Improved out-of-hospital cardiac arrest survival after the sequential implementation of 2005 AHA guidelines for compressions, ventilations, and induced hypothermia: the Wake County experience
| Autor: | Graham E. Snyder, Joseph Zalkin, Valerie J. De Maio, J. Brent Myers, Eric Reyer, Ryan Lewis, Daniel Licatese, Paul R. Hinchey |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Emergency Medical Services medicine.medical_treatment Population Heart Massage Ventricular tachycardia Statistics Nonparametric Cohort Studies Hypothermia Induced Intensive care Internal medicine medicine Confidence Intervals North Carolina Odds Ratio Humans Cardiopulmonary resuscitation education Survival analysis Aged education.field_of_study Chi-Square Distribution business.industry Impedance threshold device Middle Aged medicine.disease Respiration Artificial Survival Analysis Cardiopulmonary Resuscitation Surgery Advanced life support Heart Arrest Ventricular fibrillation Practice Guidelines as Topic Ventricular Fibrillation Emergency Medicine Cardiology Tachycardia Ventricular Female business |
| Zdroj: | Annals of emergency medicine. 56(4) |
| ISSN: | 1097-6760 |
| Popis: | Study objective We assess survival from out-of-hospital cardiac arrest after community-wide implementation of 2005 American Heart Association guidelines. Methods This was an observational multiphase before-after cohort in an urban/suburban community (population 840,000) with existing advanced life support. Included were all adults treated for cardiac arrest by emergency responders. Excluded were patients younger than 16 years and trauma patients. Intervention phases in months were baseline 16; phase 1, new cardiopulmonary resuscitation 12; phase 2, impedance threshold device 6; and phase 3, full implementation including out-of-hospital-induced hypothermia 12. Primary outcome was survival to discharge. Other survival and neurologic outcomes were compared between study phases, and adjusted odds ratios with 95% confidence intervals (CIs) for survival by phase were determined by multivariate regression. Results One thousand three hundred sixty-five cardiac arrest patients were eligible for inclusion: baseline n=425, phase 1 n=369, phase 2 n=161, phase 3 n=410. Across phases, patients had similar demographic, clinical, and emergency medical services characteristics. Overall and witnessed ventricular fibrillation and ventricular tachycardia survival improved throughout the study phases: respectively, baseline 4.2% and 13.8%, phase 1 7.3% and 23.9%, phase 2 8.1% and 34.6%, and phase 3 11.5% and 40.8%. The absolute increase for overall survival from baseline to full implementation was 7.3% (95% CI 3.7% to 10.9%); witnessed ventricular fibrillation/ventricular tachycardia survival was 27.0% (95% CI 13.6% to 40.4%), representing an additional 25 lives saved annually in this community. Conclusion In the context of a community-wide focus on resuscitation, the sequential implementation of 2005 American Heart Association guidelines for compressions, ventilations, and induced hypothermia significantly improved survival after cardiac arrest. Further study is required to clarify the relative contribution of each intervention to improved survival outcomes. |
| Databáze: | OpenAIRE |
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