The impact of response time reliability on CPR incidence and resuscitation success - a benchmark study from the German Resuscitation Registry.
Summary of "The impact of response time reliability on CPR incidence and resuscitation success - a benchmark study from the German Resuscitation Registry."
Sudden cardiac arrest is one of the most frequent causes of death in the world. In highly qualified emergency medical service (EMS) systems, including well trained emergency physicians, spontaneous circulation may be restored in up to 53% of patients at least until admission to hospital. Compared with these highly qualified EMS systems, in other systems markedly lower success rates are observed. These data clearly show that there are considerable differences between EMS systems concerning treatment success following cardiac arrest and resuscitation, although in all systems international guidelines for resuscitation are used. This study investigates the impact of response time reliability (RTR) on cardio pulmonary resuscitation (CPR) incidence and resuscitation success using return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score and data from seven German EMS systems participating in the German Resuscitation Registry.
Anonymized patient data after out of hospital cardiac arrest from 2006 to 2009 of seven EMS systems in Germany were analysed to socioeconomic factors (population, area, EMS unit hours), process quality (response time reliability, CPR incidence, special CPR measures, prehospital cooling), patient factors (age, gender, cause of cardiac arrest, bystander CPR). Endpoints were defined as ROSC, admission to hospital, 24 hour survival and hospital discharge rate. For statistical analyses, chi-square, odds-ratio and Bonferroni correction were used.
2,330 prehospital CPR from seven centres were included in this analysis. Incidence of sudden cardiac arrest differs from 36.0 to 65.1 / 100,000 inhabitants / year. We identified two EMS systems (RTR<70%) reaching the patients within eight minutes in 62.0 and 65.6% while the other five EMS systems (RTR>70%) achieved 70.4 up to 95.5%. EMS systems arriving relatively later at the patients side (RTR<70%) less frequently initiate CPR and admit fewer patients alive to hospital (calculated per 100,000 inhabitants / year)( CPR incidence [1/100.000 I/Y] RTR>70%: 57.2; RTR<70%: 36.1; p < 0.01; OR 1.586 (99%
1.383 to 1.819) ( admitted to hospital [1/100.000 I/Y] RTR>70%: 24.4; RTR<70%: 15.6; p < 0.01; OR 1.57 (99%
1.274 to 1.935)). Using ROSC rate and the multi-variate RACA score to predict outcome, the two groups did not differ, but ROSC rate were higher than predicted in both groups (ROSC [%] RTR>70%: 46.6; RTR<70%: 47.3; n.s.; OR 0.971 (95%
0.787 to 1.196)) ( ROSC RACA [%] RTR>70%: 42.4; RTR<70%: 39.5; n.s.; OR 1.127 (95%
0.911 to 1.395)).
This study demonstrates that on the level of EMS systems, faster ones will more often initiate CPR and will increase number of patients admitted to hospital alive. Furthermore it is shown that with very different approaches, all adhering to and intensely training in the ERC guidelines 2005, superior and, according to international comparison, excellent success rates following resuscitation may be achieved.
This article was published in the following journal.
Name: Critical care (London, England)
Introduction Shortening response time to an emergency call leads to the success of resuscitation by chest compression and defibrillation. However, response by ambulance or fire truck is not fast enoug...
Success rates from cardiopulmonary resuscitation (CPR) are often quantified by Utstein-style outcome reports in populations who receive an attempted resuscitation. In some cases, evidence of futility ...
The advanced life support guidelines recommend two minutes of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed docto...
During surgery, proper fluid resuscitation and hemostatic control is critical. Pleth variability index (PVI) is advocated as a reliable way of optimizing intraoperative fluid resuscitation. PVI is a m...
Studies have shown that healthcare professionals (HCPs) display a 16-55% error rate in adherence to the Neonatal Resuscitation Program (NRP) algorithm. The aim of this study was to evaluate adherence ...
The investigators hypothesize that using low oxygen concentrations during resuscitation of extremely premature infants will avoid oxidative stress derived damage and improve outcome.
The purpose of this study is to determine whether performing active compression decompression cardiopulmonary resuscitation (ACD-CPR) with an impedance threshold device (ITD) compared to c...
Fluid resuscitation of severe sepsis may consist of natural or artificial colloids or crystalloids. There is no evidence-based support for one type of fluid over another. The investigator...
HES 200/0.5 10% is equal to ringers lactat solution.
The investigators will compare the success rates and time to successful intubation of endotracheal intubation during simulated pediatric resuscitation with and without chest compression.
Medical and Biotech [MESH] Definitions
The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.
Success in bringing an effort to the desired end; the degree or level of success attained in some specified area (esp. scholastic) or in general.
The time from the onset of a stimulus until a response is observed.
A quantitative measure of the frequency on average with which articles in a journal have been cited in a given period of time.
Tendency toward a lessened strength of response due to practice or activity. It is independent of the effect of reward and is a direct function of time interval since the last response and the number of preceding responses.