younger than non-survivors
Poster Presentations / Resuscitation 84S (2013) S8–S98
(63.5 ± 15.1 vs. 69.1 ± 16.0, p = 0.002). Survival was 27.4% in documented cardiac SCA vs. 8.6% if unknown (p = 0.000), 29.4% in witnessed SCA (in contrast to 10.6% in 1992) vs. 4.7% if unwitnessed (p = 0.000), 31.9% in SCA outside vs. 19.9% in the home (p = 0.007), 33.8% in case of bystander resuscitation vs.10.5% without (p = 0.000), 34.0% when an AED was connected vs. 20.9% without an AED (p = 0.015), 40.8% when ventricular fibrillation was the initial rhythm vs. 5.0% in case of no documented ventricular fibrillation (p = 0.000). Conclusions: The present overall survival rate in the Dutch province of Limburg of resuscitation of out-of-hospital SCA is 23.8%. In the 1990s survival rate was 10.6% in witnessed SCA2 compared to 29.4% in 2012. This marked increase is likely to be related to improved resuscitation efforts within the community. Further reading 1. Jacobs I, Nadkarni V. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for resuscitation. Circulation 2004;110:3385–97. 2. De Vreede-Swagemakers JJM, Gorgels APM, Dubois-Arbouw WI, et al. Out-ofhospital cardiac arrest in the 1990s: a population-based study in the Maastricht area on incidence, characteristics and survival. Journal of the American College of Cardiology 1997;30:1500–5.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.136 AP110 Two-year survey of cases with aneurysm and dissection of the aorta that were transported by emergency medical technicians (EMTs) Hideo Inaba 1,∗ , Taiki Nishi 1 , Hiroki Matsubara 1 , Tetsuya Ishida 2 , Satoru Sakagami 3 , Testuo Maeda 1 1 Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan 2 Kaga Citizen’s Hospital, Kaga, Ishikawa, Japan 3 Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
Backgrounds and aims: To investigate the signs, symptoms and incidences of aortic aneurysm/dissection that did and did not cause OHCA and were transported by EMTs. Materials and methods: Fire departments in Ishikawa Prefecture prospectively collected the data for cases with aortic aneurysm/dissection that were transported by EMS during the period from January 2011 to December 2012. The data included the backgrounds, signs and symptoms of the patients at the scene as well as the backgrounds of bystanders. Results: Two hundred and forty-nine cases without OHCA were transported to hospital and diagnosed to have aortic aneurysm/dissection. These cases represent 0.4% of total cases with medical emergency. The characteristics of patients are follows: male gender (51%), median value (25–75%) of age (73 (62–83)), high co-morbidity (88%). The major signs and symptoms are as follows: back pain (71%), chest pain (56%), abdominal pain (30%), dyspnoea (16%), syncope (9%), nausea and vomiting (7%). These symptoms mostly (92%) happened without a hard exercise and detected mainly by family members (59%) and patients themselves (42%). In 88 (8%) out of 1066 OHCAs of presumed non-cardiac aetiology that occurred during the study period, the primary cause of arrest was identified to be aortic aneurysm/dissection. Premonitory symptoms are rarely obtained but as follows: syncope (12 cases), emesis and hematemesis (9), back pain (8), chest pain (6), abdominal pain (4). The initial ECG rhythms in EMT-unwitnessed cases are PEA and asystole. Ninety percentage of the aortic aneurysm/dissection cases
S53
were transported to major emergency hospitals where autopsy imaging is available. Conclusions: The incidence of aortic aneurysm/dissection in all medical emergencies was extremely low but that in OHCAs of noncardiac aetiology was not rare. Because typical premonitory signs including back and chest pain are rarely obtained, the real incidence in OHCA may be higher. http://dx.doi.org/10.1016/j.resuscitation.2013.08.137 AP111 The Overall Performance Category and Cerebral Performance Category to assess neurologic intact survival at discharge from a cardiac arrest. A good estimate of patients’ functioning? Stefanie Beesems ∗ , Kim Wittebrood, Rob de Haan, Rudolph Koster Academic Medical Center, Amsterdam, The Netherlands Purpose: Most studies on out-of-hospital cardiac arrest (OHCA) use the Overall Performance Category (OPC)/Cerebral Performance Category (CPC) as outcome at discharge. We studied the neurocognitive functioning (NCF) and level of independence (LoI) of patients (pts) 6–12 months after OHCA and compared the results with the OPC/CPC at discharge. Methods: The study population comprises 228 pts (>18 year) who survived 6–12 months after OHCA. Pts were interviewed by telephone with questionnaires validated for telephone. NCF was measured with the Telephonic Interview Cognitive Status (TICS) and LoI with the Modified Rankin Scale (MRS). If needed, the IQcode was used as proxy-questionnaire to measure the NCF of the pt. Neurological outcome at discharge was assessed from hospital records estimating OPC/CPC. MRS was obtained in 228 pts and the NCF in 217 pts alive at 6 months. Results: The comparison between OPC at discharge and MRS at 6–12 months is shown in the figure. Comparison of CPC at discharge and the TICS at 6–12 months showed that 30 of the 218 (14%) pts were cognitively impaired at 6–12 months while they were classified as having a good outcome (CPC 1–2) at discharge. Conclusion: MRS and other tests 6–12 months after discharge better reflect pts’ functioning at home than OPC/CPC at the moment of discharge. OPC/CPC cannot measure impairments that manifest them only in the home environment.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.138
Poster Presentations / Resuscitation 84S (2013) S8–S98
AP106
AP107
Facility-specific numbers needed to visit for an on-site AED to be cost-effective
Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment
Hiroshi Kaneko 1 , Tetsuo Hatanaka 2 , Aki Nagase 3 , Tetsuya Sakamoto 4 , Seishiro Marukawa 5
Ing-Marie Larsson 1,∗ , Ewa Wallin 1 , Marja-Leena Kristofferzon 2 , Sten Rubertsson 1
1
Nagoya City Fire Department, Nagoya, Japan Emergency Life-Saving Technique Academy, Kitakyusyu, Japan 3 Health Sciences University of Hokkaido, Sapporo, Japan 4 Teikyo University, Tokyo, Japan 5 Iseikai Hospital, Osaka, Japan 2
1 Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden 2 Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
Background and purpose: In a separate analysis, we estimated the incremental cost-effectiveness ratio (ICER) of an on-site AED in public places to be ∼74,400 EUR. Using this value, we calculated the facility-specific numbers needed to visit (NNV, per day) for an on-site AED to be cost-effective. Materials and methods: Locations of cardiac arrest from 2003 through 2010 were abstracted from the database of the Fire Department of Nagoya City with a population of 2.2 million. The location of cardiac arrest was tallied and grouped into 36 facility categories, and the number of cardiac arrest and of visitors/workers/residents within each category was determined to calculate the facilityspecific probability (Parrest ) that each visitor/worker/resident will experience a shockable cardiac arrest. The incremental qualityadjusted life year (QALY) that would be gained through receiving a public-access defibrillation (PAD) was calculated by comparing the QALY of those patients who did not receive PAD and of those patients who did after adjusting for confounders. The product of Parrest and the incremental QALY yielded an expected QALY gained (QALY) with PAD. NNV was calculated from the formula: NNV =
x + n(y + z) 365 · Parrest (QALY · ICER − CoM)
where x, cost of AED maintenance and consumables (per AED); y, the cost of BLS training (per trainee); z, productivity loss with undergoing BLS training (per trainee); n, the number of trainee (per AED), CoM; incremental cost of medical/nursing care. Results and conclusions:
Parrest NNV
(×10−9 )
Aim of the study: To investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months after cardiac arrest (CA), in patients treated with therapeutic hypothermia (TH). Method: During a 4-year period at three hospitals in Sweden, 26 patients were prospectively included after CA treated with TH. All patients completed the questionnaires Hospital Anxiety and Depression Scale (HADS), Euroqol (EQ5D), Euroqol visual analogue scale (EQ-VAS) and Short Form 12 (SF12) at three occasions, in connection with hospital discharge, and at one and 6 months after CA. Result: There was improvement over time in HRQoL, the EQ5D index (p = 0.002) and the SF12 physical component score (PCS) (p = 0.005). Changes over time in anxiety and depression were not found. Seventy-three percent of patients had an EQ-VAS score below 70 (scale 0–100) on overall health status at discharge from hospital; at 6 months the corresponding figure was 41%. Physical problems were the most common complaint affecting HRQoL. A correlation was found between depression and HRQoL, and this was strongest at six months (rs = −.44 to −.71, p ≤ 0.001). Conclusion: HRQoL is affected negatively in patients who have been treated with TH following CA, but improvement over the first 6 months can be seen. Patients reported lower levels of HRQoL on the physical as compared to mental components. The results indicate that time is an important factor, and patients may require additional support during the initial period after discharge from hospital.
Station
Sports facility
Casino
Factory
Restaurant
Nursing for elderly
http://dx.doi.org/10.1016/j.resuscitation.2013.08.135
4.2 3275
152.0 40
175.3 100
122.0 657
9.0 5370
1685.6 22
AP109
Parrest and NNV for each facility category are shown in the table. We found considerable variation in the Parrest and NNV per day among facilities. These values may help the decision-making process as to what specific facilities may merit placing an on-site AED.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.134
Survival of out-of-hospital sudden cardiac arrest has tripled in the Dutch province Limburg over the last 20 years Ruud Pijls ∗ , Anton Gorgels Maastricht University Medical Centre, Maastricht, The Netherlands Purpose of the study: To assess current survival and related factors of out-of-hospital sudden cardiac arrest (SCA) in the province of Limburg. Materials and methods: Data from all out-of-hospital SCA patients in the province of Limburg in 2012 were collected according to the Utstein Templates.1 Patients were included in the analysis if the origin of SCA was cardiac or unknown, and the SCA did not occur in the ambulance. Survival was compared with data from the Maastricht cardiac arrest registry2 (1991–1994). Results: Of 424 SCA cases included, 70.5% were men, comparable to 72% in 1990s. A total of 23.8% was discharged from the hospital alive. Survivors were younger than non-survivors
Poster Presentations / Resuscitation 84S (2013) S8–S98
(63.5 ± 15.1 vs. 69.1 ± 16.0, p = 0.002). Survival was 27.4% in documented cardiac SCA vs. 8.6% if unknown (p = 0.000), 29.4% in witnessed SCA (in contrast to 10.6% in 1992) vs. 4.7% if unwitnessed (p = 0.000), 31.9% in SCA outside vs. 19.9% in the home (p = 0.007), 33.8% in case of bystander resuscitation vs.10.5% without (p = 0.000), 34.0% when an AED was connected vs. 20.9% without an AED (p = 0.015), 40.8% when ventricular fibrillation was the initial rhythm vs. 5.0% in case of no documented ventricular fibrillation (p = 0.000). Conclusions: The present overall survival rate in the Dutch province of Limburg of resuscitation of out-of-hospital SCA is 23.8%. In the 1990s survival rate was 10.6% in witnessed SCA2 compared to 29.4% in 2012. This marked increase is likely to be related to improved resuscitation efforts within the community. Further reading 1. Jacobs I, Nadkarni V. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for resuscitation. Circulation 2004;110:3385–97. 2. De Vreede-Swagemakers JJM, Gorgels APM, Dubois-Arbouw WI, et al. Out-ofhospital cardiac arrest in the 1990s: a population-based study in the Maastricht area on incidence, characteristics and survival. Journal of the American College of Cardiology 1997;30:1500–5.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.136 AP110 Two-year survey of cases with aneurysm and dissection of the aorta that were transported by emergency medical technicians (EMTs) Hideo Inaba 1,∗ , Taiki Nishi 1 , Hiroki Matsubara 1 , Tetsuya Ishida 2 , Satoru Sakagami 3 , Testuo Maeda 1 1 Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan 2 Kaga Citizen’s Hospital, Kaga, Ishikawa, Japan 3 Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
Backgrounds and aims: To investigate the signs, symptoms and incidences of aortic aneurysm/dissection that did and did not cause OHCA and were transported by EMTs. Materials and methods: Fire departments in Ishikawa Prefecture prospectively collected the data for cases with aortic aneurysm/dissection that were transported by EMS during the period from January 2011 to December 2012. The data included the backgrounds, signs and symptoms of the patients at the scene as well as the backgrounds of bystanders. Results: Two hundred and forty-nine cases without OHCA were transported to hospital and diagnosed to have aortic aneurysm/dissection. These cases represent 0.4% of total cases with medical emergency. The characteristics of patients are follows: male gender (51%), median value (25–75%) of age (73 (62–83)), high co-morbidity (88%). The major signs and symptoms are as follows: back pain (71%), chest pain (56%), abdominal pain (30%), dyspnoea (16%), syncope (9%), nausea and vomiting (7%). These symptoms mostly (92%) happened without a hard exercise and detected mainly by family members (59%) and patients themselves (42%). In 88 (8%) out of 1066 OHCAs of presumed non-cardiac aetiology that occurred during the study period, the primary cause of arrest was identified to be aortic aneurysm/dissection. Premonitory symptoms are rarely obtained but as follows: syncope (12 cases), emesis and hematemesis (9), back pain (8), chest pain (6), abdominal pain (4). The initial ECG rhythms in EMT-unwitnessed cases are PEA and asystole. Ninety percentage of the aortic aneurysm/dissection cases
S53
were transported to major emergency hospitals where autopsy imaging is available. Conclusions: The incidence of aortic aneurysm/dissection in all medical emergencies was extremely low but that in OHCAs of noncardiac aetiology was not rare. Because typical premonitory signs including back and chest pain are rarely obtained, the real incidence in OHCA may be higher. http://dx.doi.org/10.1016/j.resuscitation.2013.08.137 AP111 The Overall Performance Category and Cerebral Performance Category to assess neurologic intact survival at discharge from a cardiac arrest. A good estimate of patients’ functioning? Stefanie Beesems ∗ , Kim Wittebrood, Rob de Haan, Rudolph Koster Academic Medical Center, Amsterdam, The Netherlands Purpose: Most studies on out-of-hospital cardiac arrest (OHCA) use the Overall Performance Category (OPC)/Cerebral Performance Category (CPC) as outcome at discharge. We studied the neurocognitive functioning (NCF) and level of independence (LoI) of patients (pts) 6–12 months after OHCA and compared the results with the OPC/CPC at discharge. Methods: The study population comprises 228 pts (>18 year) who survived 6–12 months after OHCA. Pts were interviewed by telephone with questionnaires validated for telephone. NCF was measured with the Telephonic Interview Cognitive Status (TICS) and LoI with the Modified Rankin Scale (MRS). If needed, the IQcode was used as proxy-questionnaire to measure the NCF of the pt. Neurological outcome at discharge was assessed from hospital records estimating OPC/CPC. MRS was obtained in 228 pts and the NCF in 217 pts alive at 6 months. Results: The comparison between OPC at discharge and MRS at 6–12 months is shown in the figure. Comparison of CPC at discharge and the TICS at 6–12 months showed that 30 of the 218 (14%) pts were cognitively impaired at 6–12 months while they were classified as having a good outcome (CPC 1–2) at discharge. Conclusion: MRS and other tests 6–12 months after discharge better reflect pts’ functioning at home than OPC/CPC at the moment of discharge. OPC/CPC cannot measure impairments that manifest them only in the home environment.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.138