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Biomedical subjects

L Bergner

Publications and source records attributed to L Bergner.

At least 37 records · Page 2Linked to original sources
PubMed1981

The ACLS score. Predicting survival from out-of-hospital cardiac arrest.

We developed a score predictive of survival following out-of-hospital cardiac arrest from an analysis of factors associated with 611 cases. The score is calculated from four pieces of information readily obtainable by emergency personnel directly at the scene. The four items are as follow: A, arrest witnessed; C, cardiac rhythm; L, lay bystander cardiopulmonary resuscitation (CPR); S, speed (response time of paramedic unit). Among 22 patients with favorable findings on all four predictive variables (witnessed arrest, ventricular fibrillation, bystander CPR, paramedic response time less than four minutes), 15 (70%) were discharged alive. The ACLS score for this group of patients was 70%. Among 97 patients with the most unfavorable findings (whose ACLS score was 0), one (1%) was discharged. We believe the score can provide emergency personnel with a realistic appraisal of the likelihood of successful resuscitation.

Allied Health Personnel↗
PubMed1981

The costs of a suburban paramedic program in reducing deaths due to cardiac arrest.

The marginal costs per averted death of a suburban paramedic program are estimated to be approximately $42,000, when program costs are attributed entirely to cardiac arrest cases due to underlying heart disease, and indirect costs attributable to episode-related hospitalization are included, It is suggested that at $42,000 per cardiac arrest death averted the program is cost-beneficial by two criteria. First, it compares favorably with an estimate obtained from the literature of the value to the average individual of saving the life of a myocardial infarction patient. Second, the people of King County passed a cost-commensurate Paramedic Program Property Tax Levy in 1979, revealing their willingness to support the program. Results of the study should be generalized in accordance with the facts that in King County 1) the population density averages approximately 1,300 per square mile; 2) a basic emergency medical system ensures a 4-minute average response time to initiation of cardiopulmonary resuscitation; 3) a citizen-training program in cardiopulmonary resuscitation further reduces average time to initiation of basic life support; and 4) the paramedic program is designed to ensure a 10-minute average time to definitive care.

Catchment Area, Health↗
PubMed1980

Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians.

The survival rate for patients with out-of-hospital cardiac arrest is low in communities where emergency service is provided solely by emergency medical technicians. We trained such technicians in a suburban community of 79,000 to recognize and treat out-of-hospital ventricular fibrillation with up to three defibrillatory shocks without the use of medications or special airway protection. Outcomes from cardiac arrest due to underlying heart disease were determined during two periods: two years with standard care by emergency medical technicians and one year with defibrillator-trained technicians. During the period with standard care, four of 100 patients with cardiac arrest were resuscitated and discharged alive from the hospital, as compared with 10 of 54 patients during the period with defibrillator-trained technicians (P less than 0.01). In 12 of 38 patients with ventricular fibrillation, a stable perfusing cardiac rhythm followed defibrillatory shocks given by defibrillator technicians. The enhanced survival after cardiac arrest is encouraging, and further trials of defibrillation by emergency medical technicians are warranted.

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PubMed1980

Out-of-hospital cardiac arrest: improved survival with paramedic services.

Survival after out-of-hospital cardiac arrest was studied in a suburban community (population 304000) before and after addition of paramedic services. During period 1 emergency medical technicians provided basic emergency care (cardiopulmonary resuscitation at the scene of collapse and during the journey to hospital). In period 2 additional care was given at the scene of collapse by paramedics capable of advanced emergency care (defibrillation, endotracheal intubation, drugs). During the 3-yr study 585 patients with cardiac arrest caused by heart disease received prehospital emergency resuscitation. Paramedic services improved the rate of live admission to the coronary-care or intensive-care unit from 19% to 34% (p less than 0.001) and the rate of discharge from 7% to 17% (p less than 0.01). The mean time from collapse to delivery of advanced emergency care was 27.5 min during period 1 with technician services, and 7.7 min during period 2 with paramedic services. Ventricular fibrillation caused cardiac arrest in nearly all patients who survived; it occurred in 91 of the 160 (57%) patients during period 1 whose rhythms were determined and in 192 of the 343 (56%) patients during period 2. The decreased time from collapse to delivery of advanced emergency care accounted for the improved survival with paramedic services.

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PubMed1980

Management of out-of-hospital cardiac arrest. Failure of basic emergency medical technician services.

Survival after out-of-hospital cardiac arrest treated by emergency medical technicians (EMTs) with basic life support was studied in four communities with a combined population of 380,000. During a two-year period, 18 (6%) of 321 patients with cardiac arrest were resuscitated and ultimately discharged from the hospital. This figure is compared with 55 (22%) of 253 discharged in adjacent suburban communities with paramedic services. The evident factor accounting for the difference in survival rates was the time from collapse to receiving definitive care (advanced cardiac life support)--26 minutes in the EMT area compared to 7.8 minutes in the paramedic area.

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PubMed1980

Out-of-hospital cardiac arrest: a review of major studies and a proposed uniform reporting system.

The scientific literature from January 1970 to June 1979 was reviewed for articles reporting outcomes from out-of-hospital cardiac arrest treated by paramedic programs. Only articles appearing in refereed professional journals and reporting 25 or more attempted resuscitations were included. A total of 21 articles from 15 U.S. locations were found. Four separate case definitions were distinguished. Methods and reporting formats varied considerably. Few studies used an experimental or quasi-experimental design, or control or comparison groups. The range of attempted resuscitations varied from 26 to 1.106 patients. Patients admitted to hospital varied between 22 per cent and 65 per cent (mean 38 per cent, S.D. +/- 12.4 per cent). Patients discharged alive varied from 3.5 per cent to 31 per cent (mean 17.2 per cent, S.D. +/- 7.1 per cent). Post discharge survival was either not reported or reported in different formats. A simplified reporting format is proposed using factors known to be associated with successful resuscitation: 1) underlying heart disease etiology; 2) witnessed arrest; 3) cardiac rhythm of ventricular fibrillation/ventricular tachycardia; 4) hospital admission and discharge and, when possible, by time from collapse to initiation of CPR and definitive care. Uniform reporting of outcomes will improve comparability and accurate measurement of the impact of emergency programs on out-of-hospital cardiac arrest.

Allied Health Personnel↗
PubMed1979

Cardiac resuscitation in the community. Importance of rapid provision and implications for program planning.

Several time-related variables involving resuscitation from out-of-hospital cardiac arrest were studied. Short time intervals from collapse to initiation of cardiopulmonary resuscitation (CPR) and to provision of definitive care were significantly associated with survival from cardiac arrest. The two times were jointly related, and one short time without the other was unlikely to result in survival. If CPR was initiated within four minutes and if definitive care was provided within eight minutes, 43% of patients survived. If either time was exceeded, the changes of survival fell dramatically. The time to initiation of CPR and definitive care are factors directly influenced by emergency medical service program decisions. A realistic option to improve time to initiation of CPR is widespread citizen CPR training. A possible option to improve the time to definitive care is the training of emergency medical technicians in defibrillation.

Community Health Services↗
PubMed1979

Evaluation of paramedic programs using outcomes of prehospital resuscitation for cardiac arrest.

Two evaluation methods, one statistical and one comparative, were developed to assess the effectiveness of paramedic programs in King County, Washington. The outcome of hospital admission following prehospital cardiac arrest was used as a measure of effectiveness. In the statistical method, actual outcomes were compared with predicted outcomes. Predictive variables for admission were time from collapse to initiation of cardiopulmonary resuscitation and time from collapse to definitive care. Given knowledge of the predictive variables, the statistical evaluation enabled us to determine the probability of the outcome following cardiac arrest. In the comparative method, outcomes were compared with a standard in an adjacent community. Using this method, we identified program elements that could lead to improved outcome. Both evaluation methods are easily implemented.

Emergency Medical Services↗
PubMed1979

Epidemiology of cardiac arrest and resuscitation in a suburban community.

A surveillance system identified all out-of-hospital victims of cardiac arrests who received emergency aid in King County, Washington, as well as the etiologic condition and cardiac rhythm causing each arrest. During an 18-month period, 649 cardiac arrests occurred (annual incidence 7.2/10,000). Primary heart disease was the cause in 81%. Ventricular fibrillation was the associated rhythm in 57% of cardiac arrests. Based upon the incidence of cardiac arrest in the community and the likelihood of resuscitation under optimal conditions, we estimate the maximum incidence of lives saved to be 2.0/10,000 annually.

Heart Arrest↗
PubMed1979

Evaluating emergency medical services: Quasi-experimental outcome studies.

The need to evaluate expensive, dramatic, and politically sensitive emergency medical services programs when classical controlled trials are neither ethically nor practically possible can be satisfied by quasi-experimental designs. The sequential implementation of paramedic services in several suburban areas provided a natural experimental situation in which to evaluate whether addition of the service could significantly alter the outcome of cardiac emergencies compared to the basic emergency medical technician program previously available. Before measurements and after measurements were made in a study area plus two control areas: one with paramedic services in both time periods and the other with emergency medical technician service throughout. Preliminary results indicate successful resuscitation increased from 20% to 32% (p less than .05) and discharge from the hospital went from 8% to 18% (p less than .01). The implications for program and policy decisions are noted. Development of studies that evolved from this work are outlined.

Emergency Medical Services↗
PubMed1979

Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation.

As part of an evaluation of whether the addition of paramedic services can reduce mortality from out-of-hospital cardiac arrest compared to previously existing emergency medical technician (EMT) services, factors associated with successful resuscitation were studied. A surveillance system was established to identify cardiac arrest patients receiving emergency care and to collect pertinent information associated with the resuscitation. Outcomes (death, admission, and discharge) were compared in two areas with different types of prehospital emergency care (basic emergency medical technician services vs. paramedic services). During the period April 1976 through August 1977, 604 patients with out-of-hospital cardiac arrest received emergency resuscitation. Eighty-one per cent of these episodes were attributed to primary heart disease. Considered separately, four factors were found to have a significant association with higher admission and discharge rates :1) paramedic service, 2) rapid time to initiation of cardiopulmonary resuscitation (CPR), 3) rapid time to definitive care, and 4) bystander-initiated CPR. Using multivariate analysis, rapid time to initiation of CPA and rapid time to definitive care were most predictive of admission and discharge. Age was also weakly predictive of discharge. These findings suggest that if reduction in mortality is to be maximized, cardiac arrest patients must have CPR initiated within four minutes and definitive care provided within ten minutes.

Allied Health Personnel↗
PubMed1979

Paramedic programs and out-of-hospital cardiac arrest: II. Impact on community mortality.

Out-of-hospital cardiac arrest was studied in suburban King County, Washington in an attempt to determine the impact of paramedic services on community cardiac mortality. A portion of the study area received paramedic services and the remainder received basic emergency medical technician (EMT) services. A surveillance system identified all prehospital cardiac arrest incidents. The etiology and outcome were determined. Deaths due to primary heart disease (ICDA) codes 410-414) were compared to community cardiac mortality figures for the same period of time and in the paramedic and EMT areas. Between April 1, 1976 and August 31, 1977, 1,449 deaths due to primary heart disease occurred (annual rate of 19.2/10,000 in the EMT area and 13.4/10,000 in the paramedic area). For the same period, 487 patients with out-of-hospital cardiac arrest received emergency resuscitation. The annual incidence of out-of-hospital cardiac arrest was similar in the EMT and paramedic areas (5.6 and 6.0/10,000 respectively). Proportionately more lives of persons with cardiac arrest were saved in the paramedic area than in the MET area. During this 17 month period, the reduction in community cardiac mortality was 8.4 per cent in the paramedic area and 1.3 per cent in the EMT area. These findings suggest that paramedic services have a small but measurable effect on community cardiac mortality.

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