EuReCa_Srbija 2014-2023 - Analysis of data on non-initiation of CPR in relation to the etiology of cardiac arrest
Abstract
Introduction: Cardiac arrest is one of the five leading causes of death in Europe. Timely recognition and application of cardiopulmonary resuscitation (CPR) significantly increase the chances of survival. It is necessary to better understand the reasons for not starting CPR, with the aim that their identification leads to the improvement of guidelines and an increase in survival rates.
The Aim: The aim of this study is to analyze the data on the non-initiation of CPR in the context of the etiology of cardiac arrest.
Material and Methods: The study included epidemiologic data on out-of-hospital cardiac arrest (OHCA) collected through questionnaires from the EuReCa, European Resuscitation Council (ERC) studies. The criterion for inclusion in the research was a OHCA treated by the emergency medical service (EMS). Pediatric patients were also included in the analysis. The created database consisted of information defined by the unique protocol of the EuReCa ONE study, for the period of October 1, 2014 to December 31, 2023.
Results: We found a statistically significant correlation between Utstein and EuReCa etiology of cardiac arrest and the proportion of non-initiation of CPR in recorded cases (p<0.001). The highest percentage of non-initiation of CPR was observed in patients after drowning, where out of 40 recorded cases of submersion, the application of CPR measures was not initiated in any of them, while the lowest percentage of non-initiation of CPR was recorded in electrocution, where out of a total of 15 recorded cases, CPR was not initiated in 5/ 15 (33.33%) cases. The ratio of starting and not starting CPR in the group of patients with cardiogenic cardiac arrest was almost identical, that is, CPR was not started in 3293/6708 (49.1%) cases. Binary logistic regression analysis indicated the female gender as a significant predictor of non-initiation of CPR (p<0.001, OR 2.037, 95% CI 1.880-2.208).
Conclusion: This study provides significant data that can contribute to the improvement of strategies for recognition and intervention in out-of-hospital cardiac arrest in Serbia. Additional research and continuous monitoring are needed to determine the influence of etiology, but also of other factors, on the decision not to start CPR.
References
2. Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-hospital cardiac arrest: a review. JAMA 2019;321:120010.
3. Kiguchi T, Okubo M, Nishiyama C, et al. Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation
2020;152:3949.
4. Nikolovski S S, Lazic A D, Fiser Z Z, et al. (October 06, 2021) Initial Outcomes and Survival of Out-of-Hospital Cardiac Arrest: EuReCa Serbia Multicenter Cohort Study. Cureus 13(10): e18555.
5. Randjelovic, S.S., Nikolovski, S., Selaković, D., Sreckovic, M.J., Rosic, S., Rosic, G., et al. (2024). Time Is Life: Golden Ten Minutes on Scene–EuReCa_Serbia 2014–2023. Medicina, 60.
6. Gräsner JT, Herlitz J, Tjelmeland IBM, Wnent J, Masterson S, Lilja G, et al. European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation. 2021 Apr;161:61-79.
7. Srdjan S. Nikolovski, Neda B. Bozic, Zoran Z. Fiser, Aleksandra D. Lazic, Jelena Z. Tijanic, Violetta I. Raffay. Dispatcher-assisted cardiopulmonary resuscitation — influence on return of spontaneous circulation and short-term survival. Obshchaya Reanimatologiya = General Reanimatology. 2021; 17 (5): 52–64.
8. Jakšić Horvat K, Budimski M, Momirović Stojković M, Gavrilović N, Fišer Z. EURECA Srbija One 2014. - kardiopulmonalna resuscitacija od strane svedoka. Journal Resuscitatio Balcanica. 2015;1(2):5-8.
9. Randjelovic SS, Nikolovski SS, Tijanic JZ, Obradovic IA, Fiser ZZ, Lazic AD, et al. Out-of-hospital cardiac arrest prospective epidemiology monitoring during the first five years of EuReCa program implementation in Serbia. Prehosp Disaster Med. 2023;00(00):1–8.
10. Wnent J, Tjelmeland I, Lefering R, Koster RW, Maurer H, Masterson S, et al. To ventilate or not to ventilate during bystander CPR - A EuReCa TWO analysis. Resuscitation. 2021 Sep;166:101-109.
11. Glober NK, Tainter CR, Abramson TM, Staats K, Gilbert G, Kim D. A simple decision rule predicts futile resuscitation of out-of-hospital cardiac arrest. Resuscitation. 2019 Sep
12. Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1151–1210
13. American College of Surgeons Committee on Trauma. American College of Emergency Physicians Pediatric Emergency Medicine Committee. National Association of EMS Physicians. American Academy of Pediatrics Committee on Pediatric Emergency Medicine. Fallat ME. Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest. Ann Emerg Med. 2014
14. Escutnaire J, Genin M, Babykina E, Dumont C, Javaudin F, Baert V, et al. Traumatic cardiac arrest is associated with lower survival rate vs medical cardiac arrest - Results from the French national registry. Resuscitation. 2018;131:48–54.
15. Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.Circulation 1991;84:96075.
16. Grasner JT,Lefering R,Koster RW, et al. EuReCaONE- 27 Nations, ONE Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation 2016;105:18895.
17. Gach D, Nowak JU, Krzych LJ. Epidemiology of out-of-hospital cardiac arrest in the Bielsko-Biala district: a 12-month analysis. Kardiologia Polska 2016;74:11807.
18.Rosemurgy AS, Norris PA, Olson SM, Hurst JM, Albrink MH. Prehospital traumatic cardiac arrest: the cost of futility. J Trauma 1993;35:46873.
19.Truhlar A, Deakin CD, Soar J, et al. European resuscitation council guidelines for resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015;95:148201.
20. Do SN, Luong CQ, Pham DT, Nguyen MH, Ton TT, Hoang QTA. Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study. BMC Emerg Med. 2021 Nov 23;21(1):148
21.Callaway CW, Schmicker RH, Brown SP, Albrich JM, Andrusiek DL, Aufderheide TP, et al. Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest. Resuscitation 2014; 85: 657–63.
22. Dumas F, Cariou A, Manzo-Silberman S, Grimaldi D, Vivien B, Rosencher J etal. Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest. Circ Cardiovasc Interv 2010; 3: 200–7.
23. Vyas A, Chan PS, Cram P, Nallamothu BK, McNally B, Girotra S. Early Coronary Angiography and Survival After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv. 2015 Oct;8(10):e002321.
24. Rajagopal S, Kaye CR, Lall R, Deakin CD, Gates S, Pocock H,et al. Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest. Resuscitation. 2016 Dec;109:110-115.
