Successful cardiopulmonary resuscitation outcome reviews

Knowledge and perceptions of cardiopulmonary resuscitation amongst New Zealand podiatrists: a web-based survey

Background

Podiatrists in New Zealand have a duty of care to assist patients in an emergency, and current cardiopulmonary resuscitation (CPR) certification is a requirement for registration. However, it is unknown how competent and confident podiatrists are in administering CPR and how they would respond in an emergency. Having a health professional who has a competent knowledge of CPR and skills in basic life support, can improve survival rates from sudden cardiac arrest. Therefore, the aim of this study was to survey New Zealand podiatrists to determine their CPR knowledge and qualifications; beliefs about the application of CPR; and perceptions of their competency in CPR.

Methods

This cross-sectional study used a web-based survey. Participants were New Zealand registered podiatrists with a current annual practising certificate. The 31-item survey included questions to elicit demographic information, CPR practice and attitudes, and CPR knowledge. Responses were collected between March and August 2020.

Results

171 podiatrists responded to the survey. 16 % of the podiatrists (n = 28) had performed CPR in an emergency, with a 50 % success rate. Participants were predominantly female (n = 127, 74 %) and working in private practice (n = 140,82 %). Nearly half of respondents were younger than 40 years (n = 75,44 %) and had less than 10 years of clinical experience (n = 73, 43 %). Nearly all (n = 169,97 %) participants had received formal CPR training in the past two years, with 60 % (n = 105) receiving training in the past 12 months. Most respondents (n = 167,98 %) self-estimated their CPR ability as being effective, very effective, or extremely effective. Participants’ knowledge of CPR was variable, with the percentage of correct answers for CPR protocol statements ranging between 20 and 90 %.

Conclusions

This study provides the first insight into New Zealand podiatrists’ CPR knowledge and perceptions. Podiatrists were found to have high levels of CPR confidence but demonstrated gaps in CPR knowledge. Currently, New Zealand registered podiatrists require biennial CPR re-certification. However, resuscitation authorities in New Zealand and overseas recommend an annual update of CPR skills. Based on this study’s findings, and in line with Australia and the United Kingdom, the authors recommend a change from biennial to annual CPR re-certification for podiatrists in New Zealand.

Trial registration

The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620001144909).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-021-00481-9.

Cardiopulmonary resuscitation knowledge among nursing students: a questionnaire study

Objective:

Nurses are usually first witnesses to in-hospital sudden cardiac arrests. Training of nurses has an impact on the efficiency and outcome of cardiopulmonary resuscitation (CPR), and thus, assessment of CPR knowledge among undergraduate nurses is very important to improve training program.

Methods:

The questionnaire comprised of three parts about CPR knowledge: the first dealing with general questions to understand the importance of CPR in clinical practice; the second comprising the main goal and accuracy of CPR intervention; and the last consisting of questions targeting the indications, methods, and effectiveness of CPR. Descriptive statistics and multiple response analyses were done by IBM SPSS version 20.

Results:

The students had good knowledge about the importance of CPR in clinical practice and stood average in knowing its indications and effectiveness. The mean score was 64.62±17.84 out of 100 points. While only 11% of them were completely aware about the universal compression ventilation ratio, 16.2% were aware of the current compression depth. In addition, 21.8% of participants have only indicated the order of CPR being compression, airway, and breathing.

Conclusion:

Knowledge of CPR is good among the nursing students. However, skills of CPR have to be improved by current training programs at regular intervals. Their knowledge and practical approach have to be updated with the current guidelines in CPR.

Cardiopulmonary Resuscitation in Patients With Cancer

Cancer is the second leading cause of death in the United States, with most of these deaths taking place in the hospital setting. Discussions on end-of-life care and on cardiopulmonary resuscitation in particular are an important component in the management of patients with cancer. Clinical decision making and respect for patient autonomy dictate that health care providers provide their patients with accurate information on the expected outcomes of cardiopulmonary resuscitation. This article reviews those factors that affect the outcome of cardiopulmonary resuscitation in patients with cancer and provides recommendations on obtaining do-not-resuscitate orders in these patients.

Alterations in the corticotropin-releasing hormone (CRH) neurocircuitry: Insights into post stroke functional impairments

Although it is well accepted that changes in the regulation of the hypothalamic-pituitary adrenal (HPA) axis may increase susceptibility to affective disorders in the general population, this link has been less examined in stroke patients. Yet, the bidirectional association between depression and cardiovascular disease is strong, and stress increases vulnerability to stroke. Corticotropin-releasing hormone (CRH) is the central stress hormone of the HPA axis pathway and acts by binding to CRH receptors (CRHR) 1 and 2, which are located in several stress-related brain regions. Evidence from clinical and animal studies suggests a role for CRH in the neurobiological basis of depression and ischemic brain injury. Given its importance in the regulation of the neuroendocrine, autonomic, and behavioral correlates of adaptation and maladaptation to stress, CRH is likely associated in the pathophysiology of post stroke emotional impairments. The goals of this review article are to examine the clinical and experimental data describing (1) that CRH regulates the molecular signaling brain circuit underlying anxiety- and depression-like behaviors, (2) the influence of CRH and other stress markers in the pathophysiology of post stroke emotional and cognitive impairments, and (3) context and site specific interactions of CRH and BDNF as a basis for the development of novel therapeutic targets. This review addresses how the production and release of the neuropeptide CRH within the various regions of the mesocorticolimbic system influences emotional and cognitive behaviors with a look into its role in psychiatric disorders post stroke.

Clinical Awareness of Do's and Don'ts of Cardiopulmonary Resuscitation (CPR) Among University Medical Students-A Questionnaire Study

BACKGROUND

Medical students today are tomorrow's future doctors. One of the key skills that students should develop during their graduation training is to be prepared for emergency life saving measures like cardiopulmonary resuscitation (CPR) anytime, anywhere. The students play integral role in learning, mastering and inculcating the most pragmatic clinical skill of CPR.

OBJECTIVES

a) To evaluate the CPR awareness among undergraduate medical students. b) To screen the knowledge regarding accurate, effective CPR procedural techniques and various barriers of CPR failure in clinical practice from student perspective. c) To ascertain interest in CPR training programs and also inculcating CPR as an active part of clinical practice in future.

MATERIALS AND METHODS

The questionnaire comprised of three parts, first one dealing with general questions to know the importance of CPR in clinical practice, second one comprised of the main goal and accuracy of CPR intervention and the last segment consisted of questions targeting the indications, methods and effectiveness of CPR.

STATISTICAL ANALYSIS

Descriptive statistics and multiple response analyses were done by using SPSS 17.

RESULTS

The students had good knowledge about the importance of CPR in clinical practice and stand average in knowing its indications and effectiveness. Whereas, only 1.2% of them were completely aware about the universal compression ventilation ratio, and 20.4% were aware of the current order of CPR being compression, airway and breathing.

CONCLUSION

Though, CPR awareness is good among the students but skills of CPR have to be mastered by proper certified training programs at regular intervals and knowledge has to be updated with the changing trends in CPR.

An analysis of stratagems to reduce drowning deaths of young children in private swimming pools and spas in Victoria, Australia

This population-based retrospective case series study examined the frequency and distribution of protective stratagems (legislatively compliant safety barrier, adequate caregiver supervision, water familiarisation and early administration of cardiopulmonary resuscitation [CPR]) amongst drowning deaths of young children (0-4 years) in private swimming pools or spas in Victoria, Australia. In 65.0% (52/80) of deaths, none of the four protective stratagems were known to be present and there was only one case where all four were known to be present. This indicates that if the presence of all four stratagems is increased, this may reduce drowning in this age group and setting. While these results are positive, further examination of the presence and interaction of these stratagems for effectiveness is required. Further research is also warranted to explore the impact of enforcement of pool fencing legislation and potential associations between water familiarisation and drowning risk. In addition, a consensus on the definition of adequate supervision in needed.

CPR Skill Retention of First Aid Attendants within the Workplace

Introduction

Immediate resuscitation is necessary in order to achieve conscious survival for persons who have lost airways or pulses. However, current literature suggests that even in medically-trained personnel, CPR skills are forgotten shortly after certification.

Hypothesis/Problem

The purpose of this study was to determine the CPR skill and knowledge decay in those who are paid to respond to emergency situations within the workplace.

Methods

Using an unconscious victim scenario, the sequence and accuracy of CPR events were observed and recorded in 244 participants paid to act as first responders in large industrial or service industry settings.

Results

A significant negative correlation was observed between days since training and a pre-CPR safety check variable, periodic checks for breathing and positioning. Many of the knowledge-related assessment skills (e.g., scene safety, emergency medical system (EMS) activation) appeared to deteriorate with time, although they could be contaminated by the repetition of training in those who had recertified one or more times. Skill-based components such as landmarking for chest compressions and controlling the airway declined in a more predictable fashion.

Conclusion

The results of this study suggest that repetition may be more important than days since last trained for skill and knowledge retention, and methods of “refreshing” skills should be examined. While skills deteriorate rapidly, changing frequency of certification is not necessarily the best way to increase retention of skill and knowledge.

Anderson GS, Gaetz M, Statz C. CPR skill retention of first aid attendants within the workplace. Prehosp Disaster Med. 2012;27(4):1-7.

Hypoxisch-ischämische Enzephalopathie (HIE) nach Herz-Kreislaufstillstand (HKS) – Pathophysiologie, Prognose und Outcome eines „vernachlässigten“ Krankheitsbildes

Durch die Fortschritte in der Reanimations- und Intensivmedizin steigt die Anzahl von Patienten mit einer Hypoxisch-ischämischen Enzephalopathie (HIE). Das klinische Ausprägungsspektrum dieses Krankheitsbildes reicht von milden kognitiven Dysfunktionen bis hin zum Versterben des Patienten. Der Übersichtsartikel beleuchtet mögliche Entwicklungsverläufe dieser Patientenpopulation vom Akutstadium der Erkrankung bis in die postrehabilitative Phase unter besonderer Gewichtung der zu Grunde liegenden pathophysiologischen Mechanismen, der Prognosestellung sowie des neuropsychologischen und psychosozialen Outcomes. Dabei wird verdeutlicht, dass Verbesserungen in der akuten Rettungs- und Intensivmedizin gleichsam mit Verbesserungen des rehabilitativen und vor allem des postrehabilitativen Versorgungssystems einhergehen müssen – sowohl für Patienten als auch deren Angehörigen.

Prediction of short-term and long-term outcomes after cardiac arrest: A prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations*

OBJECTIVE

To determine the prognostic accuracy of biochemical, clinical, electrophysiological, and neuropsychological investigations in predicting outcomes after cardiac arrest.

DESIGN

Prospective study.

SETTING

Intensive care unit of the Hamburg-Eppendorf University Medical Center, Hamburg, Germany.

PATIENTS

A total of 80 patients (mean age, 63.79 +/- 15.85 yrs) after cardiopulmonary resuscitation.

INTERVENTIONS

Serial blood samples (days 2-4), clinical examinations (days 2 and 4), sensory-evoked potentials (day 4), and neuropsychological assessments (<or=1 and 6 months).

MEASUREMENTS AND MAIN RESULTS

We conducted a prospective study into the combined predictive efficacy of serum concentrations of neuron-specific enolase and protein S-100B, standardized clinical examinations, and short- and long-latency sensory-evoked potentials. For the prognostic validation, both the dichotomized 5-point Glasgow-Pittsburgh Cerebral Performance Categories (1-3, favorable outcome; 4-5, unfavorable outcome) and a comprehensive neuropsychological test battery were applied. A multivariate logistic-regression analysis resulted in a model in which 85% of the variance in the dichotomized Glasgow-Pittsburgh Cerebral Performance Categories was explained by neuron-specific enolase at day 4, clinical examination score at day 4, and age. This predictor index had a sensitivity of 92% and a specificity of 93%. In addition, 26 patients (out of 33) underwent neuropsychological testing at 6 months. Significant correlations were found with selected cognitive variables and S-100B at day 3, long-latency sensory-evoked potential at day 4, and neuropsychological bedside screening.

CONCLUSIONS

A multivariate assessment approach should be used to establish an early high-certainty prognosis after cardiac arrest. However, further prospective clinical studies are necessary to confirm this derived predictor index. In addition, an early recording of S-100B, long-latency sensory-evoked potential, and neuropsychological bedside screening reflect a cognitive long-term outcome.

Factors associated with survival and neurological outcome after cardiopulmonary resuscitation of neurosurgical intensive care unit patients

OBJECTIVE

We investigated predictors of survival and the neurological outcomes of neurosurgical patients who experienced cardiac arrest and received cardiopulmonary resuscitation after being admitted to the neurosurgical intensive care unit.

METHODS

A retrospective study was conducted of adult patients in the neurosurgical intensive care unit who had experienced cardiac arrest and received cardiopulmonary resuscitation. Factors relevant to the cardiac arrest (before and after arrest) were used to study association with survival (immediate or short-term) and neurological outcome (unconscious or conscious) via statistical methods.

RESULTS

Immediate survival was seen in 105 patients (49%), 19 survived until hospital discharge, and 11 were still alive at the conclusion of this study. Of the immediate survivors, 41 patients were conscious and 64 were unconscious. Multivariate analysis showed increased mortality in patients with infection, asystole, or resuscitation time exceeding 30 minutes (P < 0.05). Additional factors associated with high in-hospital mortality included lack of spontaneous respiration, no caloric-vestibular reflex, and unconsciousness after resuscitation (P < 0.05). In addition, neurological recovery was poor in patients with infection, asystole, no caloric-vestibular reflex, conscious recovery, or resuscitation lasting more than 30 minutes (P < 0.05).

CONCLUSION

Even after initially successful resuscitation, survival and neurological recovery is quite dismal in patients with cerebral lesions. Prognostic factors for neurosurgical patients should be assessed on an individual basis to determine medical futility in the early post-resuscitation period.

Systematic review of definitions for drowning incidents

OBJECTIVES

In preparation for the World Congress on Drowning uniform reporting consensus document of drowning incidents we reviewed systematically the medical literature for the terms and definitions used to describe drowning incidents to assess the uniformity of these terms in the medical literature.

METHODS

The search strategy included a literature search of PubMed, MEDLINE and the Cochrane Database from 1966 to April 2002, as well as a review of reference lists of identified studies and a hand search of relevant textbooks and reference works. Search terms used included drowning, near-drowning, submersion, immersion, suffocation, asphyxiation, water injuries, and aspiration. Any article with drowning as a primary focus and containing a definition of drowning was included. Study designs included experimental studies, observational studies, case control studies, reviews, letters, and editorials.

RESULTS

The search identified approximately 6000 articles. Of these 650 were reviewed and 43 articles addressing the definition of drowning were identified. We found a total of 33 different definitions to describe drowning incidents, 20 for drowning and 13 for near-drowning; along with another 13 related terms. There were at least 20 different outcome measures for drowning incidents reported.

CONCLUSIONS

A review of existing drowning literature demonstrates a lack of a standard definition of drowning and a lack of agreement on measures of outcome. This variability in definitions and outcomes makes it very difficult to assess and analyze studies both individually and as a whole and draw conclusions that will influence practice. These objective findings support the need for the drowning Utstein focus on one definition of drowning and validated measures of functional and neurological outcome.

Pediatric cardiac arrhythmias resulting in hemodynamic compromise

Cardiac arrhythmias in the pediatric population generally do not result in hemodynamic compromise. There are specific scenarios, however, in which an arrhythmia poses a higher risk of deterioration in a child's overall clinical condition. To minimize this risk, clinicians must be able to recognize promptly such arrhythmias, provide rapid clinical assessment, and establish appropriate interventions to avoid cardiac arrest. This article presents a brief overview of hemodynamics in children followed by a discussion of each of the arrhythmias that have a higher-than-usual potential for resulting in hemodynamic compromise. The electrocardiographic characteristics, specific clinical interventions, and nursing implications for each of these arrhythmias also are delineated.

The Utstein template and the effect of in-hospital decisions: the impact of do-not-attempt resuscitation status on survival to discharge statistics

BACKGROUND

Variables for reporting outcome of pre-hospital cardiac arrest have been delineated in the Utstein style template. The primary outcome statistic is survival to hospital discharge (SHD). The template allows comparisons of pre-hospital care systems and has been used to determine the benefit of pre-hospital interventions. Post-resuscitation care has not been standardized and in-hospital events that affect SHD are not considered in the template.

STUDY PURPOSE

To determine the frequency and timing with which do-not-attempt resuscitation (DNAR) status is conferred following resuscitation from pre-hospital cardiac arrest and to assess the impact of this action on SHD.

METHODS

A 4-year retrospective, observational cohort study of all adult patients successfully resuscitated from nontraumatic pre-hospital cardiac arrest and admitted to a single municipal teaching hospital. Study variables included age, witnessed arrest, bystander cardiopulmonary resuscitation (CPR), initial rhythm documented by paramedics, hospital admission rate, frequency and time at which DNAR status was conferred, and SHD.

RESULTS

Four hundred and eighteen adult patients experienced pre-hospital arrest and received standard advanced cardiac life support interventions during the study period. Seventy-nine patients (19%; 95% confidence interval (CI), 15-23%) survived to be admitted to the hospital. Fifty-four of these patients (68%; 96% CI, 57-78%) were subsequently placed in DNAR status. Only one of these patients had a living will or advanced directive prior to cardiopulmonary arrest. In 37 DNAR patients (68%; 95% CI, 54-81%), DNAR status was conferred within 24 h of hospital admission. For patients made DNAR within 24 h of admission, 38% had a witnessed arrest, 22% had ventricular fibrillation as the first documented arrest rhythm, and 29% received bystander CPR. When patients made DNAR are included in the calculation of SHD rate, the SHD rate for the study period was 5.3% (95% CI, 3.3-7.8%). If DNAR patients are excluded, the SHD was 6.1% (95% CI, 3.8-9.0%), representing a 15% increase in SHD rate.

CONCLUSION

In-hospital care and medical decision making are not considered in the Utstein template and can have a significant effect on reported survival statistics. When assessing the benefit of pre-hospital interventions, it may be preferable to consider survival to hospital admission as the primary outcome statistic until such time as post-resuscitation care after hospital admission is rigidly standardized.