Guidelines 2021 - The system saving lives
Keywords:
chain of survival, European Restart a Heart Day, Kids save lives
Abstract
The European Resuscitation Council (ERC) has produced these Systems Saving Lives guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include chain of survival, measuring performance of resuscitation, social media and smartphones apps for engaging community, European Restart a Heart Day, World Restart a Heart, KIDS SAVE LIVES campaign, early warning scores, rapid response systems, and medical emergency team, cardiac arrest centres and role of dispatcher. The Systems Saving Lives chapter describes numerous and important factors that can globally improve the management of cardiac arrest patients not as a single intervention but as a system-level approach.
The aim of this paper is to provide evidence-informed best practice guidance, about interventions which can be implemented by healthcare systems to improve outcomes of out-of-hospital and/or in-hospital cardiac arrest (OHCA and IHCA). The intended audience of the paper are governments, managers of health and education systems, healthcare professionals, teachers, students and laypeople.
References
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2. Newman MM. Chain of Survival concept takes hold. J Emerg Med Serv 1989;14:11–3.
3. Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the "chain of survival" concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 1991;83:1832-47.
4. Nolan J, Soar J, Eikeland H. The chain of survival. Resuscitation 2006;71:270-1.
5. Perkins GD, Handley AJ, Koster RW, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015;95:81-99.
6. Andersen LW, Kim WY, Chase M, et al. The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest. Resuscitation 2016;98:112-7.
7. Churpek MM, Yuen TC, Winslow C, Hall J, Edelson DP. Differences in vital signs between elderly and nonelderly patients prior to ward cardiac arrest. Crit Care Med 2015;43:816-22.
8. Waalewijn RA, Tijssen JG, Koster RW. Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST). Resuscitation 2001;50:273-9.
9. Takei Y, Nishi T, Kamikura T, et al. Do early emergency calls before patient collapse improve survival after out-of-hospital cardiac arrests? Resuscitation 2015;88:20-7.
10. Olasveengen TM, Mancini ME, Perkins GD, et al. Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020;142:S41-S91. 24
11. Olasveengen TM, Semeraro F, Ristagno G, et al. European Resuscitation Council Guidelines for Basic Life Support. Resuscitation 2021.
12. Valenzuela TD, Roe DJ, Cretin S, Spaite DW, Larsen MP. Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation 1997;96:3308-13.
13. Christensen DM, Rajan S, Kragholm K, et al. Bystander cardiopulmonary resuscitation and survival in patients with out-of-hospital cardiac arrest of non-cardiac origin. Resuscitation 2019;140:98-105.
14. Kragholm K, Wissenberg M, Mortensen RN, et al. Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest. N Engl J Med 2017;376:1737-47.
15. Fordyce CB, Hansen CM, Kragholm K, et al. Association of Public Health Initiatives With Outcomes for Out-of-Hospital Cardiac Arrest at Home and in Public Locations. JAMA Cardiol 2017;2:1226-35.
16. Sondergaard KB, Wissenberg M, Gerds TA, et al. Bystander cardiopulmonary resuscitation and long-term outcomes in out-of-hospital cardiac arrest according to location of arrest. Eur Heart J 2019;40:309-18.
17. Soar J, Maconochie I, Wyckoff MH, et al. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2019;145:95-150.
18. Ro YS, Shin SD, Song KJ, et al. Effects of Dispatcher-assisted Cardiopulmonary Resuscitation on Survival Outcomes in Infants, Children, and Adolescents with Out-of-hospital Cardiac Arrests. Resuscitation 2016;108:20-6.
19. Wu Z, Panczyk M, Spaite DW, et al. Telephone cardiopulmonary resuscitation is independently associated with improved survival and improved functional outcome after out-of-hospital cardiac arrest. Resuscitation 2018;122:135-40.
20. Ro YS, Shin SD, Lee YJ, et al. Effect of Dispatcher-Assisted Cardiopulmonary Resuscitation Program and Location of Out-of-Hospital Cardiac Arrest on Survival and Neurologic Outcome. Ann Emerg Med 2017;69:52-61 e1.
21. Chang I, Lee SC, Shin SD, et al. Effects of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological recovery in paediatric patients with out-of-hospital cardiac arrest based on the pre-hospital emergency medical service response time interval. Resuscitation 2018;130:49-56.
22. Gold LS, Fahrenbruch CE, Rea TD, Eisenberg MS. The relationship between time to arrival of emergency medical services (EMS) and survival from out-of-hospital ventricular fibrillation cardiac arrest. Resuscitation 2010;81:622-5.
23. Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 1993;22:1652-8.
24. Kurz MC, Schmicker RH, Leroux B, et al. Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium. Resuscitation 2018;128:132-7.
25. Deakin CD. The chain of survival: Not all links are equal. Resuscitation 2018;126:80-2.
26. 45. Soreide E, Morrison L, Hillman K, et al. The formula for survival in resuscitation. Resuscitation 2013;84:1487-93.
27. Chamberlain DA, Hazinski MF. Education in resuscitation. Resuscitation 2003;59:11-43.
28. Semeraro F, Wingen S, Schroeder DC, et al. KIDS SAVE LIVES implementation in Europe: A survey through the ERC Research NET. Resuscitation 2016;107:e7-9.
29. Semeraro F, Wingen S, Schroeder DC, et al. KIDS SAVE LIVES-Three years of implementation in Europe. Resuscitation 2018;131:e9-e11.
30. Greif R. Education, Implementation, and Teams 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020.
31. Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Koster RW. AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest. Resuscitation 2020;150:170-7.
32. Metelmann C, Metelmann B, Kohnen D, et al. Smartphone-based dispatch of Community First Responders to Out-of-Hospital Cardiac Arrest - Statements from an International Consensus Conference. Scandavian Journal of Trauma, Resuscitation and Emergency Medicine 2021.
33. Beck B, Bray J, Cameron P, et al. Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: Results from the Aus-ROC Epistry. Resuscitation 2018;126:49-57. 32
34. Grasner JT, Wnent J, Herlitz J, et al. Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study. Resuscitation 2020;148:218-26.
35. Kitamura T, Kiyohara K, Sakai T, et al. Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan. N Engl J Med 2016;375:1649-59.
36. Lockey AS, Georgiou M. Children can save lives. Resuscitation 2013;84:399-400.
37. Bottiger BW, Lockey A, Aickin R, et al. Over 675,000 lay people trained in cardiopulmonary resuscitation worldwide - The "World Restart a Heart (WRAH)" initiative 2018. Resuscitation 2019;138:15-7.
38. Bottiger BW, Lockey A, Aickin R, et al. Up to 206 Million People Reached and Over 5.4 Million Trained in Cardiopulmonary Resuscitation Worldwide: The 2019 International Liaison Committee on Resuscitation World Restart a Heart Initiative. Journal of the American Heart Association 2020;9:e017230.
39. Baldi E, Savastano S, Contri E, et al. Mandatory cardiopulmonary resuscitation competencies for undergraduate healthcare students in Europe: A European Resuscitation Council guidance note. European Journal of Anaesthesiology 2020;37:839-41.
40. Bottiger BW, Semeraro F, Altemeyer KH, et al. KIDS SAVE LIVES: School children education in resuscitation for Europe and the world. European Journal of Anaesthesiology 2017;34:792-6.
41. Otero-Agra M, Varela-Casal C, Castillo-Pereiro N, et al. [Can we train the chain of survival while playing? Validation of the tool <>]. An Pediatr (Barc) 2020.
42. Bottiger BW, Lockey A, Georgiou M, et al. KIDS SAVE LIVES: ERC Position statement on schoolteachers' education and qualification in resuscitation. Resuscitation 2020;151:87-90.
43. Bottiger BW, Bossaert LL, Castren M, et al. Kids Save Lives - ERC position statement on school children education in CPR.: "Hands that help - Training children is training for life". Resuscitation 2016;105:A1-3.
44. De Buck E, Van Remoortel H, Dieltjens T, et al. Evidence-based educational pathway for the integration of first aid training in school curricula. Resuscitation 2015;94:8-22.
45. Boland LL, Formanek MB, Harkins KK, et al. Minnesota Heart Safe Communities: Are community-based initiatives increasing pre-ambulance CPR and AED use? Resuscitation 2017;119:33-6.
46. Becker L, Vath J, Eisenberg M, Meischke H. The impact of television public service announcements on the rate of bystander CPR. Prehosp Emerg Care 1999;3:353-6.
47. Bergamo C, Bui QM, Gonzales L, Hinchey P, Sasson C, Cabanas JG. TAKE10: A community approach to teaching compression-only CPR to high-risk zip codes. Resuscitation 2016;102:75-9.
48. Finn JC, Bhanji F, Lockey A, et al. Part 8: Education, implementation, and teams: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015;95:e203-24.
49. Stonington SD. On ethical locations: the good death in Thailand, where ethics sit in places. Soc Sci Med 2012;75:836-44.
2. Newman MM. Chain of Survival concept takes hold. J Emerg Med Serv 1989;14:11–3.
3. Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the "chain of survival" concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 1991;83:1832-47.
4. Nolan J, Soar J, Eikeland H. The chain of survival. Resuscitation 2006;71:270-1.
5. Perkins GD, Handley AJ, Koster RW, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015;95:81-99.
6. Andersen LW, Kim WY, Chase M, et al. The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest. Resuscitation 2016;98:112-7.
7. Churpek MM, Yuen TC, Winslow C, Hall J, Edelson DP. Differences in vital signs between elderly and nonelderly patients prior to ward cardiac arrest. Crit Care Med 2015;43:816-22.
8. Waalewijn RA, Tijssen JG, Koster RW. Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST). Resuscitation 2001;50:273-9.
9. Takei Y, Nishi T, Kamikura T, et al. Do early emergency calls before patient collapse improve survival after out-of-hospital cardiac arrests? Resuscitation 2015;88:20-7.
10. Olasveengen TM, Mancini ME, Perkins GD, et al. Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020;142:S41-S91. 24
11. Olasveengen TM, Semeraro F, Ristagno G, et al. European Resuscitation Council Guidelines for Basic Life Support. Resuscitation 2021.
12. Valenzuela TD, Roe DJ, Cretin S, Spaite DW, Larsen MP. Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation 1997;96:3308-13.
13. Christensen DM, Rajan S, Kragholm K, et al. Bystander cardiopulmonary resuscitation and survival in patients with out-of-hospital cardiac arrest of non-cardiac origin. Resuscitation 2019;140:98-105.
14. Kragholm K, Wissenberg M, Mortensen RN, et al. Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest. N Engl J Med 2017;376:1737-47.
15. Fordyce CB, Hansen CM, Kragholm K, et al. Association of Public Health Initiatives With Outcomes for Out-of-Hospital Cardiac Arrest at Home and in Public Locations. JAMA Cardiol 2017;2:1226-35.
16. Sondergaard KB, Wissenberg M, Gerds TA, et al. Bystander cardiopulmonary resuscitation and long-term outcomes in out-of-hospital cardiac arrest according to location of arrest. Eur Heart J 2019;40:309-18.
17. Soar J, Maconochie I, Wyckoff MH, et al. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2019;145:95-150.
18. Ro YS, Shin SD, Song KJ, et al. Effects of Dispatcher-assisted Cardiopulmonary Resuscitation on Survival Outcomes in Infants, Children, and Adolescents with Out-of-hospital Cardiac Arrests. Resuscitation 2016;108:20-6.
19. Wu Z, Panczyk M, Spaite DW, et al. Telephone cardiopulmonary resuscitation is independently associated with improved survival and improved functional outcome after out-of-hospital cardiac arrest. Resuscitation 2018;122:135-40.
20. Ro YS, Shin SD, Lee YJ, et al. Effect of Dispatcher-Assisted Cardiopulmonary Resuscitation Program and Location of Out-of-Hospital Cardiac Arrest on Survival and Neurologic Outcome. Ann Emerg Med 2017;69:52-61 e1.
21. Chang I, Lee SC, Shin SD, et al. Effects of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological recovery in paediatric patients with out-of-hospital cardiac arrest based on the pre-hospital emergency medical service response time interval. Resuscitation 2018;130:49-56.
22. Gold LS, Fahrenbruch CE, Rea TD, Eisenberg MS. The relationship between time to arrival of emergency medical services (EMS) and survival from out-of-hospital ventricular fibrillation cardiac arrest. Resuscitation 2010;81:622-5.
23. Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 1993;22:1652-8.
24. Kurz MC, Schmicker RH, Leroux B, et al. Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium. Resuscitation 2018;128:132-7.
25. Deakin CD. The chain of survival: Not all links are equal. Resuscitation 2018;126:80-2.
26. 45. Soreide E, Morrison L, Hillman K, et al. The formula for survival in resuscitation. Resuscitation 2013;84:1487-93.
27. Chamberlain DA, Hazinski MF. Education in resuscitation. Resuscitation 2003;59:11-43.
28. Semeraro F, Wingen S, Schroeder DC, et al. KIDS SAVE LIVES implementation in Europe: A survey through the ERC Research NET. Resuscitation 2016;107:e7-9.
29. Semeraro F, Wingen S, Schroeder DC, et al. KIDS SAVE LIVES-Three years of implementation in Europe. Resuscitation 2018;131:e9-e11.
30. Greif R. Education, Implementation, and Teams 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020.
31. Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Koster RW. AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest. Resuscitation 2020;150:170-7.
32. Metelmann C, Metelmann B, Kohnen D, et al. Smartphone-based dispatch of Community First Responders to Out-of-Hospital Cardiac Arrest - Statements from an International Consensus Conference. Scandavian Journal of Trauma, Resuscitation and Emergency Medicine 2021.
33. Beck B, Bray J, Cameron P, et al. Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: Results from the Aus-ROC Epistry. Resuscitation 2018;126:49-57. 32
34. Grasner JT, Wnent J, Herlitz J, et al. Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study. Resuscitation 2020;148:218-26.
35. Kitamura T, Kiyohara K, Sakai T, et al. Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan. N Engl J Med 2016;375:1649-59.
36. Lockey AS, Georgiou M. Children can save lives. Resuscitation 2013;84:399-400.
37. Bottiger BW, Lockey A, Aickin R, et al. Over 675,000 lay people trained in cardiopulmonary resuscitation worldwide - The "World Restart a Heart (WRAH)" initiative 2018. Resuscitation 2019;138:15-7.
38. Bottiger BW, Lockey A, Aickin R, et al. Up to 206 Million People Reached and Over 5.4 Million Trained in Cardiopulmonary Resuscitation Worldwide: The 2019 International Liaison Committee on Resuscitation World Restart a Heart Initiative. Journal of the American Heart Association 2020;9:e017230.
39. Baldi E, Savastano S, Contri E, et al. Mandatory cardiopulmonary resuscitation competencies for undergraduate healthcare students in Europe: A European Resuscitation Council guidance note. European Journal of Anaesthesiology 2020;37:839-41.
40. Bottiger BW, Semeraro F, Altemeyer KH, et al. KIDS SAVE LIVES: School children education in resuscitation for Europe and the world. European Journal of Anaesthesiology 2017;34:792-6.
41. Otero-Agra M, Varela-Casal C, Castillo-Pereiro N, et al. [Can we train the chain of survival while playing? Validation of the tool <
42. Bottiger BW, Lockey A, Georgiou M, et al. KIDS SAVE LIVES: ERC Position statement on schoolteachers' education and qualification in resuscitation. Resuscitation 2020;151:87-90.
43. Bottiger BW, Bossaert LL, Castren M, et al. Kids Save Lives - ERC position statement on school children education in CPR.: "Hands that help - Training children is training for life". Resuscitation 2016;105:A1-3.
44. De Buck E, Van Remoortel H, Dieltjens T, et al. Evidence-based educational pathway for the integration of first aid training in school curricula. Resuscitation 2015;94:8-22.
45. Boland LL, Formanek MB, Harkins KK, et al. Minnesota Heart Safe Communities: Are community-based initiatives increasing pre-ambulance CPR and AED use? Resuscitation 2017;119:33-6.
46. Becker L, Vath J, Eisenberg M, Meischke H. The impact of television public service announcements on the rate of bystander CPR. Prehosp Emerg Care 1999;3:353-6.
47. Bergamo C, Bui QM, Gonzales L, Hinchey P, Sasson C, Cabanas JG. TAKE10: A community approach to teaching compression-only CPR to high-risk zip codes. Resuscitation 2016;102:75-9.
48. Finn JC, Bhanji F, Lockey A, et al. Part 8: Education, implementation, and teams: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015;95:e203-24.
49. Stonington SD. On ethical locations: the good death in Thailand, where ethics sit in places. Soc Sci Med 2012;75:836-44.
Published
2021/09/01
How to Cite
Bokan, D., & Fiser, Z. (2021). Guidelines 2021 - The system saving lives. Journal Resuscitatio Balcanica, 7(18), 304 -309. https://doi.org/10.5937/jrb7-32739
Section
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