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Hyun Choi D, Ha Joo Y, Hong Kim K, Ho Park J, Joo H, Kong HJ, Lee H, Jun Song K, Kim S. A Development of a Sound Recognition-Based Cardiopulmonary Resuscitation Training System. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2024; 12:550-557. [PMID: 39155923 PMCID: PMC11329221 DOI: 10.1109/jtehm.2024.3433448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 07/06/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024]
Abstract
The objective of this study was to develop a sound recognition-based cardiopulmonary resuscitation (CPR) training system that is accessible, cost-effective, easy-to-maintain and provides accurate CPR feedback. Beep-CPR, a novel device with accordion squeakers that emit high-pitched sounds during compression, was developed. The sounds emitted by Beep-CPR were recorded using a smartphone, segmented into 2-second audio fragments, and then transformed into spectrograms. A total of 6,065 spectrograms were generated from approximately 40 minutes of audio data, which were then randomly split into training, validation, and test datasets. Each spectrogram was matched with the depth, rate, and release velocity of the compression measured at the same time interval by the ZOLL X Series monitor/defibrillator. Deep learning models utilizing spectrograms as input were trained using transfer learning based on EfficientNet to predict the depth (Depth model), rate (Rate model), and release velocity (Recoil model) of compressions. Results: The mean absolute error (MAE) for the Depth model was 0.30 cm (95% confidence interval [CI]: 0.27-0.33). The MAE of the Rate model was 3.6/min (95% CI: 3.2-3.9). For the Recoil model, the MAE was 2.3 cm/s (95% CI: 2.1-2.5). External validation of the models demonstrated acceptable performance across multiple conditions, including the utilization of a newly-manufactured device, a fatigued device, and evaluation in an environment with altered spatial dimensions. We have developed a novel sound recognition-based CPR training system, that accurately measures compression quality during training. Significance: Beep-CPR is a cost-effective and easy-to-maintain solution that can improve the efficacy of CPR training by facilitating decentralized at-home training with performance feedback.
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Affiliation(s)
- Dong Hyun Choi
- Department of Biomedical EngineeringSeoul National University College of MedicineJongnoSeoul03080South Korea
| | - Yoon Ha Joo
- Biomedical Research InstituteSeoul National University HospitalJongnoSeoul03080South Korea
- Department of Emergency MedicineSeoul National University HospitalJongnoSeoul03080South Korea
| | - Ki Hong Kim
- Department of Emergency MedicineSeoul National University HospitalJongnoSeoul03080South Korea
| | - Jeong Ho Park
- Department of Emergency MedicineSeoul National University HospitalJongnoSeoul03080South Korea
| | - Hyunjin Joo
- Innovative Medical Technology Research InstituteSeoul National University HospitalJongnoSeoul03080South Korea
| | - Hyoun-Joong Kong
- Department of Transdisciplinary MedicineInnovative Medical Technology Research InstituteSeoul National University HospitalJongnoSeoul03080South Korea
- Department of MedicineSeoul National University College of MedicineJongnoSeoul03080South Korea
| | - Hyunju Lee
- Laboratory of Emergency Medical ServicesBiomedical Research Institute, Seoul National University HospitalJongnoSeoul03080South Korea
| | - Kyoung Jun Song
- Department of Emergency MedicineSeoul Metropolitan Boramae Medical CenterDongjakSeoul07061South Korea
| | - Sungwan Kim
- Department of Biomedical EngineeringSeoul National University College of MedicineJongnoSeoul03080South Korea
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Giaume L, Le Roy B, Daniel Y, Lauga Cami H, Jost D, Travers S, Trousselard M. Psychological, cognitive, and physiological impact of hazards casualties' trainings on first responders: the example of a chemical and radiological training. An exploratory study. Front Psychol 2024; 15:1336701. [PMID: 38352026 PMCID: PMC10861781 DOI: 10.3389/fpsyg.2024.1336701] [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: 11/11/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background First responders are among the first to respond to hazards casualties. They might operate in volatile, uncertain, complex, and ambiguous (VUCA) environments. While they have underlined the need to improve their knowledge and training to face these environments, there are few data regarding the stress induced by these trainings. Chemical, biological, radiological, and nuclear (CBRN) hazards casualties' trainings seem to be a good model of "in vivo" stress. First responders must operate in a hostile and encountered environment with a CBRN protective equipment that places demand on their psychological, cognitive, and physiological capacities. Current research recognizes that the activity of the parasympathetic system (PSS) can be used as an objective marker of stress adaptation, measured as heart rate variability (HRV). Objectives To compare between baseline and simulation the evolution of the parasympathetic activity (primary outcome), anxiety, emotions, cognitive load, and body posture awareness (secondary outcomes). Methods A total of 28 first responders attended to three simulated scenarios requiring CBRN management of casualties. One day before simulation, we collected HRV data (baseline). The simulations' day (pre-, post-simulation) we collected anxiety score (STAI-Y B), emotions (SPANE), cognitive load (NASA TLX), body posture awareness (PAS) and HRV. The morning after we collected the PAS score (recovery). We compare data' evolution between different times of the simulation. Results (i) A high level of anxiety at baseline [Median 51 (46; 56)] which decreased between pre- and post-simulation (p = 0.04; F = 2.93); (ii) a post-simulation decrease in negative feelings (p = 0.03); (iii) a decrease in body awareness after simulation which returned to the initial level at recovery (p = 0.03; F = 3.48); (iv) a decrease in mean RR between baseline, pre- and post-simulation (p = 0.009; F = 5.11). There were no significant difference between times on others analysis of HRV. Conclusion Prior to simulation, participants experienced anticipatory anxiety. Simulations training practiced regularly could be one way to combat anticipatory anxiety.
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Affiliation(s)
- Louise Giaume
- Emergency Medical Department, Paris Fire Brigade, Paris, France
- French Military Biomedical Research, Brétigny-sur-Orge, France
| | | | - Yann Daniel
- Emergency Medical Department, Paris Fire Brigade, Paris, France
| | | | - Daniel Jost
- Emergency Medical Department, Paris Fire Brigade, Paris, France
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Kahsay DT, Peltonen LM, Rosio R, Tommila M, Salanterä S. The effect of standalone audio-visual feedback devices on the quality of chest compressions during laypersons' cardiopulmonary resuscitation training: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2024; 23:11-20. [PMID: 37154435 DOI: 10.1093/eurjcn/zvad041] [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: 06/24/2022] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
AIMS Individual studies that investigated the effect of standalone audio-visual feedback (AVF) devices during laypersons' cardiopulmonary resuscitation (CPR) training have yielded conflicting results. This review aimed to evaluate the effect of standalone AVF devices on the quality of chest compressions during laypersons' CPR training. METHOD AND RESULT Randomized controlled trials of simulation studies recruiting participants without actual patient CPR experience were included. The intervention evaluated was the quality of chest compressions with standalone AVF devices vs. without AVF devices. Databases, such as PubMed, Cochrane Central, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and PsycINFO, were searched from January 2010 to January 2022. The risk of bias was assessed using the Cochrane risk of bias tool. A meta-analysis alongside a narrative synthesis was used for examining the effect of standalone AVF devices.Sixteen studies were selected for this systematic review. A meta-analysis revealed an increased compression depth of 2.22 mm [95% CI (Confidence Interval), 0.88-3.55, P = 0.001] when participants performed CPR using the feedback devices. Besides, AVF devices enabled laypersons to deliver compression rates closer to the recommended range of 100-120 per min. No improvement was noted in chest recoil and hand positioning when participants used standalone AVF devices. CONCLUSION The quality of the included studies was variable, and different standalone AVF devices were used. Standalone AVF devices were instrumental in guiding laypersons to deliver deeper compressions without compromising the quality of compression rates. However, the devices did not improve the quality of chest recoil and placement of the hands. REGISTRATION PROSPERO: CRD42020205754.
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Affiliation(s)
- Desale Tewelde Kahsay
- Department of Anaesthesiology and Intensive Care, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
| | | | - Riitta Rosio
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Miretta Tommila
- Department of Anaesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku and Turku University Hospital, Turku, Finland
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von Amelunxen B, Kirk S, Hind J, Illibauer J, Krall C, Lessing S, Noyelle A, Murphy PMJ, Sterz F. A six-year teaching life supportive first aid program to eventually generate peer trainer pupils: a prospective case control study. BMC MEDICAL EDUCATION 2023; 23:496. [PMID: 37407965 DOI: 10.1186/s12909-023-04476-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Out of hospital cardiac arrest is a life-threatening condition. To improve the chances of survival, lay-person cardio-pulmonary-resuscitation (CPR) is a crucial factor. Many bystanders fail to react appropriately, even if life supporting first aid (LSFA) programs and campaigns including CPR tried to increase the handling of basic cardiac life support. To achieve an enhanced learning of CPR a pupil's grade after grade teaching program was established in a school with medical students. METHODS The learning of CPR was investigated in a prospective, case-controlled study at an international school. Pupils (12 ± 3 years old) joining our LSFA courses (n = 538, female: 243, attendance for evaluation: 476) were compared to a control group (n = 129, female: 52, attendance for evaluation: 102). Surveys and quality of CPR (QCPR%) through a computer linked "Resusci Anne" dummy were compared with Chi-squared tests, t-tests pair wisely, and by one-way ANOVA. RESULTS Knowledge and skills on the "Resusci Anne" were significantly better in trained grade 9 pupils compared to the control group (QCPR, 59 vs. 25%). The number of LSFA courses each grade 9 student had, correlated with improved practical performance (r2 = 0.21, p < 0.001). The willingness to deliver CPR to strangers increased with improved practical performance. Attitudes towards performing CPR were high in all participating grades. CONCLUSION Repetitive teaching LSFA to grade 5-9 pupil's grade after grade by medical students has been successfully established. Pupils who finish the program will eventually be able to teach LSFA to younger students. This is furthermore a good way of sharing a "learning by teaching" role and it enables to have more pupils as trainers who can provide instruction to a larger number of pupils with the purpose of having a better-trained population in LSFA.
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Affiliation(s)
| | - Samantha Kirk
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Julian Hind
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Jennifer Illibauer
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Christoph Krall
- Center of Medical Statistics, Medical University of Vienna, Wien, Austria
| | | | | | | | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria.
- Allgemeines Krankenhaus Wien Medizinische Universität Wien, Universitätsklinik für Notfallmedizin, Währinger Gürtel 18-20/6D, Wien, 1090, Austria.
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Fischer P, Rohrer U, Nürnberger P, Manninger M, Scherr D, von Lewinski D, Zirlik A, Wankmüller C, Kolesnik E. Automated external defibrillator delivery by drone in mountainous regions to support basic life support - A simulation study. Resusc Plus 2023; 14:100384. [PMID: 37091925 PMCID: PMC10120372 DOI: 10.1016/j.resplu.2023.100384] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is associated with poor survival rates. Factors that may enable survival include cardiopulmonary resuscitation (CPR) initiated by bystanders and early use of an automated external defibrillator (AED). This explorative simulation study was conceptualized to test the feasibility of a semi-autonomously operating drone that delivers an AED to a remote emergency location and its bystander-use. Methods Ten paramedics and nineteen laypersons were confronted with a manikin simulating an OHCA as single bystanders within a field test located in a mountainous region between Austria and Slovenia. The scenario included a mock-call to the local emergency response center that dispatched a drone towards the caller's GPS coordinates and supported the ongoing CPR. The outcomes were the successful delivery of the AED, the time to the first shock, hands-off times, and the overall performance of the CPR. Results The AED was delivered by drone and used in all 29 scenarios without serious adverse events. The flight time of the drone was in median 5:20 (range: 1:35-8:19) minutes. The paramedics delivered the first shock after a mean of 12:15 ± 2:03 min and hands-off times were 50 ± 22 s. The laypersons delivered the first shock after 14:04 ± 2:10 min and hands-off times were 2:11 ± 0:39 min. All participants felt confident in the handling of the delivered AED. Conclusion The delivery and usage of an AED via a semi-autonomously flying drone in a remote region is feasible. This approach can lead to early administration of shocks.
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Affiliation(s)
- Philip Fischer
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Ursula Rohrer
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
- Corresponding author.
| | - Patrick Nürnberger
- Austrian Red Cross, Landesverband Kärnten, Grete-Bittner-Straße 9, 9020 Klagenfurt am Wörthersee, Austria
| | - Martin Manninger
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Daniel Scherr
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Dirk von Lewinski
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Andreas Zirlik
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Christian Wankmüller
- Austrian Red Cross, Landesverband Kärnten, Grete-Bittner-Straße 9, 9020 Klagenfurt am Wörthersee, Austria
- Department of Operations, Energy, and Environmental Management, University of Klagenfurt, Universitätsstraße 65-67, 9020 Klagenfurt am Wörthersee, Austria
| | - Ewald Kolesnik
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
- Austrian Red Cross, Landesverband Kärnten, Grete-Bittner-Straße 9, 9020 Klagenfurt am Wörthersee, Austria
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Dazio VER, Gay JM, Hoehne SN. Cardiopulmonary resuscitation outcomes of dogs and cats at a veterinary teaching hospital before and after publication of the RECOVER guidelines. J Small Anim Pract 2022; 64:270-279. [PMID: 36562427 DOI: 10.1111/jsap.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/15/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe and compare cardiopulmonary resuscitation outcomes at a Swiss veterinary teaching hospital before and after publication of the Reassessment Campaign on Veterinary Resuscitation guidelines. MATERIALS AND METHODS Between 2018 and 2020, hospital staff underwent various types of yearly Reassessment Campaign on Veterinary Resuscitation-based cardiopulmonary resuscitation trainings. Canine and feline cardiopulmonary resuscitation events during that period (post-Reassessment Campaign on Veterinary Resuscitation) and between 2010 and 2012 (pre-Reassessment Campaign on Veterinary Resuscitation) were identified and animal, arrest and outcome variables recorded retrospectively. Factors associated with return of spontaneous circulation were determined using multi-variable logistic regression, odds ratios (95% confidence interval) generated, and significance set at P < 0.05. RESULTS Eighty-one animals were included in the pre-Reassessment Campaign on Veterinary Resuscitation group and 190 in the post-Reassessment Campaign on Veterinary Resuscitation group. Twenty-three percent in the pre-Reassessment Campaign on Veterinary Resuscitation group and 28% in the post-Reassessment Campaign on Veterinary Resuscitation group achieved return of spontaneous circulation and 1% and 4% survived to hospital discharge, respectively. Patients undergoing anaesthesia [odds ratio 4.26 (1.76 to 10.27)], elective [odds ratio 5.16 (1.06 to 25.02)] or emergent surgery [odds ratio 3.09 (1.20 to 8.00)], or experiencing cardiopulmonary arrest (CPA) due to arrhythmias [odds ratio 4.31 (1.44 to 12.93)] had higher odds of return of spontaneous circulation, while those with unknown cause of CPA [odds ratio 0.25 (0.08 to 0.78)] had lower odds. Undergoing cardiopulmonary resuscitation in the post-Reassessment Campaign on Veterinary Resuscitation period was not statistically significantly associated with return of spontaneous circulation [odds ratio 1.38 (0.68 to 2.79)]. CLINICAL SIGNIFICANCE Unchanged odds of return of spontaneous circulation in the post-Reassessment Campaign on Veterinary Resuscitation period could suggest that once-yearly cardiopulmonary resuscitation training is insufficient, effects of animal and tertiary referral hospital variables confounded results, guideline benefit is limited, or that compliance during clinical cardiopulmonary resuscitation efforts is too poor for guideline recommendations to have a positive impact. More extensive cardiopulmonary resuscitation training protocols should be established, and the compliance with and outcome benefits of a Reassessment Campaign on Veterinary Resuscitation-based cardiopulmonary resuscitation approach re-evaluated prospectively.
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Affiliation(s)
- V E R Dazio
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - J M Gay
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | - S N Hoehne
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Scott RW, Fredriksen K. Extracurricular work experience and its association with training and confidence in emergency medicine procedures among medical students: a cross-sectional study from a Norwegian medical school. BMJ Open 2022; 12:e057870. [PMID: 36167389 PMCID: PMC9516200 DOI: 10.1136/bmjopen-2021-057870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Proficiency in basic emergency procedures is important for junior doctors, but the amount of practical exposure may vary. We studied the association between students' extracurricular healthcare-related (ECHR) work experience and self-reported practical training and confidence in selected emergency medicine procedures. STUDY DESIGN Cross-sectional study. MATERIALS AND METHODS Medical students and first-year graduates answered a Likert-based questionnaire probing self-reported amount of exposure to ('training amount') and confidence with selected emergency medicine procedures. Participants also reported ECHR work experience, year of study, previous healthcare-related education, military medic training and participation in the local student association for emergency medicine (Tromsø Acute Medicine Students' Association (TAMS)). Differences within variables were analysed with independent samples t-tests, and correlation between training amount and confidence was calculated. Analysis of covariance and mixed models were applied to study associations between training amount and confidence, and work experience (primary outcomes) and the other reported factors (secondary outcomes), respectively. RESULTS 539 participants responded (70%). Among these, 81% had ECHR work experience. There was a strong correlation (r=0.878) between training amount and confidence. Work experience accounted for 5.9% and 3.5% of the total variance in training amount and confidence (primary outcomes), and respondents with work experience scored significantly higher than respondents without work experience. Year of study, previous education, military medic training and TAMS participation accounted for 49.3%, 8.7%, 6.8% and 23.6%, and 58.5%, 5.1%, 4.7% and 12.3% of the total variance in training amount and confidence, respectively (secondary outcomes). Cohen's D was 0.48 for training amount and 0.32 for confidence level, suggesting medium and weak medium-sized associations with work experience, respectively. CONCLUSION ECHR work experience is common among medical students and was associated with more training amount and higher confidence in the procedures. Year of study, previous relevant education and TAMS participation, but not military medic training, were also significantly associated with training amount and confidence.
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Affiliation(s)
- Remi William Scott
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Knut Fredriksen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Emergency Medical Services, University Hospital of North Norway, Tromsø, Norway
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De Cloedt L, Jeffers J, Alix-Séguin L, Sauthier M, Tremblay-Roy JS, Pettersen G. Pediatric Interfacility Transport Curriculum: Its Impact on the Pediatric Intensive Care and Emergency Medicine Fellows' Performance and Confidence. Air Med J 2022; 41:442-446. [PMID: 36153140 DOI: 10.1016/j.amj.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/24/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Pediatric interfacility transports are frequent. Despite the absence of a formal pediatric transport curriculum in eastern Canada, directly managing patients during transport and medical direction of the referring center and transport team are part of the pediatric critical care medicine (PCCM) and pediatric emergency medicine (PEM) program requirements. The authors developed a pediatric interfacility transport curriculum and measured its impact on fellows' confidence and performance. METHODS This was a pilot interventional prospective study in Montreal, Canada. Postcurriculum surveys were used to measure confidence, and high-fidelity simulations were used to measure performance. A target threshold for confidence was defined before implementation, and pre- and post values were compared. The simulation scenario and assessment checklist were locally developed. RESULTS The participants were 11 PCCM and 3 PEM fellows. The content of the curriculum and educational methods were selected based on the literature and a needs assessment survey. All participants rated themselves as confident at the end of the curriculum. Eighty-three percent of the participants were deemed proficient with a perfect interrater agreement. CONCLUSION The pediatric transport curriculum had a positive impact on PEM and PCCM fellows' confidence and performance in transport. Further studies should look at the impact of such a curriculum on participants' real-life performance and patient care.
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Affiliation(s)
| | - Justin Jeffers
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laurence Alix-Séguin
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Quebec, Canada
| | - Michaël Sauthier
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Quebec, Canada
| | - Jean-Sébastien Tremblay-Roy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada
| | - Géraldine Pettersen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Quebec, Canada.
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Obling L, Hassager C, Blomberg SN, Folke F. Inverse Association Between Bystander Use of Audiovisual Feedback From an Automated External Defibrillator and Return of Spontaneous Circulation. J Am Heart Assoc 2022; 11:e023232. [PMID: 35156420 PMCID: PMC9245825 DOI: 10.1161/jaha.121.023232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Treatment with an automated external defibrillator (AED) improves outcome in out‐of‐hospital cardiac arrest (OHCA). Audiovisual feedback from an AED may assist bystanders achieve higher quality cardiopulmonary resuscitation. However, the association between audiovisual feedback and clinical outcomes is not well assessed in real‐life OHCA. The aim of this study was to assess the association between audiovisual feedback from an AED used in bystander resuscitation with rates of return of spontaneous circulation (ROSC) and 30‐day survival in a real‐life cohort of patients with OHCA.
Methods and Results
We included 325 patients treated with bystander AED use before arrival of emergency medical services during 2016 to 2019 from the Capital Region of Denmark. Patients were divided into a “feedback” and a “nonfeedback” group, depending on presence of audiovisual feedback from the AED. Audiovisual feedback was defined as voice prompts with continuous feedback to ongoing resuscitation. Rates of ROSC upon hospital admission and 30‐day survival were assessed, and univariate and multivariable models were applied to decide the association to audiovisual feedback. Multivariable models were adjusted for sex, age, primary heart rhythm, and location of OHCA. A total of 155 (48%) patients had a bystander AED applied with audiovisual feedback and 170 (52%) without audiovisual feedback. A lower rate of ROSC was found in the feedback group compared with the nonfeedback group (33% [n=51] versus 45% [n=76];
P
=0.03). No association was observed between AV feedback and 30‐day survival (feedback=27% [n=42] and nonfeedback=31% [n=53];
P
=0.49). In the unadjusted logistic regression model, audiovisual feedback was associated with a decreased chance of ROSC (odds ratio, 0.61; 95% CI, 0.38–0.95;
P
=0.03), which remained significant after adjusted analysis (odds ratio, 0.53; 95% CI, 0.29–0.97;
P
=0.04), whereas we found no significant association between audiovisual feedback and 30‐day survival in the unadjusted and adjusted analyses.
Conclusions
Audiovisual feedback from an AED used by bystanders was associated with a lower chance of ROSC at hospital admission, but we found no significant difference in 30‐day survival. Focus on early and correct bystander cardiopulmonary resuscitation and AED use remain key for OHCA survival.
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Affiliation(s)
- Laust Obling
- Department of Cardiology Rigshospitalet–Copenhagen University Hospital Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Rigshospitalet–Copenhagen University Hospital Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | | - Fredrik Folke
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- Copenhagen Emergency Medical Services University of Copenhagen Denmark
- Department of Cardiology Herlev‐Gentofte Hospital‐Copenhagen University Hospital Copenhagen Denmark
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10
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Does the use of BariBoard™ improve adequacy of chest compressions in morbid obesity? A pilot study using a simulation model. Aust Crit Care 2021; 35:688-695. [PMID: 34930648 DOI: 10.1016/j.aucc.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/18/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Obesity is a growing health problem worldwide. Morbid obesity has been associated with significant barriers to effective thoracic cage compression during cardiopulmonary resuscitation. OBJECTIVE The BariBoard™ purports to improve adequacy of chest compressions in morbidly obese patients. This study uses a simulation model to evaluate this. METHODS This was a prospective blinded randomised-controlled crossover pilot trial using a simulation model of obesity. Participants, recruited from hospital departments and prehospital services, performed 2 minutes of continuous compressions on mannequins modified to emulate a morbidly obese patient. Participants were randomised by coin toss to a sequence of either control/intervention or intervention/control, with the BariBoard™ in the intervention arm. Accelerometers measured chest wall movement during compressions. The primary endpoint was a composite measure of compression adequacy (rate, depth, and recoil). Secondary endpoints comprised the individual components of the composite outcome, as both dichotomous outcomes (adequate vs. inadequate) and continuous variables. All endpoints were adjusted for potential confounders. RESULTS Of 205 participants recruited, 201 were analysed. There was a significant difference in the primary outcome between the control and intervention arms (13.4% vs. 4.5%, respectively, p = 0.001) and between the control and intervention arms for the secondary endpoints of adequate compression depth (31.3% vs. 15.9%, p < 0.001) and recoil (63.7% vs. 41.3%, p < 0.001). After adjustment for confounders and interactions, there was no difference in overall efficacy (odds ratio: 0.62, 95% confidence interval: 0.20-1.90, p = 0.40). CONCLUSION This pilot study describes the successful assessment of a device using a simulation model of obesity. Within these constraints and after adjustment for confounders, use of the BariBoard ™ did not improve efficacy of chest compressions.
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Avatar-based patient monitoring in critical anaesthesia events: a randomised high-fidelity simulation study. Br J Anaesth 2021; 126:1046-1054. [PMID: 33879327 DOI: 10.1016/j.bja.2021.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/03/2021] [Accepted: 01/17/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Failures in situation awareness cause two-thirds of anaesthesia complications. Avatar-based patient monitoring may promote situation awareness in critical situations. METHODS We conducted a prospective, randomised, high-fidelity simulation study powered for non-inferiority. We used video analysis to grade anaesthesia teams managing three 10 min emergency scenarios using three randomly assigned monitoring modalities: only conventional, only avatar, and split-screen showing both modalities side by side. The primary outcome was time to performance of critical tasks. Secondary outcomes were time to verbalisation of vital sign deviations and the correct cause of the emergency, perceived workload, and usability. We used mixed Cox and linear regression models adjusted for various potential confounders. The non-inferiority margin was 10%, or hazard ratio (HR) 0.9. RESULTS We analysed 52 teams performing 154 simulations. For performance of critical tasks during a scenario, split-screen was non-inferior to conventional (HR=1.13; 95% confidence interval [CI], 0.96-1.33; not significant in test for superiority); the result for avatar was inconclusive (HR=0.98; 95% CI, 0.83-1.15). Avatar was associated with a higher probability for verbalisation of the cause of the emergency (HR=1.78; 95% CI, 1.13-2.81; P=0.012). We found no evidence for a monitor effect on perceived workload. Perceived usability was lower for avatar (coefficient=-23.0; 95% CI, -27.2 to -18.8; P<0.0001) and split-screen (-6.7; 95% CI, -10.9 to -2.4; P=0.002) compared with conventional. CONCLUSIONS This study showed non-inferiority of split-screen compared with conventional monitoring for performance of critical tasks during anaesthesia crisis situations. The patient avatar improved verbalisation of the correct cause of the emergency. These results should be interpreted considering participants' minimal avatar but extensive conventional monitoring experience.
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Misztal-Okońska P, Goniewicz K, Goniewicz M, Ranse J, Hertelendy AJ, Gray L, Carlström E, Løwe Sørensen J, Khorram-Manesh A. Importance of Immediate Electronic-Based Feedback to Enhance Feedback for First-Time CPR Trainees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083885. [PMID: 33917203 PMCID: PMC8067975 DOI: 10.3390/ijerph18083885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
Sudden cardiac arrest is one of the leading causes of death globally. The recommended clinical management in out-of-hospital cardiac arrest cases is the immediate initiation of high-quality cardiopulmonary resuscitation (CPR). Training mannequins should be combined with technology that provides students with detailed immediate feedback on the quality of CPR performance. This study aimed to verify the impacts of the type of feedback (basic or detailed) the responders receive from the device while learning CPR and how it influences the quality of their performance and the motivation to improve their skills. The study was conducted at the Medical University of Lublin among 694 multi-professional health students during first aid classes on basic life support (BLS). The students first practiced on an adult mannequin with a basic control panel; afterward, the same mannequin was connected to a laptop, ensuring a detailed record of the performed activities through a projector. Next, the participants expressed their subjective opinion on how the feedback provided during the classes, basic vs. detailed, motivated them to improve the quality of their CPR performance. Additionally, during the classes, the instructor conducted an extended observation of students’ work and behavior. In the students’ opinion, the CPR training with detailed feedback devices provided motivation for learning and improving CPR proficiency than that with a basic control panel. Furthermore, the comments given from devices seemed to be more acceptable to the students, who did not see any bias in the device’s evaluation compared to that of the instructor. Detailed device feedback motivates student health practitioners to learn and improve the overall quality of CPR. The use of mannequins that provide detailed feedback during BLS courses can improve survival in out-of-hospital cardiac arrest.
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Affiliation(s)
- Patrycja Misztal-Okońska
- Department of Emergency Medicine, Medical University of Lublin, 20-059 Lublin, Poland;
- Correspondence:
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08-521 Dęblin, Poland;
| | - Mariusz Goniewicz
- Department of Emergency Medicine, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4215, Australia;
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, QLD 4215, Australia
| | - Attila J. Hertelendy
- Fellowship in Disaster Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, MA 02215, USA;
- Department of Emergency Medicine, Harvard Medical School, Boston, MA 02215, USA
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL 33119, USA
| | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington 6242, New Zealand;
- Joint Centre for Disaster Research, Massey University, Wellington 6021, New Zealand
| | - Eric Carlström
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden;
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3616 Kongsberg, Norway;
| | - Jarle Løwe Sørensen
- USN School of Business, University of South-Eastern Norway, 3616 Kongsberg, Norway;
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden;
- Department of Development and Research, Armed Forces Center for Defense Medicine, 426 76 Gothenburg, Västra Frölunda, Sweden
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Impact of basic life support training on knowledge of cardiac patients about first aid for out-of-hospital cardiac arrest. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bornstein K, Long B, Porta AD, Weinberg G. After a century, Epinephrine's role in cardiac arrest resuscitation remains controversial. Am J Emerg Med 2021; 39:168-172. [DOI: 10.1016/j.ajem.2020.08.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
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Theoretical knowledge and self-assessed ability to perform cardiopulmonary resuscitation: a survey among 3044 healthcare professionals in Sweden. Eur J Emerg Med 2020; 27:368-372. [PMID: 32852925 PMCID: PMC7448834 DOI: 10.1097/mej.0000000000000692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Supplemental Digital Content is available in the text. Objective Theoretical knowledge and ability to perform cardiopulmonary resuscitation (CPR) are unknown with regard to provided training. The aim of this study was to evaluate in-hospital healthcare professionals’ (HCPs) theoretical knowledge of CPR and their self-assessed ability to perform CPR and also to assess possible affecting factors. Method A questionnaire was sent to n = 5323 HCPs containing a nine-question knowledge test and a Likert scale measuring self-assessed ability. A factor score of self-assessed ability and a ratio scale of correct answers were dependent variables in multiple linear regression. Results Only 41% of the responding HCPs passed the knowledge test with seven or more correct answers. Nurses had the highest pass rate (50%) and the highest attendance rate at CPR training (56%). The ability to perform defibrillation was strongly agreed by 43% and the ability of leadership by only 7%. Working on a monitored ward, CPR training 0–6 months ago and being a nurse or physician were factors associated with more correct answers and higher ratings of abilities. Conclusion The overall theoretical knowledge was poor and ratings of self-assessed abilities to perform CPR were low. Working on a monitored ward, recently attended CPR training and being a nurse or physician were factors associated with higher theoretical knowledge and higher ratings of self-assessed ability to perform CPR. These findings imply prioritisation of CPR training.
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