Moon, Sungwoo

Background: In the simulation setting, chest compression (CC) quality is reduced when out-of-hospital cardiac arrest “patients” are prepared for transport (i.e. packaged and moved to ambulance). It is unknown whether use of real-time audiovisual CPR feedback (RTAVF) affects manual CC quality when the patient is prepared for transport during actual out-of-hospital resuscitations. We tested the hypothesis that CC quality during patient transfer would be better when using RTAVF. Methods: CC quality was monitored at two EMS agencies using an E Series monitor/defibrillator with CC sensing capability (ZOLL Medical) during the treatment of consecutive out-of-hospital cardiac arrest patients who received CC on scene and were transported with ongoing CC. Data were collected during study phases; P1: RTAVF disabled, P2: RTAVF enabled following scenario-based training. Student’s t-test and Wilcoxon-Mann Whitney tests were used to compare CC quality in P1 vs. P2 during early scene and late scene treatment. Late scene was defined as the 3 minutes prior to transport (when packaging and transfer to the ambulance occurs) and early scene was all prior minutes at the scene. Results: 211 cardiac arrest cases were included: mean age 64±15 yrs, 67% male, 8% survival to hospital discharge. The Table shows that CC quality was superior during both early scene and late scene treatment in P2, when RTAVF was enabled, vs. P1, when RTAVF was disabled. Conclusion: CC quality, particularly the CC fraction, declines when a patient is packaged for transport and moved to the ambulance. While this decline is not prevented by RTAVF, CC quality during the late scene period is significantly better when using RTAVF. Further study is required to determine the impact of this improvement on outcomes.

Background and Objectives: There are a growing number of Hispanic citizens in the US and language or other barriers may impede them receiving bystander CPR (BCPR). Our aim was to determine if there are differences in BCPR provision and outcomes for out-of-hospital cardiac arrest (OHCA) occurring in mainly Hispanic neighborhoods compared to mainly White non-Hispanic neighborhoods in Arizona. Methods: We analyzed our prospectively-collected statewide Utstein-compliant OHCA database between 1/1/10 - 12/31/11. OHCA cases were geocoded according to the incident address using ArcGIS 10.1 (Esri, Redlands, CA). Census-tract data was used to determine neighborhood characteristics of ethnicity. Neighborhoods were classified as mainly Hispanic or mainly White, non-Hispanic when each population was over 60% in the census-tract. Results: There were 4531 adult OHCA victims during the study. Cases were excluded from analysis (n=1380) due to incident location, cause of arrest, or because the arrest occurred after EMS arrival. Among 3151 cases, 2839 cases (90.1%) could be geocoded using incident address. CPR performance and outcomes by neighborhood ethnicity are shown (Table). When compared with patients who arrested in mainly White, non-Hispanic neighborhoods, those in mainly Hispanic neighborhoods were less likely to receive BCPR (odds ratio, 0.67; 95% confidence interval [CI], 0.52 to 0.84). Although no statistically significant differences were identified in the rate of survival to hospital discharge by main neighborhood ethnicity, patients who arrested in mainly Hispanic neighborhoods were less likely to have favorable neurologic outcomes (Cerebral Performance Score 1 or 2) than those in White, non-Hispanic neighborhoods (odds ratio, 0.16; 95% CI, 0.05 - 0.53). Conclusion: In Arizona, OHCA victims in mainly Hispanic neighborhoods received BCPR less frequently and had worse neurologic outcomes than those in mainly White, non-Hispanic neighborhoods.