How can we improve the results of cardiopulmonary resuscitation in out-of-hospital cardiac arrest in children? Dispatcher-assisted cardiopulmonary resuscitation is a link in the chain of survival

Owner-witnessed cardiopulmonary resuscitation in small animal emergency veterinary medicine

OBJECTIVE To determine opinions of veterinary emergency health-care providers on the topic of owner-witnessed CPR in small animal emergency medicine and to identify reasons for opposition or support of owner-witnessed CPR. DESIGN Cross-sectional survey. SAMPLE 358 surveys completed by American College of Veterinary Emergency and Critical Care diplomates and residents as well as other emergency-care veterinarians and veterinary technicians between August 14, 2016, and September 14, 2016. PROCEDURES An internet-based survey was used to collect data on respondent demographics, CPR experience, and opinions about owner-witnessed CPR. Responses were collected, and the Fisher exact test or χ² test was used to compare distributions of various opinions toward owner-witnessed CPR among certain respondent groups. RESULTS Owner presence during CPR was opposed by 277 of 356 (77.8%) respondents, with no substantial differences among demographic groups. Respondents with ≤ 10 years of experience were less willing to allow owner presence during CPR, compared with respondents with > 10 years of experience. Respondents who worked at practices that allowed owner presence during CPR were more likely to report emotional benefit for owners. CONCLUSIONS AND CLINICAL RELEVANCE Veterinary professionals surveyed had similar concerns about owner-witnessed CPR, as has been reported by human health-care providers about family-witnessed resuscitation. However, emotional benefits from family-witnessed resuscitation in human health care have been reported, and emotional impacts of owner-witnessed CPR could be an area of research in veterinary medicine. In addition, investigation is needed to obtain more information about pet owner wishes in regard to witnessing CPR performed on their pets.

Recommendations in dispatcher-assisted bystander resuscitation from emergency call center

Dispatch-assisted bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest has been shown as an effective measure to improve the survival of this process. The development of a unified protocol for all dispatch centers of the different emergency medical services can be a first step towards this goal in our environment. The process of developing a recommendations document and the realization of posters of dispatch-assisted cardiopulmonary resuscitation, agreed by different actors and promoted by the Spanish Resuscitation Council, is presented.

Simplified dispatcher instructions improve bystander chest compression quality during simulated pediatric resuscitation

AIM

Cardiopulmonary resuscitation (CPR) quality is associated with survival outcomes after out-of-hospital cardiac arrest. The objective of this study was to evaluate the effectiveness of simplified dispatcher CPR instructions to improve the chest compression (CC) quality during simulated pediatric cardiac arrest in public places.

METHODS

Adult bystanders recruited in public places were randomized to receive one of two scripted dispatcher CPR instructions: (1) "Push as hard as you can" (PUSH HARD) or (2) "Push approximately 2 inches" (TWO INCHES). A pediatric manikin with realistic CC characteristics (similar to a 6-year-old child), and a CPR recording defibrillator was used for quantitative CC data collection during a 2-min simulated pediatric scenario. The primary outcome was average CC depth treated as a continuous variable. Secondary outcomes included compliance with American Heart Association (AHA) CPR targets. Analysis was by two-sided unpaired t-test and Chi-square test, as appropriate.

RESULTS

128 out of 140 providers screened met inclusion/exclusion criteria and all 128 consented. The average CC depth (mean (SEM)) was greater in PUSH HARD compared to TWO INCHES (43 (1) vs. 36 (1) mm, p<0.01) and met AHA targets more often (39% (25/64) vs. 20% (13/64), p=0.02). CC rates trended higher in the PUSH HARD group (93 (4) vs. 82 (4) CC/min, p=0.06). More providers did not achieve full chest recoil with PUSH HARD compared to TWO INCHES (53% (34/64) vs. 75% (48/64), p=0.01).

CONCLUSIONS

Simplified dispatcher assisted pediatric CPR instructions: "Push as hard as you can" was associated with lay bystanders providing deeper and faster CCs on a simulated, 6-year-old pediatric manikin. However, percentage of providers leaning between CC increased. The potential effect of these simplified instructions in younger children remains unanswered.