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Weber A, Delport S, Delport A. Assessing student paramedics' measurements of fatigue and quality of cardiopulmonary resuscitation on a simulated cardiac arrest case. Australas Emerg Care 2023; 26:211-215. [PMID: 36526551 DOI: 10.1016/j.auec.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The International Liaison Committee on Resuscitation (ILCOR) and the Australian Resuscitation Council (ARC) recommend that high-quality cardiopulmonary resuscitation (CPR) is the key to performance outcomes, emphasising compression and rotation through this process. The proposed study has a two-stage approach to evaluating cardiopulmonary resuscitations effectiveness by out-of-hospital practitioners. The first stage aimed to evaluate the influence of providing real-time biofeedback using the Q-CPR system on the provision of CPR by student paramedics. Secondly, the study quantified the effects of physical fatigue on maintaining quality cardiopulmonary resuscitation performed by paramedic students. METHODS Forty paramedic students completed cardiopulmonary resuscitation on an instrumented manikin with and without audio-visual biofeedback (Q-CPR within the Phillips MRx defibrillator) in a balanced cross-over fashion. To quantify the quality of cardiopulmonary resuscitation concerning the percentage of applied compressions that meet the current ARC guidelines in terms of rate, depth, and recoil time, a manikin feedback system (SimMan 3 G; Laerdal, Norwegian) was used. RESULTS When using the Q-CPR prompt with bio-feedback, overall, the depth and fatigue levels increased significantly, highlighting a correlation between correct depth and increased fatigue. CONCLUSIONS Audio prompts improved compression depth; however, fatigue levels increased. The depth during manual compression compared to the Q-CPR prompt was not statistically significant.
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Affiliation(s)
- Anthony Weber
- School of Business and Law, School of Health, Medical and Applied Science, Tertiary Education Division, CQUniversity Australia, Australia.
| | - Shannon Delport
- School of Health, Medical and Applied Science, Tertiary Education Division, CQUniversity Australia, Australia
| | - Aldon Delport
- Tactical Medicine, School of Health, Medical and Applied Science, Tertiary Education Division, CQUniversity Australia, Australia
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Shaukat N, Ali DM, Jaffer M, Jarrar Z, Ashraf N, Hassan S, Daudpota AA, Qadir MA, Khowaja AH, Razzak J. Lifesaving skills training in schools - A qualitative study to explore students, teachers, and parent's perceived opportunities and challenges. BMC Public Health 2023; 23:400. [PMID: 36849931 PMCID: PMC9970688 DOI: 10.1186/s12889-023-15284-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE The objective of this study is to explore the perception of teachers, parents and students' regarding implementation of a school-based lifesaving skills program and help predict potential barriers and solutions. METHODS This qualitative exploratory study was conducted in Karachi, Pakistan, from December 2020- to October 2021. We included students, teachers, and parents of secondary (grades VIII, IX, and X) and higher secondary level students (grades XI and XII) in Karachi, Pakistan's public and private schools and colleges. We selected one public, two semi-private, and two private schools. We recruited students, teachers, and parents through convenience sampling. We conducted fifteen focus group discussions (FGDs) with the students, six FGDs with the teachers, and eighteen in-depth interviews (IDIs) with parents. We transcribed the data from audio recordings and translated it into the English language. Finally, we manually analyzed the data using thematic analyses. RESULTS This study found that bystanders' main barriers to performing lifesaving skills are lack of knowledge, fear of legal involvement, fear of hurting the patient by incorrect technique, lack of empathy among community stakeholders, and gender bias. However, the participants had a positive and supportive attitude toward implementing lifesaving skills training in schools. They suggested starting student training in the early teenage years, preferred medical staff as trainers, and suggested frequent small sessions in English/Urdu both or Urdu language and training via theory and practical hands-on drills. Furthermore, the training was proposed to be integrated into the school curriculum to make it sustainable. Finally, the government needs to support the program and make the legal environment more conducive for bystanders. CONCLUSION This study identified the significant barriers to performing lifesaving skills in an emergency in a low- and middle-income country (LMIC). The participants supported implementing a national lifesaving skills program in schools and colleges. However, the participants expressed that support is needed by the government for sustainability, integrating lifesaving skills into the school curriculum, providing legal support to the bystanders, and creating awareness among the general public.
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Affiliation(s)
- Natasha Shaukat
- Centre of Excellence for Trauma and Emergencies, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800, Pakistan.
| | - Daniyal Mansoor Ali
- Centre of Excellence for Trauma and Emergencies, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800, Pakistan
| | - Mehtab Jaffer
- School of Nursing & Midwifery, Aga Khan University, Karachi, Pakistan
| | - Zeerak Jarrar
- Centre of Excellence for Trauma and Emergencies, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800, Pakistan
| | - Naela Ashraf
- Centre of Excellence for Trauma and Emergencies, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800, Pakistan
| | - Sheza Hassan
- Centre of Excellence for Trauma and Emergencies, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800, Pakistan
| | | | | | | | - Junaid Razzak
- Centre of Excellence for Trauma and Emergencies, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800, Pakistan.,Department of Emergency Medicine, Weill Cornell Medicine, New York, USA
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Husain AA, Rai U, Sarkar AK, Chandrasekhar V, Hashmi MF. Out-of-Hospital Cardiac Arrest during the COVID-19 Pandemic: A Systematic Review. Healthcare (Basel) 2023; 11:189. [PMID: 36673557 PMCID: PMC9858873 DOI: 10.3390/healthcare11020189] [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: 11/12/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Objective: Out-of-hospital cardiac arrest (OHCA) is a prominent cause of death worldwide. As indicated by the high proportion of COVID-19 suspicion or diagnosis among patients who had OHCA, this issue could have resulted in multiple fatalities from coronavirus disease 2019 (COVID-19) occurring at home and being counted as OHCA. Methods: We used the MeSH term "heart arrest" as well as non-MeSH terms "out-of-hospital cardiac arrest, sudden cardiac death, OHCA, cardiac arrest, coronavirus pandemic, COVID-19, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)." We conducted a literature search using these search keywords in the Science Direct and PubMed databases and Google Scholar until 25 April 2022. Results: A systematic review of observational studies revealed OHCA and mortality rates increased considerably during the COVID-19 pandemic compared to the same period of the previous year. A temporary two-fold rise in OHCA incidence was detected along with a drop in survival. During the pandemic, the community's response to OHCA changed, with fewer bystander cardiopulmonary resuscitations (CPRs), longer emergency medical service (EMS) response times, and worse OHCA survival rates. Conclusions: This study's limitations include a lack of a centralised data-gathering method and OHCA registry system. If the chain of survival is maintained and effective emergency ambulance services with a qualified emergency medical team are given, the outcome for OHCA survivors can be improved even more.
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Affiliation(s)
- Amreen Aijaz Husain
- School of Pharmaceutical and Population Health Informatics, DIT University, Dehradun 248009, India
| | - Uddipak Rai
- School of Pharmaceutical and Population Health Informatics, DIT University, Dehradun 248009, India
| | | | | | - Mohammad Farukh Hashmi
- Department of Electronics and Communication Engineering, National Institute of Technology, Warangal 506004, India
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Wu G, Podlinski L, Wang C, Dunn D, Buldo D, Mazza B, Fox J, Kostelnik M, Defenza G. Intraoperative Code Blue: Improving Teamwork and Code Response Through Interprofessional, In Situ Simulation. Jt Comm J Qual Patient Saf 2022; 48:665-673. [PMID: 36192311 DOI: 10.1016/j.jcjq.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION An intraoperative cardiac arrest requires perioperative teams to be equipped with the technical skills, nontechnical skills, and confidence to provide the best resuscitative measures for the patient. In situ simulation (simulation conducted in health professionals' work environment, such as a patient care unit, and not in an off-site location) has the potential to improve team performance. The research team assessed the effects of in situ simulation on code response, teamwork, communication, and comfort in intraoperative resuscitations. METHODS This study included seven interprofessional teams consisting of RNs, anesthesiologists, surgical technologists, and patient care technicians working in the operating room of a community hospital in New Jersey. The hour-long interdisciplinary simulation training sessions consisted of a code blue scenario run twice; both times video recorded, retrospectively reviewed, and compared to each other. Technical skills were measured by "time-to-tasks"; nontechnical skills were assessed using the Team Emergency Assessment Measure (TEAM) instrument. Self-reported comfort in skills was collected before the simulation program and after completion of the training. RESULTS A total of 21 perioperative nurses, 7 anesthesiologists, 7 surgical technologists, and 4 patient care technicians participated from January to April 2021. There was a significant (p < 0.05) decrease in time to compressions (by 14 seconds, 53.5% improvement) and in time to defibrillation (by 49 seconds) between the two simulations. Significant improvements were noted in confidence levels of certain CPR-related technical skills. There were statistically significant improvements in TEAM scores in the two teams that performed lowest in the pre-debrief simulation (p < 0.05). CONCLUSION In the operative setting, where time and space for training are limited, in situ simulation training was associated with improvement in technical skills of individuals and teams, with significantly improved teamwork in teams that required the most training. The long-term effects of such training and its effects on patient outcomes require additional research.
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Vandersmissen H, Gworek H, Dewolf P, Sabbe M. Drug use during adult advanced cardiac life support: An overview of reviews. Resusc Plus 2021; 7:100156. [PMID: 34430950 PMCID: PMC8371248 DOI: 10.1016/j.resplu.2021.100156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 01/08/2023] Open
Abstract
AIM To conduct an overview of systematic reviews and meta-analyses to summarize the ever-growing evidence on drug use during advanced life support. METHODS We searched Embase, Medline, Cochrane central register of controlled trials and Web of science for systematic reviews and meta-analyses reporting on drug use during advanced life support from inception to March, 2020. Two reviewers independently assessed all abstracts for eligibility, extracted data and assessed risk of bias using the AMSTAR-2 tool. Corrected covered areas were calculated from publication citation matrices to account for potential risk of bias. Data were graphically represented using forest plots. RESULTS Twenty-two head-to-head drug comparisons from 47 included articles were analysed. Adrenaline significantly increases the incidence of return of spontaneous circulation and survival to hospital discharge, but not the incidence of neurological intact survival. Vasopressin alone or in combination with adrenaline is not superior to adrenaline alone. There is a trend favouring lidocaine over amiodarone in shockable cardiac arrest. The risk of bias assessment of included studies ranged from very low to very high and the overlap between articles was moderate to high. CONCLUSIONS In line with the guidelines, we currently suggest that a standard dose of adrenaline should be administered during resuscitation, however, studies assessing lower doses of adrenaline are pressing. There is no rationale for the combination of vasopressin and adrenaline or vasopressin alone instead of adrenaline. In addition, lidocaine is a valuable alternative for amiodarone and maybe even preferable for shockable cardiac arrest. However more research is necessary.
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Affiliation(s)
- Hans Vandersmissen
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- KULeuven, Faculty of Medicine, Leuven, Belgium
| | - Hanne Gworek
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- KULeuven, Faculty of Medicine, Leuven, Belgium
| | - Philippe Dewolf
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- KULeuven, Department of Public Health and Primary Care, Leuven, Belgium
- KULeuven, Faculty of Medicine, Leuven, Belgium
| | - Marc Sabbe
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- KULeuven, Department of Public Health and Primary Care, Leuven, Belgium
- KULeuven, Faculty of Medicine, Leuven, Belgium
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Xu J, Jiang JK, Li XL, Yu XP, Xu YG, Lu YQ. Comparative transcriptomic analysis of vascular endothelial cells after hypoxia/re-oxygenation induction based on microarray technology. J Zhejiang Univ Sci B 2021; 21:291-304. [PMID: 32253839 DOI: 10.1631/jzus.b2000043] [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] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide comprehensive data to understand mechanisms of vascular endothelial cell (VEC) response to hypoxia/re-oxygenation. METHODS Human umbilical vein endothelial cells (HUVECs) were employed to construct hypoxia/re-oxygenation-induced VEC transcriptome profiling. Cells incubated under 5% O2, 5% CO2, and 90% N2 for 3 h followed by 95% air and 5% CO2 for 1 h were used in the hypoxia/re-oxygenation group. Those incubated only under 95% air and 5% CO2 were used in the normoxia control group. RESULTS By using a well-established microarray chip consisting of 58 339 probes, the study identified 372 differentially expressed genes. While part of the genes are known to be VEC hypoxia/re-oxygenation-related, serving as a good control, a large number of genes related to VEC hypoxia/re-oxygenation were identified for the first time. Through bioinformatic analysis of these genes, we identified that multiple pathways were involved in the reaction. Subsequently, we applied real-time polymerase chain reaction (PCR) and western blot techniques to validate the microarray data. It was found that the expression of apoptosis-related proteins, like pleckstrin homology-like domain family A member 1 (PHLDA1), was also consistently up-regulated in the hypoxia/re-oxygenation group. STRING analysis found that significantly differentially expressed genes SLC38A3, SLC5A5, Lnc-SLC36A4-1, and Lnc-PLEKHJ1-1 may have physical or/and functional protein-protein interactions with PHLDA1. CONCLUSIONS The data from this study have built a foundation to develop many hypotheses to further explore the hypoxia/re-oxygenation mechanisms, an area with great clinical significance for multiple diseases.
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Affiliation(s)
- Jia Xu
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Department of Geriatric Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jiu-Kun Jiang
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Department of Geriatric Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xiao-Lin Li
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Department of Geriatric Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xiao-Peng Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Ying-Ge Xu
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Department of Geriatric Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yuan-Qiang Lu
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Department of Geriatric Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Mandala S, Cai Di T, Sunar MS, Adiwijaya. ECG-based prediction algorithm for imminent malignant ventricular arrhythmias using decision tree. PLoS One 2020; 15:e0231635. [PMID: 32407335 PMCID: PMC7224460 DOI: 10.1371/journal.pone.0231635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 03/28/2020] [Indexed: 02/01/2023] Open
Abstract
Spontaneous prediction of malignant ventricular arrhythmia (MVA) is useful to avoid delay in rescue operations. Recently, researchers have developed several algorithms to predict MVA using various features derived from electrocardiogram (ECG). However, there are several unresolved issues regarding MVA prediction such as the effect of number of ECG features on a prediction remaining unclear, possibility that an alert for occurring MVA may arrive very late and uncertainty in the performance of the algorithm predicting MVA minutes before onset. To overcome the aforementioned problems, this research conducts an in-depth study on the number and types of ECG features that are implemented in a decision tree classifier. In addition, this research also investigates an algorithm's execution time before the occurrence of MVA to minimize delays in warnings for MVA. Lastly, this research aims to study both the sensitivity and specificity of an algorithm to reveal the performance of MVA prediction algorithms from time to time. To strengthen the results of analysis, several classifiers such as support vector machine and naive Bayes are also examined for the purpose of comparison study. There are three phases required to achieve the objectives. The first phase is literature review on existing relevant studies. The second phase deals with design and development of four modules for predicting MVA. Rigorous experiments are performed in the feature selection and classification modules. The results show that eight ECG features with decision tree classifier achieved good prediction performance in terms of execution time and sensitivity. In addition, the results show that the highest percentage for sensitivity and specificity is 95% and 90% respectively, in the fourth 5-minute interval (15.1 minutes-20 minutes) that preceded the onset of an arrhythmia event. Such results imply that the fourth 5-minute interval would be the best time to perform prediction.
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Affiliation(s)
- Satria Mandala
- Human Centric (HUMIC) Engineering, Telkom University, Bandung, Indonesia
- School of Computing, Telkom University, Bandung, Indonesia
| | - Tham Cai Di
- Media and Game Innovative Centre of Excellence, Institute of Human Centered Engineering, Universiti Teknologi Malaysia, Johor Bahru, Johor, Malaysia
- School of Computing, Faculty of Engineering, Universiti Teknologi Malaysia, Johor Bahru, Johor, Malaysia
| | - Mohd Shahrizal Sunar
- Media and Game Innovative Centre of Excellence, Institute of Human Centered Engineering, Universiti Teknologi Malaysia, Johor Bahru, Johor, Malaysia
- School of Computing, Faculty of Engineering, Universiti Teknologi Malaysia, Johor Bahru, Johor, Malaysia
| | - Adiwijaya
- Human Centric (HUMIC) Engineering, Telkom University, Bandung, Indonesia
- School of Computing, Telkom University, Bandung, Indonesia
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Kaihula WT, Sawe HR, Runyon MS, Murray BL. Assessment of cardiopulmonary resuscitation knowledge and skills among healthcare providers at an urban tertiary referral hospital in Tanzania. BMC Health Serv Res 2018; 18:935. [PMID: 30514275 PMCID: PMC6278030 DOI: 10.1186/s12913-018-3725-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 11/16/2018] [Indexed: 11/24/2022] Open
Abstract
Background Early and effective CPR increases both survival rate and post-arrest quality of life. In limited resource countries like Tanzania, there is scarce data describing the basic knowledge of CPR among Healthcare providers (HCP). This study aimed to determine the current level of knowledge on, and ability to perform, CPR among HCP at Muhimbili National Hospital (MNH). Methods This was a descriptive cross sectional study of a random sample of 350 HCP from all cadres and departments at MNH from October 2015 to March 2016. Each participant completed a with 25 question multiple choice and fill-in-the-blank CPR test and a practical test using a CPR manikin where the participant was videotaped for 1–2 min. Two expert observers independently viewed the videos and rated participant performance on a structured data form. The primary outcome of interest was staff member overall performance on the written and practical CPR testing. Results We enrolled 350 HCPs from all 12 MNH clinical departments. The median participant age was 35 (IQR 29–43) years, 225 (64%) were female and 138 (39%) had clinical experience of less than 5 years. Only 57 (16%) and 88 (25%) scored above 50% in written and practical tests, respectively according to local minimum passing test score and 13(4%) and 30 (9%) scored above 75% in written and practical tests, respectively according to international minimum passing test score on CPR. The 233(67%) HCP who reported prior experience performing CPR on an adult patient scored higher on testing than those without; 40% (IQR 28–54) versus 26% (IQR 16–42) respectively, but both groups had median scores <50%. Conclusion The level of CPR knowledge and skills displayed by all cadres and in all departments was poor despite the fact that most providers reported having performed CPR in the past. Since MNH is a tertiary referral hospital, it may reflect the performance of resuscitation status of other local health centers in Tanzania and other low-income countries to employ a formal system of training every HCP in CPR. Staff should be certified and assessed regularly to ensure retention of resuscitation knowledge and skills. Electronic supplementary material The online version of this article (10.1186/s12913-018-3725-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Winfrida T Kaihula
- Emergency Medicine Department, Muhimbili National Hospital, P.O. Box 65001, Dar es Salaam, Tanzania. .,Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili National Hospital, P.O. Box 65001, Dar es Salaam, Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Michael S Runyon
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - Brittany L Murray
- Division of Paediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Li H, Shen X, Xu X, Wang Y, Chu L, Zhao J, Wang Y, Wang H, Xie G, Cheng B, Ye H, Sun Y, Fang X. Bystander cardiopulmonary resuscitation training in primary and secondary school children in China and the impact of neighborhood socioeconomic status: A prospective controlled trial. Medicine (Baltimore) 2018; 97:e12673. [PMID: 30290654 PMCID: PMC6200495 DOI: 10.1097/md.0000000000012673] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) has endorsed school bystander cardiopulmonary resuscitation (CPR) training programs. But related researches in China are limited. Therefore, we conducted this study to assess bystander CPR training in school children in China and the impact of neighborhood socio-economic status (SES) on. METHODS A total of 1,093 students from seven schools in Zhejiang province participated in this study. Theoretical and practical bystander CPR training were conducted in instructor-led classes. Students completed a 10-statement questionnaire before and after training, and then underwent a skills assessment during a simulated basic life support (BLS) scenario. Subgroup analyses were stratified according to neighborhood SES. RESULTS Before training, most students (72.83%) had a strong desire to learn bystander CPR and share with others. After training, bystander CPR theory was significantly improved (P < .01), and 92.64% students reached an 85-100% performance rate in a simulated BLS scenario. Students from low-SES neighborhoods had less pre-training knowledge of bystander CPR (P < .01). However, their performance was similar with students from higher-SES neighborhoods on the post-training questionnaire and the skills assessment, and better among students aged 13-14 years. CONCLUSION School children in China have a poor pre-training knowledge of bystander CPR. However, with training, there was a significant improvement in the basic theory and skills of CPR. Bystander CPR training efforts should be targeted to Chinese primary and secondary school children, especially in low-SES neighborhoods.
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Affiliation(s)
- Hui Li
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xu Shen
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
- Department of Anesthesiology, Jiaxing First Hospital of Zhejiang Province, Jiaxing
| | - Xia Xu
- Department of Anesthesiology, Lihuili Hospital, Ningbo Medical center, Ningbo
| | - Yan Wang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Lihua Chu
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Jialian Zhao
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | - Ya Wang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Haihong Wang
- Department of Anesthesiology, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, China
| | - Guohao Xie
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Baoli Cheng
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Hui Ye
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yaqi Sun
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xiangming Fang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
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Gu W, Zhang Q, Li CS. Effect of Splenic Regulatory T-cell Apoptosis on the Postresuscitation Immune Dysfunction in a Porcine Model. Chin Med J (Engl) 2017; 129:1577-83. [PMID: 27364795 PMCID: PMC4931265 DOI: 10.4103/0366-6999.184461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Postresuscitation immune dysfunction contributes to the low survival rate after successful resuscitation, but its mechanism remains poorly understood. The purpose of this study was to investigate whether splenic regulatory T-cell (Treg) apoptosis was involved in the postresuscitation immune dysfunction. Methods: Thirty-eight pigs were randomly divided into sham-operated group (SHAM group, n = 8), 12 h post return of spontaneous circulation (ROSC) group, 24 h post-ROSC group, and 48 h post-ROSC group (n = 10 per group). A Wuzhishan miniature porcine model of 8-min ventricular fibrillation cardiac arrest (CA) was established. The apoptosis rates of Treg in the spleen were tested by flow cytometry; the expressions of forkhead/winged helix transcription factor (Foxp3) of Treg in the spleen were detected by real-time polymerase chain reaction; and the levels of interleukin-4 (IL-4), IL-10, and interferon gamma (IFN-γ) of Treg in the spleen were detected by enzyme-linked immunosorbent assay. Results: The apoptosis rates of Treg in all post-ROSC groups were significantly lower than that of SHAM group (7.7% ± 1.9%, 7.1% ± 1.8%, 6.2% ± 0.4% vs. 13.1% ± 1.6%; P < 0.05); the expression levels of Foxp3 and IL-10 were also decreased with the increase of apoptosis rates of Treg. Helper T-cells CD4+ lymphocyte subsets were significantly lower in the post-ROSC groups compared with SHAM group (29.1% ± 2.2%, 24.3% ± 2.2%, 24.1% ± 2.5% vs. 43.8% ± 4.5%; P < 0.01) at 12, 24, and 48 h after ROSC. Compared with SHAM group, the levels of IFN-γ (161.0 ± 12.9, 167.7 ± 10.5, 191.2 ± 7.7 vs. 7.6 ± 0.9 ng/L) and IL-4 (27.7 ± 6.2, 35.9 ± 3.5, 50.6 ± 6.1 vs. 13.3 ± 2.3 ng/L) and the ratio of IFN-γ/IL-4 (8.6 ± 2.3, 4.9 ± 0.4, 4.5 ± 0.9 vs. 0.8 ± 0.2) were all greatly elevated in all post-ROSC groups (P < 0.05). Conclusions: Apoptosis rate of Treg was significantly decreased after CA, and thus the proportion of Treg was increased and the inhibitory effects were enhanced, which further led to the decrease of the amount of CD4+ T-cells. In addition, the T helper type 2/T helper type 1 (Th2/Th1) cell drift of Treg in the spleen caused postresuscitation immune dysfunction.
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Affiliation(s)
- Wei Gu
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing 100020, China
| | - Qian Zhang
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Chun-Sheng Li
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing 100020, China
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Pichler G, Fazekas F. Cardiopulmonary arrest is the most frequent cause of the unresponsive wakefulness syndrome: A prospective population-based cohort study in Austria. Resuscitation 2016; 103:94-98. [PMID: 26980348 DOI: 10.1016/j.resuscitation.2016.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/11/2016] [Accepted: 02/26/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The "Unresponsive wakefulness syndrome" (UWS) or previously termed vegetative state is a possible consequence of severe brain damage where individuals just open their eyes but show no conscious behavioural reaction. While head trauma has previously been considered the prevailing cause, clinical experience suggests shows that cardiopulmonary arrest plays an increasingly important role. We therefore attempted to study this hypothesis in a well-defined region of Austria. METHODS Prospective population-based cohort study to calculate the incidence and aetiologies of the UWS. All facilities in the state of Styria (n=38), which are involved in the medical care of patients with brain damage, participated. Among the adult population of Styria (n=1010,164) we identified all individuals who developed UWS over a one year period. The diagnosis was based on a formal neurologic evaluation at least 4 weeks after the brain damage and had to be in line with the criteria of the "Multi-society Task Force on Persistent Vegetative State". RESULTS We identified 19 individual with UWS which correspond to an annual incidence of 1.88/100,000 people. Male gender predominated (78.9%) and the mean age was 57.8 years (age range 18-78 years). The most frequent cause of UWS was cerebral hypoxia in the wake of cardiopulmonary resuscitation (63%), cerebral bleeding (21%) and brain trauma (16%). CONCLUSIONS Cardiopulmonary resuscitation has become the major cause of UWS which leads to an increasing incidence with age. These aspects may become even more prominent with the ageing of our population and need to be considered in the organisation of care.
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Affiliation(s)
- Gerald Pichler
- Department of Neurology, Albert-Schweitzer-Hospital Graz, Albert-Schweitzer-Gasse 36, 8020 Graz, Austria.
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
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Pentax Airway Scope AWS-S200 video laryngoscope for child tracheal intubation in a manikin study with 3 airway scenarios. Am J Emerg Med 2015; 33:1171-4. [DOI: 10.1016/j.ajem.2015.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 11/22/2022] Open
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