Research Review

Selected SCA Research Reviews


ASSOCIATION OF BYSTANDER AND FIRST-RESPONDER INTERVENTION WITH SURVIVAL AFTER OUT-OF-HOSPITAL CARDIAC ARREST IN NORTH CAROLINA, 2010-2013

Out-of-hospital cardiac arrest is associated with low survival, but early cardiopulmonary resuscitation (CPR) and defibrillation can improve outcomes if more widely adopted.

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A STANDARDIZED TEMPLATE FOR MEASURING AND REPORTING TELEPHONE PRE-ARRIVAL CARDIOPULMONARY RESUSCITATION INSTRUCTIONS.

Bystander cardiopulmonary resuscitation (CPR) improves out-of-hospital cardiac arrest (OHCA) survival. Telephone CPR (TCPR) comprises CPR instruction given by emergency dispatchers to bystanders responding to OHCA and the CPR performed as a result. TCPR instructions improve bystander CPR rates, but the quality of the instructions varies widely. No standardized system exists to critically evaluate the TCPR intervention.

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CHEST COMPRESSION DEPTH AND SURVIVAL IN OUT-OF-HOSPITAL CARDIAC ARREST.

Outcomes from out-of-hospital cardiac arrest (OHCA) may improve if rescuers perform chest compressions (CCs) deeper than the previous recommendation of 38–51 mm and consistent with the 2010 AHA Guideline recommendation of at least 51 mm. The aim of this study was to assess the relationship between CC depth and OHCA survival.

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INCREASING BYSTANDER CPR: POTENTIAL OF A ONE QUESTION TELECOMMUNICATOR IDENTIFICATION ALGORITHM.

This study investigates the potential for a single question to improve cardiac arrest case identification and reduce the time interval to starting chest compressions.

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ANALYSIS OF OUT-OF-HOSPITAL CARDIAC ARREST LOCATION AND PUBLIC ACCESS DEFIBRILLATOR PLACEMENT IN METROPOLITAN PHOENIX, ARIZONA.

Automated external defibrillators (AEDs) improve outcomes from out-of-hospital cardiac arrest (OHCA) but are infrequently used. We sought to compare the locations of OHCAs and AEDs in metropolitan Phoenix, Arizona.

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CHEST COMPRESSION RELEASE VELOCITY: ASSOCIATION WITH SURVIVAL AND FAVORABLE NEUROLOGIC OUTCOME AFTER OUT-OF-HOSPITAL CARDIAC ARREST.

An evaluation of the association between chest compression release velocity (CCRV) and outcomes after out-of-hospital cardiac arrest (OHCA).

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EFFECT OF REGULATING AIRWAY PRESSURE ON INTRATHORACIC PRESSURE AND VITAL ORGAN PERFUSION PRESSURE DURING CARDIOPULMONARY RESUSCITATION: A NON-RANDOMIZED INTERVENTIONAL CROSS-OVER STUDY

The objective of this investigation was to evaluate changes in intrathoracic pressure (Ppl), airway pressure (Paw) and vital organ perfusion pressures during standard and intrathoracic pressure regulation (IPR)-assisted cardiopulmonary resuscitation (CPR).

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ENHANCED PERFUSION DURING ADVANCED LIFE SUPPORT IMPROVES SURVIVAL WITH FAVORABLE NEUROLOGIC FUNCTION IN A PORCINE MODEL OF REFRACTORY CARDIAC ARREST

To improve the likelihood for survival with favorable neurologic function after cardiac arrest, we assessed a new advanced life support approach using active compression-decompression cardiopulmonary resuscitation plus an intrathoracic pressure regulator.

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SCIENCE OF CARDIOPULMONARY RESUSCITATION: JUST SCRATCHING THE SURFACE.

This editorial reviews the state of CPR — highlighting the challenges to community implementation and scientific discovery.

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DISPATCHER-DIRECTED CPR: AN ALL-AGES STRATEGY TO IMPROVE CARDIAC ARREST SURVIVAL.

This editorial comments on the potential dispatcher CPR to positively impact the provision of CPR for pediatric cardiac arrest patients.

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STATEWIDE REGIONALIZATION OF EMERGENCY MEDICAL SERVICES AND HOSPITAL CARE FOR OUT-OF-HOSPITAL CARDIAC ARREST: ASSOCIATION WITH IMPROVED OUTCOMES.

For out-of-hospital cardiac arrest, authoritative, evidence-based recommendations have been made for regionalization of postarrest care. However, system-wide implementation of these guidelines has not been evaluated. Our hypothesis is that statewide regionalization of postarrest interventions, combined with emergency medical services (EMS) triage bypass, is associated with improved survival and neurologic outcome.

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MEASURING AND IMPROVING CARDIOPULMONARY RESUSCITATION QUALITY INSIDE THE EMERGENCY DEPARTMENT.

To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality.

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CARDIAC ARREST SURVIVAL IS RARE WITHOUT PREHOSPITAL RETURN OF SPONTANEOUS CIRCULATION.

This paper addresses the issue of scene resuscitation. It is generally accepted that treating the patient at the scene of collapse is the best strategy for optimizing survival. However, many EMS systems continue to implement the “scoop and go” technique.

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EDITORIAL. CAN DRUGS EVER IMPROVE OUTCOME AFTER CARDIAC ARREST?

This is an informative editorial that reviews current evidence for the use of medications during resuscitation. There is little evidence for efficacy of many of the resuscitation drugs used today. The author discusses the ongoing search for a vasopressor that facilitates resuscitation by optimizing cerebral and coronary blood flow.

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NOVEL ADHESIVE GLOVE DEVICE (AGD) FOR ACTIVE COMPRESSION-DECOMPRESSION (ACD) CPR RESULTS IN IMPROVED CAROTID BLOOD FLOW AND CORONARY PERFUSION PRESSURE IN PIGLET MODEL OF CARDIAC ARREST.

These researchers studied the effect of providing active compression-decompression manual CPR on the quality of blood flow and perfusion, using a glove with a Velcro palm in a series of piglets.

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EXCESSIVE CHEST COMPRESSION RATE IS ASSOCIATED WITH INSUFFICIENT COMPRESSION DEPTH IN PREHOSPITAL CARDIAC ARREST.

In this Belgian study, the authors describe the relationship between compression rate and depth. This is good knowledge to help reinforce the correct rate, and to support faster is not necessarily better.

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WIDE VARIABILITY IN DRUG USE IN OUT-OF-HOSPITAL CARDIAC ARREST: A REPORT FROM THE RESUSCITATION OUTCOMES CONSORTIUM.

This manuscript from the Resuscitation Outcomes Consortium reports the use of resuscitation drugs among the ROCs 11 sites and 74 EMS agencies. Despite the knowledge that there is limited data to show beneficial effects of many of the pharmacological agents routinely used during resuscitation, this study shows that among 16,221 out-of-hospital cases, 83 percent of patients received at least one drug.

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EFFECT OF REAL-TIME FEEDBACK DURING CARDIOPULMONARY RESUSCITATION OUTSIDE HOSPITAL: PROSPECTIVE, CLUSTER-RANDOMISED TRIAL.

Although this study showed that the use of real-time feedback during an actual resuscitation moved CPR parameters closer to recommended guidelines, the use of real-time feedback did not affect the clinical endpoints of ROSC or survival to hospital discharge. The authors suggest that the ability for real-time feedback to influence outcomes is only as good as the information used to formulate the CPR guidelines. They also suggest that the use of real-time feedback in systems with good quality baseline CPR performance may only produce small improvements insufficient to significantly impact survival.

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THE EFFECTIVENESS OF ULTRABRIEF AND BRIEF EDUCATIONAL VIDEOS FOR TRAINING LAY RESPONDERS IN HANDS-ONLY CARDIOPULMONARY RESUSCITATION: IMPLICATIONS FOR THE FUTURE OF CITIZEN CARDIOPULMONARY RESUSCITATION TRAINING.

Bystander CPR is provided to about 1/3rd of out-of-hospital sudden cardiac arrest victims in the US. The low rate may be in part related to bystander's fears about their ability to correctly perform complicated traditional CPR. Compression-only CPR is much simpler than traditional CPR and can be quickly and easily learned. Utilizing simple videos coupled with a more personalized approach to enlisting layperson participation in Arizona was the key to their success.

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SURVIVAL AFTER APPLICATION OF AUTOMATIC EXTERNAL DEFIBRILLATORS BEFORE ARRIVAL OF THE EMERGENCY MEDICAL SYSTEM: EVALUATION IN THE RESUSCITATION OUTCOMES CONSORTIUM POPULATION OF 21 MILLION.

Use of AEDs by laypersons in the United States has remained at around 2-3%, despite increasingly available devices in high traffic areas. In a study completed in Amsterdam, researchers surveyed travelers in a rail station to determine bystander's level of preparedness to provide emergency defibrillation. Among 1,018 responders from 38 nations, only 47% said they would be willing to use an AED, and 53% were unable to recognize an AED. This suggests that the general public still needs a substantial amount of education about how to recognize and operate an AED as well as to convey our expectations to the public, that their help is essential during such an emergency.

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FEASIBILITY OF INTRA-ARREST HYPOTHERMIA INDUCTION: A NOVEL NASOPHARENGEAL APPROACH ACHIEVES PREFERENTIAL BRAIN COOLING.

This study involved 10 pigs that received 60 minutes of nasopharyngeal cooling using the RhinoChill device during various states of blood flow prior to ROSC. While hypothermia therapy provided in the hospital setting has proven to have a strong survival benefit for patients, beginning the therapy in the prehospital setting, either before or after ROSC has not yet been shown to provide additional survival or neurologic benefits.

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INDUCTION OF PREHOSPITAL THERAPEUTIC HYPOTHERMIA AFTER RESUSCITATION FROM NONVENTRICULAR FIBRILLATION CARDIAC ARREST.

While the effect of pre-hospital cooling on survival remains uncertain at this writing, several groups are investigating the even earlier implementation of this therapy, during the intra-arrest period. The provision of both pre-hospital and intra-arrest cooling has scientific basis. Systems using unproven therapies should ensure that neurologic outcome at hospital discharge is measured and evaluated for all SCA cases.

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A GEOSPATIAL ASSESSMENT OF TRANSPORT DISTANCE AND SURVIVAL TO DISCHARGE IN OUT OF HOSPITAL CARDIAC ARREST PATIENTS: IMPLICATIONS FOR RESUSCITATION CENTERS.

This article adds to existing literature that demonstrates a survival advantage for OHCA patients who bypass local hospitals to receive care at resuscitation centers despite a longer transport time.

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REGIONAL VARIATION IN OUT-OF-HOSPITAL CARDIAC ARREST INCIDENCE AND OUTCOME.

This article describes the wide variation in both incidence and outcome in sudden cardiac arrest across the 10 sites included in the Resuscitation Outcomes Consortium.

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EMERGENCY MEDICAL SERVICE DISPATCH CARDIOPULMONARY RESUSCITATION PREARRIVAL INSTRUCTIONS TO IMPROVE SURVIVAL FROM OUT-OF-HOSPITAL CARDIAC ARREST: A SCIENTIFIC STATEMENT FROM THE AMERICAN HEART ASSOCIATION.

This scientific statement reviews the process of providing CPR dispatch instructions to bystanders who call 9-1-1 and describes best practices and performance measurement.

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COMMUNITY APPROACHES TO IMPROVE RESUSCITATION AFTER OUT-OF-HOSPITAL SUDDEN CARDIAC ARREST.

It provides a well referenced and comprehensive review of strategies for improving bystander CPR and engaging communities and laypersons in efforts to improve survival in any community.

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