Rapid cycle deliberate practice approach on resuscitation training: A systematic review

Aim

To evaluate the effectiveness of Rapid Cycle Deliberate Practice (RCDP) compared to traditional instruction or other forms of learning on resuscitation training outcomes and on clinical and/or patient-related outcomes.

Methods

As part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation it was conducted this review and searched Medline, Embase and Cochrane from inception to Feb 12th, 2024. Risk of bias assessment was performed with the Risk of Bias in Non-randomized Studies of Interventions assessment tool and the Revised Cochrane risk-of-bias tool for randomized trials. The GRADE approach was used to evaluate the overall certainty of evidence for each outcome.

Results

4420 abstracts were retrieved by the initial search and 10 additional studies were identified through other resources. Sixty-five studies were selected for eligibility and nine simulated studies met the inclusion criteria. A meta-analysis was performed on three outcomes: time to chest compressions, time to defibrillation and time to first epinephrine given, which showed that RCDP had significantly shorter time to defibrillation and time to administration of epinephrine than controls. The overall certainty of evidence was very low across all outcomes due to risk of bias, inconsistency, indirectness, and imprecision.

Conclusion

It may be reasonable to include RCDP as an instructional design feature of basic and advanced life support training. However, substantial variations of delivering RCDP exist and there is no uniform use of RCDP. Further research is necessary on medium/long-term effects of RCDP training, and on the effects on different target groups of training.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

An effort to reduce chest compression pauses during automated external defibrillator use among laypeople: A randomized partially blinded controlled trial

Aim

To implement small methodological changes in basic life support (BLS) training to reduce unnecessary pauses during automated external defibrillator (AED) use.

Methods

One hundred and two university students with no BLS knowledge were randomly allocated into three groups (control and 2 experimental groups). Both experimental groups received a two-hour BLS training. While the contents were identical in both groups, in one of them the reduction of no-flow time was focused on (focused no-flow group). The control group did not receive any training. Finally, all of them were evaluated in the same out-of-hospital cardiac arrest simulated scenario. The primary endpoint was the compression fraction.

Results

Results from 78 participants were analysed (control group: 19; traditional group: 30; focused no-flow group: 29). The focused no-flow group achieved higher percentages of compression fraction (median: 56.0, interquartile rank (IQR): 53.5-58.5) than the traditional group (44.0, IQR: 42.0-47.0) and control group (52.0, IQR: 43.0-58.0) in the complete scenario. Participants from the control group performed compression-only cardiopulmonary resuscitation (CPR), while the other groups performed compression-ventilation CPR. CPR fraction was calculated, showing the fraction of time in which the participants were performing resuscitation manoeuvres. In this case, the focused no-flow group reached higher percentages of CPR fraction (77.6, IQR: 74.4-82.4) than the traditional group (61.9, IQR: 59.3-68.1) and the control group (52.0, IQR: 43.0-58.0).

Conclusions

Laypeople having automated external defibrillation training focused on acting in anticipation of the AED prompts contributed to a reduction in chest compression pauses during an OHCA simulated scenario.

Would anti-choking devices be correctly and quickly managed by health science students? A manikin crossover trial

BACKGROUND

The brand-new anti-choking devices (LifeVac® and DeCHOKER®) have been recently developed to treat Foreign Body Airway Obstruction (FBAO). However, the scientific evidence around these devices that are available to the public is limited. Therefore, this study aimed to assess the ability to use the LifeVac® and DeCHOKER® devices in an adult FBAO simulated scenario, by untrained health science students.

METHODS

Forty-three health science students were asked to solve an FBAO event in three simulated scenarios: 1) using the LifeVac®, 2) using the DeCHOKER®, and 3) following the recommendations of the current FBAO protocol. A simulation-based assessment was used to analyze the correct compliance rate in the three scenarios based on the correct execution of the required steps, and the time it took to complete each one.

RESULTS

Participants achieved correct compliance rates between 80-100%, similar in both devices (p = 0.192). Overall test times were significantly shorter with LifeVac® than DeCHOKER® device (36.6 sec. [31.9-44.4] vs. 50.4 s [36.7-66.9], p < 0.001). Regarding the recommended protocol, a 50% correct compliance rate was obtained in those with prior training vs. 31.3% without training, (p = 0.002).

CONCLUSIONS

Untrained health science students are able to quickly and adequately use the brand-new anti-choking devices but have more difficulties in applying the current recommended FBAO protocol.

Interrater Reliability of the Test of Gross Motor Development—Third Edition Following Raters’ Agreement on Measurement Criteria

We aimed to calculate interrater reliability of the Test of Gross Motor Development—Third Edition (TGMD-3) after raters reached a consensus regarding measurement criteria. Three raters measured the fundamental movement skills of 25 children on the TGMD-3 at two different times: (a) once when simply following the measurement criteria in the TGMD-3 manual and (b) after a 9-month washout period, following the raters’ consensus building for the measurement criteria for each skill. After calculating and comparing the interrater reliability of these three raters across these two rating times, we found improved interrater reliability after the raters’ consensus-building discussions on ratings of both locomotor skills (moderate-to-good reliability on two of six skills initially and at least moderate-to-excellent on four of six skills following criteria consensus building) and ball skills (moderate-to-good reliability on one of seven skills initially and at least moderate-to-excellent reliability on four of seven skills following criteria consensus building). For subtest scores and overall test scores, raters achieved at least moderate-to-good reliability on their second, postconsensus-building ratings. Based on this improved reliability following consensus building, we recommend that researchers include rater consensus building before assessing children’s fundamental movement skills or guiding curriculum interventions in physical education from TGMD-3 data.

Does Vibration Foam Roller Influence Performance and Recovery? A Systematic Review and Meta-analysis

Background

Foam rolling has been extensively investigated, showing benefits in performance and recovery. Recently, vibration has been added to foam rollers, with hypothesized advantages over conventional foam rollers. However, there is no systematic evidence in this regard.

Objective

To carry out a systematic review and meta-analysis about the effects of vibration foam roller (VFR) on performance and recovery.

Methods

A systematic search was conducted in PubMed/MEDLINE, Web of Science and SportDiscus according to the PRISMA guidelines. The outcomes included performance (jump, agility and strength) and recovery variables (blood flow, pain and fatigue) measured after an intervention with VFR. The methodological quality was assessed with the PEDro scale. A random-effects model was used to perform the meta-analysis.

Results

Initially, 556 studies were found and after the eligibility criteria 10 studies were included in the systematic review and 9 in the meta-analysis. There was no significant effects on jump performance (SMD = 0.14 [95% CI − 0.022 to 0.307]; p = 0.101; I² = 1.08%) and no significant beneficial effects were reported on isokinetic strength (SMD = 0.16 [95% CI − 0.041 to 0.367]; p = 0.117; I² = 9.7%). Recovery appears to be enhanced after VFR interventions, but agility does not seem to increase after VFR interventions.

Conclusion

This systematic review and meta-analysis suggest that VFR could have great potential for increasing jump performance, agility, strength and enhancing recovery. Further research is needed to confirm the effects of VFR on performance and recovery.

Trial Registration This investigation was registered in PROSPERO with the code CRD42021238104.

The Developmental Trajectory of Motor Competence of Children That Lived the COVID-19 Confinement Period: A Four-Year Follow-Up Study in Portuguese Children

Children’s motor competence (MC) was negatively affected by the COVID-19 pandemic; however, possible chronic effects have not been studied. Therefore, the aim of this study was to examine the possible impact of the forced lack of physical activity (PA) during the COVID-19 lockdown on children’s MC two years later. The motor competence of sixty-seven healthy children (7.4−12.2 years old) was assessed using the Motor Competence Assessment (MCA). All participants completed the MCA tests at two different moments (before and after the COVID-19 lockdown), four years apart. The mean values after the COVID-19 lockdown for all participants on the subscales and on the Total MCA are lower, but no significant changes were found when controlling for gender and age (p > 0.05 in all analyses). However, a significant decrease was found in the Locomotor subscale in boys (p = 0.003). After dividing the participants into three age groups, the youngest also suffered a decrease in the Locomotor subscale (p < 0.001) and their Total MCA (p = 0.04). In addition, those participants who had a higher MC at baseline decreased their scores for the Locomotor (p < 0.001) and Manipulative (p < 0.001) subscales, and for the Total MCA (p < 0.001). In conclusion, the younger children and the more motor proficient did not fully recover from the negative effects of the pandemic lockdown after two years.

Infant Cardiopulmonary Resuscitation Quality While Walking Fast: A Simulation Study

OBJECTIVE

This study focuses on the characteristics (feasibility, resuscitation quality, and physical demands) of infant cardiopulmonary resuscitation (CPR) on the forearm during fast walking, performed by a trained lay rescuer.

METHODS

Twenty-one university students from the infant education degree participated in a randomized crossover simulation study to compare a standard pediatric CPR versus a walking pediatric CPR with a manikin on the rescue forearm. Each rescuer performed 2 resuscitation tests of 2 minutes on the infant manikin. Cardiopulmonary resuscitation, physiological, and perceived effort variables were measured.

RESULTS

The quality of chest compressions was higher in standard pediatric CPR than in walking pediatric CPR (72% vs 51%; P < 0.001) and overall CPR quality (59% vs 49%; P = 0.02). There were no differences between ventilation quality (47% vs 46%). Walking pediatric CPR presented a higher percentage of maximum heart rate (52% vs 69%; P < 0.001) and perceived exertion rate (2 vs 5; P < 0.001). Participants walked an average of 197 m during the test.

CONCLUSIONS

In conclusion, pediatric walking CPR is feasible although it represents a slight quality decrease in a simulation infant CPR setting. The option "CPR while walking fast to a safe place" seems to be suitable in terms of safety both for the victim and the rescuer, as well as CPR quality in special circumstances.

Learning to resuscitate at school. Study in 8-12 year-old schoolchildren

OBJECTIVE

To quantitatively assess the learning capacity of school children aged between 8-12 years in basic life support (theory and practice) after a feasible school training programme.

MATERIAL AND METHODS

Quasi-experimental study with a convenience sample of 567 pupils in 3rd and 5th year of Primary Education, and first year of Compulsory Secondary Education, from 3 public schools in Galicia. They received 2h (one theoretical and another practical) of basic life support training by their Physical Education teachers, as part of the school program. The children were evaluated by a theoretical test and a practical skill test that measured the quality of chest compressions, and assessed the performance of the basic life support sequence.

RESULTS

The level of knowledge increased with respect to the baseline, and was higher in the higher grades (P < .001). The complete basic life support sequence was carried out by 16.5% of pupils in the 3rd year of Primary Education, 54.4% of pupils in the 5th year of Primary Education, and 28.5% of pupils in the 1st year of Secondary Education (P = .030). The following compression quality parameters improved significantly with age: continuity of compressions (P < .001), percentage of compressions performed at correct depth (P = .002), and median depth (P < .001), while the percentage of compressions with correct decompression decreased significantly (P < .001).

CONCLUSIONS

Although their anthropometric characteristics may not allow them to achieve the ideal quality of this manoeuvre, a 2h theoretical and practical training programme, taught by Physical Education teachers, helps to improve the ability of children younger than 13 years old to recognise the emergency, start the chain of survival, and initiate chest compressions.

Training frequency for educating schoolchildren in basic life support: very brief 4-month rolling-refreshers versus annual retraining-a 2-year prospective longitudinal trial

OBJECTIVE

To compare the effectiveness of 4-month rolling-refreshers and annual retraining in basic life support (BLS) on a sample of schoolchildren.

DESIGN

Prospective longitudinal trial.

SETTING AND PARTICIPANTS

Four hundred and seventy-two schoolchildren (8-12 years old).

INTERVENTIONS

Schoolchildren were instructed in BLS and then split into the following three groups: control group (CG), standard group (SG) and rolling-refresher group (RRG). Their BLS skills were assessed within 1 week (T1) and 2 years later (T2). Moreover, CG did not receive any additional training; SG received one 50 min retraining session 1 year later; RRG participated in very brief (5 min) rolling-refreshers that were carried out every 4 months.

PRIMARY AND SECONDARY OUTCOMES

Hands-on skills of BLS sequence and cardiopulmonary resuscitation.

RESULTS

BLS sequence performance was similar in all groups at T1, but SG and RRG followed the steps of the protocol in more proportion than CG at T2. When compared at T2, RRG showed higher proficiency than SG in checking safety, checking response, opening the airway and alerting emergency medical services. In addition, although the mean resuscitation quality was low in all groups, RRG participants reached a higher percentage of global quality cardiopulmonary resuscitation (CG: 16.4±24.1; SG: 25.3±28.8; RRG: 29.9%±29.4%), with a higher percentage of correct chest compressions by depth (CG: 3.9±11.8; SG: 10.8±22.7; RRG: 15.5±26.1 mm).

CONCLUSIONS

In 8-to-12-year-old schoolchildren, although annual 50 min retraining sessions help to maintain BLS performance, 4-month very brief rolling-refreshers were shown to be even more effective. Thus, we recommend implementing baseline BLS training at schools, with subsequently brief rolling-refreshers.

Teaching Basic Life Support to 5- to 8-Year-Old Children: A Cluster Randomized Trial

OBJECTIVE

We aimed to compare traditional basic life support (BLS) education with specific and innovative educative didactic material that has been previously designed and validated.

METHODS

Fifteen classes of schoolchildren aged 5 to 8 years (n = 237) were randomly assigned to 4 groups in which different didactic and complementary materials were used: (1) the Rescube tool with a cuddly toy (n = 61), (2) the Endless Book tool with a cuddly toy (n = 74), (3) traditional teaching with a cuddly toy (n = 46), and (4) traditional teaching with a manikin (n = 55). The BLS sequence was assessed at baseline (T0). After that, children took part in a one-hour theory and practice session in their assigned training modality. BLS sequence was assessed again within one week (T1) and after one month (T2).

RESULTS

The 4 modalities were successful in improving children's skills when comparing T0 with both T1 and T2 (P < .05). At T2, more schoolchildren remembered the complete BLS sequence after using the Rescube (75%) compared with the number of schoolchildren who remember the complete BLS sequence after using the Endless Book (53%), a manikin (42%), or a cuddly toy (13%) (P < .05). A higher proportion of participants who used the Rescube correctly performed all the BLS steps analyzed compared with those who used only the manikin or a cuddly toy during the learning phase. The Endless Book was also more effective except for learning to check consciousness and breathing.

CONCLUSION

Better BLS learning and knowledge retention outcomes were achieved by using our specific and adapted didactic materials (Rescube and Endless Book). These new educational tools have the potential to substantially support BLS school education programs.

Lay-rescuers in drowning incidents: A scoping review

OBJECTIVE

Many victims of drowning fatalities are lay-people attempting to rescue another. This review aims to identify the safest techniques and equipment (improved or purpose made) for an untrained bystander to use when attempting a water rescue.

METHOD

A sample of 249 papers were included after the bibliographic search, in which 19 were finally selected following PRISMA methodology and 3 peer review proceeding presented at international conferences. A total of 22 documents were added to qualitative synthesis.

RESULTS

Geographical location, economic level, physical fitness, or experience may vary the profile of the lay-rescuers and how to safely perform a water rescue. Four lay-rescuers profiles were identified: 1) Children rescuing children in low- and middle-income countries (LMICs), 2) Adults rescuing adults or children, 3) Lay-people with some experience and rescue training, 4) Lay-people with cultural or professional motivations. Three types of techniques used by those lay-rescuers profiles: a) non-contact techniques for rescues from land: throw and reach, b) non-contact techniques for rescue using a flotation device and, c) contact techniques for rescue into the water: swim and tow with or without fins.

CONCLUSION

The expert recommendation of the safest technique for a lay-rescuer is to attempt rescue using a pole, rope, or flotation equipment without entering the water. However, despite the recommendations of non-contact rescues from land, there is a global tendency to attempt contact rescues in the water, despite a lack of evidence on which technique, procedure or equipment contributes to a safer rescue. Training strategies for lay-people should be considered.

[Learning to resuscitate at school. Study in 8-12 year-old schoolchildren]

OBJECTIVE

To quantitatively assess the learning capacity of school children aged between 8-12 years in basic life support (theory and practice) after a feasible school training programme.

MATERIAL AND METHODS

Quasi-experimental study with a convenience sample of 567 pupils in 3rd, 5th and 1st year of Primary Education, and Compulsory Secondary Education, respectively, from 3 public schools in Galicia. They received 2h (one theoretical and another practical) of basic life support training by their Physical Education teachers, as part of the school program. The children were evaluated by a theoretical test and a practical skill test that measured the quality of chest compressions, and assessed the performance of the basic life support sequence.

RESULTS

The level of knowledge increased with respect to the baseline, and was higher in the higher grades (P<.001). The complete basic life support sequence was carried out by 16.5% of pupils in the 3rd year of Primary Education, 54.4% of pupils in the 5th year of Primary Education, and 28.5% of pupils in the 1st year of Secondary Education (P=.030). The following compression quality parameters improved significantly with age: continuity of compressions (P<.001), percentage of compressions performed at correct depth (P=.002), and median depth (P<.001), while the percentage of compressions with correct decompression decreased significantly (P<.001).

CONCLUSIONS

Although their anthropometric characteristics may not allow them to achieve the ideal quality of this manoeuvre, a 2-h theoretical and practical training programme, taught by Physical Education teachers, helps to improve the ability of children younger than 13 years-old to recognise the emergency, start the chain of survival, and initiate chest compressions.

Reliability of the test of gross motor development: A systematic review

OBJECTIVE

To identify, synthesise and evaluate studies that investigated the reliability of the Test of Gross Motor Development (TGMD) variants.

METHODS

A systematic search was employed to identify studies that have investigated internal consistency, inter-rater, intra-rater and test-retest reliability of the TGMD variants through Scopus, Pubmed/MEDLINE, PsycINFO, Sport Discus and Web of Science databases.

RESULTS

Of the 265 studies identified, 23 were included. Internal consistency, evaluated in 14 studies, confirming good-to-excellent consistency for the overall score and general motor quotient (GMQ), and acceptable-to-excellent levels in both subscales (locomotor and ball skills). Inter-rater reliability, evaluated in 19 studies, showing good-to-excellent intra-class correlation coefficient (ICC) values in locomotor skills score, ball skills score, overall score, and GMQ. Intra-rater reliability, evaluated in 13 studies, displaying excellent ICC values in overall score and GMQ, and good-to-excellent ICC values in locomotor skills score and ball skills score. Test-retest reliability was evaluated in 15 studies with 100% of the statistics reported above the threshold of acceptable reliability when ICC was not used. Studies with ICC statistic showed good-to-excellent values in ball skills score, overall score, and GMQ; and moderate-to-excellent values in locomotor skills score.

CONCLUSIONS

Overall, the results of this systematic review indicate that, regardless of the variant of the test, the TMGD has moderate-to-excellent internal consistency, good-to-excellent inter-rater reliability, good-to-excellent intra-rater reliability, and moderate-to-excellent test-retest reliability. Considering the few high-quality studies in terms of internal consistency, it would be recommend to carry out further studies in this field to improve their quality. Since there is no gold standard for assessing FMS, TGMD variants could be appropriate when opting for a psychometrical robust test. However, standardized training protocols for coding TGMD variants seem to be necessary both for researchers and practitioners in order to ensure acceptable reliability.

[Occupational health recommendations for lifeguards in aquatic emergencies in the Covid-19 era: prevention, rescue and resuscitation.]

Severe acute respiratory syndrome (SARS-CoV-2), which causes coronavirus disease 2019 (Covid-19), is highly contagious. Lifeguards are the first line of response in aquatic emergencies and they will suffer a strong exposure to risk this first summer of the Covid-19 era, so their occupational health must be rethought in their professional practice during the new normal. The main public health measure to prevent drowning is prevention, but when this fails and assistance or rescue is required, in most interventions, distancing will not be possible. The limitation of personal protective equipment (PPE) for rescue is a reality that must be known and that can affect the health of the lifeguard. A review of the current literature aimed at avoiding or minimizing the risk of contagion in the interventions carried out by rescuers in the Covid-19 era was performed. This article provides structured information on the prevention of contagion in lifeguards, the potential risks, the available PPE, and the recommendations for its proper use during rescue or prehospital care in aquatic settings.

Drowning: epidemiology, prevention, pathophysiology, resuscitation, and hospital treatment

This narrative review discusses the evidence relevant to key aspects of drowning, which is defined by the World Health Organization as the process of respiratory difficulty caused by submersion/immersion in liquid. The length of time the victim is submerged is a key factor in survival and neurologic damage. Although respiratory distress and hypoxia are the main events, other complications affecting various systems and organs may develop. Drowning is one of the main causes of accidental death worldwide, yet deaths from drowning are underestimated and morbidity is unknown. Prevention is essential for reducing both mortality and morbidity, but if prevention fails, the speed of access to and the quality of prehospital and hospital care will determine the prognosis. It is therefore essential to understand the factors and mechanisms involved in these emergencies.

The thermal demands of flood rescue and impacts on task performance

The aim of this study was to determine the thermal demand of simulated Flood Rescue tasks and impacts on performance. Ten participants undertook two simulations: 'Cold' (4 °C) -participants stood in knee height moving water (4.8 km·h^-1), with simulated wind and rain for 60 min. 'Warm' (20 °C) - participants performed 6x7 min walking in knee height moving water (3.2 km·h^-1), pulling 10 kg. Grip strength, manual dexterity, and jump height were measured pre and post. The cold resulted in cooling of the great toe and finger (9.98 [0.84]°C and 10.38 [8.21-12.1] °C, respectively). Jump height, manual dexterity and grip strength fell by 20%, 22% and ∼13%, respectively. In the 'Warm': heart rates were 157 (19) b·min^-1, oxygen consumption 30.62 (7.83) mL.kg^-1·min^-1, and sweat loss 1.06 (0.31) L. There were no differences in the physical tests. Flood Rescue represents significant, but different, challenges. Remaining static in the cold resulted in peripheral neuromuscular cooling, whilst exercising in the warm resulted in a significant thermal challenge. Practitioner Summary: Little is known about the physical requirements, thermal profiles and optimum personal protective equipment for flood rescue. Flood rescue represents significant challenges. In the cold, emergency responders may be incapacitated by peripheral cooling. In the heat, they may be incapacitated by heat-related exhaustion. Consideration should be given to these risks.

Physiological demands of quality cardiopulmonary resuscitation performed at simulated 3250 meters high

AIM

To analyse the effect of oxygen fraction reduction (O2 14%, equivalent to 3250 m) on Q-CPR and rescuers' physiological demands.

METHODOLOGY

A quasi-experimental study was carried out in a sample of 9 Q-CPR proficient health care professionals. Participants, in teams of 2 people, performed 10 min CPR on a Laerdal ResusciAnne mannequin (30:2 compression/ventilation ratio and alternating roles between rescuers every 2 min) in two simulated settings: T21-CPR at sea level (FiO2 of 21%) and T14 - CPR at 3250 m altitude (FiO2 of 14%). Effort self-perception was rated from 0 (no effort) to 10 (maximum demand) points.

RESULTS

Quality of chest compressions was good and similar in both conditions (T21 vs T14). However, the percentage of ventilations with adequate tidal volume was lower in altitude than at sea level conditions (35.9 ± 25.2% vs. 54.7 ± 23.2%, p = 0.035). The subjective perception of effort was significantly higher at simulated altitude (5 ± 2) than at sea level (3 ± 2) (p = 0.038). Maximum heart rate during the tests was similar in both conditions; however, mean oxygen saturation was significantly lower in altitude conditions (90.5 ± 2.5% vs. 99.3 ± 0.5%, p < 0.001).

CONCLUSION

Although performing CPR under simulated hypoxic altitude conditions significantly increases the physiological demands and subjective feeling of tiredness compared to sea level CPR, trained rescuers are able to deliver good Q-CPR in such conditions, at least in the first 10 min of resuscitation.

Two new chest compression methods might challenge the standard in a simulated infant model

Paediatric cardiorespiratory arrest is a rare event that requires a fast, quality intervention. High-quality chest compressions are an essential prognostic factor. The aim of this prospective, randomized and crossover study in infant manikin 2-min cardiorespiratory resuscitation scenario is to quantitatively compare the quality of the currently recommended method in infants (two-thumb-encircling hand techniques) with two new methods (the new two-thumb and the knocking-fingers techniques) using a 15:2 compression-to-ventilation ratio. Ten qualified health professionals were recruited. Variables analysed were mean rate and the ratio of compressions in the recommended rate range, mean depth and the ratio of compressions within the depth range recommendations, ratio of compressions with adequate chest release and ratio of compressions performed with the fingers in the correct position. Ratios of correct compressions for depth, rate, chest release and hand position were always above 70% regardless of the technique used. Reached mean depth and mean rate were similar to the 3 techniques. No statistically significant differences were found in any of the variables analysed.Conclusion: In an infant manikin, professionals are able to perform chest compressions with the new techniques with similar quality to that obtained with the standard method. What is Known: • Quality chest compressions are an essential prognostic factor in paediatric cardiorespiratory arrest. • It has been reported poor results when studied cardiorespiratory resuscitation quality in infants applying the recommended methods. What is New: • In a simulated scenario, quality of chest compressions performed with two new techniques (nTTT and KF) is similar to that obtained with the currently recommended method (TTHT).

ABCDE approach to victims by lifeguards: How do they manage a critical patient? A cross sectional simulation study

Introduction

Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards’ capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim.

Methods

A cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA).

Results

None of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008).

Conclusion

Professional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards’ limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards’ training programmes.

Training adult laypeople in basic life support. A systematic review

INTRODUCTION AND OBJECTIVES

Bystander assistance is decisive to enhance the outcomes of out-of-hospital cardiac arrest. Despite an increasing number of basic life support (BLS) training methods, the most effective formula remains undefined. To identify a gold standard, we performed a systematic review describing reported BLS training methods for laypeople and analyzed their effectiveness.

METHODS

We reviewed the MEDLINE database from January 2006 to July 2018 using predefined inclusion and exclusion criteria, considering all studies training adult laypeople in BLS and performing practical skill assessment. Two reviewers independently extracted data and evaluated the quality of the studies using the MERSQI (Medical Education Research Study Quality Instrument) scale.

RESULTS

Of the 1263 studies identified, 27 were included. Most of them were nonrandomized controlled trials and the mean quality score was 13 out of 18, with substantial agreement between reviewers. The wide heterogeneity of contents, methods and assessment tools precluded pooling of data. Nevertheless, there was an apparent advantage of instructor-led methods, with feedback-supported hands-on practice, and retraining seemed to enhance retention. Training also improved attitudinal aspects.

CONCLUSIONS

While there were insufficiently consistent data to establish a gold standard, instructor-led formulas, hands-on training with feedback devices and frequent retraining seemed to yield better results. Further research on adult BLS training may need to seek standardized quality criteria and validated evaluation instruments to ensure consistency.

Targeting relatives: Impact of a cardiac rehabilitation programme including basic life support training on their skills and attitudes

Background

Training families of patients at risk for sudden cardiac death in basic life support (BLS) has been recommended, but remains challenging. This research aimed to determine the impact of embedding resuscitation training for patients in a cardiac rehabilitation programme on relatives' BLS skill retention at six months.

Design

Intervention community study.

Methods

Relatives of patients suffering acute coronary syndrome or revascularization enrolled on an exercise-based cardiac rehabilitation programme were included. BLS skills of relatives linked to patients in a resuscitation-retraining programme (G-CPR) were compared with those of relatives of patients in a standard programme (G-Stan) at baseline, following brief instruction and six months after. Differences in skill performance and deterioration and self-perceived preparation between groups over time were assessed.

Results

Seventy-nine relatives were included and complete data from 66 (G-Stan=33, G-CPR=33) was analysed. Baseline BLS skills were equally poor, improved irregularly following brief instruction and decayed afterwards. G-CPR displayed six-month better performance and lessened skill deterioration over time compared with G-Stan, including enhanced compliance with the BLS sequence ( p = 0.006 for group*time interaction) and global resuscitation quality ( p = 0.007 for group*time interaction). Self-perceived preparation was higher in G-CPR ( p = 0.002).

Conclusions

Relatives of patients suffering acute coronary syndrome or revascularization enrolled on a cardiac rehabilitation programme showed poor BLS skills. A resuscitation-retraining cardiac rehabilitation programme resulted in relatives' higher BLS awareness, skill retention and confidence at six months compared with the standard programme. This may suggest a significant impact of this formula on the family setting and support the active role of patients to enhance health education in their environment.

Acute muscle fatigue and CPR quality assisted by visual feedback devices: A randomized-crossover simulation trial

Objective

To analyse the acute muscular fatigue (AMF) in triceps brachii and rectus abdominis during compression-only and standard cardiopulmonary resuscitation (CPR) performed by certified basic life support providers.

Methods

Twenty-six subjects were initially recruited and randomly allocated to two study groups according to the muscles analysed; eighteen finally met the inclusion criteria (nine in each group). Both groups carried out two CPR tests (compression-only and standard CPR) of 10 min divided into five 2-min intermittent periods. The ventilation method was freely chosen by each participant (mouth-to-mouth, pocket-mask or bag-valve-mask). CPR feedback was provided all the time. AMF was measured by tensiomyography at baseline and after each 2-min period of the CPR test, in triceps brachii or rectus abdominis according to the study group.

Results

Rectus abdominis’ contraction time increased significantly during the fifth CPR period (p = 0.020). Triceps brachii’s radial muscle belly displacement (p = 0.047) and contraction velocity (p = 0.018) were lower during compression-only CPR than during standard CPR. Participants who had trained previously with feedback devices achieved better CPR quality results in both protocols. Half of participants chose bag-valve-mask to perform ventilations but attained lower significant ventilation quality than the other subjects.

Conclusions

Compression-only CPR induces higher AMF than standard CPR. Significantly higher fatigue levels were found during the fifth CPR test period, regardless of the method. Adequate rescuer’s strength seems to be a requisite to take advantage of CPR quality feedback devices. Training should put more emphasis on the quality of ventilation during CPR.

Schoolteachers as candidates to be basic life support trainers: A simulation trial

BACKGROUND

The aim was to assess future schoolteachers' basic life support (BLS) knowledge and willingness to include this content in school lessons. The aim was also to determine the learning effect of a brief BLS hands-on training session, supported by real-time feedback.

METHODS

A convenience sample of 98 University students of Educational Sciences and Sports were recruited. The training program consisted of brief theoretical and hands-on interactive sessions with a 2/10 instructor/participants ratio. Knowledge and willingness was assessed by means of a survey. Chest compressions (CC) and ventilation quality were registered in 47 cases during 1 min cardiopulmonary resuscitation (CPR) tests.

RESULTS

Fifty-eight percent of subjects declared to know how to perform CPR, 62% knew the correct chest compression/ventilation ratio but only one in four knew the CC quality standards. Eighty-eight percent knew what an automated external defibrillator (AED) was; willingness to use the device improved from 70% to 98% after training. Almost half of CCs were performed atan adequate rate. Men performed deeper compressions than women (56.1 ± 4.03 mm vs. 52.17 ± 5.51 mm, p = 0.007), but in both cases the mean value was within recommendations. Full chest recoil was better in women (72.2 ± 32.8% vs. 45.4 ± 32.9%, p = 0.009). All CCs were delivered with correct hand positions.

CONCLUSIONS

Brief hands-on training supported by real-time feedback of CPR quality helps future schoolteachers improve their knowledge, self-confidence and CPR skills. BLS training should be implemented in University curricula for schoolteachers in order to promote their engagement in effective BLS training of schoolchildren.

A new chest compression technique in infants

OBJECTIVE

To compare the quality of chest compressions performed according to the classical technique (MT) versus a new technique (NM) (compression with 2thumbs with closed fists) in an infant manikin.

DESIGN

A controlled, randomized cross-over study was carried out in professionals assisting pediatric patients.

SETTING

A University Hospital with a Pediatric ICU in the north of Spain.

PARTICIPANTS

Residents and nurses in Pediatrics who had completed a basic and an advanced pediatric cardiopulmonary resuscitation course.

INTERVENTIONS

Quantitative analysis of the variables referred to chest compression quality in a 2-minute cardiopulmonary resuscitation scenario in infants. Laerdal's SimPad^® with SkillReporter™ system was used.

MAIN VARIABLES OF INTEREST

Mean rate and percentage of compressions in the recommended rate range, mean depth and percentage of compressions within the depth range of recommendations, percentage of compressions with adequate decompression, and percentage of compressions performed with the fingers in the center of the chest.

RESULTS

Global quality of the compressions (NM: 84.2±23.7% vs. MT: 80.1±25.4% [p=0.25; p=ns]), percentage of compressions with correct depth (NM: 59.9±35.8% vs. MT: 59.5±35.7% [p=0.76; p=ns]), mean depth reached (NM: 37.3±3.8mm vs. MT: 36±5.3mm [p=0.06; p=ns]), percentage of complete re-expansion of the chest (NM: 94.4±9.3% vs. MT: 92.4±18.3% [p=0.58; p=ns]), and percentage of compressions with the recommended rate (NM: 62.2±34.6% vs. MT: 51±37.2% [p=0.13; p=ns]) proved similar with both methods.

CONCLUSIONS

The quality of chest compressions with the new method (thumbs with closed fists) is similar to that afforded by the traditional method.

Basic life support training into cardiac rehabilitation programs: A chance to give back. A community intervention controlled manikin study

AIM

Early basic life support is crucial to enhance survival from out-of-hospital cardiac arrest but rates remain low, especially in households. High-risk groups' training has been advocated, but the optimal method is unclear. The CArdiac REhabilitation and BAsic life Support (CAREBAS) project aims to compare the effectiveness of two basic life support educational strategies implemented in a cardiac rehabilitation program.

METHODS

A community intervention study including consecutive patients enrolled on an exercise-based cardiac rehabilitation program after acute coronary syndrome or revascularization was conducted. A standard basic life support training (G-Stan) and a novel approach integrating cardiopulmonary resuscitation hands-on rolling refreshers (G-CPR) were randomly assigned to each group and compared. Basic life support performance was assessed by means of simulation at baseline, following brief instruction and after the 2-month program.

RESULTS

114 participants were included and 108 completed the final evaluation (G-Stan:58, G-CPR:50). Basic life support performance was equally poor at baseline and significantly improved following a brief instruction. A better skill retention was found after the 2-month program in G-CPR, significantly superior for safety and sending for an automated external defibrillator. Confidence and self-perceived preparation were also significantly greater in G-CPR after the program.

CONCLUSIONS

Integrating cardiopulmonary resuscitation hands-on rolling refreshers in the training of an exercise-based cardiac rehabilitation program is feasible and improves patients' skill retention and confidence to perform a basic life support sequence, compared to conventional training. Exporting this formula to other programs may result in increased numbers of trained citizens, enhanced social awareness and bystander resuscitation.

Benefits of Visual Feedback on Cardiopulmonary Resuscitation Training: A Non-Randomised Manikin Study with Bystanders

Introduction

Cardiopulmonary resuscitation (CPR) is vital for the survival of people who has suffered a cardiac arrest. In order to achieve a good quality CPR performance, rescuer needs a good training which could be gotten with the use of feedback devices. The aim of this study was to compare the use of visual feedback device in CPR training to learning without feedback.

Methods

Ninety-nine subjects without basic life support knowledge participating in the study were divided into three groups. All of them carried out two tests: 2 minutes of CPR with compressions and ventilations. First two groups received trainings on CPR between the tests (experimental groups): one group with instructor-led training and the other one with visual feedback device. The third group did not receive any training between the tests (control group).

Results

In the first test no differences among the three groups were found. The experimental groups improved their scores in the last test. The number of correct chest compressions by hand position and depth, and the number of correct rescue breaths was increased. The experimental group with visual feedback CPR training achieved better scores of quality CPR in the second test than the instructor-led training group.

Conclusions

The visual feedback and instruction-led training have positive effects on the quality CPR. The use of visual feedback during learning has greater benefits than instruction-led training in the three variables analysed.

How can lifeguards recover better? A cross-over study comparing resting, running, and foam rolling

PURPOSE

The aim of this study is to compare the effectiveness of active recovery in form of running or foam rolling on clearing blood lactate compared to remain sitting after a water rescue.

METHOD

A quasi experimental cross-over design was used to test the effectiveness of two active recovery methods: foam rolling (FR) and running (RR), compared with passive recovery (PR) on the blood lactate clearance after performing a water rescue. Twelve lifeguards from Marín (Pontevedra) completed the study. The participants performed a 100-meter water rescue and a 25-minute recovery protocol.

RESULTS

The post recovery lactate levels were significantly lower for foam rolling (4.4±1.5mmol/l, P=0.005, d=0.94) and running (4.9±2.3mmol/l, P=0.027, d=1.21) compared with resting (7.2±2.5mmol/l); there was no significant difference between foam rolling and running (P=1.000).

CONCLUSIONS

We found that surf lifesavers clear out blood lactate more efficient when performing an active recovery protocol. Foam rolling is an effective method of increasing the rate of blood lactate clearance. These two recovery methods are also adequate for surf lifeguards as they do not interfere with the surveillance aspect of their job.

Teachers' Perceptions of Preschool Children's Psychomotor Development in Spain

This study analyzed the psychomotor profiles of preschool stage students and to determine how these data agreed with the students' teachers' subjective assessment. We also correlated these data with other variables such as age, gender, and family influence. A total of 211 children aged 3 to 6 years, in the second cycle of preschool from 30 classes of 10 schools in Spain participated. Additionally, 30 preschool teachers from these classes participated. Study results revealed serious teacher misperceptions regarding their students' psychomotor development, with low agreement rates between students and teachers in the motor dimension and slight agreement rates in communicative, cognitive, and social areas. The reasons for and implications of these misperceptions are discussed.

Utility of a simple lighting device to improve chest compressions learning

INTRODUCTION

The recommendations on cardiopulmonary resuscitation (CPR) emphasize the quality of the manoeuvres, especially chest compressions (CC). Audiovisual feedback devices could improve the quality of the CC during CPR. The aim of this study was to evaluate the usefulness of a simple lighting device as a visual aid during CPR on a mannequin.

MATERIAL AND METHODS

Twenty-two paediatricians who attended an accredited paediatric CPR course performed, in random order, 2min of CPR on a mannequin without and with the help of a simple lighting device, which flashes at a frequency of 100 cycles per minute. The following CC variables were analyzed using a validated compression quality meter (CPRmeter^®): depth, decompression, rate, CPR time and percentage of compressions.

RESULTS

With the lighting device, participants increased average quality (60.23±54.50 vs. 79.24±9.80%; P=.005), percentage in target depth (48.86±42.67 vs. 72.95±20.25%; P=.036) and rate (35.82±37.54 vs. 67.09±31.95%; P=.024).

CONCLUSIONS

A simple light device that flashes at the recommended frequency improves the quality of CC performed by paediatric residents on a mannequin. The usefulness of this CPR aid system should be assessed in real patients.

The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation

BACKGROUND

Providing high-quality chest compressions and rescue breaths are key elements in the effectiveness of cardio-pulmonary resuscitation.

AIM

To investigate the effects of a strength training programme on the quality of prolonged basic cardiopulmonary resuscitation on a manikin.

METHODS

This was a quasi-experimental trial. Thirty-nine participants with prior basic life support knowledge were randomised to an experimental or control group. They then performed a test of 10 min of chest compressions and mouth-to-mouth ventilation on manikins equipped with a skill reporter tool (baseline or test 1). The experimental group participated in a four-week strength training programme focused on the muscles involved in chest compressions. Both groups were subsequently tested again (test 2).

RESULTS

After training, the experimental group significantly increased the mean depth of compression (53.7 ± 2.3 mm vs. 49.9 ± 5.9 mm; p = 0.003) and the correct compression fraction (68.2 ± 21.0% vs. 46.4 ± 29.1%; p = 0.004). Trained subjects maintained chest compression quality over time better than the control group. The mean tidal volume delivered was higher in the experimental than in the control group (701.5 ± 187.0 mL vs. 584.8 ± 113.6 mL; p = 0.040) and above the current resuscitation guidelines. In test 2, the percentage of rescue breaths with excessive volume was higher in the experi-mental group than in the controls (31.5 ± 19.6% vs. 15.6 ± 13.0%; p = 0.007).

CONCLUSIONS

A simple strength training programme has a significant impact on the quality of chest compressions and its maintenance over time. Additional training is needed to avoid over-ventilation of potential patients.

Cardiopulmonary Resuscitation Quality by Helicopter Rescue Swimmers While Flying

OBJECTIVE

Our objective was to assess the cardiopulmonary resuscitation (CPR) quality by helicopter rescue swimmers (HRSs) while flying.

METHODS

Twenty HRSs from the Spanish Maritime Safety took part in this study. The research protocol included 2 phases: a baseline test (5 minutes of CPR on land) and a challenge test (5 minutes of CPR on a Sikorsky S-61N helicopter in-flight). A Laerdal Resusci Anne mannequin with Laerdal PC Skill Reporting (Stavanger, Norway) was used to register CPR variables.

RESULTS

CPR quality on land versus in-flight was not significantly different. The mean chest compression (CC) depth (52.6 mm on land vs. 51.9 mm in-flight) was inside the recommended range, but mean CC rate (133 vs. 132 per minute), tidal volume (752 vs. 888 mL), and hands-off time (9 per cycle in both tests) were above the 2015 recommended goal. Incomplete chest re-expansion was observed in 19% of on land and 26% in-flight CCs. CPR quality was maintained throughout the 5-minute challenges.

CONCLUSION

HRSs are able to perform CPR in a flying helicopter with similar quality to CPR on land. They need additional training to avoid excessive CC rates, tidal volumes, and hands-off times and to permit chest re-expansion.