24 results on '"Bray, Janet E."'
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2. Cardiac arrest and cardiopulmonary resuscitation outcome reports: 2024 update of the Utstein Out-of-Hospital Cardiac Arrest Registry template.
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Grasner JT, Bray JE, Nolan JP, Iwami T, Ong MEH, Finn J, McNally B, Nehme Z, Sasson C, Tijssen J, Lim SL, Tjelmeland I, Wnent J, Dicker B, Nishiyama C, Doherty Z, Welsford M, and Perkins GD
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- Humans, Delphi Technique, Out-of-Hospital Cardiac Arrest therapy, Registries, Cardiopulmonary Resuscitation methods, Emergency Medical Services methods
- Abstract
The Utstein Out-of-Hospital Cardiac Arrest Resuscitation Registry Template, introduced in 1991 and updated in 2004 and 2015, standardizes data collection to enable research, evaluation, and comparisons of systems of care. The impetus for the current update stemmed from significant advances in the field and insights from registry development and regional comparisons. This 2024 update involved representatives of the International Liaison Committee on Resuscitation and used a modified Delphi process. Every 2015 Utstein data element was reviewed for relevance, priority (core or supplemental), and improvement. New variables were proposed and refined. All changes were voted on for inclusion. The 2015 domains-system, dispatch, patient, process, and outcomes-were retained. Further clarity is provided for the definitions of out-of-hospital cardiac arrest attended resuscitation and attempted resuscitation. Changes reflect advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes. Time intervals such as emergency medical service response time now emphasize precise reporting of the times used. New flowcharts aid the reporting of system effectiveness for patients with an attempted resuscitation and system efficacy for the Utstein comparator group. Recognizing the varying capacities of emergency systems globally, the writing group provided a minimal dataset for settings with developing emergency medical systems. Supplementary variables are considered useful for research purposes. These revisions aim to elevate data collection and reporting transparency by registries and researchers and to advance international comparisons and collaborations. The overarching objective remains the improvement of outcomes for patients with out-of-hospital cardiac arrest., (Copyright © 2024 European Resuscitation Council, American Heart Association Inc., International Liaison Committee on Resuscitation. Published by Elsevier B.V. All rights reserved.)
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- 2024
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3. Unlocking the key to increasing survival from out-of-hospital cardiac arrest - 24/7 accessible AEDs.
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Page G and Bray JE
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- Humans, Emergency Medical Services methods, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation methods, Defibrillators
- Abstract
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Greg Page is the founder and CEO of Heart of the Nation, which sells AEDs to the community (GP volunteers and is not paid by Heart of the Nation). Janet Bray is an Editor of Resuscitation Plus, and Editorial Board Member of Resuscitation and is funded by the Heart Foundation of Australia.
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- 2024
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4. Bystander cardiopulmonary resuscitation differences by sex - The role of arrest recognition.
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Munot S, Bray JE, Redfern J, Bauman A, Marschner S, Semsarian C, Denniss AR, Coggins A, Middleton PM, Jennings G, Angell B, Kumar S, Kovoor P, Vukasovic M, Bendall JC, Evens T, and Chow CK
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- Humans, Female, Male, Retrospective Studies, New South Wales epidemiology, Middle Aged, Aged, Sex Factors, Emergency Medical Services statistics & numerical data, Emergency Medical Services methods, Adult, Defibrillators statistics & numerical data, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation statistics & numerical data
- Abstract
Purpose: To assess whether bystander cardiopulmonary resuscitation (CPR) differed by patient sex among bystander-witnessed out-of-hospital cardiac arrests (OHCA)., Methods: This study is a retrospective analysis of paramedic-attended OHCA in New South Wales (NSW) between January 2017 to December 2019 (restricted to bystander-witnessed cases). Exclusions included OHCA in aged care, medical facilities, with advance care directives, from non-medical causes. Multivariate logistic regression examined the association of patient sex with bystander CPR. Secondary outcomes were OHCA recognition, bystander AED application, initial shockable rhythm, and survival outcomes., Results: Of 4,491cases, females were less likely to receive bystander CPR in private residential (Adjusted Odds ratio [AOR]: 0.82, 95%CI: 0.70-0.95) and public locations (AOR: 0.58, 95%CI:0.39-0.88). OHCA recognition during the emergency call was lower for females arresting in public locations (84.6% vs 91.6%, p = 0.002) and this partially explained the association of sex with bystander CPR (∼44%). This difference in recognition was not observed in private residential locations (p = 0.2). Bystander AED use was lower for females (4.8% vs 9.6%, p < 0.001); however, after adjustment for location and other covariates, this relationship was no longer significant (AOR: 0.83, 95%CI: 0.60-1.12). Females were less likely to be in an initial shockable rhythm (AOR: 0.52, 95%CI: 0.44-0.61), but more likely to survive the event (AOR: 1.34, 95%CI: 1.15-1.56). There was no sex difference in survival to hospital discharge (AOR: 0.96, 95%CI: 0.77-1.19)., Conclusion: OHCA recognition and bystander CPR differ by patient sex in NSW. Research is needed to understand why this difference occurs and to raise public awareness of this issue., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. JB is an Editorial Board Member of Resuscitation., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2024
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5. Beyond numbers: The importance of detailing systems of care when reporting data on the emergency response systems for cardiac arrest.
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Bray JE and Ong MEH
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- Humans, Heart Arrest therapy, Cardiopulmonary Resuscitation, Emergency Medical Services, Out-of-Hospital Cardiac Arrest therapy
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Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2024
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6. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, and Nolan JP
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- Adult, Female, Child, Infant, Newborn, Humans, First Aid, Consensus, Out-of-Hospital Cardiac Arrest therapy, Premature Birth, Cardiopulmonary Resuscitation methods, Emergency Medical Services
- Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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7. Effect of a national awareness campaign on ambulance attendances for chest pain and out-of-hospital cardiac arrest.
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Nehme Z, Cameron P, Nehme E, Finn J, Bosley E, Brink D, Ball S, Doan TN, and Bray JE
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- Humans, Ambulances, Australia, Chest Pain epidemiology, Chest Pain etiology, Chest Pain prevention & control, Registries, Out-of-Hospital Cardiac Arrest epidemiology, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest diagnosis, Cardiopulmonary Resuscitation, Emergency Medical Services, Myocardial Infarction
- Abstract
Aim: Awareness of heart attack symptoms may enhance health-seeking behaviour and prevent premature deaths from out-of-hospital cardiac arrest (OHCA). We sought to investigate the impact of a national awareness campaign on emergency medical service (EMS) attendances for chest pain and OHCA., Methods: Between January 2005 and December 2017, we included registry data for 97,860 EMS-attended OHCA cases from 3 Australian regions and dispatch data for 1,631,217 EMS attendances for chest pain across 5 Australian regions. Regions were exposed to between 11 and 28 months of television, radio, and print media activity. Multivariable negative binomial models were used to explore the effect of campaign activity on the monthly incidence of EMS attendances for chest pain and OHCA., Results: Months with campaign activity were associated with an 8.8% (IRR 1.09, 95% CI: 1.07, 1.11) increase in the incidence of EMS attendances for chest pain and a 5.6% (IRR 0.94, 95% CI: 0.92, 0.97) reduction in OHCA attendances. Larger intervention effects were associated with increasing months of campaign activity, increasing monthly media spending and media exposure in 2013. In stratified analyses of OHCA cases, the largest reduction in incidence during campaign months was observed for unwitnessed arrests (IRR 0.93, 95% CI: 0.90, 0.96), initial non-shockable arrests (IRR 0.93, 95% CI: 0.90, 0.97) and arrests occurring in private residences (IRR 0.95, 95% CI: 0.91, 0.98)., Conclusion: A national awareness campaign targeting knowledge of heart attack symptoms was associated with an increase in EMS use for chest pain and a reduction in OHCA incidence and may serve as an effective primary prevention strategy for OHCA., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ZN, JF and JB are editorial board members of Resuscitation., (Copyright © 2023 Elsevier B.V. All rights reserved.)
- Published
- 2023
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8. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, and Berg KM
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- Infant, Newborn, Child, Humans, First Aid, Consensus, Out-of-Hospital Cardiac Arrest therapy, Cardiopulmonary Resuscitation, Emergency Medical Services
- Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed., (Copyright © 2022 The European Resuscitation Council, American Heart Association, Inc, International Liaison Committee on Resuscitation. Published by Elsevier B.V. All rights reserved.)
- Published
- 2022
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9. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group.
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Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, El-Naggar W, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami MD, Kim HS, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang TL, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, and Berg KM
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- Adult, Child, Consensus, First Aid, Humans, Infant, Infant, Newborn, SARS-CoV-2, COVID-19, Cardiopulmonary Resuscitation, Emergency Medical Services, Out-of-Hospital Cardiac Arrest therapy
- Abstract
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research., (Copyright © 2021 European Resuscitation Council, American Heart Association, Inc. and International Liaison Committee on Resuscitation. Published by Elsevier B.V. All rights reserved.)
- Published
- 2021
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10. The second year of a second chance: Long-term psychosocial outcomes of cardiac arrest survivors and their family.
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Case R, Stub D, Mazzagatti E, Pryor H, Mion M, Ball J, Cartledge S, Keeble TR, Bray JE, and Smith K
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- Adult, Anxiety etiology, Humans, Prospective Studies, Quality of Life, Victoria, Out-of-Hospital Cardiac Arrest therapy, Survivors
- Abstract
Aim: Cardiac arrest (CA) survival has diverse psychosocial outcomes for both survivors and their close family, with little known regarding long-term adjustment and recovery experiences. We explored the psychological adjustment and experiential perspectives of survivors and families in the second year after out-of-hospital cardiac arrest (OHCA)., Methods: A prospective, mixed-methods study of adult OHCA survivors in Victoria, Australia was conducted. Eighteen survivors and 12 family members completed semi-structured interviews 14-19 months post-arrest. Survivors' cognition, anxiety, depression and post-traumatic stress symptoms were measured using a battery of psychological assessments. A thematic content analysis approach was applied to qualitative interview data by two independent investigators, with data coded and categorised into themes and sub-themes., Results: Survivors' cognition, depression, anxiety and post-traumatic stress symptoms were not clinically elevated in the second year post-arrest. Subjective cognitive failures were associated with increased anxiety but not with mental state. Depression was significantly correlated with post-traumatic symptoms. Six primary themes emerged from survivors' recovery stories, focused on: awakening and realisation, barriers to adjustment, psychosocial difficulties, integration, protective factors and unmet needs. Family perspectives revealed four primary themes focused on trauma exposure, survivor adjustment problems, family impact, and areas for service improvement., Conclusion: Survivors and their family members describe complex recovery journeys characterised by a range of psychosocial adjustment challenges, which are not adequately captured by common psychological measures. Post-arrest care systems are perceived by survivors and their families as inadequate due to a lack of accurate information regarding post-arrest sequalae, limited follow-up and inconsistent access to allied health care., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2021
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11. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
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Soar J, Maconochie I, Wyckoff MH, Olasveengen TM, Singletary EM, Greif R, Aickin R, Bhanji F, Donnino MW, Mancini ME, Wyllie JP, Zideman D, Andersen LW, Atkins DL, Aziz K, Bendall J, Berg KM, Berry DC, Bigham BL, Bingham R, Couto TB, Böttiger BW, Borra V, Bray JE, Breckwoldt J, Brooks SC, Buick J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Couper K, Dainty KN, Dawson JA, de Almeida MF, de Caen AR, Deakin CD, Drennan IR, Duff JP, Epstein JL, Escalante R, Gazmuri RJ, Gilfoyle E, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Holmberg MJ, Hood N, Hosono S, Hsieh MJ, Isayama T, Iwami T, Jensen JL, Kapadia V, Kim HS, Kleinman ME, Kudenchuk PJ, Lang E, Lavonas E, Liley H, Lim SH, Lockey A, Lofgren B, Ma MH, Markenson D, Meaney PA, Meyran D, Mildenhall L, Monsieurs KG, Montgomery W, Morley PT, Morrison LJ, Nadkarni VM, Nation K, Neumar RW, Ng KC, Nicholson T, Nikolaou N, Nishiyama C, Nuthall G, Ohshimo S, Okamoto D, O'Neil B, Ong GY, Paiva EF, Parr M, Pellegrino JL, Perkins GD, Perlman J, Rabi Y, Reis A, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Skrifvars MB, Smyth MA, Stanton D, Swain J, Szyld E, Tijssen J, Travers A, Trevisanuto D, Vaillancourt C, Van de Voorde P, Velaphi S, Wang TL, Weiner G, Welsford M, Woodin JA, Yeung J, Nolan JP, and Hazinski MF
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- Adolescent, Adult, Aged, Cardiopulmonary Resuscitation methods, Child, Child, Preschool, Epinephrine therapeutic use, Extracorporeal Circulation methods, Extracorporeal Circulation standards, Humans, Hyperthermia, Induced methods, Hyperthermia, Induced standards, Infant, Intubation, Intratracheal methods, Intubation, Intratracheal standards, Middle Aged, Respiration, Artificial methods, Respiration, Artificial standards, Vasoconstrictor Agents therapeutic use, Young Adult, Cardiopulmonary Resuscitation standards, Out-of-Hospital Cardiac Arrest therapy
- Abstract
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research., (Copyright © 2019 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.)
- Published
- 2019
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12. The EXACT protocol: A multi-centre, single-blind, randomised, parallel-group, controlled trial to determine whether early oxygen titration improves survival to hospital discharge in adult OHCA patients.
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Bray JE, Smith K, Hein C, Finn J, Stephenson M, Cameron P, Stub D, Perkins GD, Grantham H, Bailey P, Brink D, Dodge N, and Bernard S
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- Early Medical Intervention, Humans, Out-of-Hospital Cardiac Arrest mortality, Patient Discharge, Single-Blind Method, Survival Rate, Multicenter Studies as Topic methods, Out-of-Hospital Cardiac Arrest therapy, Oxygen administration & dosage, Oxygen Inhalation Therapy, Randomized Controlled Trials as Topic methods, Resuscitation
- Abstract
Background: Experimental and observational research suggests hyperoxia following resuscitation from cardiac arrest is associated with neurological injury and worse clinical outcomes. This paper describes the rationale and design of the EXACT trial. EXACT aims to determine whether reducing oxygen in the acute phase of post-resuscitation care for out-of-hospital cardiac arrest (OHCA) improves survival., Methods: EXACT is a multi-centre, randomised (1:1), single-blind, parallel trial. Presumed cardiac OHCA cases who achieve a return of spontaneous circulation will be eligible if they are comatose, with an advanced airway and have an oxygen saturation (SpO
2 ) ≥95% on >10 L/min (or 100% oxygen). Paramedics will randomise 1416 eligible cases to receive oxygen therapy targeting an SpO2 of 90-94% (intervention) or 98-100% (control). Study treatment will continue until admission to an intensive care unit or hospital ward. The primary outcome is survival to hospital discharge. Secondary outcomes include 12-month survival and quality of life., Results: The study has commenced in the Australian states of Victoria and South Australia, and has enrolled 167 eligible cases to date (80 intervention and 87 control). Further sites are due to commence in 2019, recruitment is expected to take three years., Conclusion: This study will determine if early reduction of oxygen leads to improved outcomes in OHCA. Such a finding may potentially change clinical practice with implications on future OHCA survival outcomes., Trial Registration Number: NCT03138005., (Copyright © 2019 Elsevier B.V. All rights reserved.)- Published
- 2019
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13. Identifying barriers to the provision of bystander cardiopulmonary resuscitation (CPR) in high-risk regions: A qualitative review of emergency calls.
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Case R, Cartledge S, Siedenburg J, Smith K, Straney L, Barger B, Finn J, and Bray JE
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- Adult, Female, Humans, Male, Middle Aged, Retrospective Studies, Victoria, Cardiopulmonary Resuscitation methods, Emergency Medical Service Communication Systems organization & administration, Emergency Medical Services organization & administration, Out-of-Hospital Cardiac Arrest therapy, Telephone statistics & numerical data
- Abstract
Introduction: Understanding regional variation in bystander cardiopulmonary resuscitation (CPR) is important to improving out-of-hospital cardiac arrest (OHCA) survival. In this study we aimed to identify barriers to providing bystander CPR in regions with low rates of bystander CPR and where OHCA was recognised in the emergency call., Methods: We retrospectively reviewed emergency calls for adults in regions of low bystander CPR in the Australian state of Victoria. Included calls were those where OHCA was identified during the call but no bystander CPR was given. A thematic content analysis was independently conducted by two investigators., Results: Saturation of themes was reached after listening to 139 calls. Calls progressed to the point of compression instructions before EMS arrival in only 26 (18.7%) of cases. Three types of barriers were identified: procedural barriers (time lost due to language barriers and communication issues; telephone problems), CPR knowledge (skill deficits; perceived benefit) and personal factors (physical frailty or disability; patient position; emotional factors)., Conclusion: A range of factors are associated with barriers to delivering bystander CPR even in the presence of dispatcher instructions - some of which are modifiable. To overcome these barriers in high-risk regions, targeted public education needs to provide information about what occurs in an emergency call, how to recognise an OHCA and to improve CPR knowledge and skills., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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14. Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial).
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Bray JE, Hein C, Smith K, Stephenson M, Grantham H, Finn J, Stub D, Cameron P, and Bernard S
- Subjects
- Aged, Emergency Medical Services methods, Emergency Medical Services statistics & numerical data, Female, Humans, Hypoxia prevention & control, Male, Middle Aged, Oximetry, Pilot Projects, Cardiopulmonary Resuscitation methods, Out-of-Hospital Cardiac Arrest therapy, Oxygen blood, Oxygen Inhalation Therapy methods
- Abstract
Introduction: Recent studies suggest the administration of 100% oxygen to hyperoxic levels following return-of-spontaneous-circulation (ROSC) post-cardiac arrest may be harmful. However, the feasibility and safety of oxygen titration in the prehospital setting is unknown. We conducted a multi-centre, phase-2 study testing whether prehospital titration of oxygen results in an equivalent number of patients arriving at hospital with oxygen saturations SpO2 ≥ 94%., Methods: We enrolled unconscious adults with: sustained ROSC; initial shockable rhythm; an advanced airway; and an SpO2 ≥ 95%. Initially (Sept 2015-March 2016) patients were randomised 1:1 to either 2 L/minute (L/min) oxygen (titrated) or >10 L/min oxygen (control) via a bag-valve reservoir. However, one site experienced a high number of desaturations (SpO2 < 94%) in the titrated arm and this arm was changed (April 2016) to an initial reduction of oxygen to 4 L/min then, if tolerated, to 2 L/min, and the desaturation limit was decreased to <90%., Results: We randomised 61 patients to titrated (n = 37: 2L/min = 20 and 2-4 L/min = 17) oxygen or control (n = 24). Patients allocated to titrated oxygen were more likely to desaturate compared to controls ((SpO2 < 94%: 43% vs. 4%, p = 0.001; SpO2 < 90%: 19% vs. 4%, p = 0.09). The majority of desaturations (81%) occurred at 2L/min. On arrival at hospital the majority of patients had a SpO2 ≥ 94% (titrated: 90% vs. control: 100%) and all patients had a SpO2 ≥ 90%. One patient (control) re-arrested. Survival to hospital discharge was similar., Conclusion: Oxygen titration post-ROSC is feasible in the prehospital environment, but incremental titration commencing at 4L/min oxygen flow may be needed to maintain an oxygen saturation >90% (NCT02499042)., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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15. ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement.
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Kleinman ME, Perkins GD, Bhanji F, Billi JE, Bray JE, Callaway CW, de Caen A, Finn JC, Hazinski MF, Lim SH, Maconochie I, Morley P, Nadkarni V, Neumar RW, Nikolaou N, Nolan JP, Reis A, Sierra AF, Singletary EM, Soar J, Stanton D, Travers A, Welsford M, and Zideman D
- Subjects
- Age Factors, Cardiopulmonary Resuscitation education, Humans, Out-of-Hospital Cardiac Arrest diagnosis, Out-of-Hospital Cardiac Arrest mortality, Outcome Assessment, Health Care, Recovery of Function, Time-to-Treatment, Cardiopulmonary Resuscitation standards, Consensus, Defibrillators standards, Emergency Medical Services standards, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines. © 2018 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved., (Copyright © 2018 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.)
- Published
- 2018
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16. Warning symptoms preceding out-of-hospital cardiac arrest: Do patient delays matter?
- Author
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Nehme Z, Bernard S, Andrew E, Cameron P, Bray JE, and Smith K
- Subjects
- Age Factors, Aged, Cardiopulmonary Resuscitation mortality, Chest Pain diagnosis, Chest Pain epidemiology, Dyspnea diagnosis, Dyspnea epidemiology, Female, Humans, Male, Middle Aged, Out-of-Hospital Cardiac Arrest diagnosis, Out-of-Hospital Cardiac Arrest therapy, Outcome Assessment, Health Care, Registries, Retrospective Studies, Emergency Medical Services statistics & numerical data, Out-of-Hospital Cardiac Arrest mortality, Prodromal Symptoms, Time-to-Treatment statistics & numerical data
- Abstract
Background: Although increasing patient delays between symptom onset and activation of emergency medical services (EMS) can lead to poorer outcomes following acute myocardial infarction, its effect in out-of-hospital cardiac arrest (OHCA) populations is unclear., Methods: Between 1st January 2003 and 31st December 2011, we included adult patients with anginal warning symptoms and subsequent EMS witnessed OHCA of presumed cardiac aetiology from the Victorian Ambulance Cardiac Arrest Registry. Multivariable logistic regression was used to assess the impact of patient delay time (i.e. symptom onset to EMS call time) on survival to hospital discharge., Results: A total of 1056 EMS witnessed OHCA were screened, of which 515 (48.8%) reported chest pain or anginal equivalent symptoms. The median patient delay time was 25min (interquartile range [IQR] 9-89min), and did not differ across survivors and non-survivors. However, patients in lowest quartile of patient delay (≤8min) also experienced significantly higher rates of non-shockable arrest rhythms and circulatory compromise. A total of 16 baseline and clinical characteristics were tested in a multivariable model of survival to hospital discharge, of which, only six were retained in the final model, including: age, dyspnoea, vomiting, shockable arrest rhythm, systolic blood pressure, and patient delay time. Every 30min increase in patient delay time was independently associated with a 2.3% (95% CI: 0.4%, 4.1%; p=0.02) reduction in the odds of survival to hospital discharge. Among patients with ST-segment deviation on the pre-arrest ECG, every 30min increase in patient delay time was associated with a 3.4% reduction in the odds of survival (OR 0.966, 95% CI: 0.937, 0.996; p=0.03)., Conclusion: Increasing delays in activating EMS before the onset OHCA may be associated with reduced survival. Future research could explore whether increasing public awareness of the warning symptoms leads to earlier medical contact for OHCA., (Copyright © 2017 Elsevier B.V. All rights reserved.)
- Published
- 2018
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17. Changing target temperature from 33°C to 36°C in the ICU management of out-of-hospital cardiac arrest: A before and after study.
- Author
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Bray JE, Stub D, Bloom JE, Segan L, Mitra B, Smith K, Finn J, and Bernard S
- Subjects
- Adult, Aged, Australia epidemiology, Female, Humans, Intensive Care Units statistics & numerical data, Male, Middle Aged, Organizational Policy, Outcome and Process Assessment, Health Care, Retrospective Studies, Cardiopulmonary Resuscitation adverse effects, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation statistics & numerical data, Fever diagnosis, Fever epidemiology, Fever prevention & control, Hypothermia, Induced adverse effects, Hypothermia, Induced methods, Hypothermia, Induced statistics & numerical data, Nervous System Diseases epidemiology, Nervous System Diseases etiology, Nervous System Diseases prevention & control, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Introduction: In December 2013, our institution changed the target temperature management (TTM) for the first 24h in ventricular fibrillation out-of-hospital cardiac arrest (VF-OHCA) patients from 33°C to 36°C. This study aimed to examine the impact this change had on measured temperatures and patient outcomes., Methods: We conducted a retrospective cohort study of consecutive VF-OHCA patients admitted to a tertiary referral hospital in Melbourne (Australia) between January 2013 and August 2015. Outcomes were adjusted for age and duration of cardiac arrest., Results: Over the 30-month period, 76 VF-OHCA cases were admitted (24 before and 52 after the TTM change). Patient demographics, cardiac arrest features and hospital interventions were similar between the two periods. After the TTM change, less patients received active cooling (100% vs. 70%, p < 0.001), patients spent less time at target temperature (87% vs. 50%, p < 0.001), and fever rates increased (0% vs. 19%, p = 0.03). During the 36°C period, there was a decrease in the proportion of patients who were discharged: alive (71% vs. 58%, p=0.31), home (58% vs. 40%, p=0.08); and, with a favourable neurological outcome (cerebral performance category score 1-2: 71% vs. 56%, p=0.22)., Conclusion: After the change from a TTM target of 33°C to 36°C, we report low compliance with target temperature, higher rates of fever, and a trend towards clinical worsening in patient outcomes. Hospitals adopting a 36°C target temperature to need to be aware that this target may not be easy to achieve, and requires adequate sedation and muscle-relaxant to avoid fever., (Copyright © 2017 Elsevier B.V. All rights reserved.)
- Published
- 2017
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18. Resuscitation attempts and duration in traumatic out-of-hospital cardiac arrest.
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Beck B, Bray JE, Cameron P, Straney L, Andrew E, Bernard S, and Smith K
- Subjects
- Adult, Decision Making, Female, Heart Arrest mortality, Humans, Logistic Models, Male, Middle Aged, Registries, Retrospective Studies, Time Factors, Out-of-Hospital Cardiac Arrest therapy, Resuscitation
- Abstract
Background: This study aimed to understand factors associated with paramedics' decision to attempt resuscitation in traumatic out-of-hospital cardiac arrest (OHCA) and to characterise resuscitation attempts ≤10min in patients who die at the scene., Methods: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all cases of traumatic OHCA between July 2008 and June 2014. We excluded cases <16 years of age or with a mechanism of hanging or drowning., Results: Of the 2334 cases of traumatic OHCA, resuscitation was attempted in 28% of cases and this rate remained steady over time (p=0.10). Multivariable logistic regression revealed that the arresting rhythm [shockable (adjusted odds ratio (AOR)=18.52, 95% confidence interval (CI):6.68-51.36) or pulseless electrical activity (AOR=12.58, 95%CI:9.06-17.45) relative to asystole] and mechanism of injury [motorcycle collision (AOR=2.49, 95%CI:1.60-3.86), fall (AOR=1.91, 95%CI:1.17-3.11) and shooting/stabbing (AOR=2.25, 95%CI:1.17-4.31) relative to a motor vehicle collision] were positively associated with attempted resuscitation. Arrests occurring in rural regions had a significantly lower odds of attempted resuscitation relative to those in urban regions (AOR=0.64, 95%CI:0.46-0.90). Resuscitation attempts ≤10min represented 34% of cases in which resuscitation was attempted but the patient died at the scene. When these resuscitation attempts were selectively excluded from the overall EMS treated population, survival to hospital discharge non-significantly increased from 3.8% to 5.0% (p=0.314)., Conclusion: Survival in our study was consistent with existing literature, however the large proportion of cases with resuscitation attempts ≤10min may under-represent survival in those patients that receive full resuscitation attempts., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2017
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19. A systematic review of basic life support training targeted to family members of high-risk cardiac patients.
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Cartledge S, Bray JE, Leary M, Stub D, and Finn J
- Subjects
- Cardiopulmonary Resuscitation mortality, Cardiovascular Diseases therapy, Humans, Multicenter Studies as Topic, Non-Randomized Controlled Trials as Topic, Out-of-Hospital Cardiac Arrest mortality, Randomized Controlled Trials as Topic, Cardiopulmonary Resuscitation education, Family, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Aim: Targeting basic life support (BLS) training to bystanders who are most likely to witness an out of hospital cardiac arrest (OHCA) is an important public health intervention. We performed a systematic review examining the evidence of the effectiveness of providing BLS training to family members of high-risk cardiac patients., Methods: A search of Ovid MEDLINE, CINAL, EMBASE, Informit, Cochrane Library, Web of Science, Scopus, ERIC and ProQuest Dissertations and Theses Global was conducted. We included all studies training adult family members of high-risk cardiac patients regardless of methods used for cardiopulmonary resuscitation (CPR) or BLS training. Two reviewers independently extracted data and evaluated the quality of evidence using GRADE (Grades of Recommendation, Assessment, Development and Evaluation)., Results: We included 26 of the 1172 studies identified. The majority of studies were non-randomised controlled trials (n=18), of very low to moderate quality. Currently, there is insufficient evidence to indicate a benefit of this intervention for patients; largely because of low numbers of OHCA events and high loss to follow-up. However, the majority of trained individuals were able to competently perform BLS skills, reported a willingness to use these skills and experienced lower anxiety., Conclusion: Whilst there is no current evidence for improvement in patient outcomes from targeted BLS training for family members, this group are willing and capable to learn these skills. Future research may need to examine longer periods of follow-up using alternate methods (e.g. cardiac arrest registries), and examine the effectiveness of training in the modern era., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
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20. Trends in traumatic out-of-hospital cardiac arrest in Perth, Western Australia from 1997 to 2014.
- Author
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Beck B, Tohira H, Bray JE, Straney L, Brown E, Inoue M, Williams TA, McKenzie N, Celenza A, Bailey P, and Finn J
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Cardiopulmonary Resuscitation, Databases, Factual, Emergency Medical Services, Female, Humans, Incidence, Male, Middle Aged, Out-of-Hospital Cardiac Arrest etiology, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest therapy, Survival Rate, Out-of-Hospital Cardiac Arrest epidemiology, Wounds and Injuries complications
- Abstract
Aim: This study aims to describe and compare traumatic and medical out-of-hospital cardiac arrest (OHCA) occurring in Perth, Western Australia, between 1997 and 2014., Methods: The St John Ambulance Western Australia (SJA-WA) OHCA Database was used to identify all adult (≥ 16 years) cases. We calculated annual crude and age-sex standardised incidence rates (ASIRs) for traumatic and medical OHCA and investigated trends over time., Results: Over the study period, SJA-WA attended 1,354 traumatic OHCA and 16,076 medical OHCA cases. The mean annual crude incidence rate of traumatic OHCA in adults attended by SJA-WA was 6.0 per 100,000 (73.9 per 100,000 for medical cases), with the majority resulting from motor vehicle collisions (56.7%). We noted no change to either incidence or mechanism of injury over the study period (p>0.05). Compared to medical OHCA, traumatic OHCA cases were less likely to receive bystander cardiopulmonary resuscitation (CPR) (20.4% vs. 24.5%, p=0.001) or have resuscitation commenced by paramedics (38.9% vs. 44.8%, p<0.001). However, rates of bystander CPR and resuscitation commenced by paramedics increased significantly over time in traumatic OHCA (p<0.001). In cases where resuscitation was commenced by paramedics there was no difference in the proportion who died at the scene (37.2% traumatic vs. 34.3% medical, p=0.17), however, fewer traumatic OHCAs survived to hospital discharge (1.7% vs. 8.7%, p<0.001)., Conclusions: Despite temporal increases in rates of bystander CPR and paramedic resuscitation, traumatic OHCA survival remains poor with only nine patients surviving from traumatic OHCA over the 18-year period., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
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21. Trends in the incidence of presumed cardiac out-of-hospital cardiac arrest in Perth, Western Australia, 1997-2010.
- Author
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Bray JE, Di Palma S, Jacobs I, Straney L, and Finn J
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Incidence, Infant, Male, Middle Aged, Time Factors, Western Australia epidemiology, Young Adult, Out-of-Hospital Cardiac Arrest epidemiology
- Abstract
Aim: This study investigated temporal trends in the incidence of out-of-hospital cardiac arrests (OHCA) in metropolitan Perth (Western Australia) between 1997 and 2010., Methods: We calculated crude and age-and-sex-standardised incidence rates (ASIRs) using the 2011 Australian population as the standard population. Incidence rates are reported per 100,000 population, and for eight age categories (0-14, 15-34, 35-64, 65-69, 70-74, 75-79, 80-84, ≥85). Temporal trends were analysed with linear regression., Results: Over the 14-years, 12,421 OHCAs of presumed cardiac aetiology were attended by St John Ambulance Western Australia paramedics. The overall ASIR per 100,000 population decreased significantly over this time (75.7-70.6, p<0.001), but predominantly between 1997 and 2002 (75.7-65.9) and in those aged ≥65 years (410.2-336.7, p<0.001). This trend was observed for both males and females and across all five-year age-groups between 65 and 84 years, but not in those ≥85 years--whom by 2010 represented 30% of the older adult (65+ years) OHCAs attended, up from 16% in 1997 (p<0.001)., Conclusions: Over the study period, a decline in the ASIR for OHCAs of presumed cardiac aetiology in Perth was observed. This is largely attributed to a decreasing incidence in the population aged 65-84 years between 1997 and 2002, and is likely the result of improvements in cardiovascular risk profiles that have previously been reported among Western Australian adults. Future studies of the impact of the ageing population are required., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2014
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22. The association between systolic blood pressure on arrival at hospital and outcome in adults surviving from out-of-hospital cardiac arrests of presumed cardiac aetiology.
- Author
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Bray JE, Bernard S, Cantwell K, Stephenson M, and Smith K
- Subjects
- Adult, Aged, Australia, Cardiopulmonary Resuscitation, Female, Humans, Hypotension complications, Hypotension therapy, Male, Middle Aged, Out-of-Hospital Cardiac Arrest therapy, Retrospective Studies, Systole physiology, Treatment Outcome, Blood Pressure, Emergency Medical Services, Hospitalization, Hypotension mortality, Out-of-Hospital Cardiac Arrest etiology, Out-of-Hospital Cardiac Arrest mortality
- Abstract
Background: The optimal blood pressure target following successful resuscitation from out-of-hospital cardiac arrest (OHCA) is uncertain. This study aimed to explore the association between level of systolic blood pressure (SBP) on arrival at hospital and survival to hospital discharge., Methods: We analysed eligible OHCAs occurring between January 2003 and December 2011 from the Victorian Ambulance Cardiac Arrest Register (VACAR). Inclusion criteria were: adults (≥18 years), presumed cardiac aetiology, not paramedic witnessed, and ROSC at hospital arrival. Multivariate logistic regression models were performed by initial rhythm (shockable/non-shockable) to examine the relationship between SBP at hospital arrival in 10 mmHg increments and survival to hospital discharge. Models were adjusted for known predictors of survival, including duration of arrest., Results: Of 3620 eligible cases, 14% were hypotensive (SBP<90 mmHg) on hospital arrival (10% shockable and 19% non-shockable). For patients in shockable rhythms, discharge survival was maximal at 120-129 mmHg (54%), and in the adjusted model (≥120 mmHg as reference) SBP decrements below 90 mmHg were associated with lower survival: 80-89 mmHg AOR=0.49 (95% CI: 0.24-0.95); <80 mmHg AOR=0.24 (95% CI: 0.10-0.61); unrecordable AOR=0.10 (95% CI: 0.04-0.30). In patients found in non-shockable rhythms, SBP was not significant associated with discharge survival (AOR=1.01, 95% CI: 0.89-1.15)., Conclusions: In an EMS system using intravenous adrenaline and fluids to maintain post-resuscitation SBP at 120 mmHg, hypotension on hospital arrival was relatively uncommon. However, in presumed cardiac OHCA patients with an initial shockable rhythm, SBPs below 90 mmHg was associated with significant lower odds of survival to hospital discharge. This level of hypotension may indicate patients who require more aggressive post-resuscitation blood pressure management., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2014
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23. Exploring gender differences and the "oestrogen effect" in an Australian out-of-hospital cardiac arrest population.
- Author
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Bray JE, Stub D, Bernard S, and Smith K
- Subjects
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Australia, Cardiopulmonary Resuscitation statistics & numerical data, Emergency Medical Services, Female, Humans, Logistic Models, Male, Middle Aged, Patient Discharge, Sex Factors, Young Adult, Out-of-Hospital Cardiac Arrest mortality
- Abstract
Background: Recent studies have suggested gender differences in out-of-hospital cardiac arrests (OHCA) including outcomes favouring young women. We aimed to investigate these findings in an Australian OHCA population using the Victorian Ambulance Cardiac Arrest Registry (VACAR)., Methods and Results: The VACAR was searched for adult presumed cardiac OHCAs between 2003 and 2010 where Emergency Medical Services (EMS) attempted resuscitation. Gender and age differences in survival to hospital arrival and to hospital discharge were examined using logistic regression adjusting for known predictors of survival. There were 10,453 OHCA meeting inclusion criteria (863 aged between 18 and 44 years). Women were less likely to be younger, have a witnessed arrest, receive bystander CPR, arrest in a public place, have an initial shockable rhythm or receive transport to 24-h cardiac interventional hospital. After adjusting for differences in pre-hospital factors, women were more likely to survive to hospital arrival than men (aOR 3.47, 95% CI: 2.19-5.50), but no gender differences were seen in survival to hospital discharge either overall or specifically in women aged between 18 and 44 years. Both younger men and younger women were more likely to survive to hospital discharge compared to older men and women., Conclusion: Women were more likely to survive to hospital arrival despite less favourable baseline variables. However, this initial improvement in survival did not translate to better survival to hospital discharge either overall, or in women of a reproductive age. Further study is required to determine gender differences in the underlying causes of OHCA and in EMS transportation practices., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2013
- Full Text
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24. Changing EMS dispatcher CPR instructions to 400 compressions before mouth-to-mouth improved bystander CPR rates.
- Author
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Bray JE, Deasy C, Walsh J, Bacon A, Currell A, and Smith K
- Subjects
- Aged, Female, Humans, Male, Retrospective Studies, Survival Rate, Cardiopulmonary Resuscitation methods, Emergency Medical Services, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Background: To examine the impact of changing dispatcher CPR instructions (400 compressions: 2 breaths, followed by 100:2 ratio) on rates of bystander CPR and survival in adults with presumed cardiac out-of-hospital arrest (OHCA) in Melbourne, Australia., Methods: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for OHCA where Emergency Medical Services (EMS) attempted CPR between August 2006 and August 2009. OHCA included were: (1) patients aged ≥18 years old; (2) presumed cardiac etiology; and (3) not witnessed by EMS., Results: For the pre- and post-study periods, 1021 and 2101 OHCAs met inclusion criteria, respectively. Rates of bystander CPR increased overall (45-55%, p<0.001) and by initial rhythm (shockable 55-70%, p<0.001 and non-shockable 40-46%, p=0.01). In VF/VT OHCA, there were improvements in the number of patients arriving at hospital with a return of spontaneous circulation (ROSC) (48-56%, p=0.02) and in survival to hospital discharge (21-29%, p=0.002), with improved outcomes restricted to patients receiving bystander CPR. After adjusting for factors associated with survival, the period of time following the change in CPR instructions was a significant predictor of survival to hospital discharge in VF/VT patients (OR 1.57, 95% CI: 1.15-2.20, p=0.005)., Conclusion: Following changes to dispatcher CPR instructions, significant increases were seen in rates of bystander CPR and improvements were seen in survival in VF/VT patients who received bystander CPR, after adjusting for factors associated with survival., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2011
- Full Text
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