The Experts below are selected from a list of 5592 Experts worldwide ranked by ideXlab platform
Sang Do Shin - One of the best experts on this subject based on the ideXlab platform.
-
association between hourly call volume in the emergency medical dispatch center and Dispatcher assisted cardiopulmonary resuscitation instruction time in out of hospital cardiac arrest
Resuscitation, 2020Co-Authors: Tae Han Kim, Youdong Sohn, Wonpyo Hong, Kyoung Jun Song, Sang Do ShinAbstract:Abstract Objectives Cardiac arrest recognition, ambulance dispatch and Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) by emergency medical dispatch (EMD) are crucial for an optimal outcome of out-of-hospital cardiac arrest (OHCA). In EMD, crowding is caused by a mismatch between the number of emergency calls and the number of Dispatchers available per shift. Crowding in the emergency department has been shown to decrease performance and outcomes; however, little is known about the effect of crowding in EMD. We aimed to evaluate the incidence of crowding in the EMD and the effect of emergency call crowding on Dispatcher-assisted CPR instruction performance in OHCA calls. Methods We used a nationwide OHCA database from 2013 to 2016 consisting of patients with the presumed cardiac origin who were dispatched by Seoul EMD. The main exposure was an hourly number of total incoming emergency calls to EMD. The number of hourly calls was categorized into quartiles (≤40 calls, 41–51 calls, 52–61 calls and ≥62 calls). The primary outcome was successful DA-CPR instruction provision within 120 s. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated to evaluate the association between EMD crowding and outcomes in the multivariable logistic regression model. Results Of a total of 12,722 patients, the proportion of successful DA instruction was highest in the least-crowded quartile and lowest in the most-crowded quartile (22.7% vs. 15.0%, p Conclusion Crowding in emergency medicine dispatch caused by increased hourly call volume was associated with delayed Dispatcher-assisted CPR instruction provision. Medical directors might consider a strategic approach to addressing crowding in EMD according to the crowding distribution.
-
Emergency medical dispatch services across Pan-Asian countries: a web-based survey
'Springer Science and Business Media LLC', 2020Co-Authors: Lee, Shawn C L, Sang Do Shin, Mao, Desmond R, Ng, Yih Y, Leong, Benjamin S, Supasaovapak Jirapong, Gaerlan, Faith J, Son, Do N, Chia, Boon Y, Lin Chih-haoAbstract:Background Dispatch services (DSs) form an integral part of emergency medical service (EMS) systems. The role of a Dispatcher has also evolved into a crucial link in patient care delivery, particularly in Dispatcher assisted cardio-pulmonary resuscitation (DACPR) during out-of-hospital cardiac arrest (OHCA). Yet, there has been a paucity of research into the emerging area of dispatch science in Asia. This paper compares the characteristics of DSs, and state of implementation of DACPR within the Pan-Asian Resuscitation Outcomes (PAROS) network. Methods A cross-sectional descriptive survey addressing population characteristics, DS structures and levels of service, state of DACPR implementation (including protocols and quality improvement programs) among PAROS DSs. Results 9 DSs responded, representing a total of 23 dispatch centres from 9 countries that serve over 80 million people. Most PAROS DSs operate a tiered dispatch response, have implemented medical oversight, and tend to be staffed by Dispatchers with a predominantly medical background. Almost all PAROS DSs have begun tracking key EMS indicators. 77.8% (n = 7) of PAROS DSs have introduced DACPR. Of the DSs that have rolled out DACPR, 71.4% (n = 5) provided instructions in over one language. All DSs that implemented DACPR and provided feedback to Dispatchers offered feedback on missed OHCA recognition. The majority of DSs (83.3%; n = 5) that offered DACPR and provided feedback to Dispatchers also implemented corrective feedback, while 66.7% (n = 4) offered positive feedback. Compression-only CPR was the standard instruction for PAROS DSs. OHCA recognition sensitivity varied widely in PAROS DSs, ranging from 32.6% (95% CI: 29.9–35.5%) to 79.2% (95% CI: 72.9–84.4%). Median time to first compression ranged from 120 s to 220 s. Conclusions We found notable variations in characteristics and state of DACPR implementation between PAROS DSs. These findings will lay the groundwork for future DS and DACPR studies in the PAROS network.This study was supported by grants from National Medical Research Council, Clinician Scientist Awards, Singapore NMRC/CSA/024/2010 and NMRC/CSA/0049/2013), Ministry of Health, Health Services Research Grant, Singapore (HSRG/0021/2012). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
-
recognition of out of hospital cardiac arrest during emergency calls and public awareness of cardiopulmonary resuscitation in communities a multilevel analysis
Resuscitation, 2018Co-Authors: Kyoung Jun Song, Sang Do Shin, Sunyoung Lee, Ki Jeong Hong, Jeong Ho ParkAbstract:Abstract Background For an effective Dispatcher-assisted cardiopulmonary resuscitation (CPR) program, recognition of out-of-hospital cardiac arrest (OHCA) by a Dispatcher is the first step in initiating bystander CPR. This study evaluated whether CPR awareness in the community is associated with recognition of arrest, Dispatcher-provided CPR instructions, and bystander CPR. Methods All emergency medical services (EMS)-treated adult OHCAs with cardiac etiology were enrolled between 2013 and 2015, excluding cases witnessed by EMS providers. Exposure was CPR awareness in the community where the OHCA occurred. Endpoints were recognition of arrest, Dispatcher-provided CPR instructions, and bystander CPR. Multilevel logistic regression analysis was performed to calculate adjusted odds ratios (AORs) per 10% increment in community CPR awareness adjusting for potential confounders. Results Of 44,185 eligible OHCAs, 20,255 (45.8%) cases were recognized by a Dispatcher, 17,858 (40.4%) received Dispatcher-provided CPR instructions, and 22,255 (50.4%) received bystander CPR (39.8% with Dispatcher assistance and 10.6% without Dispatcher assistance). Compared with OHCAs that occurred in the communities with low awareness, Dispatchers were more likely to provide CPR instructions to the caller, and bystanders were more likely to perform CPR for OHCAs that occurred in the communities with high CPR awareness. AORs (95% CIs) per 10% increment in public awareness of CPR in the community were 1.05 (1.01–1.10) for recognition of arrest, 1.11 (1.06–1.16) for Dispatcher-provided CPR instructions, and 1.07 (1.03–1.11) for bystander CPR. Conclusions Public CPR awareness of the communities where OHCAs occurred was associated with recognition of arrest during an emergency call, Dispatcher-provided CPR instructions, and bystander CPR.
-
effect of Dispatcher assisted cardiopulmonary resuscitation program and location of out of hospital cardiac arrest on survival and neurologic outcome
Annals of Emergency Medicine, 2017Co-Authors: Kyoung Jun Song, Sang Do Shin, Yu Jin Lee, Seung Chul Lee, Hyun Wook Ryoo, Marcus Eng Hock OngAbstract:STUDY OBJECTIVE We study the effect of a nationwide Dispatcher-assisted cardiopulmonary resuscitation (CPR) program on out-of-hospital cardiac arrest outcomes by arrest location (public and private settings). METHODS All emergency medical services (EMS)-treated adults in Korea with out-of-hospital cardiac arrests of cardiac cause were enrolled between 2012 and 2013, excluding cases witnessed by EMS providers and those with unknown outcomes. Exposure was bystander CPR categorized into 3 groups: bystander CPR with Dispatcher assistance, bystander CPR without Dispatcher assistance, and no bystander CPR. The endpoint was good neurologic recovery at discharge. Multivariable logistic regression analysis was performed. The final model with an interaction term was evaluated to compare the effects across settings. RESULTS A total of 37,924 patients (31.1% bystander CPR with Dispatcher assistance, 14.3% bystander CPR without Dispatcher assistance, and 54.6% no bystander CPR) were included in the final analysis. The total bystander CPR rate increased from 30.9% in quarter 1 (2012) to 55.7% in quarter 4 (2014). Bystander CPR with and without Dispatcher assistance was more likely to result in higher survival with good neurologic recovery (4.8% and 5.2%, respectively) compared with no bystander CPR (2.1%). The adjusted odds ratios for good neurologic recovery were 1.50 (95% confidence interval [CI] 1.30 to 1.74) in bystander CPR with Dispatcher assistance and 1.34 (95% CI 1.12 to 1.60) in bystander CPR without it compared with no bystander CPR. For arrests in private settings, the adjusted odds ratios were 1.58 (95% CI 1.30 to 1.92) in bystander CPR with Dispatcher assistance and 1.28 (95% CI 0.98 to 1.67) in bystander CPR without it; in public settings, the adjusted odds ratios were 1.41 (95% CI 1.14 to 1.75) and 1.37 (95% CI 1.08 to 1.72), respectively. CONCLUSION Bystander CPR regardless of Dispatcher assistance was associated with improved neurologic recovery after out-of-hospital cardiac arrest. However, for out-of-hospital cardiac arrest cases in private settings, bystander CPR was associated with improved neurologic recovery only when Dispatcher assistance was provided.
Kyoung Jun Song - One of the best experts on this subject based on the ideXlab platform.
-
association between hourly call volume in the emergency medical dispatch center and Dispatcher assisted cardiopulmonary resuscitation instruction time in out of hospital cardiac arrest
Resuscitation, 2020Co-Authors: Tae Han Kim, Youdong Sohn, Wonpyo Hong, Kyoung Jun Song, Sang Do ShinAbstract:Abstract Objectives Cardiac arrest recognition, ambulance dispatch and Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) by emergency medical dispatch (EMD) are crucial for an optimal outcome of out-of-hospital cardiac arrest (OHCA). In EMD, crowding is caused by a mismatch between the number of emergency calls and the number of Dispatchers available per shift. Crowding in the emergency department has been shown to decrease performance and outcomes; however, little is known about the effect of crowding in EMD. We aimed to evaluate the incidence of crowding in the EMD and the effect of emergency call crowding on Dispatcher-assisted CPR instruction performance in OHCA calls. Methods We used a nationwide OHCA database from 2013 to 2016 consisting of patients with the presumed cardiac origin who were dispatched by Seoul EMD. The main exposure was an hourly number of total incoming emergency calls to EMD. The number of hourly calls was categorized into quartiles (≤40 calls, 41–51 calls, 52–61 calls and ≥62 calls). The primary outcome was successful DA-CPR instruction provision within 120 s. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated to evaluate the association between EMD crowding and outcomes in the multivariable logistic regression model. Results Of a total of 12,722 patients, the proportion of successful DA instruction was highest in the least-crowded quartile and lowest in the most-crowded quartile (22.7% vs. 15.0%, p Conclusion Crowding in emergency medicine dispatch caused by increased hourly call volume was associated with delayed Dispatcher-assisted CPR instruction provision. Medical directors might consider a strategic approach to addressing crowding in EMD according to the crowding distribution.
-
recognition of out of hospital cardiac arrest during emergency calls and public awareness of cardiopulmonary resuscitation in communities a multilevel analysis
Resuscitation, 2018Co-Authors: Kyoung Jun Song, Sang Do Shin, Sunyoung Lee, Ki Jeong Hong, Jeong Ho ParkAbstract:Abstract Background For an effective Dispatcher-assisted cardiopulmonary resuscitation (CPR) program, recognition of out-of-hospital cardiac arrest (OHCA) by a Dispatcher is the first step in initiating bystander CPR. This study evaluated whether CPR awareness in the community is associated with recognition of arrest, Dispatcher-provided CPR instructions, and bystander CPR. Methods All emergency medical services (EMS)-treated adult OHCAs with cardiac etiology were enrolled between 2013 and 2015, excluding cases witnessed by EMS providers. Exposure was CPR awareness in the community where the OHCA occurred. Endpoints were recognition of arrest, Dispatcher-provided CPR instructions, and bystander CPR. Multilevel logistic regression analysis was performed to calculate adjusted odds ratios (AORs) per 10% increment in community CPR awareness adjusting for potential confounders. Results Of 44,185 eligible OHCAs, 20,255 (45.8%) cases were recognized by a Dispatcher, 17,858 (40.4%) received Dispatcher-provided CPR instructions, and 22,255 (50.4%) received bystander CPR (39.8% with Dispatcher assistance and 10.6% without Dispatcher assistance). Compared with OHCAs that occurred in the communities with low awareness, Dispatchers were more likely to provide CPR instructions to the caller, and bystanders were more likely to perform CPR for OHCAs that occurred in the communities with high CPR awareness. AORs (95% CIs) per 10% increment in public awareness of CPR in the community were 1.05 (1.01–1.10) for recognition of arrest, 1.11 (1.06–1.16) for Dispatcher-provided CPR instructions, and 1.07 (1.03–1.11) for bystander CPR. Conclusions Public CPR awareness of the communities where OHCAs occurred was associated with recognition of arrest during an emergency call, Dispatcher-provided CPR instructions, and bystander CPR.
-
effect of Dispatcher assisted cardiopulmonary resuscitation program and location of out of hospital cardiac arrest on survival and neurologic outcome
Annals of Emergency Medicine, 2017Co-Authors: Kyoung Jun Song, Sang Do Shin, Yu Jin Lee, Seung Chul Lee, Hyun Wook Ryoo, Marcus Eng Hock OngAbstract:STUDY OBJECTIVE We study the effect of a nationwide Dispatcher-assisted cardiopulmonary resuscitation (CPR) program on out-of-hospital cardiac arrest outcomes by arrest location (public and private settings). METHODS All emergency medical services (EMS)-treated adults in Korea with out-of-hospital cardiac arrests of cardiac cause were enrolled between 2012 and 2013, excluding cases witnessed by EMS providers and those with unknown outcomes. Exposure was bystander CPR categorized into 3 groups: bystander CPR with Dispatcher assistance, bystander CPR without Dispatcher assistance, and no bystander CPR. The endpoint was good neurologic recovery at discharge. Multivariable logistic regression analysis was performed. The final model with an interaction term was evaluated to compare the effects across settings. RESULTS A total of 37,924 patients (31.1% bystander CPR with Dispatcher assistance, 14.3% bystander CPR without Dispatcher assistance, and 54.6% no bystander CPR) were included in the final analysis. The total bystander CPR rate increased from 30.9% in quarter 1 (2012) to 55.7% in quarter 4 (2014). Bystander CPR with and without Dispatcher assistance was more likely to result in higher survival with good neurologic recovery (4.8% and 5.2%, respectively) compared with no bystander CPR (2.1%). The adjusted odds ratios for good neurologic recovery were 1.50 (95% confidence interval [CI] 1.30 to 1.74) in bystander CPR with Dispatcher assistance and 1.34 (95% CI 1.12 to 1.60) in bystander CPR without it compared with no bystander CPR. For arrests in private settings, the adjusted odds ratios were 1.58 (95% CI 1.30 to 1.92) in bystander CPR with Dispatcher assistance and 1.28 (95% CI 0.98 to 1.67) in bystander CPR without it; in public settings, the adjusted odds ratios were 1.41 (95% CI 1.14 to 1.75) and 1.37 (95% CI 1.08 to 1.72), respectively. CONCLUSION Bystander CPR regardless of Dispatcher assistance was associated with improved neurologic recovery after out-of-hospital cardiac arrest. However, for out-of-hospital cardiac arrest cases in private settings, bystander CPR was associated with improved neurologic recovery only when Dispatcher assistance was provided.
Thomas D. Rea - One of the best experts on this subject based on the ideXlab platform.
-
CPR with Chest Compression Alone or with Rescue Breathing
The New England Journal of Medicine, 2010Co-Authors: Thomas D. Rea, Carol Fahrenbruch, Linda Culley, Rachael T. Donohoe, Cindy Hambly, J. Innes, Megan Bloomingdale, Cleo Subido, Steven Romines, Mickey S EisenbergAbstract:Background The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the Dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing. Methods We conducted a multicenter, randomized trial of Dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-ofhospital cardiac arrest for whom Dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomes included a favorable neurologic outcome at discharge. Results Of the 1941 patients who met the inclusion criteria, 981 were randomly assigned to receive chest compression alone and 960 to receive chest compression plus rescue breathing. We observed no significant difference between the two groups in the proportion of patients who survived to hospital discharge (12.5% with chest compression alone and 11.0% with chest compression plus rescue breathing, P = 0.31) or in the proportion who survived with a favorable neurologic outcome in the two sites that assessed this secondary outcome (14.4% and 11.5%, respectively; P = 0.13). Prespecified subgroup analyses showed a trend toward a higher proportion of patients surviving to hospital discharge with chest compression alone as compared with chest compression plus rescue breathing for patients with a cardiac cause of arrest (15.5% vs. 12.3%, P = 0.09) and for those with shockable rhythms (31.9% vs. 25.7%, P = 0.09). Conclusions Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing. (Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation; ClinicalTrials.gov number, NCT00219687.)
-
Dispatcher assisted cardiopulmonary resuscitation risks for patients not in cardiac arrest
Circulation, 2010Co-Authors: Lindsay White, Carol Fahrenbruch, Linda Culley, Megan Bloomingdale, Cleo Subido, Joseph G Rogers, Mickey Eisenberg, Thomas D. ReaAbstract:Background— Dispatcher-assisted cardiopulmonary resuscitation (CPR) instructions can increase bystander CPR and thereby increase the rate of survival from cardiac arrest. The risk of bystander CPR for patients not in arrest is uncertain and has implications for how assertive dispatch is in instructing CPR. We determined the frequency of Dispatcher-assisted CPR for patients not in arrest and the frequency and severity of injury related to chest compressions. Methods and Results— The investigation was a prospective cohort study of adult patients not in cardiac arrest for whom Dispatchers provided CPR instructions in King County, Washington, between June 1, 2004, and January 31, 2007. The study focused on those who received chest compressions. Information was collected through review of the audio and written dispatch report, written emergency medical services report, hospital record, and telephone survey. Of the 1700 patients for whom Dispatcher CPR instructions were initiated, 55% (938 of 1700) were in arre...
-
Dispatcher assisted cardiopulmonary resuscitation risks for patients not in cardiac arrest
Revista Portuguesa De Pneumologia, 2010Co-Authors: Lindsay White, Carol Fahrenbruch, Linda Culley, Megan Bloomingdale, Cleo Subido, Joseph G Rogers, Mickey Eisenberg, Thomas D. ReaAbstract:Background: Dispatcher-assisted cardiopulmonary resuscitation (CPR) instructions can increase bystander CPR and there-by increase the rate of survival from cardiac arrest. The risk of bystander CPR for patients not in arrest is uncertain and has implications for how assertive dispatch is in instructing CPR. We determined the frequency of Dispatcher-assisted CPR for patients not in arrest and the frequency and severity of injury related to chest compressions. Methods and Results: The investigation was a prospective cohort study of adult patients not in cardiac arrest for whom Dispatchers provided CPR Instructions in King County, Washington, between June 1, 2004, and January 31, 2007. The study focused on those who received chest compressions. Information was collected through review of the audio and written dispatch report, written emergency medical service report, hospital record, and telephone survey. Of the 1700 patents for whom Dispatcher CPR instructions were initiated, 55% (938 of 1700) were in arrest, 45% (762 of 1700) were not in arrest, and 18% (313 of 1700) were not in arrest and received bystander chest compressions. Of the 247 not in arrest who received chest compressions and had complete outcome ascertainment, 12% (29 of 247) experienced discomfort, and 2% (6 of 247) sustained Injuries likely or possibly caused by bystander CPR. Only 2% (5 of 247) suffered a fracture, and no patients suffered visceral organ injury. Conclusions: In this prospective study, the frequency of serious injury related to Dispatcher-assisted bystander CPR among non-arrest patients was low. When coupled with the established benefits of bystander CPR among those with arrest, these results support an assertive program of dispateher-assisted CPR.
-
Dispatcher-assisted cardiopulmonary resuscitation and survival in cardiac arrest.
Circulation, 2001Co-Authors: Thomas D. Rea, Mickey S Eisenberg, Linda Culley, Linda BeckerAbstract:Background— Early cardiopulmonary resuscitation (CPR) improves survival in out-of-hospital cardiac arrest, and Dispatcher-delivered instruction in CPR can increase the proportion of arrest victims who receive bystander CPR before emergency medical service (EMS) arrival. However, little is known about the survival effectiveness of Dispatcher-delivered telephone CPR instruction. Methods and Results We evaluated a population-based cohort of EMS-attended adult cardiac arrests (n=7265) from 1983 through 2000 in King County, Washington, to assess the association between survival to hospital discharge and 3 distinct CPR groups: no bystander CPR before EMS arrival (no bystander CPR), bystander CPR before EMS arrival requiring Dispatcher instruction (Dispatcher-assisted bystander CPR), and bystander CPR before EMS arrival not requiring Dispatcher instruction (bystander CPR without Dispatcher assistance). In this cohort, 44.1% received no bystander CPR before EMS arrival, 25.7% received Dispatcher-assisted bystande...
Mickey S Eisenberg - One of the best experts on this subject based on the ideXlab platform.
-
Dispatcher assisted cardiopulmonary resuscitation time to identify cardiac arrest and deliver chest compression instructions
Circulation, 2013Co-Authors: Miranda M Lewis, Benjamin A Stubbs, Mickey S EisenbergAbstract:Background— Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), in which 9-1-1 Dispatchers provide CPR instructions over the telephone, has been shown to nearly double the rate of bystander CPR. We sought to identify factors that hampered the identification of cardiac arrest by 9-1-1 Dispatchers and prevented or delayed the provision of Dispatcher-assisted CPR chest compressions. Methods and Results— We reviewed dispatch recordings for 476 out-of-hospital cardiac arrests occurring between January 1, 2011, and December 31, 2011. We found that the Dispatcher correctly identified cardiac arrest in 80% of reviewed cases and 92% of cases in which they were able to assess patient consciousness and breathing. The median time to recognition of the arrest was 75 seconds. Chest compressions following Dispatcher-assisted CPR instructions occurred in 62% of cases when the Dispatcher had the opportunity to asses for consciousness and breathing and bystander CPR was not already started. The median time to first Dispatcher-assisted CPR chest compression was 176 seconds. Conclusions— Dispatchers are able to accurately diagnose cardiac arrest over the telephone, but recognition is likely not possible in all circumstances. In some cases, recognition of cardiac arrest may be improved through training in the detection of agonal respirations. Delays in the delivery of Dispatcher-assisted CPR chest compressions are common and are attributable to a mixture of Dispatcher behavior and factors beyond the control of the Dispatcher. Performance standards for the successful and quick recognition of cardiac arrest and delivery of first chest compressions should be adopted as metrics against which emergency medical services systems can measure their performance. # Clinical Perspective {#article-title-28}
-
CPR with Chest Compression Alone or with Rescue Breathing
The New England Journal of Medicine, 2010Co-Authors: Thomas D. Rea, Carol Fahrenbruch, Linda Culley, Rachael T. Donohoe, Cindy Hambly, J. Innes, Megan Bloomingdale, Cleo Subido, Steven Romines, Mickey S EisenbergAbstract:Background The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the Dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing. Methods We conducted a multicenter, randomized trial of Dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-ofhospital cardiac arrest for whom Dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomes included a favorable neurologic outcome at discharge. Results Of the 1941 patients who met the inclusion criteria, 981 were randomly assigned to receive chest compression alone and 960 to receive chest compression plus rescue breathing. We observed no significant difference between the two groups in the proportion of patients who survived to hospital discharge (12.5% with chest compression alone and 11.0% with chest compression plus rescue breathing, P = 0.31) or in the proportion who survived with a favorable neurologic outcome in the two sites that assessed this secondary outcome (14.4% and 11.5%, respectively; P = 0.13). Prespecified subgroup analyses showed a trend toward a higher proportion of patients surviving to hospital discharge with chest compression alone as compared with chest compression plus rescue breathing for patients with a cardiac cause of arrest (15.5% vs. 12.3%, P = 0.09) and for those with shockable rhythms (31.9% vs. 25.7%, P = 0.09). Conclusions Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing. (Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation; ClinicalTrials.gov number, NCT00219687.)
-
Dispatcher-assisted cardiopulmonary resuscitation and survival in cardiac arrest.
Circulation, 2001Co-Authors: Thomas D. Rea, Mickey S Eisenberg, Linda Culley, Linda BeckerAbstract:Background— Early cardiopulmonary resuscitation (CPR) improves survival in out-of-hospital cardiac arrest, and Dispatcher-delivered instruction in CPR can increase the proportion of arrest victims who receive bystander CPR before emergency medical service (EMS) arrival. However, little is known about the survival effectiveness of Dispatcher-delivered telephone CPR instruction. Methods and Results We evaluated a population-based cohort of EMS-attended adult cardiac arrests (n=7265) from 1983 through 2000 in King County, Washington, to assess the association between survival to hospital discharge and 3 distinct CPR groups: no bystander CPR before EMS arrival (no bystander CPR), bystander CPR before EMS arrival requiring Dispatcher instruction (Dispatcher-assisted bystander CPR), and bystander CPR before EMS arrival not requiring Dispatcher instruction (bystander CPR without Dispatcher assistance). In this cohort, 44.1% received no bystander CPR before EMS arrival, 25.7% received Dispatcher-assisted bystande...
-
Dispatcher assistance and automated external defibrillator performance among elders
Academic Emergency Medicine, 2001Co-Authors: Rob Ecker, Hendrika Meischke, Sheri Schaeffer, Peter J Kudenchuk, Mickey S EisenbergAbstract:Objectives: Automated external defibrillators (AEDs) provide an opportunity to improve survival in out-of-hospital, ventricular fibrillation (VF) cardiac arrest by enabling laypersons not trained in rhythm recognition to deliver lifesaving therapy. The potential role of emergency Dispatchers in the layperson use of AEDs is uncertain. This study was performed to examine whether Dispatcher telephone assistance affected AED skill performance during a simulated VF cardiac arrest among a cohort of older adults. The hypothesis was that Dispatcher assistance would increase the proportion who were able to correctly deliver a shock, but might require additional time. Methods: One hundred fifty community-dwelling persons aged 58-84 years were recruited from eight senior centers in King County, Washington. All participants had received AED training approximately six months previously. For this study, the participants were randomized to AED operation with or without Dispatcher assistance during a simulated VF cardiac arrest. The proportions who successfully delivered a shock and the time intervals from collapse to shock were compared between the two groups. Results: The participants who received Dispatcher assistance were more likely to correctly deliver a shock with the AED during the simulated VF cardiac arrest (91% vs 68%, p ? 0.001). Among those who were able to deliver a shock, the participants who received Dispatcher assistance required a longer time interval from collapse to shock [median (25th, 75th percentile) ? 193 seconds (165, 225) for Dispatcher assistance, and 148 seconds (138, 166) for no Dispatcher assistance, p ? 0.001]. Conclusions: Among older laypersons previously trained in AED operation, Dispatcher assistance may increase the proportion who can successfully deliver a shock during a VF cardiac arrest.
Linda Culley - One of the best experts on this subject based on the ideXlab platform.
-
CPR with Chest Compression Alone or with Rescue Breathing
The New England Journal of Medicine, 2010Co-Authors: Thomas D. Rea, Carol Fahrenbruch, Linda Culley, Rachael T. Donohoe, Cindy Hambly, J. Innes, Megan Bloomingdale, Cleo Subido, Steven Romines, Mickey S EisenbergAbstract:Background The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the Dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing. Methods We conducted a multicenter, randomized trial of Dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-ofhospital cardiac arrest for whom Dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomes included a favorable neurologic outcome at discharge. Results Of the 1941 patients who met the inclusion criteria, 981 were randomly assigned to receive chest compression alone and 960 to receive chest compression plus rescue breathing. We observed no significant difference between the two groups in the proportion of patients who survived to hospital discharge (12.5% with chest compression alone and 11.0% with chest compression plus rescue breathing, P = 0.31) or in the proportion who survived with a favorable neurologic outcome in the two sites that assessed this secondary outcome (14.4% and 11.5%, respectively; P = 0.13). Prespecified subgroup analyses showed a trend toward a higher proportion of patients surviving to hospital discharge with chest compression alone as compared with chest compression plus rescue breathing for patients with a cardiac cause of arrest (15.5% vs. 12.3%, P = 0.09) and for those with shockable rhythms (31.9% vs. 25.7%, P = 0.09). Conclusions Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing. (Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation; ClinicalTrials.gov number, NCT00219687.)
-
Dispatcher assisted cardiopulmonary resuscitation risks for patients not in cardiac arrest
Circulation, 2010Co-Authors: Lindsay White, Carol Fahrenbruch, Linda Culley, Megan Bloomingdale, Cleo Subido, Joseph G Rogers, Mickey Eisenberg, Thomas D. ReaAbstract:Background— Dispatcher-assisted cardiopulmonary resuscitation (CPR) instructions can increase bystander CPR and thereby increase the rate of survival from cardiac arrest. The risk of bystander CPR for patients not in arrest is uncertain and has implications for how assertive dispatch is in instructing CPR. We determined the frequency of Dispatcher-assisted CPR for patients not in arrest and the frequency and severity of injury related to chest compressions. Methods and Results— The investigation was a prospective cohort study of adult patients not in cardiac arrest for whom Dispatchers provided CPR instructions in King County, Washington, between June 1, 2004, and January 31, 2007. The study focused on those who received chest compressions. Information was collected through review of the audio and written dispatch report, written emergency medical services report, hospital record, and telephone survey. Of the 1700 patients for whom Dispatcher CPR instructions were initiated, 55% (938 of 1700) were in arre...
-
Dispatcher assisted cardiopulmonary resuscitation risks for patients not in cardiac arrest
Revista Portuguesa De Pneumologia, 2010Co-Authors: Lindsay White, Carol Fahrenbruch, Linda Culley, Megan Bloomingdale, Cleo Subido, Joseph G Rogers, Mickey Eisenberg, Thomas D. ReaAbstract:Background: Dispatcher-assisted cardiopulmonary resuscitation (CPR) instructions can increase bystander CPR and there-by increase the rate of survival from cardiac arrest. The risk of bystander CPR for patients not in arrest is uncertain and has implications for how assertive dispatch is in instructing CPR. We determined the frequency of Dispatcher-assisted CPR for patients not in arrest and the frequency and severity of injury related to chest compressions. Methods and Results: The investigation was a prospective cohort study of adult patients not in cardiac arrest for whom Dispatchers provided CPR Instructions in King County, Washington, between June 1, 2004, and January 31, 2007. The study focused on those who received chest compressions. Information was collected through review of the audio and written dispatch report, written emergency medical service report, hospital record, and telephone survey. Of the 1700 patents for whom Dispatcher CPR instructions were initiated, 55% (938 of 1700) were in arrest, 45% (762 of 1700) were not in arrest, and 18% (313 of 1700) were not in arrest and received bystander chest compressions. Of the 247 not in arrest who received chest compressions and had complete outcome ascertainment, 12% (29 of 247) experienced discomfort, and 2% (6 of 247) sustained Injuries likely or possibly caused by bystander CPR. Only 2% (5 of 247) suffered a fracture, and no patients suffered visceral organ injury. Conclusions: In this prospective study, the frequency of serious injury related to Dispatcher-assisted bystander CPR among non-arrest patients was low. When coupled with the established benefits of bystander CPR among those with arrest, these results support an assertive program of dispateher-assisted CPR.
-
Dispatcher-assisted cardiopulmonary resuscitation and survival in cardiac arrest.
Circulation, 2001Co-Authors: Thomas D. Rea, Mickey S Eisenberg, Linda Culley, Linda BeckerAbstract:Background— Early cardiopulmonary resuscitation (CPR) improves survival in out-of-hospital cardiac arrest, and Dispatcher-delivered instruction in CPR can increase the proportion of arrest victims who receive bystander CPR before emergency medical service (EMS) arrival. However, little is known about the survival effectiveness of Dispatcher-delivered telephone CPR instruction. Methods and Results We evaluated a population-based cohort of EMS-attended adult cardiac arrests (n=7265) from 1983 through 2000 in King County, Washington, to assess the association between survival to hospital discharge and 3 distinct CPR groups: no bystander CPR before EMS arrival (no bystander CPR), bystander CPR before EMS arrival requiring Dispatcher instruction (Dispatcher-assisted bystander CPR), and bystander CPR before EMS arrival not requiring Dispatcher instruction (bystander CPR without Dispatcher assistance). In this cohort, 44.1% received no bystander CPR before EMS arrival, 25.7% received Dispatcher-assisted bystande...
