Study on Basic Life Support for Cardiac Arrest in Community: Accessibility, Effectiveness, and Applicability of Termination-of-Resuscitation Rules
Date Issued
2013
Date
2013
Author(s)
Chiang, Wen-Chu
Abstract
Out-of-hospital cardiac arrest (OHCA) is a public health problem of paramount importance all over the world. Many lives and life-years were lost because prompt basic life support (BLS), including bystander cardiopulmonary resuscitation (CPR) and defibrillation, is not provided in the community. Besides, currently most of the recommendation in BLS applied in our community was adopted from the western countries. Characteristics of OHCAs and composition of emergency medical service (EMS) in Taipei were different from the western sites. Therefore, we conducted a series of studies in three important issues with the knowledge gaps, including (1) the accessibility of bystander-initiated CPR, (2) effectiveness of different BLS pattern, and (3) the screening of salvageable patients for hospital transport.
There were three studies included in the series. The first study is a cross-sectional design to assess the association between social determinant and chances of receiving bystander-initiated CPR for patients with cardiac arrest in community. We used the average of real estate price and hosehold income to surrogate the socioeconomic status (SES) of the community. The second study was a randomized control trial to determine the effectiveness of different patterns of BLS (compression first” (CF) versus “analyze first” (AF) strategies) in community of low prevalence of shockable rhythms. The third study was a cohort study to evaluate the applicability of rules for termination of resuscitation (TOR) and to determine whether BLS-TOR rules acceptable as the universal rule in a mixed-tire EMS as in Taipei.
The first study revealed that patients who experienced an OHCA in low-SES areas of the city were less likely to receive bystander CPR, and demonstrated worse survival outcomes. The information could guide targeted community training to promote bystander CPR. In the second study, in Taipei City, a population with low rates of shockable rhythms and bystander CPR, there were no differences in sustained return of spontaneous circulation (ROSC) between compressions first vs. analyze first strategy. Considering the EMS operation situation, a period of CPR for up to 10 cycles by paramedic prior to rhythm analysis could be a feasible strategy in this Asian community. In the third study, ALS- and BLS-TOR rules performed well in decreasing unnecessary transport of OHCA patients, and BLS-TOR rule has better performance comparing to ALS TOR rule under all provider combinations in an area with a mixed-tier response EMS system. However, because greater than 1% of those lived would be misclassified as non-survivor by current TOR rules, implementation in this community or other areas with similar characteristics should be cautious.
This series of studies provided informative knowledge to current scientific gaps, and would have implication for improving the basic life support for patients with cardiac arrest in our own community.
Subjects
基礎救命術
心肺復甦術
自動體外去顫器
緊急醫療救護
到院前心跳停止
社會經濟狀況
終止急救原則
SDGs
Type
thesis
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