‘Event tree’ analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR
Objective: The British National Service Framework (NSF) for heart disease commended the ‘Utstein style’ for auditing out-of-hospital cardiac arrests. The NSF also set standards for pre-hospital treatment and response times. To increase the flexibility of Utstein, an ‘event tree’ technique is propose...
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| creator | Dowie, Robin Campbell, Helen Donohoe, Rachael Clarke, Patricia |
| description | Objective: The British National Service Framework (NSF) for heart disease commended the ‘Utstein style’ for auditing out-of-hospital cardiac arrests. The NSF also set standards for pre-hospital treatment and response times. To increase the flexibility of Utstein, an ‘event tree’ technique is proposed as an audit tool. Event trees consist of nodes and branches on which numbers, percentages or probability values are entered.
Methods: Using the London Ambulance Service's (LAS) 1997 database on 3759 out-of-hospital cardiac arrests, 2772 arrests witnessed by lay bystanders or unwitnessed were analysed focusing on bystander cardiopulmonary resuscitation (BCPR) and response times.
Results: The Utstein template showed that witnessed arrests in ventricular fibrillation (VF) or ventricular tachycardia (VT) who had received BCPR achieved a return of spontaneous circulation (ROSC) in the field significantly more often than non-BCPR recipients—26 versus 16% (
P=0.006). But the likelihood of being admitted to a hospital bed, and discharged alive, was only marginally better for BCPR recipients. To examine the influence of BCPR on the presenting rhythm an event tree showed that in 48% of witnessed BCPR cases the presenting rhythm was VF/VT, whereas, for witnessed non-BCPR cases, 27% were in VF/VT (
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| doi_str_mv | 10.1016/S0300-9572(02)00343-X |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_73026909</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S030095720200343X</els_id><sourcerecordid>73026909</sourcerecordid><originalsourceid>FETCH-LOGICAL-c457t-e8cfe7d7161efc407f603edb0ed91d7737f3e33dbf4ceb875daf8c71f6b5143c3</originalsourceid><addsrcrecordid>eNqFkM9u1DAQhy1ERbeFRwD5AiqHwDiO44QLQqsClSqB-CP1Zjn2mBol8db2VtpbH4O-Xp8EL7tqj0gjzRy-mfnpI-Q5gzcMWPv2O3CAqheyPoH6NQBveHXxiCxYJ3nFhITHZHGPHJKjlH5DoUQvn5BDVouu73u2IOPdzZ_Ta5wzzRHx7uaW6lmPm-QTDY6Gda6Cqy5DWvmsR2p0tF4bqmPElKnVWb-jJszOx8nPv2i-ROqnVYhZzwa3F4ZNKrPFSJdfvz0lB06PCZ_t-zH5-fH0x_Jzdf7l09nyw3llGiFzhZ1xKK1kLUNnGpCuBY52ALQ9s1Jy6ThybgfXGBw6Kax2nZHMtYNgDTf8mLza3V3FcLUuSdXkk8Fx1DOGdVKSQ9320BdQ7EATQ0oRnVpFP-m4UQzUVrP6p1ltHSootdWsLsrei_2D9TChfdjaey3Ayz2gk9Gji8WHTw9cI3iJWhfu_Y7DouPaY1TJeCzurI9osrLB_yfKX7MznXM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>73026909</pqid></control><display><type>article</type><title>‘Event tree’ analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Dowie, Robin ; Campbell, Helen ; Donohoe, Rachael ; Clarke, Patricia</creator><creatorcontrib>Dowie, Robin ; Campbell, Helen ; Donohoe, Rachael ; Clarke, Patricia</creatorcontrib><description><![CDATA[Objective: The British National Service Framework (NSF) for heart disease commended the ‘Utstein style’ for auditing out-of-hospital cardiac arrests. The NSF also set standards for pre-hospital treatment and response times. To increase the flexibility of Utstein, an ‘event tree’ technique is proposed as an audit tool. Event trees consist of nodes and branches on which numbers, percentages or probability values are entered.
Methods: Using the London Ambulance Service's (LAS) 1997 database on 3759 out-of-hospital cardiac arrests, 2772 arrests witnessed by lay bystanders or unwitnessed were analysed focusing on bystander cardiopulmonary resuscitation (BCPR) and response times.
Results: The Utstein template showed that witnessed arrests in ventricular fibrillation (VF) or ventricular tachycardia (VT) who had received BCPR achieved a return of spontaneous circulation (ROSC) in the field significantly more often than non-BCPR recipients—26 versus 16% (
P=0.006). But the likelihood of being admitted to a hospital bed, and discharged alive, was only marginally better for BCPR recipients. To examine the influence of BCPR on the presenting rhythm an event tree showed that in 48% of witnessed BCPR cases the presenting rhythm was VF/VT, whereas, for witnessed non-BCPR cases, 27% were in VF/VT (
P<0.0001). With unwitnessed arrests, 31% of BCPR cases were in VF/VT compared with 18% for non-BCPR cases (
P<0.0001). Call to scene time was less than 8 min for 66% of all VF/VT arrests.
Conclusion: The event trees, when combined with the Utstein template, demonstrated the importance of examining comprehensively datasets for both witnessed and unwitnessed cardiac arrests when monitoring performance standards. The analyses also emphasised the relevance of community programmes in Greater London for teaching basic life saving skills.
Objectivo: O British National Service Framework (NSF) para doença cardı́aca recomendou o ‘Utstein style’ para auditar paragens cardı́acas extra-hospitalares. O NSF também estabeleceu padrões para tratamento e tempo de resposta pré-hospitalares. Para aumentar a flexibilidade do modelo de Utstein propomos como ferramenta de auditoria uma técnica: “árvore de eventos”. Árvores de eventos consistem em nós e ramos nos quais são introduzidos números, percentagens ou valores de probabilidades.
Métodos: Utilizando a base de dados de 1997 da London Ambulance Service's (LAS) em 3579 paragens cardı́acas extra-hospitalares foram analisadas 2772 paragens, testemunhadas por leigos ou não testemunhadas, centrando-se a análise na reanimação cardio-pulmonar por leigos (RCPL) e no tempo de resposta.
Resultados: O modelo Utstein mostrou que as paragens em fibrilhação ventricular (VF) ou taquicardia ventricular (TV) testemunhadas e submetidas a RCPL evoluı́ram para circulação espontânea (RCE), no local, com uma frequência significativamente maior que aqueles em que não foi feita RCPL—26 vs 16% (
P<0.0006). Mas a probabilidade de ser admitido a uma cama hospitalar e ter alta vivo, foi apenas marginalmente melhor para os submetidos a RCPL. Para analisar a influência do ritmo de apresentação uma árvore de eventos mostrou que em 48% de casos testemunhados com RCPL o ritmo de apresentação foi VF/VT, enquanto para casos testemunhados sem RCPL, 27% eram VF/VT (
P<0.0001). Com paragens não testemunhadas, 31% dos casos com RCPL apresentavam um ritmo VF/VT comparados com 18% para casos sem RCPL (
P<0.0001). O tempo de chamada para o local foi menor do que 8 minutos para 66% de todas as paragens em VF/VT.
Conclusão: As árvores de eventos, quando combinadas com o modelo Utstein, demonstraram a importância de examinar detalhadamente bases de dados para paragens cardı́acas testemunhadas e não testemunhadas quando se monitorizam padrões de desempenho. As análises também enfatizaram a importância de programas comunitários para ensino de competências em Suporte Básico de Vida na Grande Londres.
Objetivo: La red de servicios nacionales británicos(NSF) para la enfermedad cardı́aca recomendó el ‘estilo Utstein’ para revisar los paros cardı́acos extrahospitalarios. La NSF también estableció estándares para tratamiento prehospitalario y tiempos de respuesta. Para mejorar la flexibilidad de Utstein, se propone una técnica tipo ‘árbol de eventos’ como herramienta de revisión. Los árboles de eventos consisten en nodos y ramas en los cuales se ponen los números, porcentajes o valores de probabilidades.
Métodos: Usando la base de datos del servicio de ambulancias de Londres (LAS) de 1997 con registro de 3759 paros cardı́acos extrahospitalarios, se analizaron 2772 paros cardiacos presenciados por testigos y no presenciados, enfocando la reanimación cardiopulmonar por testigos (BCPR) y los tiempos de respuesta.
Resultados: El templado de Utstein mostró que los paros cardı́acos presenciados en fibrilación ventricular (VF) o taquicardia ventricular (VT) que habı́an recibido reanimación cardiopulmonar por testigos alcanzaron retorno a circulación espontanea (ROSC) en la escena en forma significativamente mas frecuente que aquellos que no la recibieron—26 versus 16% (
P=0.006). pero la probabilidad de ser admitido al hospital, y ser dado de alta vivo fue solo marginalmente mejor para los que recibieron BCPR. Para examinar la influencia de la BCPR sobre el ritmo de presentación un árbol de eventos mostró que en el 48% de los paros presenciados con BCPr el ritmo de presentación fue FV/TV, mientras que en los sin BCPR el 27% se presentó en FV/TV (
P<0.0001). En los paros no presenciados, el 31% de los con BCPR estaban en VF/VT comparado con el 18% de los sin BCPR (
P<0.0001). El tiempo llamada a la escena fue menor de 8 minutos para el 60% de todos los casos en VF/VT.
Conclusión: Los árboles de eventos, cuando se combinan con el templado de Utstein, demuestran la importancia de examinar en forma comprensiva de las bases de datos de paros cardiacos presenciados y no presenciados, cuando se está examinando los estándares de desempeño. El análisis también enfatizo la relevancia de los programas comunitarios de enseñanza de destrezas que pueden salvar una vida en Londres.]]></description><identifier>ISSN: 0300-9572</identifier><identifier>EISSN: 1873-1570</identifier><identifier>DOI: 10.1016/S0300-9572(02)00343-X</identifier><identifier>PMID: 12589991</identifier><identifier>CODEN: RSUSBS</identifier><language>eng</language><publisher>Shannon: Elsevier Ireland Ltd</publisher><subject>Allied Health Personnel ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Bystander CPR ; Cardiac arrest ; Cardiopulmonary Resuscitation - mortality ; Cardiopulmonary Resuscitation - statistics & numerical data ; Electric Countershock ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Emergency medical services ; Emergency Medical Services - standards ; Emergency Medical Services - trends ; Female ; Heart Arrest - mortality ; Heart Arrest - therapy ; Humans ; Intensive care medicine ; Male ; Medical sciences ; Modelo Utstein ; Out-of-hospital CPR ; Paragem cardı́aca ; Paro cardiorespiratorio ; Quality Control ; RCP ; RCP extra-hospitalar ; RCP extrahospitalaria ; RCP por testigo ; Registries ; Residence Characteristics ; retorno a circulacion espontánea ; Retorno de circulação espontânea ; Return of spontaneous circulation ; Sensitivity and Specificity ; Servicios de emergencias médicas ; Serviços de emergência médica ; Statistics as Topic ; Survival Analysis ; Templado de Utstein ; Treatment Outcome ; United Kingdom ; Utstein template ; Volunteers</subject><ispartof>Resuscitation, 2003-02, Vol.56 (2), p.173-181</ispartof><rights>2002 Elsevier Science Ireland Ltd</rights><rights>2003 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c457t-e8cfe7d7161efc407f603edb0ed91d7737f3e33dbf4ceb875daf8c71f6b5143c3</citedby><cites>FETCH-LOGICAL-c457t-e8cfe7d7161efc407f603edb0ed91d7737f3e33dbf4ceb875daf8c71f6b5143c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0300-9572(02)00343-X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14535142$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12589991$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dowie, Robin</creatorcontrib><creatorcontrib>Campbell, Helen</creatorcontrib><creatorcontrib>Donohoe, Rachael</creatorcontrib><creatorcontrib>Clarke, Patricia</creatorcontrib><title>‘Event tree’ analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR</title><title>Resuscitation</title><addtitle>Resuscitation</addtitle><description><![CDATA[Objective: The British National Service Framework (NSF) for heart disease commended the ‘Utstein style’ for auditing out-of-hospital cardiac arrests. The NSF also set standards for pre-hospital treatment and response times. To increase the flexibility of Utstein, an ‘event tree’ technique is proposed as an audit tool. Event trees consist of nodes and branches on which numbers, percentages or probability values are entered.
Methods: Using the London Ambulance Service's (LAS) 1997 database on 3759 out-of-hospital cardiac arrests, 2772 arrests witnessed by lay bystanders or unwitnessed were analysed focusing on bystander cardiopulmonary resuscitation (BCPR) and response times.
Results: The Utstein template showed that witnessed arrests in ventricular fibrillation (VF) or ventricular tachycardia (VT) who had received BCPR achieved a return of spontaneous circulation (ROSC) in the field significantly more often than non-BCPR recipients—26 versus 16% (
P=0.006). But the likelihood of being admitted to a hospital bed, and discharged alive, was only marginally better for BCPR recipients. To examine the influence of BCPR on the presenting rhythm an event tree showed that in 48% of witnessed BCPR cases the presenting rhythm was VF/VT, whereas, for witnessed non-BCPR cases, 27% were in VF/VT (
P<0.0001). With unwitnessed arrests, 31% of BCPR cases were in VF/VT compared with 18% for non-BCPR cases (
P<0.0001). Call to scene time was less than 8 min for 66% of all VF/VT arrests.
Conclusion: The event trees, when combined with the Utstein template, demonstrated the importance of examining comprehensively datasets for both witnessed and unwitnessed cardiac arrests when monitoring performance standards. The analyses also emphasised the relevance of community programmes in Greater London for teaching basic life saving skills.
Objectivo: O British National Service Framework (NSF) para doença cardı́aca recomendou o ‘Utstein style’ para auditar paragens cardı́acas extra-hospitalares. O NSF também estabeleceu padrões para tratamento e tempo de resposta pré-hospitalares. Para aumentar a flexibilidade do modelo de Utstein propomos como ferramenta de auditoria uma técnica: “árvore de eventos”. Árvores de eventos consistem em nós e ramos nos quais são introduzidos números, percentagens ou valores de probabilidades.
Métodos: Utilizando a base de dados de 1997 da London Ambulance Service's (LAS) em 3579 paragens cardı́acas extra-hospitalares foram analisadas 2772 paragens, testemunhadas por leigos ou não testemunhadas, centrando-se a análise na reanimação cardio-pulmonar por leigos (RCPL) e no tempo de resposta.
Resultados: O modelo Utstein mostrou que as paragens em fibrilhação ventricular (VF) ou taquicardia ventricular (TV) testemunhadas e submetidas a RCPL evoluı́ram para circulação espontânea (RCE), no local, com uma frequência significativamente maior que aqueles em que não foi feita RCPL—26 vs 16% (
P<0.0006). Mas a probabilidade de ser admitido a uma cama hospitalar e ter alta vivo, foi apenas marginalmente melhor para os submetidos a RCPL. Para analisar a influência do ritmo de apresentação uma árvore de eventos mostrou que em 48% de casos testemunhados com RCPL o ritmo de apresentação foi VF/VT, enquanto para casos testemunhados sem RCPL, 27% eram VF/VT (
P<0.0001). Com paragens não testemunhadas, 31% dos casos com RCPL apresentavam um ritmo VF/VT comparados com 18% para casos sem RCPL (
P<0.0001). O tempo de chamada para o local foi menor do que 8 minutos para 66% de todas as paragens em VF/VT.
Conclusão: As árvores de eventos, quando combinadas com o modelo Utstein, demonstraram a importância de examinar detalhadamente bases de dados para paragens cardı́acas testemunhadas e não testemunhadas quando se monitorizam padrões de desempenho. As análises também enfatizaram a importância de programas comunitários para ensino de competências em Suporte Básico de Vida na Grande Londres.
Objetivo: La red de servicios nacionales británicos(NSF) para la enfermedad cardı́aca recomendó el ‘estilo Utstein’ para revisar los paros cardı́acos extrahospitalarios. La NSF también estableció estándares para tratamiento prehospitalario y tiempos de respuesta. Para mejorar la flexibilidad de Utstein, se propone una técnica tipo ‘árbol de eventos’ como herramienta de revisión. Los árboles de eventos consisten en nodos y ramas en los cuales se ponen los números, porcentajes o valores de probabilidades.
Métodos: Usando la base de datos del servicio de ambulancias de Londres (LAS) de 1997 con registro de 3759 paros cardı́acos extrahospitalarios, se analizaron 2772 paros cardiacos presenciados por testigos y no presenciados, enfocando la reanimación cardiopulmonar por testigos (BCPR) y los tiempos de respuesta.
Resultados: El templado de Utstein mostró que los paros cardı́acos presenciados en fibrilación ventricular (VF) o taquicardia ventricular (VT) que habı́an recibido reanimación cardiopulmonar por testigos alcanzaron retorno a circulación espontanea (ROSC) en la escena en forma significativamente mas frecuente que aquellos que no la recibieron—26 versus 16% (
P=0.006). pero la probabilidad de ser admitido al hospital, y ser dado de alta vivo fue solo marginalmente mejor para los que recibieron BCPR. Para examinar la influencia de la BCPR sobre el ritmo de presentación un árbol de eventos mostró que en el 48% de los paros presenciados con BCPr el ritmo de presentación fue FV/TV, mientras que en los sin BCPR el 27% se presentó en FV/TV (
P<0.0001). En los paros no presenciados, el 31% de los con BCPR estaban en VF/VT comparado con el 18% de los sin BCPR (
P<0.0001). El tiempo llamada a la escena fue menor de 8 minutos para el 60% de todos los casos en VF/VT.
Conclusión: Los árboles de eventos, cuando se combinan con el templado de Utstein, demuestran la importancia de examinar en forma comprensiva de las bases de datos de paros cardiacos presenciados y no presenciados, cuando se está examinando los estándares de desempeño. El análisis también enfatizo la relevancia de los programas comunitarios de enseñanza de destrezas que pueden salvar una vida en Londres.]]></description><subject>Allied Health Personnel</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Bystander CPR</subject><subject>Cardiac arrest</subject><subject>Cardiopulmonary Resuscitation - mortality</subject><subject>Cardiopulmonary Resuscitation - statistics & numerical data</subject><subject>Electric Countershock</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</subject><subject>Emergency medical services</subject><subject>Emergency Medical Services - standards</subject><subject>Emergency Medical Services - trends</subject><subject>Female</subject><subject>Heart Arrest - mortality</subject><subject>Heart Arrest - therapy</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Modelo Utstein</subject><subject>Out-of-hospital CPR</subject><subject>Paragem cardı́aca</subject><subject>Paro cardiorespiratorio</subject><subject>Quality Control</subject><subject>RCP</subject><subject>RCP extra-hospitalar</subject><subject>RCP extrahospitalaria</subject><subject>RCP por testigo</subject><subject>Registries</subject><subject>Residence Characteristics</subject><subject>retorno a circulacion espontánea</subject><subject>Retorno de circulação espontânea</subject><subject>Return of spontaneous circulation</subject><subject>Sensitivity and Specificity</subject><subject>Servicios de emergencias médicas</subject><subject>Serviços de emergência médica</subject><subject>Statistics as Topic</subject><subject>Survival Analysis</subject><subject>Templado de Utstein</subject><subject>Treatment Outcome</subject><subject>United Kingdom</subject><subject>Utstein template</subject><subject>Volunteers</subject><issn>0300-9572</issn><issn>1873-1570</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkM9u1DAQhy1ERbeFRwD5AiqHwDiO44QLQqsClSqB-CP1Zjn2mBol8db2VtpbH4O-Xp8EL7tqj0gjzRy-mfnpI-Q5gzcMWPv2O3CAqheyPoH6NQBveHXxiCxYJ3nFhITHZHGPHJKjlH5DoUQvn5BDVouu73u2IOPdzZ_Ta5wzzRHx7uaW6lmPm-QTDY6Gda6Cqy5DWvmsR2p0tF4bqmPElKnVWb-jJszOx8nPv2i-ROqnVYhZzwa3F4ZNKrPFSJdfvz0lB06PCZ_t-zH5-fH0x_Jzdf7l09nyw3llGiFzhZ1xKK1kLUNnGpCuBY52ALQ9s1Jy6ThybgfXGBw6Kax2nZHMtYNgDTf8mLza3V3FcLUuSdXkk8Fx1DOGdVKSQ9320BdQ7EATQ0oRnVpFP-m4UQzUVrP6p1ltHSootdWsLsrei_2D9TChfdjaey3Ayz2gk9Gji8WHTw9cI3iJWhfu_Y7DouPaY1TJeCzurI9osrLB_yfKX7MznXM</recordid><startdate>20030201</startdate><enddate>20030201</enddate><creator>Dowie, Robin</creator><creator>Campbell, Helen</creator><creator>Donohoe, Rachael</creator><creator>Clarke, Patricia</creator><general>Elsevier Ireland Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20030201</creationdate><title>‘Event tree’ analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR</title><author>Dowie, Robin ; Campbell, Helen ; Donohoe, Rachael ; Clarke, Patricia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c457t-e8cfe7d7161efc407f603edb0ed91d7737f3e33dbf4ceb875daf8c71f6b5143c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Allied Health Personnel</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Bystander CPR</topic><topic>Cardiac arrest</topic><topic>Cardiopulmonary Resuscitation - mortality</topic><topic>Cardiopulmonary Resuscitation - statistics & numerical data</topic><topic>Electric Countershock</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Emergency medical services</topic><topic>Emergency Medical Services - standards</topic><topic>Emergency Medical Services - trends</topic><topic>Female</topic><topic>Heart Arrest - mortality</topic><topic>Heart Arrest - therapy</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Modelo Utstein</topic><topic>Out-of-hospital CPR</topic><topic>Paragem cardı́aca</topic><topic>Paro cardiorespiratorio</topic><topic>Quality Control</topic><topic>RCP</topic><topic>RCP extra-hospitalar</topic><topic>RCP extrahospitalaria</topic><topic>RCP por testigo</topic><topic>Registries</topic><topic>Residence Characteristics</topic><topic>retorno a circulacion espontánea</topic><topic>Retorno de circulação espontânea</topic><topic>Return of spontaneous circulation</topic><topic>Sensitivity and Specificity</topic><topic>Servicios de emergencias médicas</topic><topic>Serviços de emergência médica</topic><topic>Statistics as Topic</topic><topic>Survival Analysis</topic><topic>Templado de Utstein</topic><topic>Treatment Outcome</topic><topic>United Kingdom</topic><topic>Utstein template</topic><topic>Volunteers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dowie, Robin</creatorcontrib><creatorcontrib>Campbell, Helen</creatorcontrib><creatorcontrib>Donohoe, Rachael</creatorcontrib><creatorcontrib>Clarke, Patricia</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Resuscitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dowie, Robin</au><au>Campbell, Helen</au><au>Donohoe, Rachael</au><au>Clarke, Patricia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>‘Event tree’ analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR</atitle><jtitle>Resuscitation</jtitle><addtitle>Resuscitation</addtitle><date>2003-02-01</date><risdate>2003</risdate><volume>56</volume><issue>2</issue><spage>173</spage><epage>181</epage><pages>173-181</pages><issn>0300-9572</issn><eissn>1873-1570</eissn><coden>RSUSBS</coden><abstract><![CDATA[Objective: The British National Service Framework (NSF) for heart disease commended the ‘Utstein style’ for auditing out-of-hospital cardiac arrests. The NSF also set standards for pre-hospital treatment and response times. To increase the flexibility of Utstein, an ‘event tree’ technique is proposed as an audit tool. Event trees consist of nodes and branches on which numbers, percentages or probability values are entered.
Methods: Using the London Ambulance Service's (LAS) 1997 database on 3759 out-of-hospital cardiac arrests, 2772 arrests witnessed by lay bystanders or unwitnessed were analysed focusing on bystander cardiopulmonary resuscitation (BCPR) and response times.
Results: The Utstein template showed that witnessed arrests in ventricular fibrillation (VF) or ventricular tachycardia (VT) who had received BCPR achieved a return of spontaneous circulation (ROSC) in the field significantly more often than non-BCPR recipients—26 versus 16% (
P=0.006). But the likelihood of being admitted to a hospital bed, and discharged alive, was only marginally better for BCPR recipients. To examine the influence of BCPR on the presenting rhythm an event tree showed that in 48% of witnessed BCPR cases the presenting rhythm was VF/VT, whereas, for witnessed non-BCPR cases, 27% were in VF/VT (
P<0.0001). With unwitnessed arrests, 31% of BCPR cases were in VF/VT compared with 18% for non-BCPR cases (
P<0.0001). Call to scene time was less than 8 min for 66% of all VF/VT arrests.
Conclusion: The event trees, when combined with the Utstein template, demonstrated the importance of examining comprehensively datasets for both witnessed and unwitnessed cardiac arrests when monitoring performance standards. The analyses also emphasised the relevance of community programmes in Greater London for teaching basic life saving skills.
Objectivo: O British National Service Framework (NSF) para doença cardı́aca recomendou o ‘Utstein style’ para auditar paragens cardı́acas extra-hospitalares. O NSF também estabeleceu padrões para tratamento e tempo de resposta pré-hospitalares. Para aumentar a flexibilidade do modelo de Utstein propomos como ferramenta de auditoria uma técnica: “árvore de eventos”. Árvores de eventos consistem em nós e ramos nos quais são introduzidos números, percentagens ou valores de probabilidades.
Métodos: Utilizando a base de dados de 1997 da London Ambulance Service's (LAS) em 3579 paragens cardı́acas extra-hospitalares foram analisadas 2772 paragens, testemunhadas por leigos ou não testemunhadas, centrando-se a análise na reanimação cardio-pulmonar por leigos (RCPL) e no tempo de resposta.
Resultados: O modelo Utstein mostrou que as paragens em fibrilhação ventricular (VF) ou taquicardia ventricular (TV) testemunhadas e submetidas a RCPL evoluı́ram para circulação espontânea (RCE), no local, com uma frequência significativamente maior que aqueles em que não foi feita RCPL—26 vs 16% (
P<0.0006). Mas a probabilidade de ser admitido a uma cama hospitalar e ter alta vivo, foi apenas marginalmente melhor para os submetidos a RCPL. Para analisar a influência do ritmo de apresentação uma árvore de eventos mostrou que em 48% de casos testemunhados com RCPL o ritmo de apresentação foi VF/VT, enquanto para casos testemunhados sem RCPL, 27% eram VF/VT (
P<0.0001). Com paragens não testemunhadas, 31% dos casos com RCPL apresentavam um ritmo VF/VT comparados com 18% para casos sem RCPL (
P<0.0001). O tempo de chamada para o local foi menor do que 8 minutos para 66% de todas as paragens em VF/VT.
Conclusão: As árvores de eventos, quando combinadas com o modelo Utstein, demonstraram a importância de examinar detalhadamente bases de dados para paragens cardı́acas testemunhadas e não testemunhadas quando se monitorizam padrões de desempenho. As análises também enfatizaram a importância de programas comunitários para ensino de competências em Suporte Básico de Vida na Grande Londres.
Objetivo: La red de servicios nacionales británicos(NSF) para la enfermedad cardı́aca recomendó el ‘estilo Utstein’ para revisar los paros cardı́acos extrahospitalarios. La NSF también estableció estándares para tratamiento prehospitalario y tiempos de respuesta. Para mejorar la flexibilidad de Utstein, se propone una técnica tipo ‘árbol de eventos’ como herramienta de revisión. Los árboles de eventos consisten en nodos y ramas en los cuales se ponen los números, porcentajes o valores de probabilidades.
Métodos: Usando la base de datos del servicio de ambulancias de Londres (LAS) de 1997 con registro de 3759 paros cardı́acos extrahospitalarios, se analizaron 2772 paros cardiacos presenciados por testigos y no presenciados, enfocando la reanimación cardiopulmonar por testigos (BCPR) y los tiempos de respuesta.
Resultados: El templado de Utstein mostró que los paros cardı́acos presenciados en fibrilación ventricular (VF) o taquicardia ventricular (VT) que habı́an recibido reanimación cardiopulmonar por testigos alcanzaron retorno a circulación espontanea (ROSC) en la escena en forma significativamente mas frecuente que aquellos que no la recibieron—26 versus 16% (
P=0.006). pero la probabilidad de ser admitido al hospital, y ser dado de alta vivo fue solo marginalmente mejor para los que recibieron BCPR. Para examinar la influencia de la BCPR sobre el ritmo de presentación un árbol de eventos mostró que en el 48% de los paros presenciados con BCPr el ritmo de presentación fue FV/TV, mientras que en los sin BCPR el 27% se presentó en FV/TV (
P<0.0001). En los paros no presenciados, el 31% de los con BCPR estaban en VF/VT comparado con el 18% de los sin BCPR (
P<0.0001). El tiempo llamada a la escena fue menor de 8 minutos para el 60% de todos los casos en VF/VT.
Conclusión: Los árboles de eventos, cuando se combinan con el templado de Utstein, demuestran la importancia de examinar en forma comprensiva de las bases de datos de paros cardiacos presenciados y no presenciados, cuando se está examinando los estándares de desempeño. El análisis también enfatizo la relevancia de los programas comunitarios de enseñanza de destrezas que pueden salvar una vida en Londres.]]></abstract><cop>Shannon</cop><pub>Elsevier Ireland Ltd</pub><pmid>12589991</pmid><doi>10.1016/S0300-9572(02)00343-X</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0300-9572 |
| ispartof | Resuscitation, 2003-02, Vol.56 (2), p.173-181 |
| issn | 0300-9572 1873-1570 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_73026909 |
| source | MEDLINE; Access via ScienceDirect (Elsevier) |
| subjects | Allied Health Personnel Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Bystander CPR Cardiac arrest Cardiopulmonary Resuscitation - mortality Cardiopulmonary Resuscitation - statistics & numerical data Electric Countershock Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Emergency medical services Emergency Medical Services - standards Emergency Medical Services - trends Female Heart Arrest - mortality Heart Arrest - therapy Humans Intensive care medicine Male Medical sciences Modelo Utstein Out-of-hospital CPR Paragem cardı́aca Paro cardiorespiratorio Quality Control RCP RCP extra-hospitalar RCP extrahospitalaria RCP por testigo Registries Residence Characteristics retorno a circulacion espontánea Retorno de circulação espontânea Return of spontaneous circulation Sensitivity and Specificity Servicios de emergencias médicas Serviços de emergência médica Statistics as Topic Survival Analysis Templado de Utstein Treatment Outcome United Kingdom Utstein template Volunteers |
| title | ‘Event tree’ analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR |
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