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Carballo-Fazanes A, Izquierdo V, Mayordomo-Colunga J, Unzueta-Roch JL, Rodríguez-Núñez A. Knowledge and skills of pediatric residents in managing pediatric foreign body airway obstruction using novel airway clearance devices in Spain: A randomized simulation trial. Resusc Plus 2024; 19:100695. [PMID: 39035409 PMCID: PMC11259953 DOI: 10.1016/j.resplu.2024.100695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/23/2024] Open
Abstract
Aim Recent emergence of airway clearance devices (ACDs) as a treatment alternative for foreign body airway obstructions (FBAO) lacks substantial evidence on efficacy and safety. This study aimed to assess pediatric residents' knowledge and skills in managing a simulated pediatric choking scenario, adhering to recommended protocols, and using LifeVac© and DeCHOKER© ACDs. Methods Randomized controlled simulation trial, in which 60 pediatric residents from 3 different hospitals (median age 27 [25.0-29.9]; 76.7% female) were asked to solve an unannounced pediatric simulated choking scenario using three interventions to manage (randomized order): 1) following the recommended protocol of the European Resuscitation Council (encouraging to cough or combination of back blows and abdominal thrusts); 2) using LifeVac©; and 3) using DeCHOKER©. A Little Anne QCPR™ manikin (Laerdal Medical) was used. The variable compliance rate (%) was calculated according to the correct/incorrect execution of the steps constituting the proper actions for each test. Results Participants demonstrated a correct compliance rate only ranging between 50-75% in following the recommended protocol for managing partial FBAO progressing to severe. Despite unfamiliarity with the ACDs, pediatric residents achieved rates between 75% and 100%, with no significant difference noted between the two devices (p = 0.173). Both scenarios were successfully resolved in under a minute, with LifeVac© demonstrating a significantly shorter response time compared to DeCHOKER© (39.2 [30.4-49.1] vs. 45.1s [33.7-59.2], p = 0.010). Conclusions Only a minority of pediatric residents were able to adhere to the recommended FBAO protocol, whereas 70% of them were able to adequately use the ACDs. However, since a significant proportion could not, it seems that ACDs themselves do not address all issues.
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Affiliation(s)
- Aida Carballo-Fazanes
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
- Simulation, Life Support, and Intensive Care Research Unit (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Faculty of Nursing. University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Verónica Izquierdo
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
- Simulation, Life Support, and Intensive Care Research Unit (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Juan Mayordomo-Colunga
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
- Pediatric Intensive Care Unit. Hospital Universitario Central de Asturias, Oviedo, Spain
- University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red (CIBER) – Enfermedades Respiratorias. Instituto de Salud Carlos III, Madrid, Spain
| | - José Luis Unzueta-Roch
- Pediatric Intensive Care Unit. Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
- Simulation, Life Support, and Intensive Care Research Unit (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Faculty of Nursing. University of Santiago de Compostela, Santiago de Compostela, Spain
- Pediatric Critical, Intermediate and Palliative Care Unit, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
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Aldridge ES, Ball S, Birnie T, Perera N, Whiteside A, Bray J, Finn J. The association of out-of-hospital cardiac arrest barriers to cardiopulmonary resuscitation initiation and continuation during the emergency call: A retrospective cohort study. Resusc Plus 2024; 19:100702. [PMID: 39035412 PMCID: PMC11260372 DOI: 10.1016/j.resplu.2024.100702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 06/16/2024] [Indexed: 07/23/2024] Open
Abstract
Background In a previous study, we identified eight types of potential barriers to bystander cardiopulmonary resuscitation (CPR) initiation and continuation until the arrival of emergency medical services (EMS) on scene, in the context of emergency calls for out-of-hospital cardiac arrest (OHCA). Many cases had multiple barriers. In this study, we aimed to estimate the independent effects of these barriers after adjusting for case characteristics. Methods We used data for the 295 non-trauma OHCAs from the St John Western Australian (SJ-WA) OHCA Database. Excluded cases were: EMS-witnessed OHCA, callers not with/close to the patient, OHCA not recognised during the emergency call, bystander CPR in progress prior to the call and calls coded as obvious death by SJ-WA. We conducted two multivariable logistic regression models including the eight barriers (callers: 1) perceived inappropriateness of CPR, 2) emotional distress, 3) reluctance to perform CPR, 4) physical limitations, 5) access to the patient, 6) leaving the scene, 7) communication failure, and 8) on-scene distractions) and case characteristics. Results The callers perceiving CPR as inappropriate (adjusted odds ratio [AOR] = 0.20, 0.11-0.37) and witnessed arrest (AOR = 2.88, 95% CI 1.48-5.60) were independently associated with CPR initiation. Caller distractions such as performing other tasks or relaying information to other bystanders were negatively significantly associated with callers continuing CPR to EMS arrival (AOR = 0.27, 0.10-0.73). Conclusions Perceptions of inappropriateness and caller distractions were independent risk factors for the delivery of bystander CPR. Further research around how call-takers navigate these barriers and encourage callers should be performed.
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Affiliation(s)
- Emogene S Aldridge
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- St John Western Australia, Western Australia, Australia
| | - Tanya Birnie
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
| | - Nirukshi Perera
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
| | - Austin Whiteside
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- St John Western Australia, Western Australia, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia
- St John Western Australia, Western Australia, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
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3
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Kim T, Suh GJ, Kim KS, Kim H, Park H, Kwon WY, Park J, Sim J, Hur S, Lee JC, Shin DA, Cho WS, Kim BJ, Kwon S, Lee YJ. Development of artificial intelligence-driven biosignal-sensitive cardiopulmonary resuscitation robot. Resuscitation 2024; 202:110354. [PMID: 39122176 DOI: 10.1016/j.resuscitation.2024.110354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/16/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
AIM OF THE STUDY We evaluated whether an artificial intelligence (AI)-driven robot cardiopulmonary resuscitation (CPR) could improve hemodynamic parameters and clinical outcomes. METHODS We developed an AI-driven CPR robot which utilizes an integrated feedback system with an AI model predicting carotid blood flow (CBF). Twelve pigs were assigned to the AI robot group (n = 6) and the LUCAS 3 group (n = 6). They underwent 6 min of CPR after 7 min of ventricular fibrillation. In the AI robot group, the robot explored for the optimal compression position, depth and rate during the first 270-second period, and continued CPR with the optimal setup during the next 90-second period and beyond. The primary outcome was CBF during the last 90-second period. The secondary outcomes were coronary perfusion pressure (CPP), end-tidal carbon dioxide level (ETCO2) and return of spontaneous circulation (ROSC). RESULTS The AI model's prediction performance was excellent (Pearson correlation coefficient = 0.98). CBF did not differ between the two groups [estimate and standard error (SE), -23.210 ± 20.193, P = 0.250]. CPP, ETCO2 level and rate of ROSC also did not show difference [estimate and SE, -0.214 ± 7.245, P = 0.976 for CPP; estimate and SE, 1.745 ± 3.199, P = 0.585 for ETCO2; 5/6 (83.3%) vs. 4/6 (66.7%), P = 1.000 for ROSC). CONCLUSION This study provides proof of concept that an AI-driven CPR robot in porcine cardiac arrest is feasible. Compared to a LUCAS 3, an AI-driven CPR robot produced comparable hemodynamic and clinical outcomes.
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Affiliation(s)
- Taegyun Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Research Center for Disaster Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Gil Joon Suh
- Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Research Center for Disaster Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Research Center for Disaster Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Hayoung Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Heesu Park
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Woon Yong Kwon
- Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Research Center for Disaster Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Jaeheung Park
- Graduate School of Convergence Science and Technology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea; Advanced Institutes of Convergence Technology, 145 Gwanggyo-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16229, Republic of Korea.
| | - Jaehoon Sim
- Graduate School of Convergence Science and Technology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Sungmoon Hur
- Graduate School of Convergence Science and Technology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Jung Chan Lee
- Research Center for Disaster Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea; Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Biomedical Engineering and Innovative Medical Technology Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Dong Ah Shin
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Woo Sang Cho
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Byung Jun Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Soyoon Kwon
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Ye Ji Lee
- Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
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Lavonas EJ. Naloxone for cardiac arrest: Provocative results and important new questions (invited commentary). Resuscitation 2024; 202:110353. [PMID: 39116990 DOI: 10.1016/j.resuscitation.2024.110353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Affiliation(s)
- Eric J Lavonas
- Department of Emergency Medicine and Rocky Mountain Poison and Drug Safety, Denver Health, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
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Vallianatou L, Kapadohos T, Polikandrioti M, Sigala E, Stamatopoulou E, Kostaki EM, Stamos P, Koutsavli D, Kalogianni A. Enhancing the Chain of Survival: The Role of Smartphone Applications in Cardiopulmonary Resuscitation. Cureus 2024; 16:e68600. [PMID: 39371724 PMCID: PMC11450428 DOI: 10.7759/cureus.68600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 10/08/2024] Open
Abstract
This review explores the role of smartphone applications in providing real-time guidance for cardiopulmonary resuscitation (CPR) practices and highlights their potential to improve CPR quality among laypersons. A narrative literature review was conducted on the effectiveness of mobile CPR applications for smartphones. Studies published between 2014 and 2024 were included to ensure that new technological advances were examined. Our findings revealed that guided CPR applications significantly improve most critical parameters for efficacious resuscitation. Application users demonstrated that they achieved performance comparable to or even better than CPR-certified individuals. However, these tools have limitations, mostly related to familiarity, which may result in a delay in activating the application and, therefore, in initiating CPR. While smartphone applications are promising tools for enhancing bystander CPR, their integration into emergency medical response requires careful consideration. To fully take advantage of these applications, they should be incorporated into public health campaigns and standard CPR training. This would be even more successful if the application's functionality were standardized across different regions. Our research indicates that a combination of education and technology will likely play a major role in CPR training in the future, improving the efficacy and accessibility of life-saving measures. Smartphone applications could greatly improve the chain of survival in out-of-hospital cardiac arrest (OHCA) events. The design and accessibility of these applications as well as the integration of these applications with current emergency response frameworks should be the main areas of future research.
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Affiliation(s)
| | | | - Maria Polikandrioti
- Department of Nursing, Postgraduate Program, Applied Clinical Nursing, University of West Attica, Athens, GRC
| | - Evangelia Sigala
- Nursing Education Office, Evangelismos General Hospital, Athens, GRC
| | | | | | - Pavlos Stamos
- Informatics, Hellenic American University, Athens, GRC
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6
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Kill C, Manegold RK, Fistera D, Risse J. Airway management and ventilation techniques in resuscitation during advanced life support: an update. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:58. [PMID: 39182146 PMCID: PMC11344389 DOI: 10.1186/s44158-024-00195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
For many years, ventilation has been an essential part of advanced life support (ALS) in cardiopulmonary resuscitation (CPR). Nevertheless, there is little evidence about the best method of ventilation during resuscitation for both out-of-hospital cardiac arrest (OHCA) and inhospital cardiac arrest (IHCA) patients. Effective ventilation is one of the two main keys to successful resuscitation. In this context, the question always arises as to which airway management, along with which ventilation mode, constitutes the best strategy. Conventional ventilation modes are not designed for cardiac arrest and show important limitations that must be considered when used in CPR. Manual ventilation without the use of an automated transport ventilator (ATV) could be shown to be uncontrolled in applied volumes and pressures and should be avoided. Mechanical ventilation with an ATV is therefore superior to manual ventilation, but both volume- and pressure-controlled ventilation modes are significantly influenced by chest compressions. With the newly designed chest compression synchronized ventilation (CCSV), a special ventilation mode for resuscitation is available. Further research should be conducted to obtain more evidence of the effect of ventilation during CPR on outcomes following OHCA and not only about how to secure the airway for ventilation during CPR.
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Affiliation(s)
- Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
| | - Randi Katrin Manegold
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
| | - David Fistera
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
| | - Joachim Risse
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany.
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany.
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Shepard LN, Nadkarni VM, Ng KC, Scholefield BR, Ong GY. ILCOR pediatric life support recommendations translation to constituent council guidelines: An emphasis on similarities and differences. Resuscitation 2024; 201:110247. [PMID: 38777078 DOI: 10.1016/j.resuscitation.2024.110247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
The International Liaison Committee on Resuscitation (ILCOR) performs rigorous scientific evidence evaluation and publishes Consensus on Science with Treatment Recommendations. These evidence-based recommendations are incorporated by ILCOR constituent resuscitation councils to inform regional guidelines, and further translated into training approaches and materials and implemented by laypersons and healthcare providers in- and out-of-hospital. There is variation in council guidelines as a result of the weak strength of evidence and interpretation. In this manuscript, we highlight ten important similarities and differences in regional council pediatric resuscitation guidelines, and further emphasize three differences that identify key knowledge gaps and opportunity for "natural experiments."
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Affiliation(s)
- Lindsay N Shepard
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Kee-Chong Ng
- Department of Pediatric Emergency Medicine, Kandang Kerbau Women's and Children's Hospital, Singapore.
| | | | - Gene Y Ong
- Department of Pediatric Emergency Medicine, Kandang Kerbau Women's and Children's Hospital, Singapore.
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8
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Perkins GD, Neumar R, Hsu CH, Hirsch KG, Aneman A, Becker LB, Couper K, Callaway CW, Hoedemaekers CWE, Lim SL, Meurer W, Olasveengen T, Sekhon MS, Skrifvars M, Soar J, Tsai MS, Vengamma B, Nolan JP. Improving Outcomes After Post-Cardiac Arrest Brain Injury: A Scientific Statement From the International Liaison Committee on Resuscitation. Resuscitation 2024; 201:110196. [PMID: 38932555 DOI: 10.1016/j.resuscitation.2024.110196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
This scientific statement presents a conceptual framework for the pathophysiology of post-cardiac arrest brain injury, explores reasons for previous failure to translate preclinical data to clinical practice, and outlines potential paths forward. Post-cardiac arrest brain injury is characterized by 4 distinct but overlapping phases: ischemic depolarization, reperfusion repolarization, dysregulation, and recovery and repair. Previous research has been challenging because of the limitations of laboratory models; heterogeneity in the patient populations enrolled; overoptimistic estimation of treatment effects leading to suboptimal sample sizes; timing and route of intervention delivery; limited or absent evidence that the intervention has engaged the mechanistic target; and heterogeneity in postresuscitation care, prognostication, and withdrawal of life-sustaining treatments. Future trials must tailor their interventions to the subset of patients most likely to benefit and deliver this intervention at the appropriate time, through the appropriate route, and at the appropriate dose. The complexity of post-cardiac arrest brain injury suggests that monotherapies are unlikely to be as successful as multimodal neuroprotective therapies. Biomarkers should be developed to identify patients with the targeted mechanism of injury, to quantify its severity, and to measure the response to therapy. Studies need to be adequately powered to detect effect sizes that are realistic and meaningful to patients, their families, and clinicians. Study designs should be optimized to accelerate the evaluation of the most promising interventions. Multidisciplinary and international collaboration will be essential to realize the goal of developing effective therapies for post-cardiac arrest brain injury.
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Hasanin A, Sanfilippo F, Dünser MW, Ahmed HM, Zieleskiewicz L, Myatra SN, Mostafa M. The MINUTES bundle for the initial 30 min management of undifferentiated circulatory shock: an expert opinion. Int J Emerg Med 2024; 17:96. [PMID: 39054461 PMCID: PMC11270766 DOI: 10.1186/s12245-024-00660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Acute circulatory shock is a life-threatening emergency requiring an efficient and timely management plan, which varies according to shock etiology and pathophysiology. Specific guidelines have been developed for each type of shock; however, there is a need for a clear timeline to promptly implement initial life-saving interventions during the early phase of shock recognition and management. A simple, easily memorable bundle of interventions could facilitate standardized management with clear targets and specified timeline. The authors propose the "MINUTES" acronym which summarizes essential interventions which should be performed within the first 30 min following shock recognition. All the interventions in the MINUTES bundle are suitable for any patient with undifferentiated shock. In addition to the acronym, we suggest a timeline for each step, balancing the feasibility and urgency of each intervention. The MINUTES acronym includes seven sequential steps which should be performed in the first 30 min following shock recognition: Maintain "ABCs", INfuse vasopressors and/or fluids (to support hemodynamic/perfusion) and INvestigate with simple blood tests, Ultrasound to detect the type of shock, Treat the underlying Etiology, and Stabilize organ perfusion.
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Affiliation(s)
- Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Filippo Sanfilippo
- University Hospital Policlinico, G. Rodolico - San Marco, Catania, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Martin W Dünser
- Department of Anaesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, Krankenhausstrasse 9, Linz, Austria
| | | | - Laurent Zieleskiewicz
- Service d'anesthésie réanimation hôpital nord Marseille APHM, C2VN Aix Marseille Université, Marseille, France
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, India
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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10
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Pellegrino JL, Back A, Chan A, Muise J. Pedagogical Implementation of Directive Feedback Manikins on Cardiopulmonary Resuscitation (CPR) Competencies: Expert Versus Peer Coaching. Cureus 2024; 16:e65181. [PMID: 39184730 PMCID: PMC11343484 DOI: 10.7759/cureus.65181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/20/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Directive feedback manikins in resuscitation training evolved faster than the pedagogical evidence. Educators and learning systems must seek clarification on the efficacy of this technology to have evidence-based practices. This project explores directive feedback device use in cardiopulmonary resuscitation (CPR) education for laypersons. METHODS A prospective nonrandomized-controlled design assessed two pedagogical approaches of directive feedback manikins in adult CPR lessons. The 230 participants were distributed between three groups: a control group without directive feedback manikins (no lights, NL), an expert coaching (EC) group with directive feedback and educator interpretation, and a peer coaching (PC) group with directive feedback, peer interpretation, and expert quality assurance. RESULTS From the 25 courses observed, average compression depth (mm) did not differ between groups (p = .498), average compression rate (compressions: minute) significantly differed between groups (p = .004), and correct hand placement did not differ between groups (p = .249). A chi-square test showed no significant association between groups and CPR skill feedback, or between groups and "recommending the course to a friend or family member." The PC group was more likely to agree that they could "coach someone to do CPR skills" than the NL or EC. CONCLUSIONS This study expands the knowledge base of directive feedback manikins in a pedagogical setting to improve CPR competencies. Training organizations may consider any of these practices effective, choosing those that align with desired outcomes. CPR educators need orientation to feedback devices as well as professional development on educational options for their use. Considerations for further research include technology costs, access, and cultural aspects of implementing these tools.
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Affiliation(s)
| | - Anna Back
- Disaster Science and Emergency Services, The University of Akron, Akron, USA
| | - Ada Chan
- Health Education Solutions, Canadian Red Cross, Ottawa, CAN
| | - Joanna Muise
- Health Education Solutions, Canadian Red Cross, Ottawa, CAN
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11
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Juul Grabmayr A, Folke F, Samsoee Kjoelbye J, Andelius L, Krammel M, Ettl F, Sulzgruber P, Krychtiuk KA, Sasson C, Stieglis R, van Schuppen H, Tan HL, van der Werf C, Torp-Pedersen C, Kjær Ersbøll A, Malta Hansen C. Incidence and Survival of Out-of-Hospital Cardiac Arrest in Public Housing Areas in 3 European Capitals. Circ Cardiovasc Qual Outcomes 2024; 17:e010820. [PMID: 38766860 PMCID: PMC11186715 DOI: 10.1161/circoutcomes.123.010820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Strategies to reach out-of-hospital cardiac arrests (called cardiac arrest) in residential areas and reduce disparities in care and outcomes are warranted. This study investigated incidences of cardiac arrests in public housing areas. METHODS This register-based cohort study included cardiac arrest patients from Amsterdam (the Netherlands) from 2016 to 2021, Copenhagen (Denmark) from 2016 to 2021, and Vienna (Austria) from 2018 to 2021. Using Poisson regression adjusted for spatial correlation and city, we compared cardiac arrest incidence rates (number per square kilometer per year and number per 100 000 inhabitants per year) in public housing and other residential areas and examined the proportion of cardiac arrests within public housing and adjacent areas (100-m radius). RESULTS Overall, 9152 patients were included of which 3038 (33.2%) cardiac arrests occurred in public housing areas and 2685 (29.3%) in adjacent areas. In Amsterdam, 635/1801 (35.3%) cardiac arrests occurred in public housing areas; in Copenhagen, 1036/3077 (33.7%); and in Vienna, 1367/4274 (32.0%). Public housing areas covered 42.4 (12.6%) of 336.7 km2 and 1 024 470 (24.6%) of 4 164 700 inhabitants. Across the capitals, we observed a lower probability of 30-day survival in public housing versus other residential areas (244/2803 [8.7%] versus 783/5532 [14.2%]). The incidence rates and rate ratio of cardiac arrest in public housing versus other residential areas were incidence rate, 16.5 versus 4.1 n/km2 per year; rate ratio, 3.46 (95% CI, 3.31-3.62) and incidence rate, 56.1 versus 36.8 n/100 000 inhabitants per year; rate ratio, 1.48 (95% CI, 1.42-1.55). The incidence rates and rate ratios in public housing versus other residential areas were consistent across the 3 capitals. CONCLUSIONS Across 3 European capitals, one-third of cardiac arrests occurred in public housing areas, with an additional third in adjacent areas. Public housing areas exhibited consistently higher cardiac arrest incidences per square kilometer and 100 000 inhabitants and lower survival than other residential areas. Public housing areas could be a key target to improve cardiac arrest survival in countries with a public housing sector.
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Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
- Department of Cardiology, Gentofte Hospital (F.F., C.M.H.), Copenhagen University, Denmark
| | - Julie Samsoee Kjoelbye
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
| | - Linn Andelius
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
| | - Mario Krammel
- PULS, Austrian Cardiac Arrest Awareness Association (M.K., F.E., P.S.)
- Emergency Medical Service Vienna, Austria (M.K.)
| | - Florian Ettl
- Department of Emergency Medicine (F.E.) Medical University of Vienna, Austria
- PULS, Austrian Cardiac Arrest Awareness Association (M.K., F.E., P.S.)
| | - Patrick Sulzgruber
- Department of Internal Medicine II, Division of Cardiology (P.S., K.A.K.) Medical University of Vienna, Austria
- PULS, Austrian Cardiac Arrest Awareness Association (M.K., F.E., P.S.)
| | - Konstantin A. Krychtiuk
- Department of Internal Medicine II, Division of Cardiology (P.S., K.A.K.) Medical University of Vienna, Austria
- Duke Clinical Research Institute, Durham, NC (K.A.K.)
| | | | - Remy Stieglis
- Department of Anesthesiology (R.S., H.v.S.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Hans van Schuppen
- Department of Anesthesiology (R.S., H.v.S.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology (H.L.T.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands (H.L.T.)
| | - Christian van der Werf
- Department of Cardiology, Heart Centre, (C.v.d.W.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, the Netherlands (C.v.d.W.)
| | - Christian Torp-Pedersen
- Department of Public Health (C.T.-P.), University of Copenhagen, Denmark
- Department of Cardiology, North Zealand Hospital, Denmark (C.T.-P.)
| | - Annette Kjær Ersbøll
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- National Institute of Public Health, University of Southern Denmark (A.K.E.)
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark (A.J.G., F.F., J.S.K., L.A., A.K.E., C.M.H.)
- Department of Clinical Medicine (A.J.G., F.F., J.S.K., C.M.H.), University of Copenhagen, Denmark
- Department of Cardiology, Gentofte Hospital (F.F., C.M.H.), Copenhagen University, Denmark
- Department of Cardiology, Rigshospitalet (C.M.H.), Copenhagen University, Denmark
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12
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Ko YC, Lin HY, Chiang WC, Yang CW, Hsieh MJ, Ma MHM. Comparing the effects of blended learning and traditional instruction on basic life support for laypersons: A randomized controlled trial. J Formos Med Assoc 2024; 123:687-692. [PMID: 37996323 DOI: 10.1016/j.jfma.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/26/2023] [Accepted: 10/19/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND/PURPOSE Blended learning offers the advantages of both instructor-led and self-instruction methods in basic life support (BLS). Our study aims to compare the effects of blended learning with those of traditional instructor-led methods on the performance of laypersons taking BLS courses. METHODS A total of 108 participants were randomly assigned to three groups: traditional instruction (group A, n = 36), blended learning with two rounds of practice (group B, n = 36), and blended learning with three rounds of practice (group C, n = 36). Group A received a 90-min lecture and a 30-min hands-on practice session using a manikin and a metronome. Participants in groups B and C received 18-min standardized online video lessons and performed hands-on practice twice and thrice, respectively. The primary outcome was chest compression at a correct speed (100-120 compressions per min) after the training course. Secondary outcomes included knowledge test scores, attitudes and confidence, and individual skill performance after training. RESULTS Patient characteristics were similar between the groups. Blended learning with practicing thrice resulted in the highest compressions at a correct speed (group A vs. B vs. C, 68.09 vs 80.03 vs 89.42, p = 0.015) and the shortest average hands-off time (group A vs. B vs. C, 1.12 vs 0.86 vs 0.17 s, p = 0.015). Both blended groups performed better in confirming environmental safety (p < 0.001). No differences in scores of the knowledge test, attitude, or confidence were noted among the three groups. CONCLUSION Blended learning with three rounds of hands-on practice may be considered an alternative teaching method.
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Affiliation(s)
- Ying-Chih Ko
- Section of Emergency Medicine, Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Hao-Yang Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Chih-Wei Yang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
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Imbriaco G, Ramacciati N. Challenges and best practices of dispatcher-assisted cardiopulmonary resuscitation: A scoping review protocol. Resusc Plus 2024; 18:100634. [PMID: 38666253 PMCID: PMC11043837 DOI: 10.1016/j.resplu.2024.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction Improved survival from out-of-hospital cardiac arrest with good neurological outcome was observed in association with dispatcher-assisted cardiopulmonary resuscitation, increasing the number of bystander-initiated resuscitations and minimizing the no-flow time in the first minutes of cardiac arrest. Objective The objective of this scoping review is to map and summarise the existing literature on dispatcher-assisted cardiopulmonary resuscitation, focusing on reported experiences, challenges, and best practices, highlighting strategies that could improve the provision of cardiopulmonary resuscitation instructions to bystanders during out-of-hospital cardiac arrest. Inclusion criteria Studies related to dispatcher-assisted cardiopulmonary resuscitation, involving human subjects, with an English abstract. The concept of interest is focused on the methods of provision of dispatcher-assisted cardiopulmonary resuscitation analysing specific experiences of implementation, challenges, and best practices, and can be generalized to any country; cultural factors, geographic features, and specific racial or gender-based differences will be analysed and discussed. Methods Four databases (PubMed, Embase, Cumulative Index to Nursing & Allied Health Literature, and the Cochrane Library) will be searched for studies published from 2018 to 2023. All study designs, including experimental and observational studies, will be assessed for inclusion. Titles and abstracts of identified citations will be screened for inclusion; subsequently, full texts of potentially relevant sources will be assessed for inclusion by two reviewers. Any disagreements between the reviewers will be resolved through discussion. Relevant grey literature (conference proceedings, government documents, and theses) will be analysed and included. Data will be extracted in a standardized form, following Joanna Briggs Institute recommendations. Results will be synthesized and reported using a narrative approach, categorising findings into themes related to the effectiveness of dispatcher-assisted cardiopulmonary resuscitation, challenges, and best practices.
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Affiliation(s)
- Guglielmo Imbriaco
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- 118 Emilia Est Emergency Medical Communication Center, Maggiore Hospital, Bologna, Italy
| | - Nicola Ramacciati
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Cosenza, Italy
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Chen Y, Zhou H, Pu C, Chen F, Xing D, Mao J, Jia L, Zhang Y. Factors influencing civil servants' willingness to implement cardiopulmonary resuscitation in Chongqing, China: Based on the theory of planned behavior. Heliyon 2024; 10:e29803. [PMID: 38694069 PMCID: PMC11061698 DOI: 10.1016/j.heliyon.2024.e29803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/15/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
Background Timely bystander cardiopulmonary resuscitation is the key to improving the survival rate of out-of-hospital cardiac arrest. Civil servants are potential bystander CPR providers. This study aimed to explore civil servants' willingness to implement CPR in Chongqing, identify the influencing factors and mechanisms affecting civil servants' willingness to perform CPR, and then seek countermeasures to improve civil servants' willingness to implement CPR. Methods We introduced the theory of perceived risk into the theory of planned behavior, developed a 7-point Likert scale based on the extended theory of planned behavior, and conducted a questionnaire survey on civil servants in Chongqing, China. Descriptive statistical analysis and one-way ANOVA were employed to explore respondents' willingness and differences. Structural equation modeling was used to analyze the relationship between attitude, subjective norm, perceived behavioral control and perceived risk and respondents' willingness to implement CPR. Results A total of 1235 valid questionnaires were included for analysis. 50.1 % of respondents were willing to implement CPR. Male, over 40 years old, living with the elderly, having previous experience performing CPR on another person, and having higher CPR knowledge scores were associated with a more positive willingness to perform CPR. Attitude, subjective norm and perceived behavioral control had significant positive effects on willingness, and the standardized regression coefficients were 0.164, 0.326 and 0.313, respectively. The perceived risk has a significant negative effect on willingness, and the standardized regression coefficient was -0.109. The four latent variables accounted for 44.2 % of the variance in the willingness of civil servants to implement CPR. Conclusions The willingness of civil servants in Chongqing to implement CPR needs to be improved, and the countermeasures to enhance the subjective norm and perceived behavioral control of civil servants should be emphasized, such as developing a social support network for rescuing conduct, establishing regular training mechanisms and improving the practical applicability and popularization of the Chinese-style "Good Samaritan Law" etc., to improve the willingness of civil servants in Chongqing to implement CPR.
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Affiliation(s)
- Ying Chen
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China, 400016
| | - Huixian Zhou
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China, 400016
| | - Chuan Pu
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China, 400016
| | - Feng Chen
- Department of Pre-Hospital Emergency, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, China, 400014
| | - Dianguo Xing
- Office of Health Emergency, Chongqing Municipal Health Commission, Chongqing, China, 401147
| | - Jiani Mao
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China, 400016
| | - Ling Jia
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China, 400016
| | - Yan Zhang
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China, 400016
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15
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Meilandt C, Qvortrup M, Bøtker MT, Folke F, Borup L, Christensen HC, Milling L, Lauridsen KG, Løfgren B. Association Between Defibrillation Using LIFEPAK 15 or ZOLL X Series and Survival Outcomes in Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study. J Am Heart Assoc 2024; 13:e033913. [PMID: 38533945 PMCID: PMC11179748 DOI: 10.1161/jaha.123.033913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Defibrillation is essential for achieving return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) with shockable rhythms. This study aimed to investigate if the type of defibrillator used was associated with ROSC in OHCA. METHODS AND RESULTS This study included adult patients with OHCA from the Danish Cardiac Arrest Registry from 2016 to 2021 with at least 1 defibrillation by the emergency medical services. We used multivariable logistic regression and a difference-in-difference analysis, including all patients with or without emergency medical services shock to assess the causal inference of using the different defibrillator models (LIFEPAK or ZOLL) for OHCA defibrillation. Among 6516 patients, 77% were male, the median age (quartile 1; quartile 3) was 70 (59; 79), and 57% achieved ROSC. In total, 5514 patients (85%) were defibrillated using LIFEPAK (ROSC: 56%) and 1002 patients (15%) were defibrillated using ZOLL (ROSC: 63%). Patients defibrillated using ZOLL had an increased adjusted odds ratio (aOR) for ROSC compared with LIFEPAK (aOR, 1.22 [95% CI, 1.04-1.43]). There was no significant difference in 30-day mortality (aOR, 1.11 [95% CI, 0.95-1.30]). Patients without emergency medical services defibrillation, but treated by ZOLL-equipped emergency medical services, had a nonsignificant aOR for ROSC compared with LIFEPAK (aOR, 1.10 [95% CI, 0.99-1.23]) and the difference-in-difference analysis was not statistically significant (OR, 1.10 [95% CI, 0.91-1.34]). CONCLUSIONS Defibrillation using ZOLL X Series was associated with increased odds for ROSC compared with defibrillation using LIFEPAK 15 for patients with OHCA. However, a difference-in-difference analysis suggested that other factors may be responsible for the observed association.
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Affiliation(s)
- Carsten Meilandt
- Prehospital Emergency Medical Services, Central Denmark RegionAarhusDenmark
- Department of Research and DevelopmentPrehospital Emergency Medical Services, Central Denmark RegionAarhusDenmark
| | - Mette Qvortrup
- Department of CardiologyViborg Regional HospitalViborgDenmark
| | - Morten Thingemann Bøtker
- Prehospital Emergency Medical Services, Central Denmark RegionAarhusDenmark
- Department of Research and DevelopmentPrehospital Emergency Medical Services, Central Denmark RegionAarhusDenmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Capital Region of DenmarkCopenhagenDenmark
- Department of CardiologyHerlev Gentofte University HospitalHerlevDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Lars Borup
- Prehospital Emergency Medical Services, North Denmark RegionAalborgDenmark
| | | | - Louise Milling
- The Prehospital Research Unit, Region of Southern DenmarkOdenseDenmark
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Kasper G. Lauridsen
- Research Center for Emergency MedicineAarhus UniversityAarhusDenmark
- Department of MedicineRanders Regional HospitalRandersDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Bo Løfgren
- Research Center for Emergency MedicineAarhus UniversityAarhusDenmark
- Department of MedicineRanders Regional HospitalRandersDenmark
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 195:109992. [PMID: 37937881 DOI: 10.1016/j.resuscitation.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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17
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Zhou Y, Zhang H, Xie C, Xu L, Huang X. Application Effect of the China Association For Disaster and Emergency Rescue Medicine - Cardiopulmonary Resuscitation and Automatic Extracorporeal Defibrillation (CADERM-CPR·D) Training in Medical Teaching. Cureus 2024; 16:e52412. [PMID: 38371089 PMCID: PMC10871542 DOI: 10.7759/cureus.52412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/20/2024] Open
Abstract
Objective In China, the penetration rate of cardiopulmonary resuscitation training is not high and the effect of traditional teaching methods is not good. In this study, the case-guided cardiopulmonary resuscitation training mode was introduced to provide cardiopulmonary resuscitation training to medical students with a certain medical background, using the 2018 technical specifications for cardiopulmonary resuscitation and automatic extracorporeal defibrillation of the China Association for Disaster and Emergency Rescue Medicine. Compared with traditional teaching methods, the application effect of this training method in clinical probation teaching was analyzed. Methods 120 medical students with a certain medical background were randomly divided into the experimental group and the control group, with 60 students in each group. The knowledge, skills, and attitude of the subjects were assessed by questionnaire survey. Results A total of 120 students were included in the study and randomly divided into an experimental group and a control group. The test scores of knowledge, skill, and attitude in the experimental group (38.40±2.775, 19.07±1.118, 14.92±0.962) were significantly higher than those in the control group (32.47±3.615, 14.65±1.338, 12.68±0.930)(P<0.05). Conclusion Case-guided cardiopulmonary resuscitation training of the China Association for Disaster and Emergency Rescue Medicine specifications can improve medical students' knowledge and skills of cardiopulmonary resuscitation, enhance their confidence in treatment, and can be further applied in medical teaching.
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Affiliation(s)
- Yaoliang Zhou
- Emergency and Disaster Medicine Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, CHN
| | - Hujie Zhang
- Emergency and Disaster Medicine Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, CHN
| | - Chuyu Xie
- Emergency and Disaster Medicine Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, CHN
| | - Li Xu
- Emergency and Disaster Medicine Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, CHN
| | - Xiaoyu Huang
- Emergency and Disaster Medicine Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, CHN
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Almeida MF, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Ong YKG, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2023; 148:e187-e280. [PMID: 37942682 PMCID: PMC10713008 DOI: 10.1161/cir.0000000000001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Restin T, Hönes M, Hummler HD, Bryant MB. Effective ventilation and chest compressions during neonatal resuscitation - the role of the respiratory device. J Matern Fetal Neonatal Med 2023; 36:2276042. [PMID: 37981750 DOI: 10.1080/14767058.2023.2276042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/21/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The success of cardiopulmonary resuscitation (CPR) in newborns largely depends on effective lung ventilation; however, a direct randomized comparison using different available devices has not yet been performed. METHODS Thirty-six professionals were exposed to a realistic newborn CPR scenario. Ventilation with either a bag-valve mask (BVM), T-piece, or ventilator was applied in a randomized manner during CPR using a Laerdal manikin. The primary outcome was the number of unimpaired inflations, defined as the peak of the inflation occurring after chest compression and lasting at least 0.35 s before the following chest compression takes place. The secondary outcomes were tidal volume delivered and heart compression rate. To simulate potential distractions, the entire scenario was performed with or without a quiz. Statistically, a mixed model assessing fixed effects for experience, profession, device, and distraction was used to analyze the data. For direct comparison, one-way ANOVA with Bonferroni's correction was applied. RESULTS The number of unimpaired inflations was highest in health care professionals using the BVM with a mean ± standard deviation of 12.8 ± 2.8 (target: 15 within 30 s). However, the tidal volumes were too large in this group with a tidal volume of 42.5 ± 10.9 ml (target: 25-30 ml). The number of unimpaired breaths with the mechanical ventilator and the T-piece system were 11.6 (±3.6) and 10.1 (±3.7), respectively. Distraction did not change these outcomes, except for the significantly lower tidal volumes with the T-piece during the quiz. CONCLUSIONS In summary, for our health care professionals, ventilation using the mechanical ventilator seemed to provide the best approach during CPR, especially in a population of preterm infants prone to volutrauma.
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Affiliation(s)
- Tanja Restin
- Department of Neonatology, University of Zurich, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Marco Hönes
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, Ulm University, Ulm, Germany
| | - Helmut D Hummler
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, Ulm University, Ulm, Germany
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, Marburg University, Marburg, Germany
| | - Manuel B Bryant
- Department of Neonatology, University of Zurich, Zurich, Switzerland
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, Ulm University, Ulm, Germany
- Kantonsspital Baden, Baden, Switzerland
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20
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Marquis A, Douillet D, Morin F, Chauvat D, Sechet A, Lacour H, Poiroux L, Savary D. Comparison of chest compression quality between the overlapping hands and interlocking hands techniques: A randomised cross-over trial. Am J Emerg Med 2023; 74:9-13. [PMID: 37729735 DOI: 10.1016/j.ajem.2023.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/06/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Performing quality chest compressions is fundamental to the management of cardiopulmonary arrest. The aim of this study was to compare the efficacy of two hand positions: overlapping versus interlocking for performing chest compressions during cardiopulmonary arrest. METHODS The HP2C (for Hands Position and Chest Compression) was a prospective, randomised, open-label, cross-over, single-centre study. Participants were recruited from the Emergency Medical Service (EMS) teams and the prehospital firefighter teams. They were randomised to start chest compressions either with overlapping or interlocking hands and then performed the other technique after a washout period. The judgement criteria were the overall chest compressions success score generated by software in accordance with ILCOR recommendations, the quality of compression, release, rate and subjective intensity measured with the Borg scale. RESULTS A total of 100 participants were included in the study. The mean age of the caregivers was 38 ± 9.3 years. The median CPR score was 79.5% IQR [48.5-94.0] in the overlapping hands group and 71% IQR [38.0-92.8] in the interlocking hands group (p-value = 0.37). There was no significant difference for the other criteria, especially no difference in term of intensity of effort. However, there was a trend towards better results with overlapping hands. CONCLUSIONS This study failed to demonstrate a difference in effectiveness between overlapping and interlocking hand chest compressions during cardiopulmonary resuscitation.
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Affiliation(s)
- Aurélien Marquis
- Centre for Emergency Care Teaching (CESU 49), Angers University Hospital, Angers, France
| | - Delphine Douillet
- Centre for Emergency Care Teaching (CESU 49), Angers University Hospital, Angers, France; Emergency Department, Angers University Hospital, Avenue de l'Hôtel Dieu, 49100 Angers, France; UMR MitoVasc CNRS 6215 INSERM 1083, University of Angers, 49100 Angers, France.
| | - François Morin
- Emergency Department, Angers University Hospital, Avenue de l'Hôtel Dieu, 49100 Angers, France
| | - Damien Chauvat
- Centre for Emergency Care Teaching (CESU 49), Angers University Hospital, Angers, France; Emergency Department, Angers University Hospital, Avenue de l'Hôtel Dieu, 49100 Angers, France
| | - Aurélien Sechet
- Centre for Emergency Care Teaching (CESU 49), Angers University Hospital, Angers, France; Emergency Department, Angers University Hospital, Avenue de l'Hôtel Dieu, 49100 Angers, France
| | - Hélène Lacour
- Centre for Emergency Care Teaching (CESU 49), Angers University Hospital, Angers, France; Emergency Department, Angers University Hospital, Avenue de l'Hôtel Dieu, 49100 Angers, France
| | - Laurent Poiroux
- Delegation to Clinical Research and Innovation, Angers University Hospital, 49100 Angers, France
| | - Dominique Savary
- Emergency Department, Angers University Hospital, Avenue de l'Hôtel Dieu, 49100 Angers, France; Inserm, EHESP, University of Rennes, Irset (Institut de Recherche en Santé, environnement et travail), UMR_S 1085, 49000 Angers, France
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21
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Ong GY, Kurosawa H, Ikeyama T, Park JD, Katanyuwong P, Reyes OC, Wu ET, Hon KLE, Maconochie IK, Shepard LN, Nadkarni VM, Ng KC. Comparison of paediatric basic life support guidelines endorsed by member councils of Resuscitation Council of Asia. Resusc Plus 2023; 16:100506. [PMID: 38033347 PMCID: PMC10685309 DOI: 10.1016/j.resplu.2023.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Background Paediatric cardiac arrest outcomes, especially for infants, remain poor. Due to different training, resource differences, and historical reasons, paediatric cardiac arrest algorithms for various Asia countries vary. While there has been a common basic life support algorithm for adults by the Resuscitation Council of Asia (RCA), there is no common RCA algorithm for paediatric life support.We aimed to review published paediatric life support guidelines from different Asian resuscitation councils. Methods Pubmed and Google Scholar search were performed for published paediatric basic and advanced life support guidelines from January 2015 to June 2023. Paediatric representatives from the Resuscitation Council of Asia were sought and contacted to provide input from September 2022 till June 2023. Results While most of the components of published paediatric life support algorithms of Asian countries are similar, there are notable variations in terms of age criteria for recommended use of adult basic life support algorithms in the paediatric population less than 18 years old, recommended paediatric chest compression depth targets, ventilation rates post-advanced airway intra-arrest, and first defibrillation dose for shockable rhythms in paediatric cardiac arrest. Conclusion This was an overview and mapping of published Asian paediatric resuscitation algorithms. It highlights similarities across paediatric life support guidelines in Asian countries. There were some differences in components of paediatric life support which highlight important knowledge gaps in paediatric resuscitation science. The minor differences in the paediatric life support guidelines endorsed by the member councils may provide a framework for prioritising resuscitation research and highlight knowledge gaps in paediatric resuscitation.
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Affiliation(s)
- Gene Y. Ong
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Hiroshi Kurosawa
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children’s Hospital, Japan
| | - Takanari Ikeyama
- Center for Pediatric Emergency and Critical Care Medicine, Aichi Children's Health and Medical Center, Japan
- Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Japan
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Poomiporn Katanyuwong
- Department of Pediatrics, Division of Cardiology, Department of Pediatric, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Olivia C.F. Reyes
- Division of Pediatric Emergency Medicine, Philippine General Hospital, Manila, Philippines
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan
| | - Kam Lun Ellis Hon
- Department of Paediatrics, CUHKMC, The Chinese University of Hong Kong, Hong Kong
- Pediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - Ian K. Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, London, United Kingdom
| | - Lindsay N. Shepard
- Department of Anesthesiology, Critical Care, and Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, United States of America
| | - Vinay M. Nadkarni
- Department of Anesthesiology, Critical Care, and Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, United States of America
| | - Kee Chong Ng
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
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Duhem H, Terzi N, Segond N, Bellier A, Sanchez C, Louis B, Debaty G, Guérin C. Effect of automated head-thorax elevation during chest compressions on lung ventilation: a model study. Sci Rep 2023; 13:20393. [PMID: 37989865 PMCID: PMC10663599 DOI: 10.1038/s41598-023-47727-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023] Open
Abstract
Our goal was to investigate the effects of head-thorax elevation (HUP) during chest compressions (CC) on lung ventilation. A prospective study was performed on seven human cadavers. Chest was automatically compressed-decompressed in flat position and during progressive HUP from 18 to 35°. Lung ventilation was measured with electrical impedance tomography. In each cadaver, 5 sequences were randomly performed: one without CC at positive end-expiratory pressure (PEEP) 0cmH2O, 3 s with CC at PEEP0, 5 or 10cmH2O and 1 with CC and an impedance threshold device at PEEP0cmH2O. The minimal-to-maximal change in impedance (VTEIT in arbitrary unit a.u.) and the minimal impedance in every breathing cycle (EELI) the) were compared between flat, 18°, and 35° in each sequence by a mixed-effects model. Values are expressed as median (1st-3rd quartiles). With CC, between flat, 18° and 35° VTEIT decreased at each level of PEEP. It was 12416a.u. (10,689; 14,442), 11,239 (7667; 13,292), and 6457 (4631; 9516), respectively, at PEEP0. The same was true with the impedance threshold device. EELI/VTEIT significantly decreased from - 0.30 (- 0.40; - 0.15) before to - 1.13 (- 1.70; - 0.61) after the CC (P = 0.009). With HUP lung ventilation decreased with CC as compared to flat position. CC are associated with decreased in EELI.
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Affiliation(s)
- Hélène Duhem
- SAMU 38, Centre Hospitalier Universitaire Grenoble Alpes, 38043, Grenoble, France
- Université de Grenoble-Alpes/CNRS, UMR 5525Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France
| | - Nicolas Terzi
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Grenoble Alpes, 38043, Grenoble, France
| | - Nicolas Segond
- SAMU 38, Centre Hospitalier Universitaire Grenoble Alpes, 38043, Grenoble, France
- Université de Grenoble-Alpes/CNRS, UMR 5525Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France
| | - Alexandre Bellier
- Université de Grenoble-Alpes/CNRS, UMR 5525Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France
| | - Caroline Sanchez
- Université de Grenoble-Alpes/CNRS, UMR 5525Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France
| | - Bruno Louis
- Institut Mondor de Recherches Biomédicales INSERM-UPEC UMR 955 Eq13 - CNRS EMR 7000, 8 rue du Général Sarrail, 94010, Créteil, France
| | - Guillaume Debaty
- SAMU 38, Centre Hospitalier Universitaire Grenoble Alpes, 38043, Grenoble, France.
- Université de Grenoble-Alpes/CNRS, UMR 5525Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France.
| | - Claude Guérin
- Institut Mondor de Recherches Biomédicales INSERM-UPEC UMR 955 Eq13 - CNRS EMR 7000, 8 rue du Général Sarrail, 94010, Créteil, France
- Faculté de médecine Lyon Est, Université de Lyon, 8 avenue Rockefeller, 69373, Lyon cedex 08, France
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23
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Anesthesia in Outpatient Facilities. J Oral Maxillofac Surg 2023; 81:E35-E50. [PMID: 37833028 DOI: 10.1016/j.joms.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Juul Grabmayr A, Folke F, Tofte Gregers MC, Kollander L, Bo N, Andelius L, Jensen TW, Ettl F, Krammel M, Sulzgruber P, Krychtiuk KA, Torp-Pedersen C, Kjær Ersbøll A, Malta Hansen C. Public Out-of-Hospital Cardiac Arrest in Residential Neighborhoods. J Am Coll Cardiol 2023; 82:1777-1788. [PMID: 37879782 DOI: 10.1016/j.jacc.2023.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/17/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Although one-half of all public out-of-hospital cardiac arrests (OHCAs) occur outside private homes in residential neighborhoods, their characteristics and outcomes remain unexplored. OBJECTIVES The authors assessed interventions before ambulance arrival and survival for public OHCA patients in residential neighborhoods. METHODS Public OHCAs from Vienna (2018-2021) and Copenhagen (2016-2020) were designated residential neighborhoods or nonresidential areas. Interventions (cardiopulmonary resuscitation [CPR], automated external defibrillator [AED] attached, and defibrillation) and 30-day survival were compared using a generalized estimation equation model adjusted for age and time of day and presented as ORs. RESULTS We included 1,052 and 654 public OHCAs from Vienna and Copenhagen, respectively, and 68% and 55% occurred in residential neighborhoods, respectively. The likelihood of CPR, defibrillation, and survival in residential neighborhoods vs nonresidential areas (reference) were as follows: CPR Vienna, 73% vs 78%, OR: 0.78 (95% CI: 0.57-1.06), CPR Copenhagen, 83% vs 90%, OR: 0.54 (95% CI: 0.34-0.88), and CPR combined, 76% vs 84%, OR: 0.70 (95% CI: 0.53-0.90); AED attached Vienna, 36% vs 44%, OR: 0.69 (95% CI: 0.53-0.90), AED attached Copenhagen, 21% vs 43%, OR: 0.33 (95% CI: 0.24-0.48), and AED attached combined, 31% vs 44%, OR: 0.53 (95% CI: 0.42-0.65); defibrillation Vienna, 14% vs 20%, OR: 0.61 (95% CI: 0.43-0.87), defibrillation Copenhagen, 16% vs 36%, OR: 0.35 (95% CI: 0.24-0.51), and defibrillation combined, 15% vs 27%, OR: 0.46 (95% CI: 0.36-0.61); and 30-day survival rate Vienna, 21% vs 26%, OR: 0.84 (95% CI: 0.58-1.20), 30-day survival rate Copenhagen, 33% vs 44%, OR: 0.65 (95% CI: 0.47-0.90), and 30-day survival rate combined, 25% vs 36%, OR: 0.73 (95% CI: 0.58-0.93). CONCLUSIONS Two-thirds of public OHCAs occurred in residential neighborhoods with fewer resuscitative efforts before ambulance arrival and lower survival than in nonresidential areas. Targeted efforts to improve early CPR and defibrillation for public OHCA patients in residential neighborhoods are needed.
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Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte, Denmark
| | - Mads Christian Tofte Gregers
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Louise Kollander
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Bo
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linn Andelius
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Theo Walter Jensen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Mario Krammel
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria; Emergency Medical Service Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria; Department of Internal Medicine II - Division of Cardiology Medical University of Vienna, Vienna, Austria
| | - Konstantin A Krychtiuk
- Department of Internal Medicine II - Division of Cardiology Medical University of Vienna, Vienna, Austria; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Christian Torp-Pedersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark
| | - Annette Kjær Ersbøll
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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25
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Haskins B, Nehme Z, Andrew E, Bernard S, Cameron P, Smith K. One-year quality-of-life outcomes of cardiac arrest survivors by initial defibrillation provider. Heart 2023; 109:1363-1371. [PMID: 36928241 DOI: 10.1136/heartjnl-2021-320559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE To assess the long-term functional and health-related quality-of-life (HRQoL) outcomes for out-of-hospital cardiac arrest (OHCA) survivors stratified by initial defibrillation provider. METHODS This retrospective study included adult non-traumatic OHCA with initial shockable rhythms between 2010 and 2019. Survivors at 12 months after arrest were invited to participate in structured telephone interviews. Outcomes were identified using the Glasgow Outcome Scale-Extended (GOS-E), EuroQol-5 Dimension (EQ-5D), 12-Item Short Form Health Survey and living and work status-related questions. RESULTS 6050 patients had initial shockable rhythms, 3211 (53.1%) had a pulse on hospital arrival, while 1879 (31.1%) were discharged alive. Bystander defibrillation using the closest automated external defibrillator had the highest survival rate (52.8%), followed by dispatched first responders (36.7%) and paramedics (27.9%). 1802 (29.8%) patients survived to 12-month postarrest; of these 1520 (84.4%) were interviewed. 1088 (71.6%) were initially shocked by paramedics, 271 (17.8%) by first responders and 161 (10.6%) by bystanders. Bystander-shocked survivors reported higher rates of living at home without care (87.5%, 75.2%, 77.0%, p<0.001), upper good recovery (GOS-E=8) (41.7%, 30.4%, 30.6%, p=0.002) and EQ-5D visual analogue scale (VAS) ≥80 (64.9%, 55.9%, 52.9%, p=0.003) compared with first responder and paramedics, respectively. After adjustment, initial bystander defibrillation was associated with higher odds of EQ-5D VAS ≥80 (adjusted OR (AOR) 1.56, 95% CI 1.15-2.10; p=0.004), good functional recovery (GOS-E ≥7) (AOR 1.53, 95% CI 1.12-2.11; p=0.009), living at home without care (AOR 1.77, 95% CI 1.16-2.71; p=0.009) and returning to work (AOR 1.72, 95% CI 1.05-2.81; p=0.031) compared with paramedic defibrillation. CONCLUSION Survivors receiving initial bystander defibrillation reported better functional and HRQoL outcomes at 12 months after arrest compared with those initially defibrillated by paramedics.
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Affiliation(s)
- Brian Haskins
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Paramedicine, Victoria University, Melbourne, Victoria, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Paramedicine, Monash University, Clayton, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Emily Andrew
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Stephen Bernard
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
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Cons-Ferreiro M, Mecias-Calvo M, Romo-Perez V, Navarro-Patón R. Learning of Basic Life Support through the Flipped Classroom in Secondary Schoolchildren: A Quasi-Experimental Study with 12-Month Follow-Up. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1526. [PMID: 37763645 PMCID: PMC10534659 DOI: 10.3390/medicina59091526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: International institutions together with the World Health Organisation recommend the teaching of BLS in schools. Therefore, the objective of this research was to study the feasibility of teaching CPR and AED through the flipped classroom, exploring the medium- and long-term retention of knowledge and practical skills among high school students. Materials and Methods: The sample consisted of 260 secondary schoolchildren (137 in the experimental group (EG) and 123 in the control group (CG)) between 12 and 14 years old (M = 12.75 ± 1.02). Results: The data revealed that the EG obtained better post-course results in the correct position of the hands (p = 0.011), the depth of external cardiac compression (p > 0.001), and the mean time to apply an effective shock with the AED (p = 0.013). The CG obtained better results in compressions with complete chest re-expansion (p = 0.025). These differences disappeared at 6 months (p > 0.05) and 12 months (p > 0.05). Conclusions: A training program based on the flipped classroom is as effective and viable as traditional training, although more efficient since it is applied in less time, in the sequence of action in BLS, CPR skills, and the application of an effective shock with an AED.
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Affiliation(s)
- Miguel Cons-Ferreiro
- Faculty of Education and Sport Sciences, Campus a Xunqueira, s/n, Universidade de Vigo, 36005 Pontevedra, Spain; (M.C.-F.); (V.R.-P.)
- Facultad de Formación del Profesorado, Universidade de Santiago de Compostela, 27001 Lugo, Spain;
| | - Marcos Mecias-Calvo
- Facultad de Formación del Profesorado, Universidade de Santiago de Compostela, 27001 Lugo, Spain;
| | - Vicente Romo-Perez
- Faculty of Education and Sport Sciences, Campus a Xunqueira, s/n, Universidade de Vigo, 36005 Pontevedra, Spain; (M.C.-F.); (V.R.-P.)
| | - Rubén Navarro-Patón
- Facultad de Formación del Profesorado, Universidade de Santiago de Compostela, 27001 Lugo, Spain;
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Horning J, Griffith D, Slovis C, Brady W. Pre-Arrival Care of the Out-of-Hospital Cardiac Arrest Victim. Emerg Med Clin North Am 2023; 41:413-432. [PMID: 37391242 DOI: 10.1016/j.emc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Lay rescuers play a pivotal role in the recognition and initial management of out-of-hospital cardiac arrest. The provision of timely pre-arrival care by lay responders, including cardiopulmonary resuscitation and the use of automated external defibrillator before emergency medical service arrival, is important link in the chain of survival and has been shown to improve outcomes from cardiac arrest. Although physicians are not directly involved in bystander response to cardiac arrest, they play a key role in emphasizing the importance of bystander interventions.
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Affiliation(s)
- Jillian Horning
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Daniel Griffith
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Corey Slovis
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA; Department of Emergency Medicine, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - William Brady
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA.
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Missel AL, Drucker CJ, Kume K, Shin J, Hergert L, Neumar RW, Kudenchuk PJ, Rea T. Association between bystander physical limitations, delays in chest compression during telecommunicator-assisted cardiopulmonary resuscitation, and outcome after out-of-hospital cardiac arrest. Resuscitation 2023; 188:109816. [PMID: 37146672 PMCID: PMC11457881 DOI: 10.1016/j.resuscitation.2023.109816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Promptly initiated bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA). Many OHCA patients require repositioning to a firm surface. We examined the association between repositioning, chest compression (CC) delay, and patient outcomes. METHODS We used a quality improvement registry from review of 9-1-1 dispatch audio recordings of OHCA among adults eligible for telecommunicator-assisted CPR (T-CPR) between 2013 and 2021. OHCA was categorized into 3 groups: CC not delayed, CC delayed due to bystander physical limitations to reposition the patient, or CC delayed for other (non-physical) reasons. The primary outcome was the repositioning interval, defined as the interval between the start of positioning instructions and CC onset. We used logistic regression to assess the odds ratio of survival according to CPR group, adjusting for potential confounders. RESULTS Of the 3,482 OHCA patients eligible for T-CPR, CPR was not delayed in 1,223 (35%), delayed due to repositioning in 1,413 (41%), and delayed for other reasons in 846 (24%). The repositioning interval was longest for the physical limitation delay group (137 secs, IQR-148) compared to the other delay group (81 secs, IQR-70) and the no delay group (51 secs, IQR-32) (p < 0.001). Unadjusted survival was lowest in the physical limitation delay group (11%) versus the no delay (17%) and other delay (19%) groups and persisted after adjustment (p = 0.009). CONCLUSION Bystander physical limitations are a common barrier to repositioning patients to begin CPR and are associated with lower likelihood of receiving CPR, longer times to begin CC, and lower survival.
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Affiliation(s)
- Amanda L Missel
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Christopher J Drucker
- Emergency Medical Services Division, Public Health Seattle and King County, Seattle, WA, USA
| | - Kosuke Kume
- Emergency Medical Services Division, Public Health Seattle and King County, Seattle, WA, USA
| | - Jenny Shin
- Emergency Medical Services Division, Public Health Seattle and King County, Seattle, WA, USA
| | - Lindsey Hergert
- Emergency Medical Services Division, Public Health Seattle and King County, Seattle, WA, USA
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Peter J Kudenchuk
- Emergency Medical Services Division, Public Health Seattle and King County, Seattle, WA, USA; Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Thomas Rea
- Emergency Medical Services Division, Public Health Seattle and King County, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, Washington, USA
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Ramaswamy A, Done A, Solis R, Srikanth M, Olinde L, Belafsky P. The efficacy of two commercially available devices for airway foreign body relief: A cadaver study. Laryngoscope Investig Otolaryngol 2023; 8:708-711. [PMID: 37342119 PMCID: PMC10278115 DOI: 10.1002/lio2.1057] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 06/22/2023] Open
Abstract
Objective Foreign body aspiration events are frequent in young children and in the geriatric population. They may result in several complications such as hypoxia, edema, cardiac arrest, and death. Recently, two commercially available devices, the LifeVac and DeChoker, have entered the market with the claim of relieving foreign body aspiration. Both devices are portable, nonpowered, suction devices that are being considered for use in large public spaces such as schools, airports, and malls despite previous studies detailing variable efficacy. In this study, we aim to contribute further data on the safety and efficacy of these devices through a fresh cadaver model. Methods Commonly aspirated foods of three different sizes (saltines, grapes, and cashews) were placed at the level of the true vocal folds in a fresh cadaver. Three participants performed two trials with each food and device. Device use was performed to manufacturer specifications. Results The DeChoker resulted in gross injury to the tongue and failed to remove the obstruction in all trials. LifeVac was successful in removing the barium-moistened saltines but failed to remove all other foreign bodies. Both devices applied significant pressure to the tongue. Conclusion With the exception of the LifeVac removing saltine crackers, all trials were entirely unsuccessful in relieving foreign body aspiration. Additionally, both devices may cause significant pressure and injury to the oral cavity in a clinical setting. We conclude bystanders should continue to follow International Liaison Committee on Resuscitation's guidelines on resuscitation to aid with relieving foreign body aspiration. Level of Evidence 4.
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Affiliation(s)
- Apoorva Ramaswamy
- Department of Otolaryngology, Center for Voice and SwallowUniversity of California, DavisSacramentoCaliforniaUSA
- Department of OtolaryngologyThe Ohio State UniversityColumbusOhioUSA
| | - Aaron Done
- Department of Otolaryngology, Center for Voice and SwallowUniversity of California, DavisSacramentoCaliforniaUSA
| | - Roberto Solis
- Department of Otolaryngology, Center for Voice and SwallowUniversity of California, DavisSacramentoCaliforniaUSA
| | - Mayuri Srikanth
- Department of OtolaryngologyThe Ohio State UniversityColumbusOhioUSA
| | - Lindsay Olinde
- Department of Otolaryngology, Center for Voice and SwallowUniversity of California, DavisSacramentoCaliforniaUSA
| | - Peter Belafsky
- Department of Otolaryngology, Center for Voice and SwallowUniversity of California, DavisSacramentoCaliforniaUSA
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Hayashi M, Tanizaki S. The authors reply: mechanical vs manual chest compression. Am J Emerg Med 2023:S0735-6757(23)00228-0. [PMID: 37198062 DOI: 10.1016/j.ajem.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Affiliation(s)
- Minoru Hayashi
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
| | - Shinsuke Tanizaki
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
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Ruggeri L, Fumagalli F, Bernasconi F, Semeraro F, Meessen JM, Blanda A, Migliari M, Magliocca A, Gordini G, Fumagalli R, Sechi G, Pesenti A, Skrifvars MB, Li Y, Latini R, Wik L, Ristagno G. Amplitude Spectrum Area of ventricular fibrillation to guide defibrillation: a small open-label, pseudo-randomized controlled multicenter trial. EBioMedicine 2023; 90:104544. [PMID: 36977371 PMCID: PMC10060104 DOI: 10.1016/j.ebiom.2023.104544] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Ventricular fibrillation (VF) waveform analysis has been proposed as a potential non-invasive guide to optimize timing of defibrillation. METHODS The AMplitude Spectrum Area (AMSA) trial is an open-label, multicenter randomized controlled study reporting the first in-human use of AMSA analysis in out-of-hospital cardiac arrest (OHCA). The primary efficacy endpoint was the termination of VF for an AMSA ≥ 15.5 mV-Hz. Adult shockable OHCAs randomly received either an AMSA-guided cardiopulmonary resuscitation (CPR) or a standard-CPR. Randomization and allocation to trial group were carried out centrally. In the AMSA-guided CPR, an initial AMSA ≥ 15.5 mV-Hz prompted for immediate defibrillation, while lower values favored chest compression (CC). After completion of the first 2-min CPR cycle, an AMSA < 6.5 mV-Hz deferred defibrillation in favor of an additional 2-min CPR cycle. AMSA was measured and displayed in real-time during CC pauses for ventilation with a modified defibrillator. FINDINGS The trial was early discontinued for low recruitment due to the COVID-19 pandemics. A total of 31 patients were recruited in 3 Italian cities, 19 in AMSA-CPR and 12 in standard-CPR, and included in the data analysis. No difference in primary outcome was observed between the two groups. Termination of VF occurred in 74% of patients in the AMSA-CPR compared to 75% in the standard CPR (OR 0.93 [95% CI 0.18-4.90]). No adverse events were reported. INTERPRETATION AMSA was used prospectively in human patients during ongoing CPR. In this small trial, an AMSA-guided defibrillation provided no evidence of an improvement in termination of VF. TRIAL REGISTRATION NCT03237910. FUNDING European Commission - Horizon 2020; ZOLL Medical Corp., Chelmsford, USA (unrestricted grant); Italian Ministry of Health - Current research IRCCS.
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Characteristics and Outcomes of Emergency Transferred Patients with Foreign Body Airway Obstruction in Tokyo, Japan. Prehosp Disaster Med 2023:1-6. [PMID: 36938681 DOI: 10.1017/s1049023x23000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Foreign body airway obstruction (FBAO) is a life-threatening emergency, and the prognosis of patients with FBAO is greatly affected by the prehospital process. There are only a few large-scale studies analyzing prehospital process databases of the fire department. STUDY OBJECTIVE The aim of this study was to investigate whether characteristics of patients with FBAO were associated with prehospital factors and outcomes. METHODS In this retrospective observational study, patients transferred to the hospital by the Tokyo, Japan Fire Department for FBAO from 2017 through 2019 were included. The association between neurologically favorable survival among the characteristics of patients with FBAO and prehospital factors affecting the outcomes was evaluated. RESULTS Of the 2,429,175 patients, 3,807 (0.2%) patients had FBAO. The highest number of FBAO cases was 99 (2.6%), which occurred on January 1 (New Year's Day), followed by 40 cases (1.1%) on January 2, and 28 cases (0.7%) on January 3. The number of patients who experienced out-of-hospital cardiac arrest (OHCA) caused by FBAO was 1,644 (43.2%). Comparing the OHCA and non-OHCA groups, there were significant differences in age, sex, time spent at the site, and distance between the site and hospital. Cardiac arrest was significantly lower in infants after FBAO (P < .001). In total, 98.2% of patients who did not have return of spontaneous circulation (ROSC) before hospital arrival died within 30 days, a significantly higher mortality rate than that in patients who had ROSC (98.2% versus 65.8%; P < .001). CONCLUSIONS Among patients who did not have ROSC following FBAO upon arrival at the hospital, 98.2% died within 30 days. Thus, it is important to remove foreign bodies promptly and provide sufficient ventilation to the patient at the scene to increase the potential for ROSC. Further, more precautions should be exercised to prevent FBAO at the beginning of the year.
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Hasegawa Y, Hanaki K. Bystanders' Willingness to Perform Basic Life Support and Its Relationship with Facilitative and Obstructive Factors: A Nationwide Survey in Japan. Yonago Acta Med 2023; 66:67-77. [PMID: 36820282 PMCID: PMC9937965 DOI: 10.33160/yam.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/16/2022] [Indexed: 02/06/2023]
Abstract
Background The administration of basic life support (BLS) by bystanders is essential to improve the survival rates of patients who have experienced out-of-hospital cardiac arrest (OHCA). Although providing BLS to individuals who experience OHCA greatly improves their chances of survival, the actual implementation rate is low. Therefore, we investigated the association between bystanders' willingness to perform BLS and facilitative/obstructive factors with the objective of identifying educational methods that would improve the likelihood of bystanders performing BLS should they encounter a patient with OHCA. Methods The study participants included 502 male and 498 female Japanese residents (total, 1000 participants) with no experience in performing BLS and 42 male and 59 female Japanese residents (total 101 participants) with experience in performing BLS. The participants were aged 15-65 years. Both groups graded the strength of their willingness to perform BLS in the future on a 4-point scale, as well as their level of agreement with factors facilitating or obstructing their willingness to perform BLS. These factors were established based on the theory of helping behavior, which defines psychological states when helping others in social psychology.We then analyzed the associations between willingness to perform BLS in the future and their level of agreement with factors facilitating or obstructing their willingness to perform BLS. Results The willingness to perform BLS decreased in accordance with the increase in the level of intervention required for patients who experienced OHCA , and was significantly associated with four facilitating factors: sufficient ability and experience to perform BLS, personal advantage, high personal norms, and psychological closeness to the patient. Conclusion Our results suggested that workshops and other educational activities focused on these facilitative factors may be helpful in increasing the rate at which bystanders perform BLS.
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Affiliation(s)
- Yoshiyuki Hasegawa
- Graduate School of Medical Sciences Major in Health Sciences, Tottori University, Yonago 683-8503, Japan,School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Keiichi Hanaki
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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Michelland L, Murad MH, Bougouin W, Van Der Broek M, Prokop LJ, Anys S, Perier MC, Cariou A, Empana JP, Marijon E, Jouven X, Jabre P. Association between basic life support and survival in sports-related sudden cardiac arrest: a meta-analysis. Eur Heart J 2023; 44:180-192. [PMID: 36285872 DOI: 10.1093/eurheartj/ehac586] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 08/12/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
AIMS To evaluate the association of basic life support with survival after sports-related sudden cardiac arrest (SR-SCA). METHODS AND RESULTS In this systematic review and meta-analysis, a search of several databases from each database inception to 31 July 2021 without language restrictions was conducted. Studies were considered eligible if they evaluated one of three scenarios in patients with SR-SCA: (i) bystander presence, (ii) bystander cardiopulmonary resuscitation (CPR), or (iii) bystander automated external defibrillator (AED) use and provided information on survival. Risk of bias was evaluated using Risk of Bias in Non-randomized Studies of Interventions. The primary outcome was survival at the longest follow up. The meta-analysis was conducted using the random-effects model. The Grading of Recommendations Assessment, Development, and Evaluations (GRADE) approach was used to rate certainty in the evidence. In total, 28 non-randomized studies were included. The meta-analysis showed significant benefit on survival in all three groups: bystander presence [odds ratio (OR) 2.55, 95% confidence interval (CI) 1.48-4.37; I2 = 25%; 9 studies-988 patients], bystander CPR (OR 3.84, 95% CI 2.36-6.25; I2 = 54%; 23 studies-2523 patients), and bystander AED use (OR 5.25, 95% CI 3.58-7.70; I2 = 16%; 19 studies-1227 patients). The GRADE certainty of evidence was judged to be moderate. CONCLUSION In patients with SR-SCA, bystander presence, bystander CPR, and bystander AED use were significantly associated with survival. These results highlight the importance of witness intervention and encourage countries to develop their first aid training policy and AED installation in sport settings.
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Affiliation(s)
- Laurianne Michelland
- Department of Emergency, Service Mobile d'Urgence et Réanimation (SMUR), Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.,Université Paris Cité, INSERM, UMR-S970, Paris Cardiovascular Research Center, Team "Integrative Epidemiology of Cardiovascular Diseases", Paris, France
| | - Mohammad H Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wulfran Bougouin
- Université Paris Cité, INSERM, UMR-S970, Paris Cardiovascular Research Center, Team "Integrative Epidemiology of Cardiovascular Diseases", Paris, France.,Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | | | | | - Soraya Anys
- Université Paris Cité, INSERM, UMR-S970, Paris Cardiovascular Research Center, Team "Integrative Epidemiology of Cardiovascular Diseases", Paris, France.,Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Marie-Cécile Perier
- Université Paris Cité, INSERM, UMR-S970, Paris Cardiovascular Research Center, Team "Integrative Epidemiology of Cardiovascular Diseases", Paris, France
| | - Alain Cariou
- Université Paris Cité, INSERM, UMR-S970, Paris Cardiovascular Research Center, Team "Integrative Epidemiology of Cardiovascular Diseases", Paris, France.,Medical Intensive Care Unit, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Jean Philippe Empana
- Université Paris Cité, INSERM, UMR-S970, Paris Cardiovascular Research Center, Team "Integrative Epidemiology of Cardiovascular Diseases", Paris, France
| | - Eloi Marijon
- Université Paris Cité, INSERM, UMR-S970, Paris Cardiovascular Research Center, Team "Integrative Epidemiology of Cardiovascular Diseases", Paris, France.,Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Xavier Jouven
- Université Paris Cité, INSERM, UMR-S970, Paris Cardiovascular Research Center, Team "Integrative Epidemiology of Cardiovascular Diseases", Paris, France.,Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Patricia Jabre
- Université Paris Cité, INSERM, UMR-S970, Paris Cardiovascular Research Center, Team "Integrative Epidemiology of Cardiovascular Diseases", Paris, France.,Service d'Aide Médicale d'Urgence-SAMU de Paris, Necker-Enfants malades Hospital, AP-HP, 149 Rue de Sèvres, 75015 Paris, France
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Donizeti Silva M, Augusto Barbieri R, Figueiredo Foresti Y, Augusto Cursiol J, Antônio Viana F, Fernando dos Santos E, Pereira Rodrigues K, da Silva Rodrigues G, da Silva Garcia Nascimento J, Barcellos Dalri MC. Association of Training in Basic Life Support with the Evolution of Cardiopulmonary Resuscitation Performed by Firefighters. Emerg Med Int 2023; 2023:8150697. [PMID: 37188319 PMCID: PMC10181904 DOI: 10.1155/2023/8150697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/03/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction This study aimed to compare the results of professional technical and anthropometric anamnesis data with the transmission of external chest compressions performed by military firefighters at different execution times. Objective The objective was to evaluate the performance and perceived effort of the sequence of external chest compressions performed in two minutes, as well as the evolution of the technique over time. Materials and Methods This was a descriptive, correlational study involving adult firefighters who were members of a specific firefighter group, comprising a population of 105 individuals with a voluntary sample of 44 participants. The study used a Bayesian statistical approach to provide probabilistic expressions. Results The participants had an average work experience of 17 years, an average age of 38.6 years, an average weight of 81.48 kilograms, an average height of 176 centimeters, and an average of 2.5 qualifications. The results indicated that the firefighters performed external chest compressions with excellent technique and a moderate level of perceived effort in a two-minute evaluation. The evaluation of the evolution of the technique over time showed that the participants were able to maintain high-quality compressions for an average of 6 minutes, with a maximum of 20 uninterrupted minutes. Conclusion The study underscores the critical role of professional firefighters in performing and maintaining high-quality external chest compressions, which has the potential to reduce morbidity and mortality in cases of cardiorespiratory arrest.
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Affiliation(s)
- Marcelo Donizeti Silva
- School of Nursing of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirao Preto, São Paulo, Brazil
| | - Ricardo Augusto Barbieri
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirao Preto, São Paulo, Brazil
| | - Yan Figueiredo Foresti
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirao Preto, São Paulo, Brazil
| | - Jônatas Augusto Cursiol
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirao Preto, São Paulo, Brazil
| | | | | | - Karine Pereira Rodrigues
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | - Maria Celia Barcellos Dalri
- School of Nursing of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirao Preto, São Paulo, Brazil
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36
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Kumar A, Aggarwal P. Basic life support. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:29-35. [PMID: 37615137 DOI: 10.25259/nmji_581_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Sun M, Jing GG, Zhang QY. The "Hand as Foot" teaching method in the endotracheal intubation. Asian J Surg 2022; 45:2911-2912. [PMID: 35778240 DOI: 10.1016/j.asjsur.2022.06.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Min Sun
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, 256600, China
| | - Guan-Gjian Jing
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, 256600, China
| | - Quan-Yi Zhang
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, 256600, China.
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Lee SGW, Hong KJ, Kim TH, Choi S, Shin SD, Song KJ, Ro YS, Jeong J, Park YJ, Park JH. Quality of chest compressions during prehospital resuscitation phase from scene arrival to ambulance transport in out-of-hospital cardiac arrest. Resuscitation 2022; 180:1-7. [PMID: 36087637 DOI: 10.1016/j.resuscitation.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
AIM Prehospital cardiopulmonary resuscitation is performed from scene arrival to hospital arrival. The diverse prehospital resuscitation phases can affect the quality of chest compressions. This study aimed to evaluate the dynamic changes in chest compression quality during prehospital resuscitation. METHODS Adult out-of-hospital cardiac arrest patients treated without prehospital return of spontaneous circulation were included in Seoul between July 2020 and September 2021. The chest compressions quality was assessed using a real-time chest compression feedback device. The prehospital phase was divided by key events during the prehospital resuscitation timeline (phase 1: first 2 min after initiation of chest compression, phase 2: from the end of phase 1 to 1 min prior to ambulance departure; phase 3: from 1 min before to 1 min after ambulance departure; phase 4: from the end of phase 3 to hospital arrival). The main outcome was no-flow fraction. The no-flow fraction between prehospital phases was compared using repeated-measure analysis of variance. RESULTS In total, 788 patients were included. Mean no-flow fraction was the highest in phase 3 (phase 1: 11.3% ± 13.8, phase 2: 19.3% ± 12.3, phase 3: 33.0% ± 34.9, phase 4: 18.7% ± 23.7, p < 0.001). The mean number of total no-flow events per minute was also the highest in phase 3. The minute-by-minute analysis showed that the no-flow fraction rapidly increased before ambulance departure and decreased during ambulance transport. CONCLUSION Dynamic changes in chest compression quality were observed during prehospital resuscitation phase. The no-flow fraction was the highest from 1 min before to 1 min after ambulance departure.
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Affiliation(s)
- Stephen Gyung Won Lee
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Tae Han Kim
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Seulki Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joo Jeong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Yong Joo Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Birkun A. Toward development of the standardized dispatcher algorithm for telephone assistance in choking. Acad Emerg Med 2022; 29:1401-1402. [PMID: 35881011 DOI: 10.1111/acem.14572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Alexei Birkun
- Department of General Surgery, Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation
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Modesti PA, Casolo G, Olivotto I, Pellegrino A. Sudden death in young athletes: Is it preventable? Eur J Intern Med 2022; 104:13-20. [PMID: 35718646 DOI: 10.1016/j.ejim.2022.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 01/09/2023]
Abstract
Sudden death in young athletes is a rare but always dramatic condition. Unlike all other rare diseases, the estimate of its real incidence is made complex not only because of the uncertain number of correctly identified cases (numerator) but also because of the uncertain estimation of the real number of the reference population, the athletes (denominator). New elements of complexity are also emerging with regard to prevention. The current two pillars of prevention are pre-participation screening (proactive strategy) and promoting use / access to the automated external defibrillator (reactive strategy). The standardization of procedures implemented over the past two decades for pre-participation screening can now allow us to assess the impact of this approach. The result is complex to evaluate. While screening may allow the identification of conditions potentially associated with SDA, and therefore the adoption of specific treatments, in about 0.4% of screened subjects, a single study investigated the yield in terms of mortality showing a positive predictive value of 4.7% with 25% sensitivity. Conversely, the reactive strategy appears considerably effective, due to the widespread use of the automated external defibrillators in sports facilities, calling for a homogeneous implementation worldwide. On a broader perspective, the vast attention devoted to SDA prevention in the world of sports represents a major driver for transfer of a reactive prevention strategy to the general population.
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Affiliation(s)
- Pietro Amedeo Modesti
- Sport Medicine Unit, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy.
| | - Giancarlo Casolo
- Cardiology Department, Ospedale Versilia, Lido di Camaiore, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessio Pellegrino
- Sport Medicine Unit, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy
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Cons-Ferreiro M, Mecías-Calvo M, Romo-Pérez V, Navarro-Patón R. The Effects of an Intervention Based on the Flipped Classroom on the Learning of Basic Life Support in Schoolchildren Aged 10–13 Years: A Quasi-Experimental Study. CHILDREN 2022; 9:children9091373. [PMID: 36138682 PMCID: PMC9497573 DOI: 10.3390/children9091373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022]
Abstract
Most out-of-hospital cardiac arrests are attended first by bystanders who are usually friends and/or relatives of the victim. Therefore, the objective of this research was to analyse the impact of a training process based on the flipped classroom on basic life support skills in primary education students. The sample consisted of 308 children (148 experimental group (EG) and 160 control group (CG)) between 10 and 13 years old (M = 10.68 ± 0.64) from 2 schools in Galicia, Spain. The data reveal that the quality parameters are obtained in the number of total compressions in 2 min (CG = 213 and EG = 217; p = 0.024) and in the percentage of correct compressions (CG = 87.23% and EG = 91.6%; p = 0.013) except for the mean depth and the percentage of correct compressions, which were not reached in any case. Regarding the application of an effective discharge with the Automated external defibrillator (AED), there were no significant differences in the time used by schoolchildren between both methods (p = 0.795), but 97.5% (n = 156) of the CG and 100% (n = 148) of the EG are able to do it in just over 1 min. Based on the results obtained, we can conclude that a training program based on the flipped classroom is as effective and viable as traditional training in psychomotricity on CPR techniques and the application of an effective discharge using an AED.
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Affiliation(s)
- Miguel Cons-Ferreiro
- Faculty of Education and Sport Sciences, University of Vigo, Campus a Xunqueira, s/n, 36005 Pontevedra, Spain
- Facultad de Formación del Profesorado, Universidade de Santiago de Compostela, 27001 Lugo, Spain
| | - Marcos Mecías-Calvo
- Facultad de Formación del Profesorado, Universidade de Santiago de Compostela, 27001 Lugo, Spain
- Correspondence: ; Tel.: +34-982-821069
| | - Vicente Romo-Pérez
- Faculty of Education and Sport Sciences, University of Vigo, Campus a Xunqueira, s/n, 36005 Pontevedra, Spain
| | - Rubén Navarro-Patón
- Facultad de Formación del Profesorado, Universidade de Santiago de Compostela, 27001 Lugo, Spain
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Birkun A, Gautam A, Trunkwala F, Böttiger BW. Open online courses on basic life support: Availability and resuscitation guidelines compliance. Am J Emerg Med 2022; 62:102-107. [PMID: 35965163 PMCID: PMC9359675 DOI: 10.1016/j.ajem.2022.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alexei Birkun
- Department of General Surgery, Anesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Lenin Blvd, 5/7, Simferopol 295051, Russian Federation.
| | - Adhish Gautam
- Regional Government Hospital, Una (H.P.) 174303, India
| | - Fatima Trunkwala
- University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, England, United Kingdom
| | - Bernd W Böttiger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
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Murphy TW, Cohen SA, Hwang CW, Avery KL, Balakrishnan MP, Balu R, Chowdhury MAB, Crabb DB, Elmelige Y, Maciel CB, Gul SS, Han F, Becker TK. Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020. J Am Coll Emerg Physicians Open 2022; 3:e12773. [PMID: 35845142 PMCID: PMC9282171 DOI: 10.1002/emp2.12773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/15/2022] [Accepted: 06/02/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its third year, the goals of the review are to highlight annual updates in the interdisciplinary world of clinical cardiac arrest research with a focus on clinically relevant and impactful clinical and population-level studies from 2020. Methods A search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and abstracts were screened for relevance and sorted into 7 categories: Epidemiology & Public Health Initiatives; Prehospital Resuscitation, Technology & Care; In-Hospital Resuscitation & Post-Arrest Care; Prognostication & Outcomes; Pediatrics; Interdisciplinary Guidelines & Reviews; and a new section dedicated to the coronavirus disease 2019 (COVID-19) pandemic. Screened manuscripts underwent standardized scoring of methodological quality and impact on the respective fields by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99 percentiles by category were selected for full critique. Systematic differences between editors' and reviewers' scores were assessed using Wilcoxon signed-rank test. Results A total of 3594 articles were identified on initial search; of these, 1026 were scored after screening for relevance and deduplication, and 51 underwent full critique. The leading category was Prehospital Resuscitation, Technology & Care representing 35% (18/51) of fully reviewed articles. Four COVID-19 related articles were included for formal review that was attributed to a relative lack of high-quality data concerning cardiac arrest and COVID-19 specifically by the end of the 2020 calendar year. No significant differences between editor and reviewer scoring were found among review articles (P = 0.697). Among original research articles, section editors scored a median 1 point (interquartile range, 0-3; P < 0.01) less than reviewers. Conclusions Several clinically relevant studies have added to the evidence base for the management of cardiac arrest patients including methods for prognostication of neurologic outcome following arrest, airway management strategy, timing of coronary intervention, and methods to improve expeditious performance of key components of resuscitation such as chest compressions in adults and children.
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Affiliation(s)
- Travis W. Murphy
- Division of Critical Care MedicineDepartment of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
- Cardiothoracic Critical CareMiami Transplant InstituteUniversity of MiamiMiamiFloridaUSA
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Scott A. Cohen
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Charles W. Hwang
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - K. Leslie Avery
- Division of Pediatric Critical CareDepartment of PediatricsUniversity of FloridaGainesvilleFloridaUSA
| | | | - Ramani Balu
- Division of Neurocritical CareDepartment of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - David B. Crabb
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Yasmeen Elmelige
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Carolina B. Maciel
- Division of Neurocritical CareDepartment of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of NeurologyYale UniversityNew HavenConnecticutUSA
- Division of Neurocritical CareDepartment of NeurologyUniversity of FloridaGainesvilleFloridaUSA
| | - Sarah S. Gul
- Department of SurgeryYale UniversityNew HavenConnecticutUSA
| | - Francis Han
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
- Lake Erie College of Osteopathic MedicineBradentonFloridaUSA
| | - Torben K. Becker
- Division of Critical Care MedicineDepartment of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
- Department of Emergency MedicineUniversity of FloridaGainesvilleFloridaUSA
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Cicek M, Pasli S, Imamoglu M, Yadigaroglu M, Beser MF, Gunduz A. Simulation-Based Drone Assisted Search Operations in a River. Wilderness Environ Med 2022; 33:311-317. [PMID: 35843856 DOI: 10.1016/j.wem.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/18/2022] [Accepted: 05/01/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Drones can transmit live video and geographic coordinates during the planning stages for search and rescue operations and the operations themselves. There are few simulation studies in which drones provided rescue support. However, the literature does not contain any simulation studies involving the use of drones to locate lost "victims" represented by dummies in rivers. We developed a simulation model to compare the first visual contact times for drone-assisted search techniques (DAST) and classic search techniques (CST). METHODS In this prospective experimental simulation study, we used both DAST and CST to perform a series of river searches for unconscious victims (represented by dummies). We calculated the first visual contact times, total scanned area, scanned area per minute, flight-walking distances, and flight-walking speeds and compared the results between both groups. The data are presented as mean±SD. RESULTS We performed 20 search and rescue operations, 10 with the CST and 10 with the DAST. The time to reach the victim was 823±177 s using CST and 80±14 s using DAST. The area scanned by unit time was 3091±54 m2·min-1 using CST and 22,640±1622 m2·min-1 using DAST. CONCLUSIONS The drone-assisted search technique located a simulated victim drifting in a river faster than the classic search technique. The use of drones in search and rescue operations could improve the time to find victims.
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Affiliation(s)
- Mustafa Cicek
- Kanuni Education and Research Hospital Department of Emergency Medicine, Trabzon.
| | - Sinan Pasli
- Karadeniz Technical University Faculty of Medicine Department of Emergency Medicine, Trabzon
| | - Melih Imamoglu
- Karadeniz Technical University Faculty of Medicine Department of Emergency Medicine, Trabzon
| | - Metin Yadigaroglu
- Samsun University Faculty of Medicine Department of Emergency Medicine, Samsun
| | - Muhammed Fatih Beser
- Karadeniz Technical University Faculty of Medicine Department of Emergency Medicine, Trabzon
| | - Abdulkadir Gunduz
- Samsun University Faculty of Medicine Department of Emergency Medicine, Samsun
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Moll-Khosrawi P, Falb A, Pinnschmidt H, Zöllner C, Issleib M. Virtual reality as a teaching method for resuscitation training in undergraduate first year medical students during COVID-19 pandemic: a randomised controlled trial. BMC MEDICAL EDUCATION 2022; 22:483. [PMID: 35733135 PMCID: PMC9214467 DOI: 10.1186/s12909-022-03533-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 06/03/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Virtual reality (VR) is a computer-generated simulation technique which yields plenty of benefits and its application in medical education is growing. This study explored the effectiveness of a VR Basic Life Support (BLS) training compared to a web-based training during the COVID-19 pandemic, in which face-to-face trainings were disrupted or reduced. METHODS This randomised, double-blinded, controlled study, enrolled 1st year medical students. The control group took part in web-based BLS training, the intervention group received an additional individual VR BLS training. The primary endpoint was the no-flow time-an indicator for the quality of BLS-, assessed during a structural clinical examination, in which also the overall quality of BLS (secondary outcome) was rated. The tertiary outcome was the learning gain of the undergraduates, assessed with a comparative self-assessment (CSA). RESULTS Data from 88 undergraduates (n = 46 intervention- and n = 42 control group) were analysed. The intervention group had a significant lower no-flow time (p = .009) with a difference between the two groups of 28% (95%-CI [8%;43%]). The overall BLS performance of the intervention group was also significantly better than the control group with a mean difference of 15.44 points (95%-CI [21.049.83]), p < .001. In the CSA the undergraduates of the intervention group reported a significant higher learning gain. CONCLUSION VR proved to be effective in enhancing process quality of BLS, therefore, the integration of VR into resuscitation trainings should be considered. Further research needs to explore which combination of instructional designs leads to deliberate practice and mastery learning of BLS.
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Affiliation(s)
- Parisa Moll-Khosrawi
- Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Alexander Falb
- Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans Pinnschmidt
- Center for Experimental Medicine, Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Zöllner
- Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Malte Issleib
- Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Alkubati SA, McClean C, Yu R, Albagawi B, Alsaqri SH, Alsabri M. Basic life support knowledge in a war-torn country: a survey of nurses in Yemen. BMC Nurs 2022; 21:141. [PMID: 35668520 PMCID: PMC9169348 DOI: 10.1186/s12912-022-00923-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Successful implementation of Basic life support (BLS) is critical to improving survival rates and outcomes, especially among healthcare workers. To our knowledge, there is no available literature pertaining to the level of BLS knowledge of health care professionals in Yemen. Methods Data was collected for this cross-sectional descriptive study from June to August 2020, using a 10-item questionnaire related to cardiopulmonary resuscitation (CPR) and BLS, along with questions on socio-demographic characteristics. Participants were nurses in public and private hospitals located in Al-Rahida and Al-dimna cities, Taiz governance and Hodeidah city, Hodeidah governance in Yemen. Results Out of 220 distributed questionnaires, 200 were returned with a response rate of 90.9%. More than a half (53.65%) of answer choices for BLS knowledge were correct. There was a significant difference in knowledge score based on level of education where those who had Bachelor degree had more knowledge (P = 0.000). Those who said they had received training in CPR or received information about CPR had significantly higher scores than those who did not receive (P = 0.000). Conclusions BLS knowledge among nurses in Yemen is below an acceptable level to ensure maximum survival in the event of cardiac arrest. Disseminating BLS information and training in a cost effective and efficient manner will provide a large benefit in terms of lives saved with minimal costs.
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Affiliation(s)
- Sameer A Alkubati
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail City, Saudi Arabia. .,Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen.
| | | | - Rebecca Yu
- Saba University School of Medicine, The Bottom, Caribbean, Netherlands
| | - Bander Albagawi
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail City, Saudi Arabia
| | - Salman H Alsaqri
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail City, Saudi Arabia
| | - Mohammed Alsabri
- Al-Thawra Modern General Teaching Hospital, Sana'a City, Yemen. .,Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, NY, 11212, USA.
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Hitosugi T, Awata N, Miki Y, Tsukamoto M, Yokoyama T. A Comparison of Two Stool Positions for Stabilizing a Dental Chair During CPR. Anesth Prog 2022; 69:11-16. [PMID: 35849814 DOI: 10.2344/anpr-68-03-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/02/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Most dental chairs lack sufficient stability to perform effective manual chest compression (MCC) during cardiopulmonary resuscitation (CPR). A stabilizing stool can significantly reduce backrest vertical displacement in all chair types; however, a severely curved exterior backrest may negatively impact the stool's effectiveness. This study evaluated the efficacy of 2 stool positions for stabilizing a dental chair during MCC. METHODS Chest compressions were performed on a manikin positioned in a dental chair while vertical displacement of the chair backrest during MCC was recorded using video and measured. Vertical displacement data were captured with no stool and with a stabilizing stool in 2 different positions. Reduction ratios were calculated to evaluate the effectiveness of the 2 stool positions. RESULTS With no stool, the backrest median (interquartile range) vertical displacement during chest compressions was 16.5 (2.5) mm as compared with 12.0 (1.5) mm for the stabilizing stool positioned under the area of MCC and 8.5 (1.0) mm under the shoulders. The stool positioned under the shoulders produced a significantly increased calculated reduction ratio of 48% (14%) compared with 27% (20%) under the area of MCC (P < .001). CONCLUSIONS Positioning a stabilizing stool under the shoulders was more effective at reducing vertical displacement of the dental chair backrest during chest compressions than positioning the stool under the area of MCC.
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Affiliation(s)
- Takashi Hitosugi
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Norimasa Awata
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yoichiro Miki
- School of Interdisciplinary Science and Innovation, Faculty of Arts and Science, Kyushu University, Fukuoka, Japan
| | - Masanori Tsukamoto
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
| | - Takeshi Yokoyama
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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The experience of pre-hospital emergency personnel in breaking death news: a phenomenological study. BMC Nurs 2022; 21:127. [PMID: 35614483 PMCID: PMC9130693 DOI: 10.1186/s12912-022-00899-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today, breaking the death of patients to their families has become one of the challenges for medical staff. Considering the lack of study in the pre-hospital emergency, the present study aimed to explore the experience of pre-hospital emergency personnel regarding the breaking death news to families. METHOD In this qualitative study with a descriptive phenomenological method, data were collected by purposeful sampling method through in-depth interviews with thirteen pre-hospital emergency personnel in Kermanshah and Kurdistan provinces. After recording and writing the interviews, the data were managed by MAQUDA-10 software and analyzed using the Collaizi approach. RESULTS Of 13 participants, five from Kermanshah, eight from Kurdistan, and 12 (92%) were married. The mean age and work experience were 34.38 and 10.38 years, respectively. Five main extracted themes were 1) perceived stress, 2) challenge factors of breaking death news, 3) unnecessary actions, 4) death breaking precautions, and 5) BDN requirements. They were covered fifteen sub-themes. CONCLUSION In this study, emergency medical employees were always faced with stress and challenges to announce the patient's death to families, including the stress of violence against employees. Hereof, personnel had to take unnecessary care actions such as slow resuscitation to transfer the patient to the hospital.
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Dunning J, Archbold A, de Bono JP, Butterfield L, Curzen N, Deakin CD, Gudde E, Keeble TR, Keys A, Lewis M, O'Keeffe N, Sarma J, Stout M, Swindell P, Ray S. Joint British Societies' guideline on management of cardiac arrest in the cardiac catheter laboratory. BRITISH HEART JOURNAL 2022; 108:e3. [PMID: 35470236 DOI: 10.1136/heartjnl-2021-320588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.
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Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
| | - Andrew Archbold
- Department of General & Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Joseph Paul de Bono
- Department of Cardiology, Queen Elizabeth Hospital, University of Birmingham, Birmingham, West Midlands, UK
| | - Liz Butterfield
- School of Nursing, Midwifery and Social Work, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton and Department of Cardiology, Southampton, UK
| | - Charles D Deakin
- Anaesthesia and Intensive Care, Southampton University Hospitals NHS Trust, Southampton, Southampton, UK
| | - Ellie Gudde
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Alan Keys
- Cardiovascular Care Partnership (UK), British Cardiovascular Society, London, London, UK
| | - Mike Lewis
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, UK
| | - Niall O'Keeffe
- Department of Cardiothoracic Anaesthesia and Critical Care, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Jaydeep Sarma
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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50
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Optimal Landmark for Chest Compressions during Cardiopulmonary Resuscitation Derived from a Chest Computed Tomography in Arms-Down Position. J Cardiovasc Dev Dis 2022; 9:jcdd9040100. [PMID: 35448077 PMCID: PMC9033090 DOI: 10.3390/jcdd9040100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/01/2023] Open
Abstract
Compressions at the left ventricle increase rate of return of spontaneous circulation. This study aimed to identify the landmark of the point of maximal left ventricular diameter on the sternum (LVmax) by using chest computed tomography (CCT) in the arms-down position, which was similar to an actual cardiac arrest patient. A retrospective study was conducted between September 2014 and November 2020. We included adult patients who underwent CCT in an arms-down position and measured the rescuer’s hand. We measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand, which placed the lowest palmar margin of the rescuer’s reference hand at the xiphisternal junction. Thirty-nine patients were included. The LVmax was located below the lower half of the sternum; DLVmax and DLH were 12.6 and 10.0 cm, respectively (p < 0.001). Distance from the sternal notch to the point of maximal force of the left hand, with the ulnar border located at the xiphisternal junction, was close to DLVmax; 11.3 and 12.6 cm, respectively (p = 0.076). In conclusion, LVmax was located below the lower half of the sternum, which is recommended by current guidelines.
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