Association Between Delay to First Shock and Successful First-Shock Ventricular Fibrillation Termination in Patients With Witnessed Out-of-Hospital Cardiac Arrest.

Background: In patients with out-of-hospital cardiac arrest who present with an initial shockable rhythm, a longer delay to the first shock decreases the probability of survival, often attributed to cerebral damage. The mechanisms of this decreased survival have not yet been elucidated. Estimating the probability of successful defibrillation and other factors in relation to the time to first shock may guide prehospital care systems to implement policies that improve patient survival by decreasing time to first shock.

Strategic placement of volunteer responder system defibrillators.

Volunteer responder systems (VRS) alert and guide nearby lay rescuers towards the location of an emergency. An application of such a system is to out-of-hospital cardiac arrests, where early cardiopulmonary resuscitation (CPR) and defibrillation with an automated external defibrillator (AED) are crucial for improving survival rates. However, many AEDs remain underutilized due to poor location choices, while other areas lack adequate AED coverage.

Ventilation during cardiopulmonary resuscitation with mechanical chest compressions: How often are two insufflations being given during the 3-second ventilation pauses?

Background: Mechanical chest compression devices in 30:2 mode provide 3-second pauses to allow for two insufflations. We aimed to determine how often two insufflations are provided in these ventilation pauses, in order to assess if prehospital providers are able to ventilate out-of-hospital cardiac arrest (OHCA) patients successfully during mechanical chest compressions.

Methods: Data from OHCA cases of the regional ambulance service of Utrecht, The Netherlands, were prospectively collected in the UTrecht studygroup for OPtimal registry of cardIAc arrest database (UTOPIA).

Severe silent ischaemia detected with an Apple Watch in the home setting: a case report.

Background: The Apple Watch has the capability to record a lead 1 electrocardiogram (ECG) and can identify and report atrial fibrillation. The use for detecting myocardial ischaemia is not endorsed by Apple but is documented in this case.

Case Summary: A 76-year-old man made a lead 1 ECG with his Apple Watch immediately after exercising on a cross trainer.

Wolf creek XVII part 4: Amplifying lay-rescuer response.

Introduction: Amplifying lay-rescuer response is a key priority to increase survival from out-of-hospital cardiac arrest (OHCA). We describe the current state of lay-rescuer response, how we envision the future, and the gaps, barriers, and research priorities that will amplify response to OHCA.

Methods: 'Amplifying Lay-Rescuer Response' was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17, 2023, in Ann Arbor, Michigan, USA.

Automated external defibrillator electrode size and termination of ventricular fibrillation in out-of-hospital cardiac arrest.

Smaller electrodes allow more options for design of automated external defibrillator (AED) user interfaces. However, previous studies employing monophasic-waveform defibrillators found that smaller electrode sizes have lower defibrillation shock success rates. We hypothesize that, for impedance-compensated, biphasic truncated exponential (BTE) shocks, smaller electrodes increase transthoracic impedance (TTI) but do not adversely affect defibrillation success rates.

Manual chest compression pause duration for ventilations during prehospital advanced life support - An observational study to explore optimal ventilation pause duration for mechanical chest compression devices.

Aim: Mechanical chest compression devices in the 30:2 mode generally provide a pause of three seconds to give two insufflations without evidence supporting this pause duration. We aimed to explore the optimal pause duration by measuring the time needed for two insufflations, during advanced life support with manual compressions.

Methods: Prospectively collected data in the AmsteRdam REsuscitation STudies (ARREST) registry were analysed, including thoracic impedance signal and waveform capnography from manual defibrillators of the Amsterdam ambulance service.

Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation.

Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge.

Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation.

Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge.

Alert system-supported lay defibrillation and basic life-support for cardiac arrest at home.

Aims: Automated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home.

Methods And Results: In residential areas, 785 AEDs were placed and 5735 volunteer responders were recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient.

To ventilate or not to ventilate during bystander CPR - A EuReCa TWO analysis.

Background: Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR).

To transport or to terminate resuscitation on-site. What factors influence EMS decisions in patients without ROSC? A mixed-methods study.

Background: If a patient in out-of-hospital cardiac arrest (OHCA) does not achieve return of spontaneous circulation (ROSC) despite advanced life support, emergency medical services can decide to either transport the patient with ongoing CPR or terminate resuscitation on scene.

Purpose: To determine differences between patients without ROSC to be transported vs. terminated on scene and explore medical and nonmedical factors that contribute to the decision-making of paramedics on scene.

Optimizing airway management and ventilation during prehospital advanced life support in out-of-hospital cardiac arrest: A narrative review.

Airway management and ventilation are essential components of cardiopulmonary resuscitation to achieve oxygen delivery in order to prevent hypoxic injury and increase the chance of survival. Weighing the relative benefits and downsides, the best approach is a staged strategy; start with a focus on high-quality chest compressions and defibrillation, then optimize mask ventilation while preparing for advanced airway management with a supraglottic airway device. Endotracheal intubation can still be indicated, but has the largest downsides of all advanced airway techniques.

Analyzing the heart rhythm during chest compressions: Performance and clinical value of a new AED algorithm.

Purpose: Automated external defibrillators (AED) prompt the rescuer to stop chest compressions (CC) for ECG analysis during out-of-hospital cardiac arrest (OHCA). We assessed the diagnostic accuracy and clinical benefit of a new AED algorithm (cprINSIGHT), which analyzes ECG and impedance signals during CC, allowing rhythm analysis with ongoing chest compressions.

Methods: Amsterdam Police and Fire Fighters used a conventional AED in 2016-2017 (control) and an AED with cprINSIGHT in 2018-2019 (intervention).

Management of first responder programmes for out-of-hospital cardiac arrest during the COVID-19 pandemic in Europe.

Aim: First responder (FR) programmes dispatch professional FRs (police and/or firefighters) or citizen responders to perform cardiopulmonary resuscitation (CPR) and use automated external defibrillators (AED) in out-of-hospital cardiac arrest (OHCA). We aimed to describe management of FR-programmes across Europe in response to the Coronavirus Disease 2019 (COVID-19) pandemic.

Methods: In June 2020, we conducted a cross-sectional survey sent to OHCA registry representatives in 18 European countries with active FR-programmes.

European first responder systems and differences in return of spontaneous circulation and survival after out-of-hospital cardiac arrest: A study of registry cohorts.

Background: In Europe, survival-rates after out-of-hospital cardiac arrest (OHCA) vary widely between regions. Whether a system dispatching First Responders (FRs; main FR-types: firefighters, police officers, citizen-responders) is present or not may be associated with survival-rates. This study aimed to assess the association between having a dispatched FR-system and rates of return of spontaneous circulation (ROSC) and survival across Europe.

Association of beta-blockers and first-registered heart rhythm in out-of-hospital cardiac arrest: real-world data from population-based cohorts across two European countries.

Aims: Conflicting results have been reported regarding the effect of beta-blockers on first-registered heart rhythm in out-of-hospital cardiac arrest (OHCA). We aimed to establish whether the use of beta-blockers influences first-registered rhythm in OHCA.

Methods And Results: We included patients with OHCA of presumed cardiac cause from two large independent OHCA-registries from Denmark and the Netherlands.

Time to Return of Spontaneous Circulation and Survival: When to Transport in out-of-Hospital Cardiac Arrest?

In out-of-hospital cardiac arrest (OHCA), 10-50% of patients have return of spontaneous circulation (ROSC) before hospital arrival. It is important to investigate the relation between time-to-ROSC and survival to determine the optimal timing of transport to the hospital in patients without ROSC. We analyzed data of OHCA patients with a presumed cardiac cause (excluding traumatic and other obvious non-cardiac causes) and ROSC before hospital arrival from the Amsterdam Resuscitation Study (ARREST) database.

Occurrence of shockable rhythm in out-of-hospital cardiac arrest over time: A report from the COSTA group.

Background: Prior research suggests that the proportion of a shockable initial rhythm in out-of-hospital cardiac arrest (OHCA) declined during the last decades. This study aims to investigate if this decline is still ongoing and explore the relationship between location of OHCA and proportion of a shockable initial rhythm as initial rhythm.

Methods: We calculated the proportion of patients with a shockable initial rhythm between 2006-2015 using pooled data from the COSTA-group (Copenhagen, Oslo, Stockholm, Amsterdam).