Clinical paperPerceptions of collapse and assessment of cardiac arrest by bystanders of out-of-hospital cardiac arrest (OOHCA)☆
Section snippets
Background
Out-of-hospital cardiac arrest (OOHCA) is a major cause of death in industrialised nations, accounting for some 400,000 cases per year in the U.S. and Europe.1, 2 There is sound evidence that bystander CPR is one of the most important predictors of favourable outcome following OOHCA.3, 4, 5, 6, 7 One could characterise this crucial time interval between the victim's collapse and start of professional BLS as “bystander's window” (Fig. 1). In spite of various efforts to improve aspects of the
Methods
From August 15th 2006 to August 14th 2007, we prospectively analysed all witnessed CA cases of the mobile intensive care unit (MICU) and the helicopter emergency medical system (HEMS) based at our hospital. The MICU serves mixed suburban and inner-city regions, and the HEMS operates evenly distributed over the whole city area. Berlin EMS serves a metropolitan area of 3.5 Million inhabitants and is organised as a two-tired system. ALS units (15 MICU and 1 HEMS) are physician-staffed, while BLS
Patient's data
From 277 screened cases 76 were excluded, specific reasons are given in Fig. 2.
Discussion
The “bystander's window” is a crucial part of the chain of survival and might at present be the most effective measure to improve survival in OOHCA. The obligatory step before initiating BLS is perception of arrest, so our study aimed to analyse the bystander's perspective under reality conditions. This was performed systematically for the first time, highlighting severe deficits in perception of arrest, and on the other hand giving valuable information on features which are detectable by lay
Conclusion
Only half of the interviewed bystanders in this study were able to detect arrest while witnessing OOHCA. Bystanders frequently reported bluish skin colour and abnormal breathing. Agonal breathing often hindered the detection of CA. If assessment of circulation was undertaken pulse check was performed by almost all interviewees. Poor detection skills might be an important reason of low bystander resuscitation rates. For detection of arrest we could demonstrate a significant dependence on
Conflict of interest
All authors declare that they have no competing interests concerning all issues connected to this paper. This study was carried out by an academic institution and there was no external funding.
JB designed the study and is responsible for the intellectual content, SS developed the protocol and conducted all interviews including statistics, HRA was involved in the study design and gave important intellectual input discussing the content.
References (20)
- et al.
Incidenc of EMS-treated out-of-hospital cardiac arrest in the United States
Resuscitation
(2004) - et al.
Incidence of EMS treated out-of-hospital cardiac arrest in Europe
Resusciation
(2005) - et al.
Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden
Am Heart J
(2005) - et al.
Utstein style analysis of out-of-hospital cardiac arrest—bystander CPR and expired carbon dioxide
Resuscitation
(2007) - et al.
Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases
Resuscitation
(2003) - et al.
Bystander-initiated cardiopulmonary resuscitation out-of-hospital. A first description of the bystanders and their experiences
Resuscitation
(1996) - et al.
Factors impeding dispatcher-assisted telephone cardiopulmonary resuscitation
Ann Emerg Med
(2003) - et al.
Disagreeable physical characteristics affecting bystander CPR
Ann Emerg Med
(1989) - et al.
Teaching recognition of agonal breathing improves accuracy of diagnosing cardiac arrest
Resuscitation
(2006) - et al.
European Resuscitation Council Guidelines for Resuscitation 2005
Resuscitation
(2005)
Cited by (0)
- ☆
“A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.06.028”.