The factor influencing the rate of ROSC for nontraumatic OHCA in New Taipei city

Development and evaluation of a virtual reality basic life support for undergraduate students in Thailand: a project by Mae Fah Luang University (MFU BLiS VR)

BACKGROUND

In traditional basic life support training for university students or the public, trainees practice simulations only once or twice during the course, potentially limiting their competence. In contrast, virtual reality allows trainees to independently study and practice as often as needed, enhancing their skills. This research and development project aimed to develop and evaluate a novel learning device, virtual reality basic life support for undergraduate students of Mae Fah Luang University (MFU BLiS VR).

METHODS

This study employed a two-group, pre- and post-test design, involving seventy students (n = 35 in each group) from Mae Fah Luang University, Thailand. Data were collected from March 2022 to January 2023. The experimental group received the MFU BLiS VR, in addition to traditional teaching, while the control group received only traditional teaching. Data analysis employed descriptive statistics, Chi-square, Mann-Whitney U test, and Wilcoxon signed ranks test.

RESULTS

"MFU BLiS VR" provided a learning experience in out-of-hospital basic life support for adult patients in four scenarios: (1) a person who was not breathing but had a pulse; (2) a person who was not breathing, had no pulse, and required defibrillation; (3) a person who was not breathing, had no pulse, and did not require defibrillation; and (4) a person with normal breathing and pulse but was unconscious. Each scenario was presented sequentially from scenario one to scenario four. The scenarios encompassed common and complex situations requiring prompt and effective bystander responses to save lives. The results revealed that the experimental group had a significantly shorter no-flow time compared to the control group (Z = -5.02, p < .001) and achieved significantly higher knowledge scores than the control group (Z = -3.39, p < .01) as well as superior practical skills (Z = -7.26, p < .001). Both groups reported the highest satisfaction levels in all aspects, with no significant differences.

CONCLUSION

MFU BLiS VR is an effective training approach for teaching and learning basic life support and the use of an automated electronic defibrillator. It captures students' attention and enhances their understanding of these essential life support skills, which are crucial for everyone.

Haemodynamic impact of aortic balloon occlusion combined with percutaneous left ventricular assist device during cardiopulmonary resuscitation in a swine model of cardiac arrest

AIM

To investigate the effect of tandem use of transient balloon occlusion of the descending aorta (AO) and percutaneous left ventricular assist device (pl-VAD) during cardiopulmonary resuscitation in a large animal model of prolonged cardiac arrest.

METHODS

Ventricular fibrillation was induced and left untreated for 8 minutes followed by 16 minutes of mechanical CPR (mCPR) in 24 swine, under general anesthesia. Animals were randomized to 3 treatment groups (n = 8 per group): A) pL-VAD (Impella CP®) B) pL-VAD+AO, and C) AO. Impella CP® and the aortic balloon catheter were inserted via the femoral arteries. mCPR was continued during treatment. Defibrillation was attempted 3 times starting at minute 28 and then every 4 minutes. Haemodynamic, cardiac function and blood gas measurements were recorded for up to 4 hours.

RESULTS

Coronary perfusion pressure (CoPP) in the pL-VAD+AO Group increased by a mean (SD) of 29.2(13.94) mmHg compared to an increase of 7.1(12.08) and 7.1(5.95) mmHg for groups pL-VAD and AO respectively (p = 0.02). Similarly, cerebral perfusion pressure (CePP) in pL-VAD+AO increased by a mean (SD) of 23.6 (6.11), mmHg compared with 0.97 (9.07) and 6.9 (7.98) mmHg for the other two groups (p < 0.001). The rate of return of spontaneous heartbeat (ROSHB) was 87.5%, 75%, and 100% for pL-VAD+AO, pL-VAD, and AO.

CONCLUSION

Combined AO and pL-VAD improved CPR hemodynamics compared to either intervention alone in this swine model of prolonged cardiac arrest.

Lactate versus Phosphate as Biomarkers to Aid Mechanical Circulatory Support Decisions in Patients with Out-of-Hospital Cardiac Arrest and Return of Spontaneous Circulation

AIMS

Identifying patients who may benefit from mechanical circulatory support (MCS) after out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) remains challenging; thus, a search for helpful biomarkers is warranted. We aimed to evaluate phosphate and lactate levels on admission regarding their associations with survival with and without MCS.

METHODS

In 224 OHCA patients who achieved ROSC, the initial phosphate and lactate levels were investigated to discriminate in-hospital mortality by receiver operating characteristic (ROC) curves. According to the Youden Index (YI) from the respective ROC, the groups were risk stratified by both biomarkers, and 30-day mortality was analyzed in patients with and without MCS.

RESULTS

Within the entire collective, MCS was not associated with a better chance of survival. Both phosphate and lactate level elevations showed good yet comparable discriminations to predict mortality (areas under the curve: 0.80 vs. 0.79, p = 0.74). In patients with initial phosphate values > 2.2 mmol/L (>YI), 30-day mortality within the MCS cohort was lower (HR 2.3, 95% CI: 1.4-3.7; p = 0.0037). In patients with lower phosphate levels and groups stratified by lactate, 30-day mortality was similar in patients with and without MCS.

CONCLUSIONS

We found a significant association between survival and MCS therapy in patients with phosphate levels above 2.2 mmol/L (Youden Index), and a similar discrimination of patient overall survival by lactate and phosphate. Prospective studies should assess the possible independent prognostic value of phosphate and its clearance for MCS efficiency.

End-Stage Renal Disease Patients Undergoing Hemodialysis Have Higher Possibility of Return of Spontaneous Circulation during Out-of-Hospital Cardiac Arrest and Non-Inferior Short-Term Survival

End-stage renal disease (ESRD) patients on long-term hemodialysis (HD) have an elevated risk of sudden cardiac death. This study hypothesizes, for the first time, that these patients have a higher odds of return of spontaneous circulation (ROSC) and subsequent better hospital-outcomes, post out-of-hospital cardiac arrest (OHCA), as opposed to non-ESRD patients. A national database from Taiwan was utilized, in which 101,876 ESRD patients undergoing HD and propensity score-matched non-ESRD patients were used to conduct two analyses: (i) Cox-proportional-hazards-regression for OHCA incidence and (ii) logistic-regression analysis of attaining ROSC after OHCA, both for ESRD patients in comparison to non-ESRD patients. Kaplan-Meier analyses were conducted to determine the difference of survival rates after ROSC between the two cohorts. ESRD patients were found to be at a higher risk of OHCA (adjusted-HR = 2.11, 95% CI: (1.89−2.36), p < 0.001); however, they were at higher odds of attaining ROSC (adjusted-OR = 2.47, 95% CI: 1.90−3.21, p < 0.001), as opposed to non-ESRDs. Further, Kaplan-Meier analysis demonstrated ESRD patients with a better 30-day hospital survival rate than non-ESRD patients. Although ESRD patients had a higher risk of OHCA, they demonstrated higher possibility of ROSC and a better short-term hospital outcome than non-ESRDs. Chronic toxin tolerance and the training of vascular-compliance during regular HD may be possible explanations for better outcomes in ESRD patients.