Resuscitation
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Out-of-hospital cardiac arrest (OHCA) during COVID-19 has been reported by countries with high case numbers and overwhelmed healthcare services. Imposed restrictions and treatment precautions may have also influenced OHCA processes-of-care. We investigated the impact of the COVID-19 pandemic period on incidence, characteristics, and survival from OHCA in Victoria, Australia. ⋯ The COVID-19 pandemic period did not influence OHCA incidence but appears to have disrupted the system-of-care in Australia. However, this could not completely explain reductions in survival.
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Early recognition of out-of-hospital cardiac arrest (OHCA) by 9-1-1 dispatchers is a critical first step along the resuscitation pathway. Barriers to recognition may lead to adverse outcomes among patients. This study aims to determine the impact of seizure-like activity among OHCA patients during 9-1-1 calls. ⋯ Reported seizure-like activity among patients in cardiac arrest poses a barrier to recognition of cardiac arrests by dispatchers leading to delays in resuscitation instructions.
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Data supporting epinephrine administration during resuscitation of in-hospital cardiac arrest (IHCA) are limited. We hypothesized that more frequent epinephrine administration would predict greater early end-organ dysfunction and worse outcomes after IHCA. ⋯ Higher rates of epinephrine administration during IHCA are associated with more severe early global illness severity.
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The defibrillator prompt, which directs callers to retrieve a defibrillator during out-of-hospital cardiac arrest, is crucial to the emergency call because it can save lives. We evaluated communicative effectiveness of the prompt instated by the Medical Priority Dispatch System™ Version 13, namely: if there is a defibrillator (AED) available, send someone to get it now, and tell me when you have it. ⋯ While the Version 13 prompt aims to ensure the use of an available automatic external defibrillator, its effectiveness is undermined by the three-clause composition of the prompt and exclusion of a question structure. We recommend testing of a re-phrased defibrillator prompt in order to maximise comprehension and caller action.
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Observational Study
Prospective evaluation of airway management in pediatric out-of-hospital cardiac arrest.
The objective of the study was to identify the association between airway management modality and time to the initial dose of epinephrine in pediatric out-of-hospital cardiac arrest (OHCA). ⋯ In this prospective study, the airway management modality was not associated with the time to the initial dose of epinephrine. Unexpectedly, pneumonia was significantly more common among children treated with TI compared to BMV. SGAs had high first-attempt success rates, while intubation success rates were low.