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Moretti MA, Camboim ADO, Ferrandez CA, Ramos IC, Costa IB, Canonaco JS, Mathia VL, Ferreira JFM, Chagas ACP. Retention of Cardiopulmonary Resuscitation Skills in Medical Students. Arq Bras Cardiol 2021; 117:1030-1035. [PMID: 34406321 PMCID: PMC8682095 DOI: 10.36660/abc.20200546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
Fundamento A redução da mortalidade e das sequelas de uma vítima de parada cardíaca depende de um atendimento eficaz, rápido e iniciado o mais precocemente possível. O suporte básico de vida (SBV) compreende uma série de etapas que podem ser iniciadas fora do ambiente hospitalar, e ensinadas para qualquer pessoa em cursos específicos. Porém, é importante que o socorrista retenha o conhecimento e as habilidades, pois nunca se sabe quando será necessário realizar uma ressuscitação cardiopulmonar (RCP). Entretanto, estudos mostram que existe uma perda das habilidades em executar uma RCP já com 30 dias após o treinamento, com variações segundo algumas características das pessoas e da atividade profissional. Objetivo Avaliar se os estudantes de medicina são capazes de reter as habilidades por mais de seis meses. Métodos Estudo prospectivo, caso controle, observacional. Estudantes de medicina realizaram um curso sobre morte súbita e parada cardíaca de 40 horas. A avaliação das habilidades foi realizada imediatamente após o curso e seis meses depois. Foram comparadas as notas individuais entre dois momentos, foi avaliada a porcentagem de acerto em cada etapa e uma análise global do atendimento foi classificado como ótimo, bom e ruim. Os avaliadores e critérios foram os mesmos nos dois momentos. Os dados foram analisados pelos teste-t pareado e teste de McNemar, onde para um nível de confiança de 95% o critério para significância foi p < 0,05. Resultados Cinquenta estudantes (27 do sexo feminino) do primeiro ano, com idade entre 18 e 24 anos (média 21), realizaram o curso. O número de etapas cumpridas de forma correta após seis meses foi significativamente menor que logo após o curso (10,8 vs 12,5 p < 0,001). O sexo e idade não interferiram nos resultados. A qualidade global foi considerada ótima em 78% dos atendimentos realizados logo após o curso, significativamente, maior que os 40% após seis meses (p < 0,01). Após seis meses, maior número de erros foi observado nas etapas relacionadas às habilidades mais práticas (como posicionamento das mãos). Conclusão Seis meses após o curso observamos uma perda significativa das habilidades, entre estudantes de medicina, prejudicando a eficácia global do atendimento.
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Affiliation(s)
| | | | | | | | - Iaggo Bemini Costa
- Faculdade de Medicina da Fundação do ABC - Cardiologia,1 Santo André, SP - Brasil
| | | | - Vanessa Lopes Mathia
- Faculdade de Medicina da Fundação do ABC - Cardiologia,1 Santo André, SP - Brasil
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Abstract
Cardiac arrest remains a significant cause of death and disability throughout the world. However, as our understanding of cardiac arrest and resuscitation physiology has developed, new technologies are fundamentally altering our potential to improve survival and neurologic sequela. Some advances are relatively simple, requiring only alterations in current basic life support measures or integration with pre-hospital organization, whereas others, such as extra-corporeal membrane oxygenation, require significant time and resource investments. When combined with consistent rescuer and patient-physiologic monitoring, these innovations allow an unprecedented capacity to personalize cardiac arrest resuscitation to patient-specific pathophysiology. However, as more extensive options are established, it can be difficult for providers to incorporate novel resuscitation techniques into a cardiac arrest protocol which can fit a wide variety of cases with varying complexity. This article will explore recent advances in our understanding of cardiac arrest physiology and resuscitation sciences, with particular focus on the metabolic phase after significant ischemia has been induced. To this end, we establish a practical consideration for providers seeking to integrate novel advances in cardiac arrest resuscitation into daily practice.
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Affiliation(s)
- Cyrus E Kuschner
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA
| | - Lance B Becker
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA
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Liu Y, Huang Z, Li H, Zheng G, Ling Q, Tang W, Yang Z. CPR feedback/prompt device improves the quality of hands-only CPR performed in manikin by laypersons following the 2015 AHA guidelines. Am J Emerg Med 2018. [PMID: 29525478 DOI: 10.1016/j.ajem.2018.02.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We investigated the effects of a cardiopulmonary resuscitation (CPR) feedback/prompt device on the quality of chest compression (CC) during hands-only CPR following the 2015 AHA guidelines. METHODS A total of 124 laypersons were randomly assigned into three groups. The first (n=42) followed the 2010 guidelines, the second (n=42) followed the 2015 guidelines with no feedback/prompt device, the third (n=40) followed the 2015 guidelines with a feedback/prompt device (2015F). Participants underwent manual CPR training and took a written basic life support examination, then required to perform 2min of hands-only CPR monitored by a CPR feedback/prompt device. The quality of CPR was quantified as the percentage of correct CCs (mean CC depth and rate, complete recoil and chest compression fraction (CCF)) per 20s, as recorded by the CPR feedback/prompt device. RESULTS Significantly higher correct ratios of CC, CC depth, and rate were achieved in the 2010 group in each minute vs the 2015 group. The greater mean CC depth and rate were observed in the 2015F group vs the 2015 group. The correct ratio of CC was significantly higher in the 2015F group vs the 2015 group. CCF was also significantly higher in the 2015F group vs the 2015 group in the last 20s of CPR. CONCLUSIONS It is difficult for a large percentage of laypersons to achieve the targets of CC depth and rate following the 2015 AHA guidelines. CPR feedback/prompt devices significantly improve the quality of hands-only CPR performance by laypersons following the standards of the 2015 AHA guidelines.
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Affiliation(s)
- Yuanshan Liu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China
| | - Zitong Huang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China
| | - Heng Li
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China; Cardiovascular Department, Tung Wah Affiliated Hospital, Sun Yat-sen University, Dongguan, China
| | - Guanghui Zheng
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China
| | - Qin Ling
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Weil Institute of Emergency and Critical Care Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Wanchun Tang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Weil Institute of Emergency and Critical Care Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA.
| | - Zhengfei Yang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Weil Institute of Emergency and Critical Care Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China.
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Yamaguchi R, Makino Y, Chiba F, Torimitsu S, Yajima D, Inokuchi G, Motomura A, Hashimoto M, Hoshioka Y, Shinozaki T, Iwase H. Frequency and influencing factors of cardiopulmonary resuscitation-related injuries during implementation of the American Heart Association 2010 Guidelines: a retrospective study based on autopsy and postmortem computed tomography. Int J Legal Med 2017; 131:1655-1663. [PMID: 28905100 DOI: 10.1007/s00414-017-1673-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 08/30/2017] [Indexed: 02/08/2023]
Abstract
AIM To determine the frequency of cardiopulmonary resuscitation (CPR)-related injuries and factors involved in their occurrence, data based on forensic autopsy and postmortem computed tomography (PMCT) during implementation of the 2010 American Heart Association Guidelines for CPR were studied. METHODS We retrospectively evaluated data on adult patients with non-traumatic deaths who had undergone manual CPR and autopsy from January 2012 to December 2014. CPR-related injuries were analyzed on autopsy records and PMCT images and compared with results of previous studies. RESULTS In total, 180 consecutive cases were analyzed. Rib fractures and sternal fractures were most frequent (overall frequency, 66.1 and 52.8%, respectively), followed by heart injuries (12.8%) and abdominal visceral injuries (2.2%). Urgently life-threatening injuries were rare (2.8%). Older age was an independent risk factor for rib fracture [adjusted odds ratio (AOR), 1.06; 95% confidence interval (CI), 1.04-1.08; p < 0.001], ≥ 3 rib fractures (AOR, 1.06; 95% CI, 1.02-1.09; p = 0.002), and sternal fracture (AOR, 1.03; 95% CI, 1.01-1.05; p < 0.001). Female sex was significantly associated with sternal fracture (AOR, 2.08; 95% CI, 1.02-4.25; p = 0.04). Chest compression only by laypersons was inversely associated with rib and sternal fractures. Body mass index and in-hospital cardiac arrest were not significantly associated with any complications. The frequency of thoracic skeletal injuries was similar to that in recent autopsy-based studies. CONCLUSIONS Implementation of the 2010 Guidelines had little impact on the frequency of CPR-related thoracic skeletal injuries or urgently life-threatening complications. Older age was the only independent factor related to thoracic skeletal injuries.
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Affiliation(s)
- Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan.,Education and Research Center of Legal Medicine, Department of Forensic Radiology and Imaging, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Mari Hashimoto
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan
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Wang GN, Chen XF, Qiao L, Mei Y, Lv JR, Huang XH, Shen B, Zhang JS. Comparison of extracorporeal and conventional cardiopulmonary resuscitation: A meta-analysis of 2 260 patients with cardiac arrest. World J Emerg Med 2017; 8:5-11. [PMID: 28123613 DOI: 10.5847/wjem.j.1920-8642.2017.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This meta-analysis aimed to determine whether extracorporeal cardiopulmonary resuscitation (ECPR), compared with conventional cardiopulmonary resuscitation (CCPR), improves outcomes in adult patients with cardiac arrest (CA). DATA RESOURCES PubMed, EMBASE, Web of Science, and China Biological Medicine Database were searched for relevant articles. The baseline information and outcome data (survival, good neurological outcome at discharge, at 3-6 months, and at 1 year after CA) were collected and extracted by two authors. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using Review Manager 5.3. RESULTS In six studies 2 260 patients were enrolled to study the survival rate to discharge and long-term neurological outcome published since 2000. A significant effect of ECPR was observed on survival rate to discharge compared to CCPR in CA patients (RR 2.37, 95%CI 1.63-3.45, P<0.001), and patients who underwent ECPR had a better long-term neurological outcome than those who received CCPR (RR 2.79, 95%CI 1.96-3.97, P<0.001). In subgroup analysis, there was a significant difference in survival to discharge favoring ECPR over CCPR group in OHCA patients (RR 2.69, 95%CI 1.48-4.91, P=0.001). However, no significant difference was found in IHCA patients (RR 1.84, 95%CI 0.91-3.73, P=0.09). CONCLUSION ECPR showed a beneficial effect on survival rate to discharge and long-term neurological outcome over CCPR in adult patients with CA.
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Affiliation(s)
- Gan-Nan Wang
- Department of Emergency Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xu-Feng Chen
- Department of Emergency Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Qiao
- Department of Emergency Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yong Mei
- Department of Emergency Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Ru Lv
- Department of Emergency Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xi-Hua Huang
- Department of Emergency Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bin Shen
- Department of Emergency Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Song Zhang
- Department of Emergency Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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