Resuscitation
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Observational Study
Nationwide trends in residential and non-residential out-of-hospital cardiac arrest and differences in bystander cardiopulmonary resuscitation.
Singapore is highly-urbanized, with >90% of the population living in high-rise apartments. She has implemented several city-wide interventions such as dispatcher-assisted CPR, community CPR training and smartphone activation of volunteers to increase bystander CPR (BCPR) rates for out-of-hospital cardiac arrest (OHCA). These may have different impact on residential and non-residential OHCA. We aimed to evaluate the characteristics, processes-of-care and outcome differences between residential and non-residential OHCA and study the differences in temporal trends of BCPR rates. ⋯ Residential cardiac arrests had poorer bystander intervention and survival from 2010 to 2016 in Singapore. BCPR had improved more in residential arrests compared to non-residential arrests over a period of city-wide interventions to improve BCPR.
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Randomized Controlled Trial
The influence of prolonged temperature management on acute kidney injury after out-of-hospital cardiac arrest: A post-hoc analysis of the TTH48 trial.
Acute kidney injury (AKI) is common after cardiac arrest and targeted temperature management (TTM). The impact of different lengths of cooling on the development of AKI has not been well studied. In this study of patients included in a randomised controlled trial of TTM at 33 °C for 24 versus 48 h after cardiac arrest (TTH48 trial), we examined the influence of prolonged TTM on AKI and the incidence and factors associated with the development of AKI. We also examined the impact of AKI on survival. ⋯ We did not find any association between prolonged TTM at 33 °C and the risk of AKI during the first seven days in the ICU. AKI is prevalent after cardiac arrest and TTM and occurs in almost half of all ICU admitted patients and more commonly in the elderly, with an increasing BMI and longer arrest duration. AKI after cardiac arrest is an independent predictor of time to death.
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To explore the value of electroencephalogram (EEG) pattern in predicting awakening of comatose patients after cardiopulmonary resuscitation (CPR). ⋯ The slow wave pattern of EEG had a good predictive value for awakening in comatose patients after CPR, and the highest accuracy occurred within 8-14 days from coma.
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Prior research suggests that the proportion of a shockable initial rhythm in out-of-hospital cardiac arrest (OHCA) declined during the last decades. This study aims to investigate if this decline is still ongoing and explore the relationship between location of OHCA and proportion of a shockable initial rhythm as initial rhythm. ⋯ We found a decline in the proportion of patients with a shockable initial rhythm in OHCAs at a residential location; this decline levelled off during the second half of the study period (2011-2015). In public locations, we observed no decline in shockable initial rhythm over time.
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Defibrillation by public Automated External Defibrillators (AEDs) before EMS arrival is associated with high survival rates. Previous recommendSations suggest that an AED should be placed within a 1-1.5 min "brisk walk" from a cardiac arrest. Current guidelines hold no recommendation. The real-time it takes for a volunteer to retrieve an AED in a public setting has not been studied. ⋯ The median travelling speed of all lay responders dispatched to suspected OHCAs was 2.3 m/s. In densely populated areas the travelling speed was 1.8 m/s. This can be used as support in guidelines for planning placement of AEDs, in simulation studies, as well as in configuration of mobile-based dispatch systems.