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  • Ovid Technologies (Wolters Kluwer Health)  (19)
  • 1
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    Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest : A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. 13 ( 2015-09-29), p. 1286-1300
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. 13 ( 2015-09-29), p. 1286-1300
    Abstract: Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents’ assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system−treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIR.0000000000000144
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 2
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    Association Between Delays in Time to Bystander CPR and Survival for Witnessed Cardiac Arrest in the United States
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 17, No. 2 ( 2024-02)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 17, No. 2 ( 2024-02)
    Abstract: Prompt initiation of bystander cardiopulmonary resuscitation (CPR) is critical to survival for out-of-hospital cardiac arrest (OHCA). However, the association between delays in bystander CPR and OHCA survival is poorly understood. METHODS: In this observational study using a nationally representative US registry, we identified patients who received bystander CPR from a layperson for a witnessed OHCA from 2013 to 2021. Hierarchical logistic regression was used to estimate the association between time to CPR ( 〈 1 minute versus 2–3, 4–5, 6–7, 8–9, and ≥10-minute intervals) and survival to hospital discharge and favorable neurological survival (survival to discharge with cerebral performance category of 1 or 2 [ie, without severe neurological disability]). RESULTS: Of 78 048 patients with a witnessed OHCA treated with bystander CPR, the mean age was 63.5±15.7 years and 25, 197 (32.3%) were women. The median time to bystander CPR was 2 (1–5) minutes, with 10% of patients having a≥10-minute delay before initiation of CPR. Overall, 15 000 (19.2%) patients survived to hospital discharge and 13 159 (16.9%) had favorable neurological survival. There was a graded inverse relationship between time to bystander CPR and survival to hospital discharge ( P for trend 〈 0.001). Compared with patients who received CPR within 1 minute, those with a time to CPR of 2 to 3 minutes were 9% less likely to survive to discharge (adjusted odds ratio, 0.91 [95% CI, 0.87–0.95]) and those with a time to CPR 4 to 5 minutes were 27% less likely to survive (adjusted odds ratio, 0.73 [95% CI, 0.68–0.77] ). A similar graded inverse relationship was found between time to bystander CPR and favorable neurological survival ( P for trend 〈 0.001). CONCLUSIONS: Among patients with witnessed OHCA, there was a dose-response relationship between delays in bystander initiation of CPR and lower survival rates.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/CIRCOUTCOMES.123.010116
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
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  • 3
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    Abstract 22: Racial And Ethnic Differences In Bystander Cardiopulmonary Resuscitation For Witnessed Out-of-Hospital Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 15, No. Suppl_1 ( 2022-05)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 15, No. Suppl_1 ( 2022-05)
    Abstract: Background: Racial disparities in bystander cardiopulmonary resuscitation (CPR) treatment contributes to inequities in survival for out-of-hospital cardiac arrest (OHCA). Whether bystander CPR rates differ by race/ethnicity for witnessed OHCAs in public settings is unclear but critical to understand for informing public health interventions. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we identified 110,054 witnessed OHCAs during 2013-2019. Using hierarchical logistic regression, we compared rates of bystander CPR in Blacks/Hispanics vs. Whites for OHCAs at home vs. in public locations, overall and by neighborhood race and income groups. Results: Overall, 35,469 (32.2%) witnessed OHCAs occurred in Black/Hispanic individuals and 25,758 (23.4%) OHCAs occurred in public locations. Blacks/Hispanics were less likely to receive bystander CPR at home (38.5% vs. 47.4% for Whites; adjusted OR [aOR]=0.74 [95% CI: 0.71-0.76] ) and in public (45.6% vs. 60.0%; aOR=0.59 [0.56-0.63]), and the magnitude of this disparity was greater for OHCAs occurring in public ( P for interaction 〈 0.001). Lower bystander CPR rates for Blacks/Hispanics at home and in public were found in majority Black/Hispanic, Integrated, and predominantly White neighborhoods ( Table ), and the magnitude of this difference was greater for public OHCAs in each neighborhood race/ethnicity stratum (all P- values for interaction 〈 0.02). A similar pattern was found in high, middle, and low-income neighborhoods, with lower bystander CPR rates for Blacks/Hispanics at home and in public and a larger treatment disparity for OHCAs in public vs. at home in each income strata (all P- values for interaction 〈 0.001). Conclusions: Black and Hispanic victims of witnessed OHCA are less likely to receive potentially life-saving bystander CPR, as compared with White patients, and the magnitude of this disparity was greater for OHCAs witnessed in public than at home.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/circoutcomes.15.suppl_1.22
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 4
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    Abstract 273: Implications of Expanding the Utstein Case Definition for Out of Hospital Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_4 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_4 ( 2020-11-17)
    Abstract: Background: The Utstein population is defined by non-traumatic, bystander-witnessed out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF). It is used to compare resuscitation performance across emergency medical services (EMS) systems. We hypothesized there being a system-specific survival correlation between the current Utstein and other VF populations inclusive of unwitnessed and EMS-witnessed VF OHCA that supports expanding performance metrics to this more comprehensive population that is more representative of the actual community burden of VF OHCA. Methods: We performed a cohort investigation of all non-traumatic, VF OHCA in the Cardiac Arrest Registry to Enhance Survival from 1/1/2013-12/31/2018 among EMS agencies that treated 〉 =100 VF OHCA. We evaluated sample size and survival with the addition of the new VF populations. We used the Pearson coefficient to assess the correlation of agency-specific survival between the current Utstein population and unwitnessed and EMS-witnessed VF OHCA. Results: A total of 107 EMS agencies treated 38,836 VF arrests: 22,918 current Utstein, 11,297 unwitnessed VF, and 4621 EMS-witnessed VF OHCA. Overall, survival was 29.8% (11,567/38,836): 33.9% (7,774/22,918) among current Utstein, 17.2% (1942/11,297) among unwitnessed VF, and 40.1% (1851/4621) among EMS-witnessed VF. For agency-specific survival outcome, the Pearson correlation was 0.52 between current the Utstein population versus combined unwitnessed and EMS-witnessed groups. For survival with Cerebral Performance Category 1-2, the Pearson correlation was 0.61. Conclusion: Expanding the Utstein population to include unwitnessed and EMS-witnessed VF OHCA achieves a simpler, more inclusive case definition that minimizes variability in case determination and increases the number of survivors and eligible population by ~50%, while still achieving a distinguishing metric of system-specific performance.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_4.273
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 5
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    Abstract 236: Gender Disparities in Bystander CPR and Defibrillation Persist in Black and Hispanic Neighborhoods in the US
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_4 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_4 ( 2020-11-17)
    Abstract: Introduction: Bystander CPR (B-CPR) and defibrillation for sudden cardiac arrest (SCA) vary by gender with females being less likely to receive these interventions. Despite known differences by race and ethnicity, it is unknown whether gender disparities in B-CPR and defibrillation persist by neighborhood race and ethnicity. Objectives: We examined the likelihood of receiving B-CPR and defibrillation by gender stratified by public location and neighborhood racial/ethnic composition. We hypothesized that in public locations within Black neighborhoods, females will have a lower likelihood of receiving B-CPR compared to males. Methods: We conducted a retrospective cohort study using data from the US Cardiac Arrest Registry to Enhance Survival (CARES) registry. Neighborhoods were classified by census tract based on percent of Black or Hispanic residents using the threshold in the definition of “White flight” where Whites leave a neighborhood when it exceeds 〉 30% of a minority population. We independently modeled the likelihood of receipt of B-CPR and defibrillation by gender stratified by public location and neighborhood racial/ethnic composition controlling for confounding variables. Results: From 2013-2018, CARES collected 350,722 US arrests; after excluding pediatric arrests, those witnessed by EMS, or those that occurred in a healthcare facility, 214,464 were included. Mean age was 64±16 and 65% were male; 39% received B-CPR, 9% received bystander defibrillation prior to 9-1-1 responders arrival, and 18% occurred in the public. In Black neighborhoods, females who had SCA in public locations were 22% less likely to receive B-CPR (OR: 0.78 (0.64-0.95), p=0.01) and 42% less likely to receive defibrillation (OR: 0.58 (0.45-0.74), p 〈 0.01) compared to males. In Hispanic neighborhoods, females who had SCA in public locations were also less likely to receive B-CPR (OR: 0.72 (0.59-0.87), p 〈 0.01) and less likely to receive defibrillation (OR: 0.62 (0.48-0.80), p 〈 0.01) compared to males. Conclusion: Females with public SCA have a decreased likelihood of receiving B-CPR and defibrillation, and these findings persist in Black and Hispanic neighborhoods. This has implications for strategies to reduce disparities around bystander response to SCA.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_4.236
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 6
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    Abstract 118: The Epidemiology of Airway Management Following Pediatric Out-of-Hospital Cardiac Arrest in the United States
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Circulation Vol. 138, No. Suppl_2 ( 2018-11-06)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 138, No. Suppl_2 ( 2018-11-06)
    Abstract: Introduction: Bag mask ventilation (BMV) has been associated with improved survival following out of hospital cardiac arrest (OHCA), however advanced airway placement remains part of pre-hospital protocols for many emergency medical services (EMS) agencies. Hypothesis: To characterize airway management for pediatric OHCA and assess whether BMV alone vs. BMV plus advanced airway (supraglottic airway or tracheal intubation) is associated with neurologically favorable survival. Methods: Analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years, non-traumatic OHCA from 2013 through 2017, resuscitated by EMS. To adjust for covariate imbalance, propensity score matching and entropy balancing were utilized; variables included age category, sex, bystander CPR, and shockable rhythm. The primary outcome was favorable neurologically favorable survival defined as a cerebral performance category scale of 1 or 2. Results: Of 5241 cardiac arrests, 2588 (49.3%) had BVM and 2653 (50.6%) had advanced airway placement. The majority 5118 (97.7%) were resuscitated by agencies using both BMV and advanced airways. Advanced airway placement was more common in older children compared to infants, arrests with bystander CPR, in white and Hispanic children, witnessed arrests, arrests with a shockable rhythm, and AED use (Table). Neurologically favorable survival was significantly higher with BMV compared to advanced airways in bivariate analysis (11.4% vs. 5.7%, p 〈 0.001). In multivariable analysis, advanced airway placement was associated with lower neurologically favorable survival (adjusted proportion 4.9% vs. 13.5% BVM, OR 0.21, 95% CI 0.17, 0.28). These results were robust on propensity analysis 3.0% advanced airway vs.11.9% BMV (OR 0.18, 95% CI 0.14, 0.25), and entropy balance 5.9% advanced airway, 15.0% for BMV (OR 0.28, 95% CI 0.22). Conclusion: In pediatric OHCA, advanced airways are placed in half of cardiac arrests where resuscitation is attempted. Advanced airway, compared to BMV alone management, is associated with lower neurologically favorable survival.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.138.suppl_2.118
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 7
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    Race/Ethnicity and Neighborhood Characteristics Are Associated With Bystander Cardiopulmonary Resuscitation in Pediatric Out‐of‐Hospital Cardiac Arrest in the United States: A Study From CARES
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of the American Heart Association Vol. 8, No. 14 ( 2019-07-16)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 14 ( 2019-07-16)
    Abstract: Whether racial and neighborhood characteristics are associated with bystander cardiopulmonary resuscitation ( BCPR ) in pediatric out‐of‐hospital cardiac arrest ( OHCA ) is unknown. Methods and Results An analysis was conducted of CARES (Cardiac Arrest Registry to Enhance Survival) for pediatric nontraumatic OHCA s from 2013 to 2017. An index (range, 0–4) was created for each arrest based on neighborhood characteristics associated with low BCPR ( 〉 80% black; 〉 10% unemployment; 〈 80% high school; median income, 〈 $50 000). The primary outcome was BCPR . BCPR occurred in 3399 of 7086 OHCA s (48%). Compared with white children, BCPR was less likely in other races/ethnicities (black: adjusted odds ratio [ aOR ], 0.59; 95% CI , 0.52–0.68; Hispanic: aOR , 0.78; 95% CI , 0.66–0.94; and other: aOR , 0.54; 95% CI , 0.40–0.72). Compared with arrests in neighborhoods with an index score of 0, BCPR occurred less commonly for arrests with an index score of 1 ( aOR , 0.80; 95% CI , 0.70–0.91), 2 ( aOR , 0.75; 95% CI , 0.65–0.86), 3 ( aOR , 0.52; 95% CI , 0.45–0.61), and 4 ( aOR , 0.46; 95% CI , 0.36–0.59). Black children had an incrementally lower likelihood of BCPR with increasing index score while white children had an overall similar likelihood at most scores. Black children with an index of 4 were approximately half as likely to receive BCPR compared with white children with a score of 0. Conclusions Racial and neighborhood characteristics are associated with BCPR in pediatric OHCA . Targeted CPR training for nonwhite, low‐education, and low‐income neighborhoods may increase BCPR and improve pediatric OHCA outcomes.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.119.012637
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 8
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    Abstract 148: No Bystander Cardiopulmonary Resuscitation For Out-Of-Hospital Cardiac Arrest In Vietnam: Impact On The Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Bystander CPR is not often performed on OHCA patients, particularly in limited-resource regions. This study aimed to investigate the rate of OHCA patients who did not receive bystander CPR and its impact on the outcomes in an LMIC. Hypothesis: Understanding the reasons bystanders are reluctant to call EMS and how no bystander CPR impacts the outcomes of OHCA patients are crucial for improving survival in Vietnam. Methods: We performed a multicenter prospective cohort study of OHCA patients (≥18 years) presenting to three central hospitals in Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes and compared these data between patients who did not receive bystander CPR and patients who did. Using logistic regression, we assessed factors associated with survival and good neurological function on discharge (a CPC score of 1 or 2). Results: Of 521 patients, 388 (74.5%) were male, and the mean age was 56.71 years (SD: 17.32). Although most cardiac arrests (68.7%; 358/521) occurred at home and 67.9% (353/520) were witnessed by bystanders, a high rate (77.9%, 406/521) of these patients did not receive bystander CPR. Only half of the patients were taken by EMS (8.1%, 42/521) or private ambulance (42.8%, 223/521); 50.8% (133/262) of whom were given resuscitation attempts by EMS or private ambulance. There was no significant difference in survival to admission (16.7%; 68/406 and 24.3%; 28/115; p=0.064) and survival to discharge (7.9%; 32/406 and 14.8%; 17/115; p=0.094) between patients who did not receive bystander CPR and patients who did. In contrast, the rate of good neurological function of patients who did not receive bystander CPR (4.7%, 19/406) was significantly lower than that of patients who received bystander CPR (12.2%, 14/115; p=0.004). Moreover, multivariate analysis showed that no bystander CPR (OR: 0.276; 95% CI: 0.124-0.614) was inversely and independently associated with good neurological function. Conclusions: In our study, poor outcomes emphasize the need for increasing bystander CPR performance, increasing the number of EMS ambulances and the utilization of private ambulances, and developing a standard emergency first-aid program for both healthcare personnel and the community.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.148
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 9
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    A Qualitative Study to Identify Barriers to Local Implementation of Prehospital Termination of Resuscitation Protocols
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 2, No. 4 ( 2009-07), p. 361-368
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 2, No. 4 ( 2009-07), p. 361-368
    Abstract: Background— Despite the existence of national American Heart Association guidelines and 2 termination-of-resuscitation (TOR) rules for ceasing efforts in refractory out-of-hospital cardiac arrest, many emergency medical services agencies in the United States have adopted their own local protocols. Public policies and local perceptions may serve as barriers or facilitators to implementing national TOR guidelines at the local level. Methods and Results— Three focus groups, lasting 90 to 120 minutes, were conducted at the National Association of Emergency Medical Services Physicians meeting in January 2008. Snowball sampling was used to recruit participants. Two reviewers analyzed the data in an iterative process to identify recurrent and unifying themes. We identified 3 distinct groups whose current policies or perceptions may impede efforts to adopt national TOR guidelines: payers who incentivize transport; legislators who create state mandates for transport and allow only narrow use of do-not-resuscitate orders; and communities where cultural norms are perceived to impede termination of resuscitation. Our participants suggested that national organizations, such as the American Heart Association and American College of Emergency Physicians, may serve as potential facilitators in addressing these barriers by taking the lead in asking payers to change reimbursement structures; encouraging legislators to revise laws to reflect the best available medical evidence; and educating the public that rapid transport to the hospital cannot substitute for optimal provision of prehospital care. Conclusion— We have identified 3 influential groups who will need to work with national organizations to overcome current policies or prevailing perceptions that may impede implementing national TOR guidelines.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/CIRCOUTCOMES.108.830398
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
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  • 10
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    Association of Neighborhood Characteristics With Bystander-Initiated CPR
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Survey of Anesthesiology Vol. 57, No. 2 ( 2013-04), p. 102-103
    Details
    In: Survey of Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 57, No. 2 ( 2013-04), p. 102-103
    Type of Medium: Online Resource
    ISSN: 0039-6206
    URL: Article
    DOI: 10.1097/01.SA.0000427310.10937.13
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 2071157-8
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