Cardiac Arrest, Cardiopulmonary Arrest, Heart Arrest, Out of Hospital Cardiac Arrest, Sudden Cardiac Death
Conditions
Keywords
Prehospital emergency care, Out of hospital cardiac arrest, Cardiopulmonary resuscitation, CPR, Heart arrest, Outcome, Bystander
Brief summary
The investigators hypothesized that pre-arrival instructions would increase the likelihood of bystanders performing Cardiopulmonary Resuscitation (CPR).
Detailed description
The City of Milwaukee and surrounding communities combine to form Milwaukee County covering 241 square miles and serving approximately 959,521 people. Milwaukee County includes 19 separate municipalities. Community demographics and other characteristics have remained largely stable for the past decade. The study will take place in Milwaukee County from 2009 - 2013 in the communities providing Cardiopulmonary Resuscitation (CPR) pre-arrival instructions: West Allis and Oak Creek. In Milwaukee County Basic Live Support (BLS) shall be started on all patients in cardiac arrest with the exception of victims with: decapitation; rigor mortis; evidence of tissue decomposition; dependent lividity; presence of a valid Do-Not-Resuscitate (DNR) or Physician Orders for Life-Sustaining Treatment (POLST); fire victim with full thickness burns to 90% or greater body surface area; hypothermic patients with signs of frozen tissue, rigid airway, ice formation in mouth, or chest noncompliant for Cardiopulmonary Resuscitation (CPR). The system standard is: Cardiopulmonary Resuscitation (CPR) will be provided whenever patient is pulseless; compressions at least 100/minute; hands on chest more than 75% of time; minimum compression depth of 2 inches in adults 75% of the time. Therefore, the investigators will analyze data to assess how Cardiopulmonary Resuscitation (CPR) pre-arrival instructions may have affected the probability of receiving bystander Cardiopulmonary Resuscitation (CPR).
Interventions
OTHERPre-Arrival Instructions
Out of Hospital Cardiac Arrest (OHCA) Pre-Arrival Instructions (PAI)
Sponsors
Medical College of Wisconsin
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients 21 years old or older * Presumed cardiac origin as indicated on the Milwaukee County Emergency Medical Services (MCEMS) report * Non-Emergency Medical Services (EMS) witnessed arrest
Exclusion criteria
* Patients younger than 21 years old * Patients who are "obviously dead" (decomposition, rigor mortis, decapitation, or other) * Trauma victims, including hanging and burns * Patients with cardiac arrests clearly of other non-cardiac origin including drug overdose, carbon monoxide poisoning, drowning, exsanguination, electrocution, asphyxia, hypoxia related to respiratory disease, cerebrovascular accident and documented terminal illness * Patients determined to be a do-not-resuscitate (DNR) upon arrival of Emergency Medical Services (EMS) providers * Cardiopulmonary Resuscitation (CPR) by someone other than Emergency Medical Services (EMS) who is a trained first responder or health care provider with a predetermined duty to provide care.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Bystander Cardiopulmonary Resuscitation (CPR) in Out of Hospital Cardiac Arrest (OHCA) | Up to 2 years prior to intervention and up to 2 years post intervention | The overall goal of this study is to determine the rate of bystander Cardiopulmonary Resuscitation (CPR) before and after implementation of Cardiopulmonary Resuscitation (CPR) pre-arrival instructions program in Milwaukee County |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Survival to Hospital Discharge or to December, 31 2013 Whichever Comes First | Up to 2 years prior to intervention and up to 2 years post intervention | Explore any relationship to age and gender of the patient, location of arrest, time of year, and other indicators known to affect survival on the overall difference in patient discharge. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORKhalid A. Ateyyah, MD, SBEM
Medical College of Wisconsin
Participant flow
Recruitment details
Subjects were \> 21 years with non-EMS witnessed OHCA of presumed cardiac origin. Cases of obvious irreversible death, trauma-related OHCA, known DNR, or in which EMS or other healthcare provider CPR was performed were excluded Total 344 OHCA in 2 communities 20 \< 21 years, 50 non-cardiac arrest, 75 CPR not specified, so 199 met inclusion criteria
Pre-assignment details
Analyze how implementation of CPR pre-arrival instruction affected probability of receiving bystander CPR, to determine rate of bystander CPR before and after implementation of instructions, explore relationship to age, gender, location of arrest on survival to hospital discharge. Total 344 OHCA in 2 communities, 20 \< 21 year, 50 non-cardiac arrest
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 64.7 years |
| Region of Enrollment United States | 68 participants |
| Sex: Female, Male Female | 24 Participants |
| Sex: Female, Male Male | 177 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
None listed