Background

Emergency Cardiovascular Care (ECC) chain of survival, requires five elements to

be acted upon to improve a patient’s chance of survival from cardiac arrest:

• Immediate recognition of cardiac arrest / activation of the emergency response

system.

• Early cardiopulmonary resuscitation (CPR) with an emphasis on chest

compressions

• Rapid defibrillation

• Effective advanced life support

• Integrated post-cardiac arrest care

National Ambulance recently introduced services to the Northern Emirates

providing:

• Appropriately dispatched resources (minimising delays in delivery of care) - via

utilisation of geo-location technology.

• Early initiation of telephone CPR advice to bystanders- utilising Criteria Based

Dispatched.2

• Basic Life Support (BLS) trained clinicians, equipped with Automated External

Defibrillators (AED) – to ensure early defibrillation.

• Mechanical CPR device (LUCAS 2) - to ensure continual effective chest

compressions.3

• Supraglottic airways (iGel) – quick and easy to use airway adjunct, ensuring

minimal interruption of chest compressions.4

• Fully equipped BLS ambulances - for early transportation to advanced life

support facilities.

To evaluate adherence to the chain of survival and its effects on Return of

Spontaneous Circulation (ROSC), the interventions performed and outcomes of

resuscitation attempts were reported to the Pan-Asian Resuscitation Outcomes

Study (PAROS).

PAROS is a collaborative research group, which through the creation of a platform

helps support and stimulate research into effective strategies to improve survivalrates from cardiac arrest.5

Methods

• Post attending a cardiac arrest, clinicians completed documentation which

evidenced the care that they had provided.

• Findings were entered onto the PAROS database - rate of intervention utilisation

and ROSC rate were subsequently determined.

Conclusion

• The rate of interventions performed demonstrated overall good compliance. The

LUCAS 2 and the iGel were not always utilised, this was however attributed to

contraindications or proximity to the receiving Emergency Department.

• These preliminary findings demonstrate that the early initiation of the systematic

chain of survival by National Ambulance in the Northern Emirates, is positively

effecting cardiac arrest survival outcomes in the population studied so far.

• LUCAS 2 was applied to 71.6% of cardiac arrest patients, and utilised in 58.3%

(n=7) of patients where ROSC was reported (figure 2).

• 75% of ROSC patients had bystander CPR performed as a result of CPR advice.

• All ROSC patients had an AED applied by National Ambulance clinicians; and

75% of these patients were defibrillated pre-hospitally (figure 2).

• An overall ROSC rate of 5.2% (n=12) was recorded. 3.9% (n=9) ROSC was

observed when bystander CPR was initiated compared to only 1.3% (n=3) ROSC

when bystander CPR was not performed (figure 2).

References

1. Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, et al. Part 1: executive

summary: 2010 American Heart Association Guidelines for Cardiopulmonary

Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov;122(18 Suppl

3):S640-56.

2. Hardeland, C, Olasveengen, T.M, Lawrence, R, Garrison, D, et al. Comparison of Medical

Priority Dispatch (MPD) and Criteria Based Dispatch (CBD) Resuscitation, May 2014,

85(5):612-616

3. Rubertsson S, Karlsten R. Increased cortical cerebral blood flow with LUCAS: a new

device for mechanical chest compressions compared to standard external compressions

during experimental cardiopulmonary resuscitation. Resuscitation. 2005;65:357–63.

4. Gatward JJ, Thomas MJC, Nolan JP, Cook TM. Effect of chest compressions on the time

taken to insert airway devices in a manikin. British Journal of Anaesthesia, Aug 2008;

100(3): 351-356

5. Ong M.EH, Shin S.D, Tanaka H, Ma MH, et al. Pan-Asian Resucitation Outcomes Study

(PAROS): Rationale, methodology, and implementation. Emergency Medicine. Aug

2011,18(8);890-897.

Acknowledgements:

• Northern Emirates Emergency Medical Technicians and Ambulance Control Centre staff

who kindly cooperated with this study.

• Clinical Education & Research staff who helped collate the PAROS data – B.Corrigan,

D.Lonergan, E.Ganiieva, J.Steele, S.Bond, M.Navalta.

Implementation of Chain of Survival Initiatives to Improve

Pre-hospital Return of Spontaneous Circulation Rates

Al Hajeri A1, Minton ME1, Haskins BA1, Batt AM1, Cummins FH1,2,3

1 Clinical Education & Research, National Ambulance LLC, Abu Dhabi, UAE.2 Graduate Entry Medical School, University of Limerick, Ireland. 3 Charles Sturt University, NSW, Australia.

Figure 2. Rate of Interventions performed in cardiac arrest.2

Figure 1. The Chain of Survival1

Results

• Over a six month period National Ambulance control centre received 19,390 calls

from Northern Emirates - 232 of these were cardiac arrest incidents.

• Telephone CPR advice was offered to all callers who reported the patient was

unconscious with absent or altered breathing2 - bystander CPR was performed

in 33% (n=77) of these cases.