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Background: Previous large retrospective analyses have found an association between duration of peri-shock pauses in cardiopulmonary resuscitation (CPR) and survival. In a randomized trial, we tested whether shortening these pauses improves survival after out-of-hospital cardiac arrest (OHCA).Methods: Patients with OHCA between May 2006 and January 2014 with shockable initial rhythm, treated by first responders, were randomized to two automated external defibrillator (AED) treatment protocols. In the control protocol AEDs performed post-shock analysis and prompted rescuers to a pulse check (Guidelines 2000). In the experimental protocol a 15s period of CPR during and after charging of the AED was added to the voice prompts and CPR was resumed immediately after defibrillation (modification of the Guidelines 2005). Survival was assessed at hospital admission and discharge.Results: Of 1174 OHCA patients, 456 met the inclusion criteria: 227 were randomly assigned to the experimental protocol and 229 to the control protocol. The experimental group experienced shorter pre-shock pauses (6 [5-11]s vs. 20 [18-23]s; P<0.001), and shorter post-shock pauses (7 [6-9]s vs. 27 [16-34]s; P<0.001). Similar proportions of patients survived to hospital admission (experimental: 62% vs.Control: 65%; RR [95%CI] 0.96 [0.83-1.10], P=0.51), and hospital discharge (experimental: 42% vs.Control: 38%; RR [95%CI] 1.09 [0.87-1.37], P=0.46).Conclusion: In patients with OHCA and shockable initial rhythms, treatment with AEDs with the experimental protocol shortened pre-shock and post-shock CPR pauses, and increased overall CPR time, but did not improve survival to hospital admission or discharge.Clinical Trial Registration: http://www.isrctn.com unique identifier: ISRCTN72257677. [ABSTRACT FROM AUTHOR]

Background-Over the last decades, a gradual decrease in ventricular fibrillation (VF) as initial recorded rhythm during resuscitation for out-of-hospital cardiac arrest (OHCA) has been noted. We sought to establish the contribution of implantable cardioverter-defibrillator (ICD) therapy to this decline. Methods and Results-Using a prospective database of all OHCA resuscitation in the province North Holland in the Netherlands (Amsterdam Resuscitation Studies [ARREST]), we collected data on all patients in whom resuscitation for OHCA was attempted in 2005-2008. VF OHCA incidence (per 100 000 inhabitants per year) was compared with VF OHCA incidence data during 1995-1997, collected in a similar way. We also collected ICD interrogations of all ICD patients from North Holland and identified all appropriate ICD shocks in 2005-2008; we calculated the number of prevented VF OHCA episodes, considering that only part of the appropriate shocks would result in avoided resuscitation. VF OHCA incidence decreased from 21.1/100 000 in 1995-1997 to 17.4/100 000 in 2005-2008 (P<0.00l). Non-VF OHCA increased from 12.2/100 000 to 19.4/100 000 (P<0.001). VF as presenting rhythm declined from 63% to 47%. In 2005-2008, 1972 ICD patients received 977 shocks. Of these shocks, 339 were caused by a life-threatening arrhythmia. We estimate that these 339 shocks have prevented 81 (minimum, 39; maximum, 152) cases of VF OHCA, corresponding with 33% (minimum, 16%; maximum, 63%) of the observed decline in VF OHCA incidence. - Conclusions-The incidence of VF OHCA decreased over the last 10 years in North Holland. ICD therapy explained a decrease of 1.2/100 000 inhabitants per year, corresponding with 33% of the observed decline in VP OHCA. [ABSTRACT FROM AUTHOR]

Background--There have been few studies on the effectiveness of bystander automated external defibrillator (AED) use in out-of-hospital cardiac arrest. The objective of this study was to determine whether actual use of onsite or dispatched AED reduces the time to first shock compared with no AED use and thereby improves survival. Methods and Results--We performed a population-based cohort study of 2833 consecutive patients with a nontraumatic out-of-hospital cardiac arrest before emergency medical system arrival between 2006 and 2009. The primary outcome, neurologically intact survival to discharge, was compared by use of multivariable logistic regression analysis. An onsite AED had been applied in 128 of the 2833 cases, a dispatched AED in 478, and no AED in 2227. Onsite AED use reduced the time to first shock from 11 to 4.1 minute. Neurologically intact survival was 49.6% for patients treated with an onsite AED compared with 14.3% without an AED (unadjusted odds ratio, 5.63; 95% confidence interval, 3.91-8.10). The odds ratio remained statistically significant after adjustment for confounding (odds ratio, 2.72; 95% confidence interval, 1.77-4.18). Dispatched AED use reduced the time from call to first shock to 8.5 minutes. Neurologically intact survival was 17.2% for patients treated with a dispatched AED (unadjusted odds ratio. 1.07; 95% confidence interval, 0.82-1.39). Every year, onsite AEDs saved 3.6 lives per 1 million inhabitants; dispatched AEDs saved 1.2 lives. Conclusions--The use of an onsite AED leads to a doubling of neurologically intact survival. In our system, the survival benefit of dispatched AED use was much smaller than that of onsite AED use. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to determine comprehensively the incidence of pediatric out-of-hospital cardiac arrest (OHCA) and its contribution to total pediatric mortality, the causes of pediatric OHCA, and the outcome of resuscitation of pediatric OHCA patients. Background: There is a paucity of complete studies on incidence, causes, and outcomes of pediatric OHCA. Methods: In this prospective, population-based study, OHCA victims younger than age 21 years in 1 province of the Netherlands were registered through both emergency medical services and coroners over a period of 4.3 years. Death certificate data on total pediatric mortality, survival status, and neurological outcome at hospital discharge also were obtained. Results: With a total mortality of 923 during the study period and 233 victims of OHCA (including 221 who died and 12 who survived), OHCA caused 24% (221 of 923) of total pediatric mortality. Natural causes of OHCA amounted to 115 (49%) cases, with cardiac causes being most prevalent (n = 90, 39%). The incidence of pediatric OHCA was 9.0 per 100,000 pediatric person-years (95% confidence interval: 7.8 to 10.3), whereas the incidence of pediatric OHCA from cardiac causes was 3.2 (95% confidence interval: 2.5 to 3.9). Of 51 resuscitated patients, 12 (24%) survived; among survivors, 10 (83%) had a neurologically intact outcome. Conclusions: Out-of-hospital cardiac arrest accounts for a significant proportion of pediatric mortality, and cardiac causes are the most prevalent causes of OHCA. The vast majority of OHCA survivors have a neurologically intact outcome. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this investigation was to estimate and contrast the global incidence and outcome of out-of-hospital cardiac arrest (OHCA) to provide a better understanding of the variability in risk and survival of OHCA. Methods: We conducted a review of published English-language articles about incidence of OHCA, available through MEDLINE and EmBase. For studies including adult patients and both adult and paediatric patients, we used Utstein data reporting guidelines to calculate, summarize and compare incidences per 100,000 person-years of attended OHCAs, treated OHCAs, treated OHCAs with a cardiac cause, treated OHCA with ventricular fibrillation (VF), and survival-to-hospital discharge rates following OHCA. Results: Sixty-seven studies from Europe, North America, Asia or Australia met inclusion criteria. The weighted incidence estimate was significantly higher in studies including adults than in those including adults and paediatrics for treated OHCAs (62.3 vs 34.7; P <0.001); and for treated OHCAs with a cardiac cause (54.6 vs 40.8; P =0.004). Neither survival to discharge rates nor VF survival to discharge rates differed statistically significant among studies. The incidence of treated OHCAs was higher in North America (54.6) than in Europe (35.0), Asia (28.3), and Australia (44.0) (P <0.001). In Asia, the percentage of VF and survival to discharge rates were lower (11% and 2%, respectively) than those in Europe (35% and 9%, respectively), North America (28% and 6%, respectively), or Australia (40% and 11%, respectively) (P <0.001, P <0.001). Conclusions: OHCA incidence and outcome varies greatly around the globe. A better understanding of the variability is fundamental to improving OHCA prevention and resuscitation. [Copyright &y& Elsevier]

Abstract: Background: This study aimed to determine whether automated external defibrillator (AED) use during resuscitation is associated with lower in-hospital health care costs. Methods: For this observational prospective study, we included all treated out-of-hospital cardiac arrests of suspected cardiac cause. Clinical, survival and cost data were collected from July 2005 until March 2008. Cost data were based on hospital transport, duration of admission in hospital wards, diagnostics and interventions. We divided the study population in three groups based on AED use: (1) onsite AED, (2) dispatched AED, (3) no AED. The endpoint was survival to discharge. P <0.05 is indicated by *. Results: Of the 2126 included patients, 136 were treated with an onsite AED, 365 with a dispatched AED and 1625 without AED. Overall (95% confidence interval [CI]) survival rate was 43% (35–51%), 16% (13–20%) and 14% (12–16%), respectively*. Per 100 survivors, the mean duration admitted at intensive care unit [ICU] were 267 (166–374), 495 (344–658), and 537 (450–609) days, respectively*; total duration of hospital admission was 2188 (1800–2594), 3132 (2573–3797), and 2765 (2519–3050) days, respectively*. Mean costs per survivor for hospital stay were €9233 (€7351–€11,280), €14,194 (€11,656–€17,254), and €13,693 (€12,226–€15,166), respectively*; total health care costs were €29,575 (€24,695–€34,183), €34,533 (€29,832–€39,487) and €31,772 (€29,217–€34,385), respectively. For both survivors and non-survivors, total costs per patient were €14,727 (€11,957–€18,324), €7703 (€6141–€9366) and €6580 (€5875–€7238), respectively*. Conclusions: Onsite AED use was associated with higher survival rates. Surviving patients of the onsite AED group had lower total costs, mainly due to the shorter ICU stay. [Copyright &y& Elsevier]

Abstract: Introduction: The purpose of this study was to investigate whether the takeover by Advanced Life Support [ALS] trained ambulance paramedics from rescuers using an automated external defibrillator [AED] delays shocks and if this delay is associated with decreased survival after out-of-hospital cardiac arrest [OHCA]. Methods: We analyzed continuous ECG recordings of LIFEPAK AEDs and associated manual defibrillator recordings of OHCA of presumed cardiac cause, prospectively collected from July 2005 to July 2009. The primary outcome measure was survival to discharge. Among 693 patients treated with AEDs, 110 had a shockable initial rhythm and a shockable rhythm during ALS takeover. We measured the time interval between the expected shock if the AED would remain attached to the patient and the first observed shock given by the manual defibrillator [shock timing]. Results: Survival was 62% (13/21) if the shock was given early (<−20s), 52% (11/21; odds ratio [OR]=0.68, ns) if given on time (−20 to 20s), 29% (10/34; OR=0.26, 95% confidence interval [CI]=0.08–0.81; P =0.02) if the shock was 20–150s delayed and 21% (7/34; OR=0.16, 95% CI=0.05–0.54; P =0.003) if the shock was delayed >150s. The OR for trend was 0.41, 95% CI=0.25–0.71; P =0.001. The association between shock timing and survival was significant for patients with more than 150s shock delay (OR=0.19; 95% CI=0.04–0.71; P =0.02) or for trend in shock timing (0.42, 95% CI=0.20–0.84; P =0.02) after multivariable adjustment for prognostic factors age and slope of ventricular fibrillation. Conclusions: ALS takeover delays the next shock delivery in almost two-third of cases. This delay is associated with decreased survival. [Copyright &y& Elsevier]

Abstract: Introduction: In December 2005, updated resuscitation Guidelines (G) were introduced worldwide and will be revised again in 2010. This study sought to elucidate how long it takes to implement new guidelines. Methods: This was a prospective observational study. From July 2005 to January 2008, we included all patients with an out-of-hospital cardiac arrest of suspected cardiac cause. We analyzed Emergency Medical System (EMS) Guideline usage via defibrillator recordings of the continuous ECG and impedance signals. We excluded patients with missing or otherwise unusable ECGs. All shocks and CPR cycles were individually classified. The same Guideline needed to be applied for at least 75% of all shocks and CPR cycles. If no shocks had been given, continuous ECGs were classified by its CPR status only. Continuous ECGs were classified as G1992, G2000 or G2005. If at least 75% of the shocks were given according to G2000 and at least 75% of the CPR was according to G2005, the Guideline protocol was classified as intermediate. All analyses that did not fulfil any Guideline criteria were classified as indeterminate. Results: Of 1672 analyzable resuscitations, 31 (2%) used G1992, 826 (49%) G2000, 608 (36%) G2005, and 125 (7%) intermediate Guidelines. The Guideline protocol could not be identified for the remaining 81 (5%) patients. It took 17 months (from publication) until EMS personnel applied GL2005 in over 80% of cases. Conclusion: Our experience shows it took one-and-a-half years to effectively implement new resuscitation Guidelines. We believe improvements in implementation can shorten this to six months. [Copyright &y& Elsevier]

Background: People with epilepsy are at increased risk for sudden death. The most prevalent cause of sudden death in the general population is sudden cardiac arrest (SCA) due to ventricular fibrillation (VF). SCA may contribute to the increased incidence of sudden death in people with epilepsy. We assessed whether the risk for SCA is increased in epilepsy by determining the risk for SCA among people with active epilepsy in a community-based study. Methods and Results: This investigation was part of the Amsterdam Resuscitation Studies (ARREST) in the Netherlands. It was designed to assess SCA risk in the general population. All SCA cases in the study area were identified and matched to controls (by age, sex, and SCA date). A diagnosis of active epilepsy was ascertained in all cases and controls. Relative risk for SCA was estimated by calculating the adjusted odds ratios using conditional logistic regression (adjustment was made for known risk factors for SCA). We identified 1019 cases of SCA with ECG-documented VF, and matched them to 2834 controls. There were 12 people with active epilepsy among cases and 12 among controls. Epilepsy was associated with a three-fold increased risk for SCA (adjusted OR 2.9 [95%CI 1.1- 8.0.], p = 0.034). The risk for SCA in epilepsy was particularly increased in young and females. Conclusion: Epilepsy in the general population seems to be associated with an increased risk for SCA. [ABSTRACT FROM AUTHOR]