Influence of nationwide policy on citizens’ awareness and willingness to perform bystander cardiopulmonary resuscitation

Aims

Public awareness to cardiopulmonary resuscitation (CPR) and cardiac arrest is influenced by systemic factors including related policies and legislations in the community. Here, we describe and compare the results of the two nationwide CPR surveys in 2007 and 2011 examining public awareness and attitudes to bystander CPR in South Korea along with changes in nationwide CPR policies and systemic factors.

Methods

This population-based study used specially designed questionnaires via telephone surveys. We conducted bi-temporal surveys by stratified cluster sampling to assess the impact of age, gender, and geographic regions in 2007 (n = 1029) and in 2011 (n = 1000). Logistic regression analysis was performed to identify factors associated with willingness to perform bystander CPR.

Results

Public awareness of automated external defibrillators increased from 3.0% in 2007 to 32.6% in 2011. The proportion of the population that underwent CPR training within the previous 2 years increased significantly from 26.9% to 49.0%. The factors most related with intention of bystander CPR were male gender, younger age, CPR awareness, recent CPR training, and qualified CPR learning. In 2011, 75.8% of respondents were more willing to perform bystander CPR for stranger vs. 68.3% in 2007 (p = 0.002). Additional dispatcher hands-only CPR increased this proportion (85.8%, p < 0.001). However, bystander CPR experience rates remained unchanged (3.6–3.9%).

Conclusion

Changes in nationwide CPR policies and systemic factors affected citizens’ awareness and willingness to perform bystander CPR. Additionally, applied dispatcher hands-only CPR and publicity increased public willingness to perform bystander CPR.     

Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: A before–after population-based study

Background

The goal of this study was to determine the effects of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-CPR) on outcomes of out-of-hospital cardiac arrest (OHCA).

Methods

All EMS in a metropolitan city with a population of 10 million are dispatched by a single, centralized, and physician-supervised center. Data on patients with adult OHCA with cardiac etiology were collected from the dispatch center registry and from EMS run sheets and hospital medical record review from 2009 to 2011. A standardized DA-CPR protocol (aligned with the 2010 AHA guidelines) we implemented as an intervention in January 2011. The end points were survival to discharge, good neurological outcome, and bystander CPR rate. Multivariate logistic analysis was used to compare between intervention group (2011) and historical control group (2009–2010).

Results

Of 8.144 eligible patients, bystander CPR was performed for the patients in 5.7% (148/2600) of cases in 2009, 6.7% (190/2857) in 2010, and 12.4% (334/2686) in 2011 (p < 0.001). The survival to discharge rates was 7.1% (2009), 7.1% (2010), and 9.4% (2011) (p = 0.001). Good neurological outcomes occurred in 2.1% (2009), 2.0% (2010), and 3.6% (2011) of cases (p < 0.001). The adjusted ORs (95% CIs) for survival to discharge compared with 2009 were 1.33 (1.07–1.66) in 2011 and 1.12 (0.89–1.41) in 2010. The adjusted ORs (95% CIs) for good neurological outcomes were 1.67 (1.13–2.45) in 2011 and 1.13 (0.74–1.72) in 2010.

Conclusions

An EMS intervention using the DA-CPR protocol was associated with a significant increase in bystander CPR and an improved survival and neurologic outcome after OHCA.     

Quality of CPR performed by trained bystanders with optimized pre-arrival instructions

Objective

Telephone-CPR (T-CPR) can increase initiation of bystander CPR. We wanted to study if quality oriented continuous T-CPR would improve CPR performance vs. standard T-CPR.

Method

Ninety-five trained rescuers aged 22–69 were randomized to standard T-CPR or experimental continuous T-CPR (comprises continuous instructions, questions and encouragement). They were instructed to perform 10 min of chest compressions-only on a manikin, which recorded CPR performance in a small, confined kitchen. Three video-cameras captured algorithm time data, CPR technique and communication. Demography and training experience were captured during debriefing.

Results

Participants receiving continuous T-CPR delivered significantly more chest compressions (median 1000 vs. 870 compressions, p = 0.014) and compressed more frequently to a compression rate between 90 and 120 min⁻¹ (median 87% vs. 60% of compressions, p < 0.001), compared to those receiving standard T-CPR. This also resulted in less time without compressions after CPR had started (median 12 s vs. 64 s, p < 0.001), but longer time interval from initiating contact with dispatcher to first chest compression (median 144 s vs. 84 s, p < 0.001). There was no difference in chest compression depth (mean 47 mm vs. 48 mm, p = 0.90) or in demography, education and previous CPR training between the groups.

Conclusion

In our simulated scenario with CPR trained lay rescuers, experimental continuous T-CPR gave better chest compression rate and less hands-off time during CPR, but resulted in delayed time to first chest compression compared to standard T-CPR instructions.     

Does dispatcher-assisted CPR generate the same outcomes as spontaneously delivered bystander CPR in Japan?

Aim

We investigated whether DA-CPR would have the same effect as spontaneously-delivered bystander CPR.

Implementation of the ALERT algorithm,a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol,in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centres

Objectives

Early bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest (OHCA). The ALERT (Algorithme Liégeois d’Encadrement à la Réanimation par Téléphone) algorithm has the potential to help bystanders initiate CPR. This study evaluates the effectiveness of the implementation of this protocol in a non-Advanced Medical Priority Dispatch System area.

Methods

We designed a before and after study based on a 3-month retrospective assessment of victims of OHCA in 2009, before the implementation of the ALERT protocol in Liege emergency medical communication centre (EMCC), and the prospective evaluation of the same 3 months in 2011, immediately after the implementation.

Results

At the moment of the call, dispatchers were able to identify 233 OHCA in the first period and 235 in the second. Victims were predominantly male (59%, both periods), with mean ages of 64.1 and 63.9 years, respectively. In 2009, only 9.9% victims benefited from bystander CPR, this increased to 22.5% in 2011 (p < 0.0002). The main reasons for protocol under-utilisation were: assistance not offered by the dispatcher (42.3%), caller physically remote from the victim (20.6%). Median time from call to first compression, defined here as no flow time, was 253 s in 2009 and 168 s in 2011 (NS). Ten victims were admitted to hospital after ROSC in 2009 and 13 in 2011 (p = 0.09).

Conclusion

From the beginning and despite its under-utilisation, the ALERT protocol significantly improved the number of patients in whom bystander CPR was attempted.     

Performing bystander CPR for sudden cardiac arrest: Behavioral intentions among the general adult population in Arizona

Study objectives

The odds of surviving an out-of-hospital cardiac arrest are significantly improved by the provision of bystander cardiopulmonary resuscitation (CPR), but many cardiac arrest victims do not receive it. The existing literature remains equivocal as to why people are unwilling to perform traditional CPR. This study's objectives were to determine the behavioral intentions of the general population in Arizona regarding performing bystander CPR and to assess the reasons for being unwilling to perform CPR.

Methods

This was a general population survey using a mailed, self-administered questionnaire. The questionnaire was mailed to random samples of Arizona residents in a rural and urban county.

Results

Usable questionnaires were received from 49.5% (n = 370) and 49.6% (n = 385) of the samples from the urban and rural county, respectively. More than 50% of respondents reported being willing to perform CPR on a stranger and over 80% reported being willing to perform CPR on a family member. There were no significant differences between the proportions of respondents in each county willing to perform CPR. The reasons for not being willing to perform CPR were relatively evenly divided among the five reasons listed.

Conclusions

Although our findings likely overestimate the proportion of individuals who would perform bystander CPR, the relative importance of the reasons for not performing CPR is informative. Based on the reasons reported, there is potential to change the CPR-related attitudes, beliefs, and skill levels of the general public to enhance the number of people willing and able to perform bystander CPR.     

Changing EMS dispatcher CPR instructions to 400 compressions before mouth-to-mouth improved bystander CPR rates

Background

To examine the impact of changing dispatcher CPR instructions (400 compressions: 2 breaths, followed by 100:2 ratio) on rates of bystander CPR and survival in adults with presumed cardiac out-of-hospital arrest (OHCA) in Melbourne, Australia.

Methods

The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for OHCA where Emergency Medical Services (EMS) attempted CPR between August 2006 and August 2009. OHCA included were: (1) patients aged ≥18 years old; (2) presumed cardiac etiology; and (3) not witnessed by EMS.

Results

For the pre- and post-study periods, 1021 and 2101 OHCAs met inclusion criteria, respectively. Rates of bystander CPR increased overall (45-55%, p < 0.001) and by initial rhythm (shockable 55-70%, p < 0.001 and non-shockable 40-46%, p = 0.01). In VF/VT OHCA, there were improvements in the number of patients arriving at hospital with a return of spontaneous circulation (ROSC) (48-56%, p = 0.02) and in survival to hospital discharge (21-29%, p = 0.002), with improved outcomes restricted to patients receiving bystander CPR. After adjusting for factors associated with survival, the period of time following the change in CPR instructions was a significant predictor of survival to hospital discharge in VF/VT patients (OR 1.57, 95% CI: 1.15-2.20, p = 0.005).

Conclusion

Following changes to dispatcher CPR instructions, significant increases were seen in rates of bystander CPR and improvements were seen in survival in VF/VT patients who received bystander CPR, after adjusting for factors associated with survival.     

A tale of two cities: The role of neighborhood socioeconomic status in spatial clustering of bystander CPR in Austin and Houston

Background

Despite evidence to suggest significant spatial variation in out-of-hospital cardiac arrest (OHCA) and bystander cardiopulmonary resuscitation (BCPR) rates, geographic information systems (GIS) and spatial analysis have not been widely used to understand the reasons behind this variation. This study employs spatial statistics to identify the location and extent of clusters of bystander CPR in Houston and Travis County, TX.

Methods

Data were extracted from the Cardiac Arrest Registry to Enhance Survival for two U.S. sites – Austin-Travis County EMS and the Houston Fire Department – between October 1, 2006 and December 31, 2009. Hierarchical logistic regression models were used to assess the relationship between income and racial/ethnic composition of a neighborhood and BCPR for OHCA and to adjust expected counts of BCPR for spatial cluster analysis. The spatial scan statistic was used to find the geographic extent of clusters of high and low BCPR.

Results

Results indicate spatial clusters of lower than expected BCPR rates in Houston. Compared to BCPR rates in the rest of the community, there was a circular area of 4.2 km radius where BCPR rates were lower than expected (RR = 0.62; p < 0.0001 and RR = 0.55; p = 0.037) which persist when adjusted for individual-level patient characteristics (RR = 0.34; p = 0.027) and neighborhood-level race (RR = 0.34; p = 0.034) and household income (RR = 0.34; p = 0.046). We also find a spatial cluster of higher than expected BCPR in Austin. Compared to the rest of the community, there was a 23.8 km radius area where BCPR rates were higher than expected (RR = 1.75; p = 0.07) which disappears after controlling for individual-level characteristics.

Conclusions

A geographically targeted CPR training strategy which is tailored to individual and neighborhood population characteristics may be effective in reducing existing disparities in the provision of bystander CPR for out-of-hospital cardiac arrest.     

A history of smoking is associated with improved survival in patients treated with mild therapeutic hypothermia following cardiac arrest

Objectives

To assess the association between smoking and survival with a good neurologic outcome in patients following cardiac arrest treated with mild therapeutic hypothermia (TH).

Methods

We conducted a retrospective observational study of a prospectively collected cohort of 188 consecutive patients following cardiac arrest treated with TH between May 2007 and January 2012. Smoking status was retrospectively collected via chart review and was classified as “ever” or “never”. Primary endpoint was survival to hospital discharge with a good neurologic outcome and was compared between smokers and nonsmokers. Logistic regression analysis was used to assess the association between smoking status and neurologic outcome at hospital discharge; adjusting for age, initial rhythm, time to return of spontaneous circulation (ROSC), bystander CPR, and time to initiation of TH.

Results

Smokers were significantly more likely to survive to hospital discharge with good neurologic outcome compared to nonsmokers (50% vs. 28%, p = 0.003). After adjusting for age, initial rhythm, time to ROSC, bystander CPR, and time to initiation of TH, a history of smoking was associated with increased odds of survival to hospital discharge with good neurologic outcome (OR 3.54, 95% CI 1.41–8.84, p = 0.007).

Conclusions

Smoking is associated with improved survival with good neurologic outcome in patients following cardiac arrest. We hypothesize that our findings reflect global ischemic conditioning caused by smoking.     

Hypothermia and associated outcomes in seriously injured trauma patients in a predominantly sub-tropical climate

Aim

This study aimed to determine factors linked to hypothermia (<35 °C) in Queensland trauma patients. The relationship of hypothermia with mortality, admission to intensive care and hospital length of stay was also explored.

Methods

A retrospective analysis of data from the Queensland Trauma Registry was undertaken, and included all patients admitted to hospital for ≥24 h during 2003 and 2004 with an injury severity score (ISS) > 15. Demographic, injury, environmental, care and clinical status factors were considered.

Results

A total of 2182 patients were included; 124 (5.7%) had hypothermia on admission to the definitive care hospital, while a further 156 (7.1%) developed hypothermia during hospitalisation. Factors associated with hypothermia on admission included winter, direct admission to a definitive care hospital, an ISS ≥ 40, a Glasgow Coma Scale of 3 or ventilated and sedated, and hypotension on admission. Hypothermia on admission to the definitive care hospital was an independent predictor of mortality (odds ratio [OR] = 4.05; 95% confidence interval [CI] 2.26–7.24) and hospital length of stay (incidence rate ratio [IRR] = 1.22; 95% CI 1.03–1.43). Hypothermia during definitive care hospitalisation was independently associated with mortality (OR = 2.52; 95% CI 1.52–4.17), intensive care admission (OR = 1.73; 95% CI 1.20–2.93) and hospital length of stay (IRR = 1.18; 95% CI 1.02–1.36).

Conclusions

Trauma patients in a predominantly sub-tropical climate are at risk of accidental and endogenous hypothermia, with associated higher mortality and care requirements. Prevention of hypothermia is important for all severely injured patients.     

Bystander-initiated CPR in an Asian metropolitan: Does the socioeconomic status matter?

Objectives

To determine the association of neighborhood socioeconomic status (SES) with bystander-initiated cardiopulmonary resuscitation (CPR) and patient outcomes of out of hospital cardiac arrests (OHCAs) in an Asian metropolitan area.

Methods

We performed a retrospective study in a prospectively collected cohort from the Utstein registry of adult non-traumatic OHCAs in Taipei, Taiwan. Average real estate value was assessed as the first proxy of SES. Twelve administrative districts in Taipei City were categorized into low versus high SES areas to test the association. The primary outcome was bystander-initiated CPR, and the secondary outcome was patient survival status. Factors associated with bystander-initiated CPR were adjusted for in multivariate analysis. The mean household income was assessed as the second proxy of SES to validate the association.

Results

From January 1, 2008 to December 30, 2009, 3573 OHCAs received prehospital resuscitation in the community. Among these, 617 (17.3%) cases received bystander CPR. The proportion of bystander CPR in low-SES vs. high-SES areas was 14.5% vs. 19.6% (p < 0.01). Odds ratio of receiving bystander-initiated CPR in low-SES areas was 0.72 (95% confidence interval: [0.60–0.88]) after adjusting for age, gender, witnessed status, public collapse, and OHCA unrecognized by the online dispatcher. Survival to discharge rate was significantly lower in low-SES areas vs. high-SES areas (4.3% vs. 6.8%; p < 0.01). All results above remained consistent in the analyses by mean household income.

Conclusions

Patients who experienced an OHCA in low-SES areas were less likely to receive bystander-initiated CPR, and demonstrated worse survival outcomes.     

Schoolchildren as BLS instructors for relatives and friends: Impact on attitude towards bystander CPR

Introduction

We investigated the impact of Cardio-Pulmonary Resuscitation (CPR) instruction by children on the attitude of people to perform bystander CPR.

Methods

In 2012, children from primary and secondary school (age span 11–13 years) received a free individual CPR training package containing an inexpensive manikin and a training video. After a CPR training session by their class teacher, they were invited to teach their relatives and friends. After the training, the trainees of the children were invited to participate in a web survey, containing a test and questions about prior CPR training and about their attitude towards bystander CPR (BCPR) before and after the training. We measured the impact on the attitude to perform BCPR and the theoretical knowledge transfer by the children.

Results

A total of 4012 training packages were distributed to 72 schools of which 55 class teachers subscribed their students (n = 822) for the training programme for relatives and friends. After a validation procedure, 874 trainees of 290 children were included in the study. In comparison to trainees of secondary schoolchildren, trainees of primary schoolchildren scored better for the test as well as for a positive change of attitude towards future BCPR (P < 0.001). For every child-instructor 1.7 people changed their attitude towards BCPR positively.

Conclusions

Instructing schoolchildren to teach their relatives and friends in Basic Life Support (BLS) led to a more positive attitude towards BCPR. The results were more positive with trainees from primary schoolchildren than with trainees from secondary schoolchildren.     

Effects of stomach inflation on haemodynamic and pulmonary function during cardiopulmonary resuscitation in pigs

Aim

Stomach inflation during cardiopulmonary resuscitation (CPR) is frequent, but the effect on haemodynamic and pulmonary function is unclear. The purpose of this study was to evaluate the effect of clinically realistic stomach inflation on haemodynamic and pulmonary function during CPR in a porcine model.

Methods

After baseline measurements ventricular fibrillation was induced in 21 pigs, and the stomach was inflated with 0 L (n = 7), 5 L (n = 7) or 10 L air (n = 7) before initiating CPR.

Results

During CPR, 0, 5, and 10 L stomach inflation resulted in higher mean pulmonary artery pressure [median (min–max)] [35 (28–40), 47 (25–50), and 51 (49–75) mmHg; P < 0.05], but comparable coronary perfusion pressure [10 (2–20), 8 (4–35) and 5 (2–13) mmHg; P = 0.54]. Increasing (0, 5, and 10 L) stomach inflation decreased static pulmonary compliance [52 (38–98), 19 (8–32), and 12 (7–15) mL/cmH₂O; P < 0.05], and increased peak airway pressure [33 (27–36), 53 (45–104), and 103 (96–110) cmH₂O; P < 0.05). Arterial oxygen partial pressure was higher with 0 L when compared with 5 and 10 L stomach inflation [378 (88–440), 58 (47–113), and 54 (43–126) mmHg; P < 0.05). Arterial carbon dioxide partial pressure was lower with 0 L when compared with 5 and 10 L stomach inflation [30 (24–36), 41(34–51), and 56 (45–68) mmHg; P < 0.05]. Return of spontaneous circulation was comparable between groups (5/7 in 0 L, 4/7 in 5 L, and 3/7 in 10 L stomach inflation; P = 0.56).

Conclusions

Increasing levels of stomach inflation had adverse effects on haemodynamic and pulmonary function, indicating an acute abdominal compartment syndrome in this CPR model.     

Aspects on the increase in bystander CPR in Sweden and its association with outcome

Aim

To describe changes in the proportion of bystanders performing cardiopulmonary resuscitation (CPR) in out of hospital cardiac arrest (OHCA) in Sweden and to study the impact of bystander CPR on ventricular fibrillation and on survival during various times.

Patients and methods

All patients who suffered from OHCA in Sweden in whom CPR was attempted and who were included in the Swedish cardiac arrest register (SCAR) between 1992 and 2005. Crew witnessed cases were excluded.

Results

In all 34,125 patients were included in the survey. Among witnessed OHCA the proportion of patients receiving bystander CPR increased from 40% in 1992 to 55% in 2005 (p < 0.0001). In non-witnessed OHCA the corresponding proportion increased from 22% to 44% (p < 0.0001). There was a significant increase in bystander CPR regardless of age, sex and place. The increase was only found when CPR was performed by lay persons (21% in 1992 to 40% in 2005; p < 0.0001). Bystander CPR was associated with an increased proportion of patients found in a shockable rhythm and a lower number of shocks to receive return of spontaneous circulation. Bystander CPR was associated with a similar increase in survival early and late in the evaluation.

Conclusion

There was a marked increase in bystander CPR in OHCA, when performed by lay persons, during the last 14 years in Sweden. Bystander CPR was associated with positive effects both on ventricular fibrillation and survival.     

Reduced effectiveness of vasopressin in repeated doses for patients undergoing prolonged cardiopulmonary resuscitation

Introduction

The efficacy of repeated administration of vasopressin alone during prolonged cardiopulmonary resuscitation (CPR) remains unconfirmed. This study was conducted to estimate the effectiveness of the repeated administration of vasopressin vs. epinephrine for cardiopulmonary arrest (CPA) patients receiving prolonged CPR.

Methods

We conducted a prospective randomized controlled study on patients who experienced out-of-hospital CPA. The patients were randomly assigned to receive a maximum of four injections of either 40 IU of vasopressin (vasopressin group) or 1 mg of epinephrine (epinephrine group) immediately after emergency room (ER) admission. Patients who received vasopressors before ER admission or suffered non-cardiogenic CPA were excluded after randomization.

Results

In total, 336 patients were enrolled (vasopressin group, n = 137; epinephrine group, n = 118). No differences were found between these groups (vasopressin group vs. epinephrine group) in the rates of return of spontaneous circulation (ROSC) (28.7% vs. 26.6%), 24-h survival (16.9% vs. 20.3%), or survival to hospital discharge (5.6% vs. 3.8%). In a subgroup analysis by the Fisher's exact test, the rate of ROSC was higher in the vasopressin group than in the epinephrine group, among the patients whose arrests were witnessed (48.1% vs. 27.8%, p = 0.010) or who received bystander CPR (68.0% vs. 38.5%, p = 0.033). When the independent predictors of ROSC were calculated in the subgroup analysis, however, vasopressin administration (Odds ratio: 0.87–0.28) did not affect the outcome.

Conclusions

This is the first report of a possible vasopressin-alone resuscitation without additional epinephrine. However, repeated injections of either vasopressin or epinephrine during prolonged advanced cardiac life support resulted in comparable survival.     

Comparison of Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD) relating to cardiac arrest calls

Background

Prompt emergency medical service (EMS) system activation with rapid delivery of pre-hospital treatment is essential for patients suffering out-of-hospital cardiac arrest (OHCA). The two most commonly used dispatch tools are Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD). We compared cardiac arrest call processing using these two dispatch tools in two different dispatch centres.

Methods

Observational study of adult EMS confirmed (non-EMS witnessed) OHCA calls during one year in Richmond, USA (MPD) and Oslo, Norway (CBD). Patients receiving CPR prior to call, interrupted calls or calls where the caller did not have access to the patients were excluded from analysis. Dispatch logs, ambulance records and digitalized dispatcher and caller voice recordings were compared.

Results

The MPDS-site processed 182 cardiac arrest calls and the CBD-site 232, of which 100 and 140 calls met the inclusion criteria, respectively. The recognition of cardiac arrest was not different in the MPD and CBD systems; 82% vs. 77% (p = 0.42), and pre-EMS arrival CPR instructions were offered to 81% vs. 74% (p = 0.22) of callers, respectively. Time to ambulance dispatch was median (95% confidence interval) 15 (13, 17) vs. 33 (29, 36) seconds (p < 0.001) and time to chest compression delivery; 4.3 (3.7, 4.9) vs. 3.7 (3.0, 4.1) min for the MPD and CBD systems, respectively (p = 0.05).

Conclusion

Pre-arrival CPR instructions were offered faster and more frequently in the CBD system, but in both systems chest compressions were delayed 3–4 min. Earlier recognition of cardiac arrest and improved CPR instructions may facilitate earlier lay rescuer CPR.     

Ability of code leaders to recall CPR quality errors during the resuscitation of older children and adolescents

Aim

Performance of high quality CPR is associated with improved resuscitation outcomes. This study investigates code leader ability to recall CPR error during post-event interviews when CPR recording/audiovisual feedback-enabled defibrillators are deployed.

Patients and methods

Physician code leaders were interviewed within 24 h of 44 in-hospital pediatric cardiac arrests to assess their ability to recall if CPR error occurred during the event. Actual CPR quality was assessed using quantitative recording/feedback-enabled defibrillators. CPR error was defined as an overall average event chest compression (CC) rate <95/min, depth <38 mm, ventilation rate >10/min, or any interruptions in CPR >10 s. We hypothesized that code leaders would recall error when it actually occurred ≥75% of the time when assisted by audiovisual alerts from a CPR recording feedback-enabled defibrillators (analysis by χ²).

Results

810 min from 44 cardiac arrest events yielded 40 complete data sets (actual and interview); ventilation data was available in 24. Actual CPR error was present in 3/40 events for rate, 4/40 for depth, 32/40 for interruptions >10 s, and 17/24 for ventilation frequency. In post-event interviews, code leaders recalled these errors in 0/3 (0%) for rate, 0/4 (0%) for depth, and 19/32 (59%) for interruptions >10 s. Code leaders recalled these CPR quality errors less than 75% of the time for rate (p = 0.06), for depth (p < 0.01), and for CPR interruption (p = 0.04). Quantification of errors not recalled: missed rate error median = 94 CC/min (IQR 93–95), missed depth error median = 36 mm (IQR 35.5–36.5), missed CPR interruption >10 s median = 18 s (IQR 14.4–28.9). Code leaders did recall the presence of excessive ventilation in 16/17 (94%) of events (p = 0.07).

Conclusion

Despite assistance by CPR recording/feedback-enabled defibrillators, pediatric code leaders fail to recall important CPR quality errors for CC rate, depth, and interruptions during post-cardiac arrest interviews.     

Cardiac arrest due to drowning—Changes over time and factors of importance for survival

Aim

To evaluate changes in characteristics and survival over time in out-of-hospital cardiac arrest (OHCA) due to drowning and describe factors of importance for survival.

Method

Retrospectively reported and treated drowning cases reported to the Swedish OHCA registry between 1990 and 2012, n = 529. The data were clustered into three seven-year intervals for comparisons of changes over time.

Results

There were no changes in age, gender, witnessed status, shockable rhythm or place of OHCA during the time periods. Bystander CPR increased over time, 59% in interval 1992–1998, versus 74% in interval 2006–2012 (p = 0.005). There was a decrease in delay between OHCA and calling for the Emergency Medical Service (EMS) over the years, while calling for the EMS to arrival increased in terms of time. Survival to hospital admission appears to have increased over the years (p = 0.009), whereas survival to one month did not change significantly over time. In a multivariate analysis, witnessed status, female gender, bystander CPR, place–home and EMS response time were associated with survival to hospital admission. For survival to one month, place, age, shockable rhythm and logarithmised delay from calling for an ambulance to arrival were of significance for survival.

Conclusion

In OHCA due to drowning, over a period of 20 years, bystanders have called for help at an earlier stage and administered CPR more frequently in the past few years. Survival to hospital admission has increased, while shockable rhythm and early arrival of the EMS appear to be the most important factors for survival to one month.