2.50
Hdl Handle:
http://hdl.handle.net/10755/163085
Type:
Presentation
Title:
The Three-Phase EMS Cardiac Arrest Model for Ventricular Fibrillation
Abstract:
The Three-Phase EMS Cardiac Arrest Model for Ventricular Fibrillation
Conference Sponsor:Emergency Nurses Association
Conference Year:2004
Author:Metz, Marcelyn, RN, BS, CEN
P.I. Institution Name:County of San Diego, Division of EMS
Title:Quality Assurance Specialist
Contact Address:6255 Mission Gorge Road, San Diego, CA, 92120, USA
Contact Telephone:(619) 285-6429
Co-Authors:Patricia Murrin, RN, MPH; Gary M. Vilke, MD, FACEP, FAAEM
Purpose: Cardiac arrest is responsible for significant morbidity and mortality, with consistently poor outcomes
despite the rapid availability of prehospital personnel for defibrillation attempts in patients with
ventricular fibrillation (VF). Recent evidence suggests a period of cardiopulmonary resuscitation (CPR)
prior to defibrillation attempts may improve outcomes in patients with 4- to 10-minute down times (time
of arrest to defibrillation). The purpose of this study was to determine cardiac arrest outcomes in our community
and explore the relationship between down time, performance of bystander CPR, and survival.
Design: A retrospective cohort study was used to collect data over an 18-month period.
Setting: San Diego is a diverse county with urban to wilderness densities and a resident population of 3
million. Transport times vary from less than 5 minutes to more than one hour.
Sample: All non-traumatic cardiac arrest adult patients treated by paramedics for VF arrest of suspected
cardiac etiology were included. The study population was 62% male. Patients were excluded for age < 18
years, "Do Not Resuscitate" (DNR) directive, determination of non-cardiac etiology, and presenting rhythm
other than VF.
Methodology: Prehospital records were stratified by down time (< 4 min, 4 to 10 min, > 10 min, or
unknown) and bystander CPR status. Hospital discharge records were compared on survival and neurological
outcome.
Results: Of 1,141 cardiac arrest patients identified, 272 presented with VF. From these 272, 185 had a suspected
cardiac etiology for the arrest; survival to hospital discharge was 15% in this group, with 82% having
good outcome or only moderate disability. Survival was highest among patients with down times of < 4
minutes and decreased with increasing down time. There were no survivors among patients with down
times > 10 minutes. Surviving patients with down time (time from arrest to defibrillation) of > 4 minutes
had a much greater likelihood of bystander CPR than non-survivors did. There was no difference between
survivors and non-survivors with regard to the performance of bystander CPR among patients with down
times < 4 minutes [OR 1.1 (0.1, 8.8)].
Conclusions: The performance of bystander CPR prior to defibrillation attempts is associated with
improved survival among patients with down times longer than 4 minutes but not less than 4 minutes.
This supports the three-phase model of cardiac arrest that if a patient is found to be in VF with a greater
than 4 minute downtime, then CPR should be initiated prior to the giving the first countershock. These
findings support considering the three-phase model by nurses in VF cardiac arrest patients in other venues.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Three-Phase EMS Cardiac Arrest Model for Ventricular Fibrillationen_GB
dc.identifier.urihttp://hdl.handle.net/10755/163085-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Three-Phase EMS Cardiac Arrest Model for Ventricular Fibrillation</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Metz, Marcelyn, RN, BS, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">County of San Diego, Division of EMS</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Quality Assurance Specialist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">6255 Mission Gorge Road, San Diego, CA, 92120, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(619) 285-6429</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">marcy.metz@sdcounty.ca.gov</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Patricia Murrin, RN, MPH; Gary M. Vilke, MD, FACEP, FAAEM<br/></td></tr><tr><td colspan="2" class="item-abstract">Purpose: Cardiac arrest is responsible for significant morbidity and mortality, with consistently poor outcomes<br/>despite the rapid availability of prehospital personnel for defibrillation attempts in patients with<br/>ventricular fibrillation (VF). Recent evidence suggests a period of cardiopulmonary resuscitation (CPR)<br/>prior to defibrillation attempts may improve outcomes in patients with 4- to 10-minute down times (time<br/>of arrest to defibrillation). The purpose of this study was to determine cardiac arrest outcomes in our community<br/>and explore the relationship between down time, performance of bystander CPR, and survival.<br/>Design: A retrospective cohort study was used to collect data over an 18-month period.<br/>Setting: San Diego is a diverse county with urban to wilderness densities and a resident population of 3<br/>million. Transport times vary from less than 5 minutes to more than one hour.<br/>Sample: All non-traumatic cardiac arrest adult patients treated by paramedics for VF arrest of suspected<br/>cardiac etiology were included. The study population was 62% male. Patients were excluded for age &lt; 18<br/>years, &quot;Do Not Resuscitate&quot; (DNR) directive, determination of non-cardiac etiology, and presenting rhythm<br/>other than VF.<br/>Methodology: Prehospital records were stratified by down time (&lt; 4 min, 4 to 10 min, &gt; 10 min, or<br/>unknown) and bystander CPR status. Hospital discharge records were compared on survival and neurological<br/>outcome.<br/>Results: Of 1,141 cardiac arrest patients identified, 272 presented with VF. From these 272, 185 had a suspected<br/>cardiac etiology for the arrest; survival to hospital discharge was 15% in this group, with 82% having<br/>good outcome or only moderate disability. Survival was highest among patients with down times of &lt; 4<br/>minutes and decreased with increasing down time. There were no survivors among patients with down<br/>times &gt; 10 minutes. Surviving patients with down time (time from arrest to defibrillation) of &gt; 4 minutes<br/>had a much greater likelihood of bystander CPR than non-survivors did. There was no difference between<br/>survivors and non-survivors with regard to the performance of bystander CPR among patients with down<br/>times &lt; 4 minutes [OR 1.1 (0.1, 8.8)].<br/>Conclusions: The performance of bystander CPR prior to defibrillation attempts is associated with<br/>improved survival among patients with down times longer than 4 minutes but not less than 4 minutes.<br/>This supports the three-phase model of cardiac arrest that if a patient is found to be in VF with a greater<br/>than 4 minute downtime, then CPR should be initiated prior to the giving the first countershock. These<br/>findings support considering the three-phase model by nurses in VF cardiac arrest patients in other venues.</td></tr></table>en_GB
dc.date.available2011-10-27T10:39:17Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:39:17Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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