Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest

Objectives:. To construct a highly detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest. Design, Setting, and Patients:. Population-based outcomes following out-of-hospital cardiac arrest were collated for 10 U.S. c...

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Autores principales:	Paul E. Pepe, MD, MPH, MCCM, Tom P. Aufderheide, MD, MS, Lionel Lamhaut, MD, PhD, Daniel P. Davis, MD, Charles J. Lick, MD, Kees H. Polderman, MD, Kenneth A. Scheppke, MD, Charles D. Deakin, MD, Brian J. O’Neil, MD, Hans van Schuppen, MD, Michael K. Levy, MD, Marvin A. Wayne, MD, Scott T. Youngquist, MD, MS, Johanna C. Moore, MD, MS, Keith G. Lurie, MD, Jason A. Bartos, MD, PhD, Kerry M. Bachista, MD, EMT-P, Michael J. Jacobs, EMT-P, Carolina Rojas-Salvador, MD, Sean T. Grayson, MS, EMT-P, James E. Manning, MD, Michael C. Kurz, MD, Guillaume Debaty, MD, PhD, Nicolas Segal, MD, PhD, Peter M. Antevy, MD, David A. Miramontes, MD, Sheldon Cheskes, MD, Joseph E. Holley, MD, Ralph J. Frascone, MD, Raymond L. Fowler, MD, Demetris Yannopoulos, MD, on behalf of fellow International Resuscitation Collaborative Members, Paul E. Pepe, Tom P. Aufderheide, Lionel Lamhaut, Daniel P. Davis, Charles J. Lick, Kees H. Polderman, Kenneth A. Scheppke, Charles D. Deakin, Brian J. O’Neil, Hans van Schuppen, Michael K. Levy, Marvin A. Wayne, Scott T. Youngquist, Johanna C. Moore, Keith G. Lurie, Jason A. Bartos, Kerry M. Bachista, Michael J. Jacobs, Carolina Rojas-Salvador, Sean T. Grayson, James E. Manning, Michael C. Kurz, Guillaume Debaty, Nicolas Segal, Peter M. Antevy, David A. Miramontes, Sheldon Cheskes, Joseph E. Holley, Ralph J. Frascone, Brent Parquette, Raymond L. Fowler, Demetris Yannopoulos, Brent A. Parquette, Ganesh Raveendran, Alice Hutin, Renaud Tissier, Robert Niskanen, James H. Logan, Debbie Gillquist
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2020
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/2293fcceaf264f8bb835c398f745db9d
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id	oai:doaj.org-article:2293fcceaf264f8bb835c398f745db9d
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Paul E. Pepe, MD, MPH, MCCM Tom P. Aufderheide, MD, MS Lionel Lamhaut, MD, PhD Daniel P. Davis, MD Charles J. Lick, MD Kees H. Polderman, MD Kenneth A. Scheppke, MD Charles D. Deakin, MD Brian J. O’Neil, MD Hans van Schuppen, MD Michael K. Levy, MD Marvin A. Wayne, MD Scott T. Youngquist, MD, MS Johanna C. Moore, MD, MS Keith G. Lurie, MD Jason A. Bartos, MD, PhD Kerry M. Bachista, MD, EMT-P Michael J. Jacobs, EMT-P Carolina Rojas-Salvador, MD Sean T. Grayson, MS, EMT-P James E. Manning, MD Michael C. Kurz, MD Guillaume Debaty, MD, PhD Nicolas Segal, MD, PhD Peter M. Antevy, MD David A. Miramontes, MD Sheldon Cheskes, MD Joseph E. Holley, MD Ralph J. Frascone, MD Raymond L. Fowler, MD Demetris Yannopoulos, MD on behalf of fellow International Resuscitation Collaborative Members Paul E. Pepe Tom P. Aufderheide Lionel Lamhaut Daniel P. Davis Charles J. Lick Kees H. Polderman Kenneth A. Scheppke Charles D. Deakin Brian J. O’Neil Hans van Schuppen Michael K. Levy Marvin A. Wayne Scott T. Youngquist Johanna C. Moore Keith G. Lurie Jason A. Bartos Kerry M. Bachista Michael J. Jacobs Carolina Rojas-Salvador Sean T. Grayson James E. Manning Michael C. Kurz Guillaume Debaty Nicolas Segal Peter M. Antevy David A. Miramontes Sheldon Cheskes Joseph E. Holley Ralph J. Frascone Brent Parquette Raymond L. Fowler Demetris Yannopoulos Brent A. Parquette Ganesh Raveendran Alice Hutin Renaud Tissier Robert Niskanen James H. Logan Debbie Gillquist Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest
description	Objectives:. To construct a highly detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest. Design, Setting, and Patients:. Population-based outcomes following out-of-hospital cardiac arrest were collated for 10 U.S. counties in Alaska, California, Florida, Ohio, Minnesota, Utah, and Washington. The 10 identified emergency medical services systems were those that had recently reported significant improvements in neurologically intact survival after introducing a more comprehensive approach involving citizens, hospitals, and evolving strategies for incorporating technology-based, highly choreographed care and training. Detailed inventories of in-common elements were collated from the ten 9-1-1 agencies and assimilated. For reference, combined averaged outcomes for out-of-hospital cardiac arrest occurring January 1, 2017, to February 28, 2018, were compared with concurrent U.S. outcomes reported by the well-established Cardiac Arrest Registry to Enhance Survival. Interventions:. Most commonly, interventions and components from the ten 9-1-1 systems consistently included extensive public cardiopulmonary resuscitation training, 9-1-1 system-connected smart phone applications, expedited dispatcher procedures, cardiopulmonary resuscitation quality monitoring, mechanical cardiopulmonary resuscitation, devices for enhancing negative intrathoracic pressure regulation, extracorporeal membrane oxygenation protocols, body temperature management procedures, rapid cardiac angiography, and intensive involvement of medical directors, operational and quality assurance officers, and training staff. Measurements and Main Results:. Compared with Cardiac Arrest Registry to Enhance Survival (n = 78,704), the cohorts from the 10 emergency medical services agencies examined (n = 2,911) demonstrated significantly increased likelihoods of return of spontaneous circulation (mean 37.4% vs 31.5%; p < 0.001) and neurologically favorable hospital discharge, particularly after witnessed collapses involving bystander cardiopulmonary resuscitation and shockable cardiac rhythms (mean 10.7% vs 8.4%; p < 0.001; and 41.6% vs 29.2%; p < 0.001, respectively). Conclusions:. The likelihood of neurologically favorable survival following out-of-hospital cardiac arrest can improve substantially in communities that conscientiously and meticulously introduce a well-sequenced, highly choreographed, system-wide portfolio of both traditional and nonconventional approaches to training, technologies, and physiologic management. The commonalities found in the analyzed systems create a compelling case that other communities can also improve out-of-hospital cardiac arrest outcomes significantly by conscientiously exploring and adopting similar bundles of system organization and care.
format	article
author	Paul E. Pepe, MD, MPH, MCCM Tom P. Aufderheide, MD, MS Lionel Lamhaut, MD, PhD Daniel P. Davis, MD Charles J. Lick, MD Kees H. Polderman, MD Kenneth A. Scheppke, MD Charles D. Deakin, MD Brian J. O’Neil, MD Hans van Schuppen, MD Michael K. Levy, MD Marvin A. Wayne, MD Scott T. Youngquist, MD, MS Johanna C. Moore, MD, MS Keith G. Lurie, MD Jason A. Bartos, MD, PhD Kerry M. Bachista, MD, EMT-P Michael J. Jacobs, EMT-P Carolina Rojas-Salvador, MD Sean T. Grayson, MS, EMT-P James E. Manning, MD Michael C. Kurz, MD Guillaume Debaty, MD, PhD Nicolas Segal, MD, PhD Peter M. Antevy, MD David A. Miramontes, MD Sheldon Cheskes, MD Joseph E. Holley, MD Ralph J. Frascone, MD Raymond L. Fowler, MD Demetris Yannopoulos, MD on behalf of fellow International Resuscitation Collaborative Members Paul E. Pepe Tom P. Aufderheide Lionel Lamhaut Daniel P. Davis Charles J. Lick Kees H. Polderman Kenneth A. Scheppke Charles D. Deakin Brian J. O’Neil Hans van Schuppen Michael K. Levy Marvin A. Wayne Scott T. Youngquist Johanna C. Moore Keith G. Lurie Jason A. Bartos Kerry M. Bachista Michael J. Jacobs Carolina Rojas-Salvador Sean T. Grayson James E. Manning Michael C. Kurz Guillaume Debaty Nicolas Segal Peter M. Antevy David A. Miramontes Sheldon Cheskes Joseph E. Holley Ralph J. Frascone Brent Parquette Raymond L. Fowler Demetris Yannopoulos Brent A. Parquette Ganesh Raveendran Alice Hutin Renaud Tissier Robert Niskanen James H. Logan Debbie Gillquist
author_facet	Paul E. Pepe, MD, MPH, MCCM Tom P. Aufderheide, MD, MS Lionel Lamhaut, MD, PhD Daniel P. Davis, MD Charles J. Lick, MD Kees H. Polderman, MD Kenneth A. Scheppke, MD Charles D. Deakin, MD Brian J. O’Neil, MD Hans van Schuppen, MD Michael K. Levy, MD Marvin A. Wayne, MD Scott T. Youngquist, MD, MS Johanna C. Moore, MD, MS Keith G. Lurie, MD Jason A. Bartos, MD, PhD Kerry M. Bachista, MD, EMT-P Michael J. Jacobs, EMT-P Carolina Rojas-Salvador, MD Sean T. Grayson, MS, EMT-P James E. Manning, MD Michael C. Kurz, MD Guillaume Debaty, MD, PhD Nicolas Segal, MD, PhD Peter M. Antevy, MD David A. Miramontes, MD Sheldon Cheskes, MD Joseph E. Holley, MD Ralph J. Frascone, MD Raymond L. Fowler, MD Demetris Yannopoulos, MD on behalf of fellow International Resuscitation Collaborative Members Paul E. Pepe Tom P. Aufderheide Lionel Lamhaut Daniel P. Davis Charles J. Lick Kees H. Polderman Kenneth A. Scheppke Charles D. Deakin Brian J. O’Neil Hans van Schuppen Michael K. Levy Marvin A. Wayne Scott T. Youngquist Johanna C. Moore Keith G. Lurie Jason A. Bartos Kerry M. Bachista Michael J. Jacobs Carolina Rojas-Salvador Sean T. Grayson James E. Manning Michael C. Kurz Guillaume Debaty Nicolas Segal Peter M. Antevy David A. Miramontes Sheldon Cheskes Joseph E. Holley Ralph J. Frascone Brent Parquette Raymond L. Fowler Demetris Yannopoulos Brent A. Parquette Ganesh Raveendran Alice Hutin Renaud Tissier Robert Niskanen James H. Logan Debbie Gillquist
author_sort	Paul E. Pepe, MD, MPH, MCCM
title	Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest
title_short	Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest
title_full	Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest
title_fullStr	Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest
title_full_unstemmed	Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest
title_sort	rationale and strategies for development of an optimal bundle of management for cardiac arrest
publisher	Wolters Kluwer
publishDate	2020
url	https://doaj.org/article/2293fcceaf264f8bb835c398f745db9d
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spelling	oai:doaj.org-article:2293fcceaf264f8bb835c398f745db9d2021-11-25T07:52:32ZRationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest2639-802810.1097/CCE.0000000000000214https://doaj.org/article/2293fcceaf264f8bb835c398f745db9d2020-10-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000214https://doaj.org/toc/2639-8028Objectives:. To construct a highly detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest. Design, Setting, and Patients:. Population-based outcomes following out-of-hospital cardiac arrest were collated for 10 U.S. counties in Alaska, California, Florida, Ohio, Minnesota, Utah, and Washington. The 10 identified emergency medical services systems were those that had recently reported significant improvements in neurologically intact survival after introducing a more comprehensive approach involving citizens, hospitals, and evolving strategies for incorporating technology-based, highly choreographed care and training. Detailed inventories of in-common elements were collated from the ten 9-1-1 agencies and assimilated. For reference, combined averaged outcomes for out-of-hospital cardiac arrest occurring January 1, 2017, to February 28, 2018, were compared with concurrent U.S. outcomes reported by the well-established Cardiac Arrest Registry to Enhance Survival. Interventions:. Most commonly, interventions and components from the ten 9-1-1 systems consistently included extensive public cardiopulmonary resuscitation training, 9-1-1 system-connected smart phone applications, expedited dispatcher procedures, cardiopulmonary resuscitation quality monitoring, mechanical cardiopulmonary resuscitation, devices for enhancing negative intrathoracic pressure regulation, extracorporeal membrane oxygenation protocols, body temperature management procedures, rapid cardiac angiography, and intensive involvement of medical directors, operational and quality assurance officers, and training staff. Measurements and Main Results:. Compared with Cardiac Arrest Registry to Enhance Survival (n = 78,704), the cohorts from the 10 emergency medical services agencies examined (n = 2,911) demonstrated significantly increased likelihoods of return of spontaneous circulation (mean 37.4% vs 31.5%; p < 0.001) and neurologically favorable hospital discharge, particularly after witnessed collapses involving bystander cardiopulmonary resuscitation and shockable cardiac rhythms (mean 10.7% vs 8.4%; p < 0.001; and 41.6% vs 29.2%; p < 0.001, respectively). Conclusions:. The likelihood of neurologically favorable survival following out-of-hospital cardiac arrest can improve substantially in communities that conscientiously and meticulously introduce a well-sequenced, highly choreographed, system-wide portfolio of both traditional and nonconventional approaches to training, technologies, and physiologic management. The commonalities found in the analyzed systems create a compelling case that other communities can also improve out-of-hospital cardiac arrest outcomes significantly by conscientiously exploring and adopting similar bundles of system organization and care.Paul E. Pepe, MD, MPH, MCCMTom P. Aufderheide, MD, MSLionel Lamhaut, MD, PhDDaniel P. Davis, MDCharles J. Lick, MDKees H. Polderman, MDKenneth A. Scheppke, MDCharles D. Deakin, MDBrian J. O’Neil, MDHans van Schuppen, MDMichael K. Levy, MDMarvin A. Wayne, MDScott T. Youngquist, MD, MSJohanna C. Moore, MD, MSKeith G. Lurie, MDJason A. Bartos, MD, PhDKerry M. Bachista, MD, EMT-PMichael J. Jacobs, EMT-PCarolina Rojas-Salvador, MDSean T. Grayson, MS, EMT-PJames E. Manning, MDMichael C. Kurz, MDGuillaume Debaty, MD, PhDNicolas Segal, MD, PhDPeter M. Antevy, MDDavid A. Miramontes, MDSheldon Cheskes, MDJoseph E. Holley, MDRalph J. Frascone, MDRaymond L. Fowler, MDDemetris Yannopoulos, MDon behalf of fellow International Resuscitation Collaborative MembersPaul E. PepeTom P. AufderheideLionel LamhautDaniel P. DavisCharles J. LickKees H. PoldermanKenneth A. ScheppkeCharles D. DeakinBrian J. O’NeilHans van SchuppenMichael K. LevyMarvin A. WayneScott T. YoungquistJohanna C. MooreKeith G. LurieJason A. BartosKerry M. BachistaMichael J. JacobsCarolina Rojas-SalvadorSean T. GraysonJames E. ManningMichael C. KurzGuillaume DebatyNicolas SegalPeter M. AntevyDavid A. MiramontesSheldon CheskesJoseph E. HolleyRalph J. FrasconeBrent ParquetteRaymond L. FowlerDemetris YannopoulosBrent A. ParquetteGanesh RaveendranAlice HutinRenaud TissierRobert NiskanenJames H. LoganDebbie GillquistWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 2, Iss 10, p e0214 (2020)

Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest

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