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Addis A, Baggiani M, Citerio G. Intracranial Pressure Monitoring and Management in Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2023; 39:59-69. [PMID: 37280411 PMCID: PMC10499755 DOI: 10.1007/s12028-023-01752-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/12/2023] [Indexed: 06/08/2023]
Abstract
Aneurysmal subarachnoid hemorrhage is a medical condition that can lead to intracranial hypertension, negatively impacting patients' outcomes. This review article explores the underlying pathophysiology that causes increased intracranial pressure (ICP) during hospitalization. Hydrocephalus, brain swelling, and intracranial hematoma could produce an ICP rise. Although cerebrospinal fluid withdrawal via an external ventricular drain is commonly used, ICP monitoring is not always consistently practiced. Indications for ICP monitoring include neurological deterioration, hydrocephalus, brain swelling, intracranial masses, and the need for cerebrospinal fluid drainage. This review emphasizes the importance of ICP monitoring and presents findings from the Synapse-ICU study, which supports a correlation between ICP monitoring and treatment with better patient outcomes. The review also discusses various therapeutic strategies for managing increased ICP and identifies potential areas for future research.
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Affiliation(s)
- Alberto Addis
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Neurological Intensive Care Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | | | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
- Neurological Intensive Care Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy.
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2
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Baggiani M, Graziano F, Rebora P, Robba C, Guglielmi A, Galimberti S, Giussani C, Suarez JI, Helbok R, Citerio G. Intracranial Pressure Monitoring Practice, Treatment, and Effect on Outcome in Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2023; 38:741-751. [PMID: 36471182 DOI: 10.1007/s12028-022-01651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intracranial pressure (ICP) monitoring and its management in aneurysmal subarachnoid hemorrhage (aSAH) is variable worldwide. The present study aimed to explore the practice of ICP monitoring, its variability across countries, and the association with 6-month outcomes in aSAH. METHODS This was a preplanned subanalysis of SYNAPSE-ICU, a multicenter, international, prospective, observational cohort study focused on patients diagnosed with aSAH. We evaluated the variability in ICP monitoring across countries through a logistic regression model adjusted for case-mix and considered countries as a random effect. The association between ICP probe insertion and 6-month mortality and a poor neurological outcome, defined as an Glasgow Outcome Score Extended ≤ 4, was assessed by using a propensity score approach. RESULTS A total of 423 patients with aSAH from 92 centers across 32 countries were included in this analysis. ICP monitoring was used in 295 (69.7%) patients. Significant between-country variability in ICP insertion was observed, with an incidence ranging between 4.7% and 79.9% (median odd ratio 3.04). The median duration of ICP monitoring was 12 days (first quartile [Q1] through third quartile [Q3] range 8-18), with an overall daily median ICP value of 14 mm Hg (Q1-Q3 10-19) and a median maximum value of 21 mm Hg (Q1-Q3 16-30). Patients monitored with ICP received more aggressive therapy treatments compared with non-monitored patients (therapy intensity level, TIL, score 10.33 [standard deviation 3.61] vs. 6.3 [standard deviation 4.19], p < 0.001). In more severe patients, ICP monitoring was significantly associated with better 6-month outcome (poor neurological outcome: odds ratio 0.14, 95% confidence interval 0.02-0.53, p = 0.0113; mortality: hazard ratio 0.25, 95% confidence interval 0.13-0.49, p < 0.0001). However, no significant effect was observed in patients with both reactive pupils. CONCLUSIONS Our cohort demonstrated high variability in ICP insertion practice among countries. A more aggressive treatment approach was applied in ICP-monitored patients. In patients with severe aSAH, ICP monitoring might reduce unfavorable outcomes and mortality at 6 months.
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Affiliation(s)
- Marta Baggiani
- Ospedale Maggiore della Carità di Novara, Università del Piemonte Orientale, Novara, Italy
| | - Francesca Graziano
- Department of Health Science, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paola Rebora
- Department of Health Science, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Chiara Robba
- Department of Anesthesia and Critical Care, San Martino Policlinico Hospital, Istituto Di Ricovero E Cura a Carattere Scientifico for Oncology and Neuroscience, Genoa, Italy
| | - Angelo Guglielmi
- Anaesthesia and Intensive Care Unit , Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Stefania Galimberti
- Department of Health Science, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Carlo Giussani
- Department of Health Science, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
- Neurosurgery Unit, Neuroscience Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raimund Helbok
- Neurocritical Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Giuseppe Citerio
- Department of Health Science, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
- Neurointensive Care Unit, Neuroscience Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
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3
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Messina A, Robba C, Calabrò L, Zambelli D, Iannuzzi F, Molinari E, Scarano S, Battaglini D, Baggiani M, De Mattei G, Saderi L, Sotgiu G, Pelosi P, Cecconi M. Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery. Crit Care 2021; 25:205. [PMID: 34116707 PMCID: PMC8194047 DOI: 10.1186/s13054-021-03629-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/06/2021] [Indexed: 12/12/2022]
Abstract
Background Postoperative complications impact on early and long-term patients’ outcome. Appropriate perioperative fluid management is pivotal in this context; however, the most effective perioperative fluid management is still unclear. The enhanced recovery after surgery pathways recommend a perioperative zero-balance, whereas recent findings suggest a more liberal approach could be beneficial. We conducted this trial to address the impact of restrictive vs. liberal fluid approaches on overall postoperative complications and mortality. Methods Systematic review and meta-analysis, including randomised controlled trials (RCTs). We performed a systematic literature search using MEDLINE (via Ovid), EMBASE (via Ovid) and the Cochrane Controlled Clinical trials register databases, published from 1 January 2000 to 31 December 2019. We included RCTs enrolling adult patients undergoing elective abdominal surgery and comparing the use of restrictive/liberal approaches enrolling at least 15 patients in each subgroup. Studies involving cardiac, non-elective surgery, paediatric or obstetric surgeries were excluded. Results After full-text examination, the metanalysis finally included 18 studies and 5567 patients randomised to restrictive (2786 patients; 50.0%) or liberal approaches (2780 patients; 50.0%). We found no difference in the occurrence of severe postoperative complications between restrictive and liberal subgroups [risk difference (95% CI) = 0.009 (− 0.02; 0.04); p value = 0.62; I2 (95% CI) = 38.6% (0–66.9%)]. This result was confirmed also in the subgroup of five studies having a low overall risk of bias. The liberal approach was associated with lower overall renal major events, as compared to the restrictive [risk difference (95% CI) = 0.06 (0.02–0.09); p value = 0.001]. We found no difference in either early (p value = 0.33) or late (p value = 0.22) postoperative mortality between restrictive and liberal subgroups Conclusions In major abdominal elective surgery perioperative, the choice between liberal or restrictive approach did not affect overall major postoperative complications or mortality. In a subgroup analysis, a liberal as compared to a restrictive perioperative fluid policy was associated with lower overall complication renal major events, as compared to the restrictive. Trial Registration CRD42020218059; Registration: February 2020, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218059. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03629-y.
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Affiliation(s)
- Antonio Messina
- Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy. .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - Chiara Robba
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy
| | - Lorenzo Calabrò
- Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
| | - Daniel Zambelli
- Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
| | - Francesca Iannuzzi
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Edoardo Molinari
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Silvia Scarano
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Denise Battaglini
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy
| | - Marta Baggiani
- Anesthesia and Intensive Care Medicine, Maggiore Della Carità University Hospital, Novara, Italy
| | - Giacomo De Mattei
- Anesthesia and Intensive Care Medicine, Azienda Sanitaria Universitaria Integrata Udine, Udine, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental, University of Sassari, Sassari, Italy
| | - Paolo Pelosi
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Maurizio Cecconi
- Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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4
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Messina A, Robba C, Calabrò L, Zambelli D, Iannuzzi F, Molinari E, Scarano S, Battaglini D, Baggiani M, De Mattei G, Saderi L, Sotgiu G, Pelosi P, Cecconi M. Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery. Crit Care 2021; 25:43. [PMID: 33522953 PMCID: PMC7849093 DOI: 10.1186/s13054-021-03464-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/07/2021] [Indexed: 01/07/2023]
Abstract
Background Appropriate perioperative fluid management is of pivotal importance to reduce postoperative complications, which impact on early and long-term patient outcome. The so-called perioperative goal-directed therapy (GDT) approach aims at customizing perioperative fluid management on the individual patients’ hemodynamic response. Whether or not the overall amount of perioperative volume infused in the context of GDT could influence postoperative surgical outcomes is unclear.
Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the efficacy of GDT approach between study population and control group in reducing postoperative complications and perioperative mortality, using MEDLINE, EMBASE and the Cochrane Controlled Clinical trials register. The enrolled studies were grouped considering the amount infused intraoperatively and during the first 24 h after the admission in the critical care unit (perioperative fluid). Results The metanalysis included 21 RCTs enrolling 2729 patients with a median amount of perioperative fluid infusion of 4500 ml. In the studies reporting an overall amount below or above this threshold, the differences in postoperative complications were not statically significant between controls and GDT subgroup [43.4% vs. 34.2%, p value = 0.23 and 54.8% vs. 39.8%; p value = 0.09, respectively]. Overall, GDT reduced the overall rate of postoperative complications, as compared to controls [pooled risk difference (95% CI) = − 0.10 (− 0.14, − 0.07); Chi2 = 30.97; p value < 0.0001], but not to a reduction of perioperative mortality [pooled risk difference (95%CI) = − 0.016 (− 0.0334; 0.0014); p value = 0.07]. Considering the rate of organ-related postoperative events, GDT did not reduce neither renal (p value = 0.52) nor cardiovascular (p value = 0.86) or pulmonary (p value = 0.14) or neurological (p value = 0.44) or infective (p value = 0.12) complications. Conclusions Irrespectively to the amount of perioperative fluid administered, GDT strategy reduces postoperative complications, but not perioperative mortality. Trial Registration CRD42020168866; Registration: February 2020 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=168866
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Affiliation(s)
- Antonio Messina
- Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy. .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Lorenzo Calabrò
- Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
| | - Daniel Zambelli
- Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
| | - Francesca Iannuzzi
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Edoardo Molinari
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Silvia Scarano
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Denise Battaglini
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Marta Baggiani
- Anesthesia and Intensive Care Medicine, Maggiore Della Carità University Hospital, Novara, Italy
| | - Giacomo De Mattei
- Anesthesia and Intensive Care Medicine, Azienda Sanitaria Universitaria Integrata Udine, Udine, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental, University of Sassari, Sassari, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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5
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Vaschetto R, Barone-Adesi F, Racca F, Pissaia C, Maestrone C, Colombo D, Olivieri C, De Vita N, Santangelo E, Scotti L, Castello L, Cena T, Taverna M, Grillenzoni L, Moschella MA, Airoldi G, Borrè S, Mojoli F, Della Corte F, Baggiani M, Baino S, Balbo P, Bazzano S, Bonato V, Carbonati S, Crimaldi F, Daffara V, De Col L, Maestrone M, Malerba M, Moroni F, Perucca R, Pirisi M, Rondi V, Rosalba D, Vanni L, Vigone F, Navalesi P, Cammarota G. Outcomes of COVID-19 patients treated with continuous positive airway pressure outside the intensive care unit. ERJ Open Res 2021; 7:00541-2020. [PMID: 33527074 PMCID: PMC7607967 DOI: 10.1183/23120541.00541-2020] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023] Open
Abstract
Aim We aimed to characterise a large population of coronavirus disease 2019 (COVID-19) patients with moderate-to-severe hypoxaemic acute respiratory failure (ARF) receiving continuous positive airway pressure (CPAP) outside the intensive care unit (ICU), and to ascertain whether the duration of CPAP application increased the risk of mortality for patients requiring intubation. Methods In this retrospective, multicentre cohort study, we included adult COVID-19 patients, treated with CPAP outside ICU for hypoxaemic ARF from 1 March to 15 April, 2020. We collected demographic and clinical data, including CPAP therapeutic goal, hospital length of stay and 60-day in-hospital mortality. Results The study included 537 patients with a median (interquartile range (IQR) age of 69 (60-76) years. 391 (73%) were male. According to the pre-defined CPAP therapeutic goal, 397 (74%) patients were included in the full treatment subgroup, and 140 (26%) in the do not intubate (DNI) subgroup. Median (IQR) CPAP duration was 4 (1-8) days, while hospital length of stay was 16 (9-27) days. 60-day in-hospital mortality was 34% (95% CI 0.304-0.384%) overall, and 21% (95% CI 0.169-0.249%) and 73% (95% CI 0.648-0.787%) for full treatment and DNI subgroups, respectively. In the full treatment subgroup, in-hospital mortality was 42% (95% CI 0.345-0.488%) for 180 (45%) CPAP failures requiring intubation, and 2% (95% CI 0.008-0.035%) for the remaining 217 (55%) patients who succeeded. Delaying intubation was associated with increased mortality (hazard ratio 1.093, 95% CI 1.010-1.184). Conclusions We described a large population of COVID-19 patients treated with CPAP outside ICU. Intubation delay represents a risk factor for mortality. Further investigation is needed for early identification of CPAP failures.
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Affiliation(s)
- Rosanna Vaschetto
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy.,Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.,These authors contributed equally
| | - Francesco Barone-Adesi
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.,These authors contributed equally
| | - Fabrizio Racca
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Department of Anaesthesia and Intensive Care, Alessandria, Italy, EU
| | - Claudio Pissaia
- Ospedale degli Infermi, Dipartimento di Anestesia e Terapia Intensiva, Ponderano, Biella, Italy
| | - Carlo Maestrone
- Presidio Ospedaliero Domodossola e Verbania, Anestesia Rianimazione ASL VCO, Direzione dipartimento chirurgico, Largo Caduti Lager Nazisti, Domodossola, Italy
| | - Davide Colombo
- Ospedale Ss. Trinità, Department of Anaesthesia and Critical Care, Borgomanero, Italy
| | - Carlo Olivieri
- Azienda Ospedaliera Sant'Andrea, Department of Anaesthesia and Critical Care, Vercelli, Italy
| | - Nello De Vita
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Erminio Santangelo
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Lorenza Scotti
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Luigi Castello
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.,Azienda Ospedaliero Universitaria "Maggiore della Carità", Medicina d'Urgenza, Novara, Italy
| | - Tiziana Cena
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy
| | - Martina Taverna
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Department of Anaesthesia and Intensive Care, Alessandria, Italy, EU
| | - Luca Grillenzoni
- Ospedale degli Infermi, Medicina D'Urgenza, Ponderano, Biella, Italy
| | - Maria Adele Moschella
- Presidio Ospedaliero Domodossola, Medicina Interna ASL VCO, Largo Caduti Lager Nazisti, Domodossola, Italy
| | | | - Silvio Borrè
- Azienda Ospedaliera Sant'Andrea, Malattie Infettive, Vercelli, Italy
| | - Francesco Mojoli
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Anaesthesia and Intensive Care, Pavia, Italy
| | - Francesco Della Corte
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy.,Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Marta Baggiani
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Sara Baino
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Piero Balbo
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Pneumologia, Novara, Italy
| | - Simona Bazzano
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy
| | - Valeria Bonato
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Department of Anaesthesia and Intensive Care, Alessandria, Italy, EU
| | - Sara Carbonati
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Federico Crimaldi
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Veronica Daffara
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Luca De Col
- Ospedale degli Infermi, Dipartimento di Anestesia e Terapia Intensiva, Ponderano, Biella, Italy
| | - Matteo Maestrone
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Mario Malerba
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.,Azienda Ospedaliera Sant'Andrea, Pneumologia, Vercelli, Italy
| | - Federica Moroni
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Raffaella Perucca
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy
| | - Mario Pirisi
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.,Azienda Ospedaliero Universitaria "Maggiore della Carità", Clinica Medica, Novara, Italy
| | - Valentina Rondi
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Daniela Rosalba
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Letizia Vanni
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Francesca Vigone
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Paolo Navalesi
- Istituto di Anestesia e Rianimazione, Azienda Ospedale-Università di Padova, Dipartimento di Medicina - DIMED - Università di Padova, Padua, Italy.,These authors contributed equally
| | - Gianmaria Cammarota
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy.,These authors contributed equally
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6
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Messina A, Montagnini C, Cammarota G, Giuliani F, Muratore L, Baggiani M, Bennett V, Della Corte F, Navalesi P, Cecconi M. Assessment of Fluid Responsiveness in Prone Neurosurgical Patients Undergoing Protective Ventilation. Anesth Analg 2020; 130:752-761. [DOI: 10.1213/ane.0000000000004494] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7
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Messina A, Dell'Anna A, Baggiani M, Torrini F, Maresca GM, Bennett V, Saderi L, Sotgiu G, Antonelli M, Cecconi M. Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness. Crit Care 2019; 23:264. [PMID: 31358025 PMCID: PMC6664788 DOI: 10.1186/s13054-019-2545-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/17/2019] [Indexed: 01/22/2023]
Abstract
Background Bedside functional hemodynamic assessment has gained in popularity in the last years to overcome the limitations of static or dynamic indexes in predicting fluid responsiveness. The aim of this systematic review and metanalysis of studies is to investigate the reliability of the functional hemodynamic tests (FHTs) used to assess fluid responsiveness in adult patients in the intensive care unit (ICU) and operating room (OR). Methods MEDLINE, EMBASE, and Cochrane databases were screened for relevant articles using a FHT, with the exception of the passive leg raising. The QUADAS-2 scale was used to assess the risk of bias of the included studies. In-between study heterogeneity was assessed through the I2 indicator. Bias assessment graphs were plotted, and Egger’s regression analysis was used to evaluate the publication bias. The metanalysis determined the pooled area under the receiving operating characteristic (ROC) curve, sensitivity, specificity, and threshold for two FHTs: the end-expiratory occlusion test (EEOT) and the mini-fluid challenge (FC). Results After text selection, 21 studies met the inclusion criteria, 7 performed in the OR, and 14 in the ICU between 2005 and 2018. The search included 805 patients and 870 FCs with a median (IQR) of 39 (25–50) patients and 41 (30–52) FCs per study. The median fluid responsiveness was 54% (45–59). Ten studies (47.6%) adopted a gray zone analysis of the ROC curve, and a median (IQR) of 20% (15–51) of the enrolled patients was included in the gray zone. The pooled area under the ROC curve for the end-expiratory occlusion test (EEOT) was 0.96 (95%CI 0.92–1.00). The pooled sensitivity and specificity were 0.86 (95%CI 0.74–0.94) and 0.91 (95%CI 0.85–0.95), respectively, with a best threshold of 5% (4.0–8.0%). The pooled area under the ROC curve for the mini-FC was 0.91 (95%CI 0.85–0.97). The pooled sensitivity and specificity were 0.82 (95%CI 0.76–0.88) and 0.83 (95%CI 0.77–0.89), respectively, with a best threshold of 5% (3.0–7.0%). Conclusions The EEOT and the mini-FC reliably predict fluid responsiveness in the ICU and OR. Other FHTs have been tested insofar in heterogeneous clinical settings and, despite promising results, warrant further investigations. Electronic supplementary material The online version of this article (10.1186/s13054-019-2545-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antonio Messina
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.
| | - Antonio Dell'Anna
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marta Baggiani
- Department of Anesthesiology and Intensive Care Medicine, A.O.U. Maggiore della Carità, Novara, Italy
| | - Flavia Torrini
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gian Marco Maresca
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Victoria Bennett
- Department of Intensive Care Medicine, St George's University Hospital NHS Foundation Trust, London, UK
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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8
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Paglino M, Contri E, Baggiani M, Tonani M, Costantini G, Bonomo MC, Baldi E. A video-based training to effectively teach CPR with long-term retention: the ScuolaSalvaVita.it ("SchoolSavesLives.it") project. Intern Emerg Med 2019; 14:275-279. [PMID: 30209672 DOI: 10.1007/s11739-018-1946-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
Enhancing CPR knowledge in schools is the key to improving bystander CPR rate and survival after an out-of-hospital cardiac arrest, but the best method to do so in a whole area is unknown. We wanted to assess if a province-based project, which involves the Secondary Schools of a whole Province, is effective in teaching schoolchildren CPR, and how well the skills are retained. We trained 100 teachers from the 21 Secondary Schools of the Province of Pavia with a BLS/AED course and we supplied each school with 10 low-budget manikins and four educational videos. These videos, about 2 min each, consist of a motivational part, an instructive part, a demonstrative part and a practice-while-watching part. We explained to the teachers how to use manikins and videos in a 2-h course. We carried out both a theoretical and a practical test in 21 classes, randomly selected between the classes trained by the teachers, 3 months and 6 months after the training. In the first 5 months of the project, 5146 schoolchildren aged 14-19, in the 21 Secondary Schools of our Province, were trained by their teachers. We tested 304 students 3 months after the course and 318 students 6 months after the course, with good results both in theoretical and practical skills. Our study demonstrates that the ScuolaSalvaVita project is able to effectively teach CPR through teachers using a video-based training in the Secondary Schools of a whole Province obtaining good long-term memory of CPR skills.
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Affiliation(s)
- Martina Paglino
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- School of Anesthesia and Intensive Care, University of Pavia, 27100, Pavia, Italy
| | - Enrico Contri
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- School of Anesthesia and Intensive Care, University of Pavia, 27100, Pavia, Italy
- AREU - Azienda Regionale Emergenza Urgenza - AAT Pavia, Department of Intensive Care Medicine, Fondazione IRCCS Policlinico San Matteo Hospital, Pavia, Italy
| | - Marta Baggiani
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- University of Piemonte Orientale, 18100, Novara, Italy
| | - Michela Tonani
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- Emergency Medicine Department, Ospedale Maggiore di Lodi, 26900, Lodi, Italy
| | - Giulia Costantini
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- School of Surgery, University of Pavia, 27100, Pavia, Italy
| | - Maria Concetta Bonomo
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- School of Anesthesia and Intensive Care, University of Pavia, 27100, Pavia, Italy
| | - Enrico Baldi
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy.
- Robbio nel Cuore, IRC-Comunità Training Center, 27038, Robbio, Italy.
- School of Cardiovascular Disease, Department of Molecular Medicine, University of Pavia, 27100, Pavia, Italy.
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9
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Bajunaid K, Mullah MAS, Winkler-Schwartz A, Alotaibi FE, Fares J, Baggiani M, Azarnoush H, Christie S, Al-Zhrani G, Marwa I, Sabbagh AJ, Werthner P, Del Maestro RF. Impact of acute stress on psychomotor bimanual performance during a simulated tumor resection task. J Neurosurg 2017; 126:71-80. [DOI: 10.3171/2015.5.jns15558] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Severe bleeding during neurosurgical operations can result in acute stress affecting the bimanual psychomotor performance of the operator, leading to surgical error and an adverse patient outcome. Objective methods to assess the influence of acute stress on neurosurgical bimanual psychomotor performance have not been developed. Virtual reality simulators, such as NeuroTouch, allow the testing of acute stress on psychomotor performance in risk-free environments. Thus, the purpose of this study was to explore the impact of a simulated stressful virtual reality tumor resection scenario by utilizing NeuroTouch to answer 2 questions: 1) What is the impact of acute stress on bimanual psychomotor performance during the resection of simulated tumors? 2) Does acute stress influence bimanual psychomotor performance immediately following the stressful episode?
METHODS
Study participants included 6 neurosurgeons, 6 senior and 6 junior neurosurgical residents, and 6 medical students. Participants resected a total of 6 simulated tumors, 1 of which (Tumor 4) involved uncontrollable “intraoperative” bleeding resulting in simulated cardiac arrest and thus providing the acute stress scenario. Tier 1 metrics included extent of blood loss, percentage of tumor resected, and “normal” brain tissue volume removed. Tier 2 metrics included simulated suction device (sucker) and ultrasonic aspirator total tip path length, as well as the sum and maximum forces applied in using these instruments. Advanced Tier 2 metrics included efficiency index, coordination index, ultrasonic aspirator path length index, and ultrasonic aspirator bimanual forces ratio. All metrics were assessed before, during, and after the stressful scenario.
RESULTS
The stress scenario caused expected significant increases in blood loss in all participant groups. Extent of tumor resected and brain volume removed decreased in the junior resident and medical student groups. Sucker total tip path length increased in the neurosurgeon group, whereas sucker forces increased in the senior resident group. Psychomotor performance on advanced Tier 2 metrics was altered during the stress scenario in all participant groups. Performance on all advanced Tier 2 metrics returned to pre-stress levels in the post–stress scenario tumor resections.
CONCLUSIONS
Results demonstrated that acute stress initiated by simulated severe intraoperative bleeding significantly decreases bimanual psychomotor performance during the acute stressful episode. The simulated intraoperative bleeding event had no significant influence on the advanced Tier 2 metrics monitored during the immediate post-stress operative performance.
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Affiliation(s)
- Khalid Bajunaid
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
- 2Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Jeddah
| | | | - Alexander Winkler-Schwartz
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
| | - Fahad E. Alotaibi
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
- 5National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City
| | - Jawad Fares
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
| | - Marta Baggiani
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
| | - Hamed Azarnoush
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
- 7Department of Biomedical Engineering, Tehran Polytechnic, Tehran, Iran
| | - Sommer Christie
- 4University of Calgary, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Gmaan Al-Zhrani
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
- 5National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City
| | - Ibrahim Marwa
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
| | - Abdulrahman Jafar Sabbagh
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
- 5National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City
- 6Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; and
| | - Penny Werthner
- 4University of Calgary, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Rolando F. Del Maestro
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
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10
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Winkler-Schwartz A, Bajunaid K, Mullah MAS, Marwa I, Alotaibi FE, Fares J, Baggiani M, Azarnoush H, Zharni GA, Christie S, Sabbagh AJ, Werthner P, Del Maestro RF. Bimanual Psychomotor Performance in Neurosurgical Resident Applicants Assessed Using NeuroTouch, a Virtual Reality Simulator. J Surg Educ 2016; 73:942-953. [PMID: 27395397 DOI: 10.1016/j.jsurg.2016.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/01/2016] [Accepted: 04/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Current selection methods for neurosurgical residents fail to include objective measurements of bimanual psychomotor performance. Advancements in computer-based simulation provide opportunities to assess cognitive and psychomotor skills in surgically naive populations during complex simulated neurosurgical tasks in risk-free environments. This pilot study was designed to answer 3 questions: (1) What are the differences in bimanual psychomotor performance among neurosurgical residency applicants using NeuroTouch? (2) Are there exceptionally skilled medical students in the applicant cohort? and (3) Is there an influence of previous surgical exposure on surgical performance? DESIGN Participants were instructed to remove 3 simulated brain tumors with identical visual appearance, stiffness, and random bleeding points. Validated tier 1, tier 2, and advanced tier 2 metrics were used to assess bimanual psychomotor performance. Demographic data included weeks of neurosurgical elective and prior operative exposure. SETTING This pilot study was carried out at the McGill Neurosurgical Simulation Research and Training Center immediately following neurosurgical residency interviews at McGill University, Montreal, Canada. PARTICIPANTS All 17 medical students interviewed were asked to participate, of which 16 agreed. RESULTS Performances were clustered in definable top, middle, and bottom groups with significant differences for all metrics. Increased time spent playing music, increased applicant self-evaluated technical skills, high self-ratings of confidence, and increased skin closures statistically influenced performance on univariate analysis. A trend for both self-rated increased operating room confidence and increased weeks of neurosurgical exposure to increased blood loss was seen in multivariate analysis. CONCLUSIONS Simulation technology identifies neurosurgical residency applicants with differing levels of technical ability. These results provide information for studies being developed for longitudinal studies on the acquisition, development, and maintenance of psychomotor skills. Technical abilities customized training programs that maximize individual resident bimanual psychomotor training dependant on continuously updated and validated metrics from virtual reality simulation studies should be explored.
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Affiliation(s)
- Alexander Winkler-Schwartz
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - Khalid Bajunaid
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Muhammad A S Mullah
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Ibrahim Marwa
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Fahad E Alotaibi
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, National Neuroscience Institute (NNI), King Fahad Medical City (KFMC), Riyadh, Saudi Arabia
| | - Jawad Fares
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Marta Baggiani
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Hamed Azarnoush
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Gmaan Al Zharni
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, National Neuroscience Institute (NNI), King Fahad Medical City (KFMC), Riyadh, Saudi Arabia
| | - Sommer Christie
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Abdulrahman J Sabbagh
- Section of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (Gen. Org) - Jeddah Branch, Jeddah, Saudi Arabia
| | - Penny Werthner
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Rolando F Del Maestro
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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11
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Contri E, Baggiani M, Bonomo MC, Tonani M, Fichtner FE, Cornara S, Baldi E. Video-based compression-only CPR teaching: A feasible and effective way to spread CPR in secondary schools. Resuscitation 2016. [DOI: 10.1016/j.resuscitation.2016.07.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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