Scientifically research of HeartsafeLiving

HeartsafeLiving considers it is important that scientifically research forms the basis for proper care. That is why we support this kind of studies. In the future HeartsafeLiving will also be involved in scientifically research, sometimes by initiating it, sometimes by supporting it. Here you can find some studies where HeartsafeLiving provided support.

 

Will a ‘Do not resuscitate medal’ be recognised by rescuers?

The Dutch Resuscitation Council recommends lay rescuers not to start CPR if a ‘Do not resuscitate’ (DNR) declaration is available with the victim and the rescuer is sure it belongs to the victim. Stop performing CPR might be of great psychological benefit and therefore the lay rescuer is not responsible if he decides to continue. CPR is an automated skill in a well-trained provider. Therefore it might be that a lay rescuer provides CPR without noticing any specific information.

Material & method
This study was undertaken to compare the recognition of a DNR medal by (trained) lay rescuers to EMS providers. Forty lay rescuers and 39 EMS providers were included.

Without any warning before they were taken from their daily work situation. They were invited to provide help to a victim who collapsed. No additional information was given. Two certified BLS/ALS instructors assessed each situation, using a validated form. For all items, time from entering was taken. A face impression or spoken words, indicating that the medal was observed, was taken as start of recognition.

Conclusion is that Lay rescuers seem to be well informed about the non-resuscitation medal. However, EMS professionals, who have a duty to respect the declaration do not all recognizes the medal, and if they do, 23,1 % still decides to continue help.

Click here for the full article and precise results.

FACT OR FICTION; AED connected to conscious patients with VT

A lay rescuer should first check for consciousness (shake and shout) prior to the decision to start CPR and attach an AED.1 However, it is said that some instructors advise providers to attach an AED when the victim is still conscious but complains about chest pain.

This study presents the results about the ideas of the instructors about attaching an AED to a conscious victim and the occurrence of this advice in real life.

Materials & methods
The study had two data collection events:
1. An online survey with six questions was send to CPR/AED-instructors in The Netherlands.
2. The records of five ambulance services in the Netherland were searched for any report of conscious patients with an AED attached.

It seems that the incidence of misuse of an AED is very low, if not zero. CPR/AED-instructors should be advised to follow the algorithm unconditionally to avoid misconception and confusion for the lay rescuer.

Click here for the full article and precise results.

Improved survival after out-of-hospital cardiac arrest and use of AED

Background
In recent years, a wider use of automated external defibrillators (AEDs) to treat out-of-hospital cardiac arrest was advocated in The Netherlands. We aimed to establish whether survival with favorable neurologic outcome after out- of-hospital cardiac arrest has significantly increased, and, if so, whether this is attributable to AED use.
 
Methods and Results
We performed a population-based cohort study, including patients with out-of-hospital cardiac arrest from cardiac causes between 2006 and 2012, excluding emergency medical service–witnessed arrests. We determined survival status at each stage (to emergency department, to admission, and to discharge) and examined temporal trends using logistic regression analysis with year of resuscitation as an independent variable. By adding each covariable subsequently to the regression model, we investigated their impact on the odds ratio of year of resuscitation. Analyses were performed according to initial rhythm (shockable versus nonshockable) and AED use.

Rates of survival with favorable neurologic outcome after out-of-hospital cardiac arrest increased significantly (N=6133, 16.2% to 19.7%; P for trend=0.021), although solely in patients presenting with a shockable initial rhythm (N=2823; 29.1% to 41.4%; P for trend<0.001). In this group, survival increased at each stage but was strongest in the prehospital phase (odds ratio, 1.11 [95% CI, 1.06–1.16]). Rates of AED use almost tripled during the study period (21.4% to 59.3%; P for trend <0.001), thereby decreasing time from emergency call to defibrillation-device connection (median, 9.9 to 8.0 minutes; P<0.001). AED use statistically explained increased survival with favorable neurologic outcome by decreasing the odds ratio of year of resuscitation to a nonsignificant 1.04.

Conclusions
Increased AED use is associated with increased survival in patients with a shockable initial rhythm. We recommend continuous efforts to introduce or extend AED programs. (Circulation. 2014;130:00-00.)

See the full article here.

High survival rate of 43% in out-of-hospital cardiac arrest patients in an optimised chain of survival

Aims
Survival to hospital discharge after out-of-hospital car- diac arrest (OHCA) varies widely. This study describes short- term survival after OHCA in a region with an extensive care path and a follow-up of 1 year.

Methods
Consecutive patients ≥16 years admitted to the emergency department between April 2011 and December 2012 were included. In July 2014 a follow-up took place. Socio-demographic data, characteristics of the OHCA and interventions were described and associations with survival were determined.

Results
Two hundred forty-two patients were included (73 % male, median age 65 years). In 76 % the cardiac arrest was of cardiac origin and 52 % had a shockable rhythm. In 74 % the cardiac arrest was witnessed, 76 % received bystander cardio- pulmonary resuscitation and in 39 % an automatic external defibrillator (AED) was used. Of the 168 hospitalised patients, 144 underwent therapeutic procedures. A total of 105 patients survived until hospital discharge. Younger age, cardiac arrest in public area, witnessed cardiac arrest, cardiac origin with a shockable rhythm, the use of an AED, shorter time until return of spontaneous circulation, Glasgow Coma Scale (GCS) ≥13 during transport and longer length of hospital stay were asso- ciated with survival. Of the 105 survivors 72 survived for at least 1 year after cardiac arrest and 6 patients died. Conclusion A survival rate of 43 % after OHCA is achievable. Witnessed cardiac arrest, cardiac cause of arrest, initial cardiac rhythm and GCS ≥13 were associated with higher survival.

See the full article here.