Letteratura scientifica selezionata sul tema "Cardiac-Arrest assistance app"

Introduction: Out-of-hospital cardiac arrest (OHCA) constitutes a significant global health burden, with a survival rate of only 10-12%. Early intervention is vital but limited by ambulance response times, low rates of bystander assistance, and access to AEDs. Smartphone technologies have been developed that crowdsource willing volunteers to nearby OHCAs in order to initiate resuscitation prior to ambulance arrival. We performed a scoping review to map the available literature on these crowdsourcing technologies and compared their key operational features. Methods: A search strategy was developed for five online databases: Medline, Cochrane, Embase, and Web of Science, as well as Google Scholar. We searched for primary studies and grey literature describing mobile phone technologies that alerted users of nearby cardiac arrests in the community. Two reviewers independently screened all articles and extracted relevant study information. Subsequently, we performed a search of the Google and Apple app stores, a general internet search, and consulted experts to identify all available technologies that might not be described in literature. We contacted developers for information on technology use and specifications to create a detailed features table. Results: We included 72 articles examining bystander alerting technologies from 15 countries worldwide, owing to the increasing importance of this topic. We identified 25 unique technologies, of which 18 were described in the included literature. Technologies were either text message-based systems (n = 4) or mobile phone applications (n = 21). Most (23/25) used global positioning systems to direct bystanders to victims and nearby AEDs. Response radii for alerts varied widely from 200m to 10km. Some technologies had advanced features such as video-conferencing with ambulance dispatch and detailed alert settings. Not all systems required volunteers to have first aid training. There were 18 studies examining effects on bystander intervention, all of which showed significant improvements using the technologies. However, only six studies assessed impact on survival outcomes. Key barriers discussed included false positive alerts, legal liability, and potential psychological impact on volunteers. Conclusion: Our review provides a comprehensive overview of crowdsourcing technologies for bystander intervention in out-of-hospital cardiac arrest. Future work in this growing field should focus on survival outcomes and methods of addressing barriers to implementation.

Introduction: ST-elevation myocardial infarction (STEMI) presenting to the ED is a significant health burden. The provision of IV morphine with doses titrated to provide comfort is recommended in the AHA STEMI Guidelines, yet there is limited evidence of safety in this setting. The primary objective of this study was to measure potential harm associated with the provision of IV morphine in STEMI patients presenting to the ED. Methods: This was a two centre retrospective chart review from an urban, inner city, academic ED with an annual census of 85,000 visits, and an affiliated community hospital with 35,000 annual visits. Consecutive patients from April 2009 to January 2015 presenting to the 2 EDs with a diagnosis of STEMI were identified in the ED database. Eight trained research assistants, blinded to the study hypothesis, used standardized data collection templates. The primary investigator double collected 20% of all data to ensure completeness and accuracy. Results: We included 311 patients with STEMI (124 received morphine [M]; 187 no morphine [nM]). The ages of the two groups were similar (mean 64 yrs [M] & 67 yrs [nM]; median 63 yrs [M] & 66 yrs [nM]; IQR 45-81 [M] and 45.5-86.5 [nM]); as were the proportion of female patients (21.0% [M] & 23.5% [nM]. The pre-STEMI Charlson comorbidity scores (mean 2.6), median time to first ECG (11 min [M] & 16 min [nM]), and mean time-to-needle for PCI (96.8 min [M] & 92.0 min [nM]) were similar between groups. The mean CCU length of stay (LOS) (9.3 days vs 6.3 days) and hospital LOS (7.4 days vs 4.6 days) were longer for patients receiving morphine than those not receiving morphine. Rates of congestive heart failure, acute kidney injury and cardiac arrest in hospital were unchanged between the groups. Unadjusted mortality was similar (10.5% [M] vs 13.3% [nM]) between groups. Binary logistic regression controlling for age, Charlson score, first and peak troponin values demonstrated an association between receiving morphine in the ED and an increased risk of death at 30 days (OR 8.1; 95% CI 7.1.-9.1). Conclusion: The provision of morphine to patients with STEMI in the ED may be associated with increased CCU and hospital LOS. When controlling for age, pre-STEMI Charlson score, first and peak troponin values, receiving morphine was associated with an increased risk of death at 30 days. Further research to elucidate this association is warranted.

<p><strong>Aim:</strong> The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery.<br /><strong>Methods:</strong> From January 2010 to December 2015, 49 patients with Stanford type A aortic dissection combined with aortic insufficiency underwent ascending aortic replacement. All patients were divided into 3 groups: valve-sparing procedures (group 1, n = 11), combined aortic valve and supracoronary ascending aortic replacement (group 2, n = 12), and Bentall procedure (group 3, n = 26). We assessed the initial status of patients, incidence of complications and efficacy of valve-sparing ascending aortic replacement.<br /><strong>Results:</strong> The hospital mortality rate was 8.2% (4/49 patients). The amount of surgical correction correlated with the initial diameter of the aorta at the level of the sinuses of Valsalva. During the hospital period, none of patients from group 1 developed aortic insufficiency exceeding Grade 2 and the vast majority of patients had trivial aortic regurgitation. The parameters of cardiopulmonary bypass, cross-clamp time and circulatory arrest time did not correlate with the initial size of the ascending aorta and aortic valve blood flow impairment, neither did they influence significantly the incidence and severity of neurological complications. The baseline size of the ascending aorta and degree of aortic regurgitation did not impact the course of the early hospital period.<br /><strong>Conclusions:</strong> Supracoronary ascending aortic replacement combined with aortic valve repair in ascending aortic dissection and aortic regurgitation is effective and safe. The initial size of the ascending aorta and aortic arch do not influence immediate results. The diameter of the aorta at the level of the sinuses of Valsalva and the condition of aortic valve leaflets could be considered as the limiting factors. Further long-term follow-up is needed.</p><div class="well well-small"><strong>Funding</strong></div><p><strong></strong> The study has been performed within the framework of the 2015-2017 government task, “Cardiovascular diseases” platform, Theme No. 4 Research on genome/cellular mechanisms responsible for aorta/aortic valve pathology development and elaboration of new methods of its multimodality treatment including hybrid technologies.<br /><strong></strong></p><p><strong>Conflict of interest</strong></p><p><strong></strong>The authors declare no conflict of interest.</p><p><strong>Acknowledgement</strong></p><p>The authors express their deep gratitude for assistance in diagnostics and management of patients with aortic pathologies, as well as in preparation of this article to A.Yu. Bakanov, PhD, Head of Research Laboratory of Perfusiology and Cardiac Protection; V.V. Volkov, Fellow of Research Laboratory of Perfusiology and Cardiac Protection; A.V. Naymushin, PhD, Head of Anesthesiology &amp; Resuscitation/ICU-2 Department; I.V. Basek, Phd, Head of X-Ray Computer Tomography Department and the specialists of X-Ray Computer Tomography Department, as well as to the employees of Research Center for Non-Coronary Heart Diseases and to specialists of cardiovascular surgery departments.</p>

Paper Setup must be in A4 size with Margin: Top 0.7”, Bottom 0.7”, Left 0.65”, 0.65”, Gutter 0”, and Gutter Position Top. Paper must be in two Columns after Authors Name with Width 8.27”, height 11.69” Spacing 0.2”. Whole paper must be with: Abstract: Time is a crucial factor in medical casualties. Emergency Medical Services (EMS) takes longer time leading to life loss, whether it’s about an accident, out of hospital cardiac arrest (OOHCA) or drug delivery during the disaster. This paper proposes an efficient way to overcome this limitation by providing a medical aid aerially via a Multipurpose Medical Drone. A Quad-copter reaches the fatality spot employing GPS, carrying a payload containing components like AED (automatic external defibrillator), ECG, Temperature and Respiratory sensor to measure critical human body parameters. The measured values will be transmitted to a nearby hospital telemetrically using GSM or Wi-Fi for analyzing a patient’s condition beforehand and for diagnosis. It can also be used to carry blood sample, critical drug depending on the situation. Drone aid can be got using the helpline or an app where location and the particularities describing the situation is entered and the aid is rendered to the required spot. This assistance can save lives preserving the precious seconds and reduces the death toll in casualties.

Introduction Early defibrillation remains the highest priority in the chain of survival for out-of-hospital cardiac arrest. Shock delivery should be performed within 5 minutes of collapse to achieve a 50% survival rate. Google Maps has been one of the most popular mobile navigation applications worldwide. Our primary objective was to assess the efficacy of Google Maps in locating nearby public automated external defibrillators (AEDs). Methods Local and non-local populations were enrolled. Participants were randomly assigned to locate AEDs with or without the assistance of Google Maps. Participants used Google Maps on the same smartphone and cellular data network, an activity tracker recorded data for distance covered and time required to retrieve the AED. AEDs were located within 150 seconds of the starting point. Results Out of 100 recruited participants there was no difference in baseline characteristics. In the local population group, Google Maps assistance did not show statistical significance in successfully locating the AED within 150 seconds. Correspondingly, the travel time also showed no difference (173.52 ± 50.99 seconds for Google Maps vs. 206.20 ± 159.53 seconds for control group). The result in the non-local population group revealed no significant difference in successfully locating AEDs within 150 seconds: Google Maps (18.52%) vs. control group (39.13%); p=0.126. The recorded travel time between the Google Maps group and control group were similar (307.59 ± 220.10 seconds vs. 284.0 ± 222.37 seconds; p=0.709). Conclusion In Thailand, using Google Maps mobile assistance was found to be unhelpful in accessing nearby public AEDs.

Background: Administrative records are the mainstay of many national surveillance and quality assessment efforts, but the ICD-9-CM recording of diagnoses are known to be of variable validity. The Recovery After In-Hospital Cardiac Arrest: Late Outcomes & Utilization (ResCU) study looks specifically at patients who survived in-hospital cardiac arrest (IHCA). A key factor in this study is to ensure that IHCA is correctly identified in order to examine the long-term outcomes of Veteran survivors. Objective: To determine the positive predictive value of ICD-9-CM codes for IHCA as compared to a gold standard of medical record review, using a standardized Eligibility Screener Questionnaire (ESQ) conducted by Masters level researchers. Methods: ICD-9-CM codes 427.5 (cardiac arrest), 99.60 (cardiopulmonary resuscitation), and 99.63 (closed chest cardiac massage) were abstracted from the electronic medical record (EMR) of patients who were discharged from any VA Medical Center between September 1, 2013 and October 31, 2013. One hour of initial training and a second hour of detailed team review of the first dozen cases took place. Subsequently, two Masters level research assistants and the project coordinator independently reviewed the patient’s EMR to confirm eligibility. The ESQ included the following questions: (1) “Did the patient have a cardiac arrest?”; (2) “Where did the cardiac arrest take place?”; (3) “What was the presenting rhythm?”; (4) “Was the patient defibrillated during the treatment of their cardiac arrest?”; (5)”Is the patient eligible for this study?”. After individual screening, reviewers logged their answers in separate documents to determine inter-rater reliability. Furthermore, the team reviewed each case collaboratively to ensure eligibility agreement. In situations where discrepancies were present, a physician investigator reviewed the case to determine eligibility. Results: There were 324 patients discharged with an IHCA code between September 1, 2013 and October 31, 2013, of which 257 were deceased. 67 patients were therefore eligible for the inclusion in this study. Of these 67, 2 (3%) were deceased and 14 (21%) did not have an IHCA. Of these 14, 11 incorrectly coded for cardiac arrest (e.g., activation of a rapid response team, defibrillation of atrial tachyarrhythmia) and 3 had a cardiac arrest outside of a VA facility as compared to a gold standard of medical record review. Thus, the positive predictive value for these conventional IHCA codes was 76% (binomial 95% CI: 0.64-0.86). The inter-rater reliability was high (86.6%, kappa = 0.64); 3 cases required physician review due to discrepancies. Conclusion: Conventional ICD-9-CM codes for IHCA provide high but imperfect positive predictive value in Veteran survivors. Rapid review of medical records by Masters level researchers is feasible to enhance the purity of samples constructed from administrative records.

BackgroundSudden cardiac arrest (SCA) in young people represents a dramatic event, often leading to severe neurologic outcomes or sudden cardiac death (SCD), and is frequently caused by genetic heart diseases. In this study, we report the results of the Tuscany registry of sudden cardiac death (ToRSADE) registry, aimed at monitoring the incidence and investigating the genetic basis of SCA and SCD occurring in subjects &lt; 50 years of age in Tuscany, Italy.Methods and resultsCreation of the ToRSADE registry allowed implementation of a repository for clinical, molecular and genetic data. For 22 patients, in whom a genetic substrate was documented or suspected, blood samples could be analyzed; 14 were collected at autopsy and 8 from resuscitated patients after SCA. Next generation sequencing (NGS) analysis revealed likely pathogenetic (LP) variants associated with cardiomyopathy (CM) or channelopathy in four patients (19%), while 17 (81%) carried variants of uncertain significance in relevant genes (VUS). In only one patient NGS confirmed the diagnosis obtained during autopsy: the p.(Asn480Lysfs*20) PKP2 mutation in a patient with arrhythmogenic cardiomyopathy (AC).ConclusionSystematic genetic screening allowed identification of LP variants in 19% of consecutive patients with SCA/SCD, including subjects carrying variants associated with hypertrophic cardiomyopathy (HCM) or AC who had SCA/SCD in the absence of structural cardiomyopathy phenotype. Genetic analysis combined with clinical information in survived patients and post-mortem evaluation represent an essential multi-disciplinary approach to manage juvenile SCD and SCA, key to providing appropriate medical and genetic assistance to families, and advancing knowledge on the basis of arrhythmogenic mechanisms in inherited cardiomyopathies and channelopathies.

The use of The aim of the study was to evaluate the effectiveness of using ISS as a learning opportunity to disseminate and trial the introduction of a new cardiac arrest proforma.We ran the scenario on two separate occasions involving 11 participants. The simulation involved a low-fidelity manikin and a simulated monitor app. Real equipment is used and the simulation is run in real-time – learners were encouraged to manage the patient as they would in real life. Learners include doctors, nurses, healthcare assistants and student nurses/doctors. Learners are briefed prior to the simulation; in this particular case, the learners were informed that we would be utilizing a cardiac arrest proforma and encouraged to use this. The learners are then debriefed using a promoting excellence and reflective learning (PEARLs) framework and discussion amongst themselves is central to the debrief framework Feedback obtained from this simulation concluded that it was a valuable learning opportunity. Figure 1 shows the results of learner responses (n = 11). The scale included was 5 (strongly agree) to 1 (strongly disagree) – an average of responses is included within the graph.Using ISS to trial our proforma allowed us to implement it within the ED. Collating feedback allowed us to make amendments to our proforma based on multi-disciplinary opinions. As well as recognizing that ISS can be used to achieve this purpose, it also provided a valuable learning opportunity. ISS can be used in future to introduce new guidelines, distribute vital information and provide learning.

Introduction High quality cardiopulmonary resuscitation (CPR) improves survival from cardiac arrest, yet CPR quality is often suboptimal, even among trained rescuers. St John Western Australia sought to gather anonymous baseline data on CPR performance by paramedics and ambulance officers in a simulation setting. Methods In a cross-sectional study, participants performed 2 minutes of CPR on a manikin. CPR quality was recorded and compared to recommended standards. Comparisons were also made between women and men. Results The final cohort comprised 1320 participants; 56% paramedics, 20% transport officers and 18% volunteer emergency medical technicians and emergency medical assistants. More than half achieved an overall score of 90% or greater. The median compression score was 96% (IQR 83–99%) while the median ventilation score was 94% (76–99%). Participants achieved the recommended chest compression fraction of ≥60% in 98% of cases. More than half of participants had 99% or more of their compressions reach a depth of ≥50 mm. Two-thirds (68%) recorded a mean compression rate in the range 100–120 compressions per minute. Although there were significant differences in the percentage of compressions deep enough (p<0.01) and the 2-minute mean compression depth (p<0.01) between men and women, the effect size was small. However, men were less likely than women to fully release pressure on the chest after compressions (p<0.01). Conclusion This study provides useful baseline data about CPR quality in a manikin model. Participants achieved relatively high scores for most CPR quality metrics and complied with CPR guidelines in the majority of cases.

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Assistance Publiques Hôpitaux de Paris (APHP) Background Congenital long QT syndrome (LQTS) is still associated with syncope and a risk of sudden cardiac death despite the dramatic reduction in mortality associated with beta-blocker therapy. Current risk stratification tools are imperfect. Objective To assess the contribution of automated scalar ECG descriptors of ventricular repolarization for arrrhythmic risk stratification in genotyped LQTS patients. Methods Patients with genotyped type 1, 2 or 3 LQTS with at least 1 digital ECG recording have been included in the study. History at diagnosis, and follow-up data were collected. Cardiac events included syncope, aborted cardiac arrest, appropriate implantable cardioverter-defibrillator therapy in VF zone, and sudden death. ECG were analyzed using the BRAVO algorithm embedded in the CalECG software, version 4.1.0. QT interval duration was manually checked but ECG descriptors of Ventricular Repolarization were fully automatic. Multivariate cox regression analysis were performed to identify parameters associated with cardiac events. Results 467 patients (58% female, median age at diagnosis=25, LQT1,2,3 54%, 39%, 7%) were followed-up during 15.2±9.2 years. Rate of cardiac event was 1.2/100 patients-year before diagnosis and 0.9/100 patients-year during follow-up. QTc duration was associated with the occurrence of cardiac events in the whole study population (HR=1.01 95%CI 1.0-1.01, p=0.03). Ventricular repolarization parameters associated with cardiac events were different according to LQTS type. Cardiac events were associated with increased time to accumulate 50% of T-wave energy (HR=1.53 95%CI 1.04-2.26, p=0.03) in LQT1 but with a decrease in T-wave slopes (ascending slope HR=0.63 95%CI 0.17-0.75, p&lt;0.01) in type 2 LQTS patients. QTc duration was not independently associated with cardiac events in genotype specific multivariate models. Conclusions T-wave morphology parameters are associated with cardiac events in a gene-specific manner. Change in T-wave symmetry and T-wave flattening are associated with cardiac events in type 1 and type 2 LQTS respectively. The descriptors of ventricular repolarization are promising parameters or risk stratification beyond QTc duration in LQTS patients.

Cette thèse adopte une perspective de recherche en sciences sociales pour examiner les usages de l'application SMSlivräddare (eng. SMSlifesaving), devenue Heartrunner, ayant pour objectif de solliciter des bénévoles à proximité de personnes presumées victimes d'un arrêt cardiaque extra-hospitalier. Cette étude de cas sur les usages de cette application médicale et de santé juxtapose les « portraits » publics de l'application, de ses utilisateurs potentiels, de leurs rôles actifs et de leurs pratiques d'usage et les témoignages des utilisateurs bénévoles. Cette analyse explore les dimensions des rôles actifs de l'application et de ses utilisateurs tels qu’ils sont délégués par les « portraits » de la technologie et tels qu’ils sont perçus par ses utilisateurs. Cette analyse rend visibles les aspects des rôles actifs et des pratiques des utilisateurs bénévoles au moment de la mise en œuvre de cette technologie dans deux premières régions, avant son adoption ultérieure dans d'autres régions de Suède ainsi qu’au Danemark. La perspective de la recherche médicale a jusqu'à présent dominé les études sur les applications de secourisme. Ces études ont évalué les résultats de l'usage de l'application par les bénévoles et se sont concentrées sur l'examen de l'efficacité de ces applications, par des indicateurs tels que le nombre d'utilisateurs arrivés sur place et le nombre de ceux qui ont participé à la réanimation des personnes victimes. Dans le même temps, ces travaux ont contribué à la construction de discours prometteurs et à des approches instrumentales appliquées pour comprendre les significations et les usages des applications médicales et de santé. En revanche, en s'appuyant sur l'analyse discursive et thématique du matériel de recherche qualitative, cette thèse cherche à mettre en évidence les perspectives des utilisateurs dans leur co-construction de la technologie de secourisme à travers leurs pratiques d'usage de l'application. Par une approche théorique socio-matérielle, elle explore de manière critique les rôles actifs des utilisateurs tels qu'ils sont délégués par les discours des développeurs du projet, des gestionnaires et des évaluateurs de cette technologie médicale et tels qu'ils sont négociés par les utilisateurs dans leurs pratiques quotidiennes. Cette thèse examine tout d'abord les « portraits » de l'application publiés en ligne, de ses utilisateurs et de leurs rôles actifs, mais aussi dans les pratiques de recrutement des utilisateurs et enfin dans une publication de recherche médicale évaluant cette technologie de secourisme. Ensuite, la thèse examine comment les bénévoles décrivent les motifs de leur décision de devenir usagers de l’application, le contexte social de leurs décisions et les significations qu'ils attribuent à leurs pratiques. Troisièmement, la thèse examine comment les récits des bénévoles, en juxtaposition avec les « portraits » en ligne de la technologie SMSlifesaving, représentent les pratiques d'usage de l'application par les bénévoles aux differentes étapes: avant la réception des notifications les informant des cas d'arrêts cardiaques, au moment de la réception de ces notifications, et après leur acceptation.Contribuant au champ de la recherche sociale critique sur les applications médicales et de santé, la thèse met en relief que les utilisateurs de l'application SMSlifesaving et les technologies qu'ils co-construisent ont des rôles actifs. Elle illustre les rôles actifs délégués et négociés par les utilisateurs ; ces derniers lorsqu'ils surmontent les dépendances quotidiennes de l'application et mesurent l'importance de leur travail bénévole, par l’intermédiaire de leur usage de l’application, par rapport à leur travail rémunéré et à leurs engagements de vie privée, développent un engagement consciencieux envers l'application et redéfinissent les promesses médicales de l'application pour les personnes victimes et leurs familles
This thesis embraces a social science research perspective to examine uses of the app SMSlivräddare (eng. SMSlifesaving), now Heartrunner, dedicated to alert volunteers nearby to assist people suspected to suffer from a cardiac arrest outside hospital. This case study of the uses of the health and medical app juxtaposes the public portrayals of the app, its prospective users, their agencies and use practices with the volunteer users’ own accounts. The analysis explores dimensions of the app’s and its users’ agencies as delegated by the technology’s portrayals and perceived by its users. It renders visible also possibly obscured aspects of the volunteer users’ agencies and practices at the time of the technology’s implementation in the two first regions, before its subsequent adoption in other Swedish regions and in Denmark. A medical research perspective has so far dominated the studies of lifesaving apps. Such research evaluates the patients’ health outcomes resulting from the app use by the volunteers and concentrates on the examination of the efficiency aspects of the app, such as how many users arrived and how many engaged in resuscitating the patients. At the same time, it contributes to the promissory discourses and instrumental approaches applied to understand the meanings and uses of health and medical apps. In contrast, building on the discourse and thematic analysis of the qualitative research material, this thesis seeks to highlight the users’ perspectives in their co-constructing of the SMSlifesaving technology through their app use practices; it embraces a socio-material theoretical approach and critically explores the users’ agencies as delegated by the discourses of the project developers, managers and evaluators of the medical technology and as negotiated by the users in their daily practices. This thesis, first, investigates the public portrayals of the app, its users and their agencies published online, in the user-recruiting practices, and in a medical research publication evaluating the SMSlifesaving technology. Next, it examines how the volunteers’ accounts describe the rationales of their entry into their SMSlifesaving app use practices, the social context embedding their entry and the meanings which they ascribe to their practices. Third, the study investigates how the volunteers’ accounts in juxtaposition to the online portrayals of the SMSlifesaving technology represent the volunteers’ app use before their receptions of the app’s notifications which inform them about cardiac-arrest cases nearby, at the time of reception of such notifications, and following acceptance of such notifications.Contributing to the field of critical social research on health and medical apps, the thesis identifies that both the SMSlifesaving app users and the technologies they co-construct have agencies. It illustrates the users’ agencies delegated and negotiated; the latter when they overcome the app everyday dependencies and judge the app-mediated volunteer work importance versus their paid work and private life commitments, develop dutiful engagement with the app and re-define the app’s medical promises for the patients and their families